February 03, 2010

Web Based Learning in Rheumatology, where are we now, and where do we need to be?

We all know about the potential of the web, but how should it be best put to use? Here are some of my musings frommy own thoughts on web based learning and rheumatology as it stands today.internal rotation of the shoulder


When considering web based learning (WBL), extensive research has been conducted to compare e-learning against more traditional teaching methods. Up until recent years, the majority of educational research studies into WBL were non inferiority studies, or comparisons of additional e-learning resources ‘added into’ standard curricula (Cook, 2005, 2008). The largest meta-analysis of WBL learning in healthcare conducted to date has concluded that it is not if, but how we deliver web based learning that is the most critical question facing educators (Cook, 2008). It was confirmed by Wong (2003) that delivery of web based teaching is not simply a case of ‘putting your course on the web’. Robust evidence does not exist on exactly how the delivery of this material influences learning. Few studies attempt to directly compare two different approaches, with almost no data on an ‘interactive video’ based approach compared to a standard online presentation of material.

WBL in Rheumatology
Education in musculoskeletal medicine provides some evidence for some forms of WBL when added to traditional methods (Wilson, 2006); however I have identified no trials that compare different online strategies to teach a clinical skill. Various e-learning techniques have been tried, but they are often not web based. The Arthritis Research Campaign (ARC) have produced a more traditional CD ROM based e-learning package has been evaluated, and been shown to improve OSCE scores post intervention and improve self reported confidence (Vivekananda-Schmidt, 2005), however WBL has not been studied extensively studied by the ARC, or other research groups.

How is WBL Delivered
Web based learning (WBL) is commonly delivered in the form of a Virtual Learning Environment (VLE). A VLE can be thought of as a navigational menu driven system by which a student directs his or her educational pathway through a series of resources or activities. Any accessory materials such as pre/ post teaching evaluation can be delivered, with the results often being automatically collated by the VLE. This structure allows the delivery of educational material to trainees, in a reproducible, secure way. Each VLE can be accessed by students and teachers, with different priorities and user privileges available to users depending on a pre determined level of access.

Online material can be presented I a number of formats inside a VLE, namely via traditional text and pictures with associated connections between topics (hyperlinks), or via more detailed methods incorporating video and audio based aids to assist in their development. There is evidence to support that the more sophisticated the technology or advanced the delivery method, there is an increased associated cost. Furthermore this has been shown as one factor to dissuade medical schools in the United States to sharing online e-learning material, or producing open access medical resources (Huang, 2007).

In summary there is a large amount that is still to be studied relating to web based learning in  Rheumatology. Where do we go from here?

Selected References and Further Reading, if you're interested...

Badcock LJ, Raj N, Gadsby K, Deighton CM. Meeting the needs of increasing numbers of medical students--a best practise approach. Rheumatology  2006;45(7):799-803.

Cook DA, Levinson AJ, Garside MD et al. Internet-Based Learning in the Health Professions, A Meta-analysis. JAMA. 2008;300(10):1181-1196.

Cook DA. The research we still are not doing: an agenda for the study of computer-based learning. Acad Med 2005;80:541-8.

Cook DA. Where are we with Web-based learning in medical education? Med Teach. 2006;28(7):594-8.

Downing SM. Reliability: on the reproducibility of assessment data. Med Educ. 2004;38(9):1006-12.   

Huang G, Reynolds R, Candler C. Virtual Patient Simulation at U.S. and Canadian Medical Schools. Acad Med. 2007;82:446-451

Kay LJ, Deighton CM, Walker DJ, Hay EM. Undergraduate rheumatology teaching in the UK: a survey of current practice and changes since 1990. Arthritis Research Campaign Undergraduate Working Party of the ARC Education Sub-committee. Rheumatology. 2000;39(7):800-3

Norman G Eva KW. Quantitative Research methods in medical education. AMSE. Edinburgh 2008.

Vivekananda-Schmidt P, Lewis M, Hassell AB.Cluster randomized controlled trial of the impact of a computer-assisted learning package on the learning of musculoskeletal examination skills by undergraduate medical students. Arthritis Rheum. 2005 15;53(5):764-71.

Wilson AS, Goodall JE, Ambrosini G, Carruthers DM, Chan H, Ong SG, Gordon C, Young SP. Development of an interactive learning tool for teaching rheumatology- a simulated clinical case studies program. Rheumatology (Oxford). 2006 Sep;45(9):1158-61.

Wong G, Greenhalgh T, Russell J, Boynton P, Toon P. Putting your course on the Web: lessons from a case study and systematic literature review. Med Educ. 2003;37(11):1020-3.

- 2 comments by 1 or more people Not publicly viewable

  1. Dean Jenkins

    Maybe there’s more to web-based learning in rheumatology than how the media is presented!

    Computers-as-a-delivery-mechanism for media (multi-media) or as a media-player is only one way they can be used.

    They can also be used to facilitate discussion, analyse behaviours or knowledge, and so on. Clinical skills lend themselves very well to task analysis and different aspects of the task require different modes of learning.

    09 Feb 2010, 16:41

  2. James Bateman

    Thanks for that. I guess I have a real bee in my bonnet about web based learning and how it can best be used.

    You make a very valid point. Obviously if what we’re teaching is rubbish, then we’re not going to get anywhere, and the delivery method is just one component of that. I can’t help thinking back to all the web based learning modules I’ve used, and pretty much hated most of them. Design is important, and as for the best design to promote different things, who knows.

    I also think that e-learning is probably best placed when it comes to knowledge acquisition and putting down the building blocks for clinical reasoning- illness scripts / grounding basic knowledge for future hypothetico-deductive clinical reasoning skills.

    Its interesting if you take an online app for a smart phone which is well designed (see the post below), you can actually learn quite a lot form it.

    I hope to put some of these concepts to the test with some future educational research!

    10 Feb 2010, 21:16

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