WHITCOMB, MICHAEL E. MD
During the past decade, a number of medical schools made remarkable changes in the design and conduct of their medical students' education programs. For example, many schools replaced the discipline-specific, departmentally controlled courses—that for decades dominated the first two years of the curriculum—with centrally governed courses that present material relevant to a specific topic by integrating content drawn from multiple disciplines. In addition, the lecture format that previously dominated the way faculty presented material to students has been replaced to a great extent by small-group, interactive sessions designed to promote active learning. And in almost all schools, first- and second-year students now gain direct insights into clinical medicine by spending half-day sessions in the offices of practicing physicians.
Once these changes were well established, schools turned their attention to the last two years of the curriculum. In doing so, some schools have made significant changes in the clinical education of their students. Recognizing the growing importance of a number of clinical disciplines, many schools have increased the number of clerkships that students are required to complete before graduation. Neurology, emergency medicine, and sub-internship experiences in medicine or surgery are now requirements in many schools. In addition to changes in the number and scope of required clerkships, a number of schools now allow, and in some cases require, increasing numbers of their students to fulfill their clerkship requirements at clinical sites—both ambulatory-care–based and institutionally based—well distant from the location of the medical school.
Perhaps most challenging, many schools are now making efforts to integrate into the clinical curriculum lecture-based sessions covering material relevant to certain contemporary issues in medicine, issues that are not specific to any of the clinical disciplines per se. Because of the nature of these contemporary issues (e.g., end-of-life care, cultural sensitivity, population health, etc), there is general agreement that they are best covered during the course of students' clinical education. Schools are using various strategies to accomplish this. Some present the material by scheduling several-day blocks between clerkships (inter-sessions), thus allowing students to participate in lecture sessions without having any clinical responsibilities. Others have set aside half-day or full-day periods during several or all clerkships for this purpose.
Not unexpectedly, medical school deans and faculties have faced a number of extraordinary challenges in attempting to implement these far-reaching changes. For example, how can faculty members who are teaching in small-group sessions conducted as part of a multidisciplinary, integrated course access for use in those sessions learning materials beyond the scope of their expertise? How do members of the faculty and the school's administration communicate with students, and distribute to them, course materials of various kinds, when they are dispersed across a large geographic area? How can faculty members conduct core lecture-based sessions for students who are located at different sites? How can the faculty be assured that students assigned to different clinical sites for required clerkships are being exposed to a common set of clinical conditions? Needless to say, these questions, and others, must be addressed satisfactorily if schools are to continue to offer high-quality, coherent educational experiences for their students.
This issue of the journal contains papers that describe a number of innovative information technology applications that have been developed to address these issues. Without the kinds of innovative uses of technology described in the papers, it is difficult to imagine how the far-reaching curriculum changes described above could be effected in ways that would provide effective educational experiences. These applications have been developed in only the past half-dozen years or so, which demonstrates the extraordinary commitment that members of the medical education community have for developing strategies for maintaining the quality of medical education, and their ability to do so.
Lee and her colleagues describe the Tufts Health Sciences Database, one of the earliest institutional efforts undertaken to use information technology applications to enhance the management and quality of education in the health sciences. The program has been highly successful, and it has served as a model for other institutions. Fleiszer and Posel describe the effort under way at McGill University to develop a similar resource. The McGill initiative has spurred the development of collaborative projects involving faculty from several Canadian schools and has led to the creation of a Canadian National Medical Digital Library, a resource that will serve students and faculty at all of the Canadian medical schools.
The experiences of Tufts, McGill, and other institutions have made it clear that substantial resources are required to develop the kinds of sophisticated information technology applications that schools need to maintain the quality of their educational programs. The resources required are beyond the means of many, if not most, schools. This explains to a great extent the rationale for the collaborative effort under way in Canada under the auspices of the Association of Canadian Medical Colleges, and similar efforts under way in the United States. Candler and his colleagues describe the development of the Health Education Assets Library (HEAL), a resource that will make a full array of very sophisticated educational resources available to the faculties of all medical schools that choose to participate in the initiative. And Salas and his colleagues describe the development of the Curriculum Management and Information Tool (CurrMIT), a product developed by staff of the Association of American Medical Colleges. CurrMIT, a powerful tool for managing all aspects of a school's curriculum, is available to all medical schools in the United States, including schools of osteopathic medicine.
Several other papers in this issue provide important insights into how technologies can be used in the conduct of specific educational experiences. Ogrinc and his colleagues describe the lessons learned in using interactive video as the prime means for delivering lecture-based and interactive learning experiences to learners located at sites distant from the institution offering the curriculum. Their observations are noteworthy given the increasingly distributed nature of the educational experiences offered by medical schools. Uijtdehaage et al. identify the barriers that block the free exchange of educational multimedia and the incentives that could be created to overcome educators' concerns. Finally, Crowley and his colleagues, and Leong et al., describe how Web-based resources can enhance the education of learners rotating through individual clinical learning experiences.
Taken as a whole, these papers make it clear that those responsible for the design and conduct of medical education programs are no longer limited by the number and size of the classrooms available at a particular site, the location of faculty with expertise in a specific discipline, or the location of sites where students can gain valuable clinical experience. The challenge that deans and faculties face now, and will continue to face in the future, is how to use available technologies in ways that will truly enhance the quality of their educational programs. Because of the rapid evolution of information technologies and the ways they might be applied in educating students, the specific challenges they will face in the future will not be the same as the ones they are facing today. It is quite clear that all medical schools need to develop strategies for how they will address their current and future education technology needs. Clearly, a new age is dawning for the medical education community.