IT in Medical Education
The Impact of E-Learning in Medical Education
Ruiz, Jorge G. MD; Mintzer, Michael J. MD; Leipzig, Rosanne M. MD, PhD
Dr. Ruiz is assistant professor of clinical medicine, Division of Gerontology and Geriatric Medicine, University of Miami Miller School of Medicine, Miami, Florida; associate director for education/evaluation, Geriatric Research, Education, and Clinical Center, VA Medical Center, Miami, Florida; and senior investigator, Stein Gerontological Institute, Miami, Florida.
Dr. Mintzer is associate professor of clinical medicine, Division of Gerontology and Geriatric Medicine, University of Miami Miller School of Medicine, Miami, Florida; director, Community Academic Partnerships, and investigator, Geriatric Research, Education, and Clinical Center, VA Medical Center, Miami, Florida; and senior investigator, Stein Gerontological Institute, Miami, Florida.
Dr. Leipzig is professor, Department of Geriatrics and Adult Development; and vice chair for education, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York.
Correspondence should be addressed to Dr. Ruiz, VA Medical Center, GRECC (11GRC), 1201 NW 16th Street, Miami, FL 33125; telephone: (305) 575-3388; fax: (305) 575-3365; e-mail: 〈firstname.lastname@example.org〉.
The authors provide an introduction to e-learning and its role in medical education by outlining key terms, the components of e-learning, the evidence for its effectiveness, faculty development needs for implementation, evaluation strategies for e-learning and its technology, and how e-learning might be considered evidence of academic scholarship.
E-learning is the use of Internet technologies to enhance knowledge and performance. E-learning technologies offer learners control over content, learning sequence, pace of learning, time, and often media, allowing them to tailor their experiences to meet their personal learning objectives. In diverse medical education contexts, e-learning appears to be at least as effective as traditional instructor-led methods such as lectures. Students do not see e-learning as replacing traditional instructor-led training but as a complement to it, forming part of a blended-learning strategy. A developing infrastructure to support e-learning within medical education includes repositories, or digital libraries, to manage access to e-learning materials, consensus on technical standardization, and methods for peer review of these resources. E-learning presents numerous research opportunities for faculty, along with continuing challenges for documenting scholarship. Innovations in e-learning technologies point toward a revolution in education, allowing learning to be individualized (adaptive learning), enhancing learners' interactions with others (collaborative learning), and transforming the role of the teacher. The integration of e-learning into medical education can catalyze the shift toward applying adult learning theory, where educators will no longer serve mainly as the distributors of content, but will become more involved as facilitators of learning and assessors of competency.
Today's medical educators are facing different challenges than their predecessors in teaching tomorrow's physicians. In the past few decades, changes in health care delivery and advances in medicine have increased demands on academic faculty, resulting in less time for teaching than has previously been the case.1 Changes in sites of health care delivery, from acute care institutions to community-based settings for chronic care, have required adaptations in educational venues.2 Finding time to teach “new” fields such as genomics, palliative care, geriatrics, and complementary medicine is difficult when medical school curricula are already challenged to cover conventional materials.1 Traditional instructor-centered teaching is yielding to a learner-centered model that puts learners in control of their own learning. A recent shift toward competency-based curricula emphasizes the learning outcome, not the process, of education.3
E-learning refers to the use of Internet technologies to deliver a broad array of solutions that enhance knowledge and performance.4,5 E-learning can be used by medical educators to improve the efficiency and effectiveness of educational interventions in the face of the social, scientific, and pedagogical challenges noted above. It has gained popularity in the past decade; however, its use is highly variable among medical schools and appears to be more common in basic science courses than in clinical clerkships.6,7
In this article, we review the current state of e-learning in medical education by outlining the following: key terms, the components of e-learning, the evidence for its effectiveness, faculty development needs for implementing e-learning, evaluation strategies for e-learning and its technology, and the potential for e-learning to be considered evidence of academic scholarship.
E-learning is also called Web-based learning, online learning, distributed learning, computer-assisted instruction, or Internet-based learning. Historically, there have been two common e-learning modes: distance learning and computer-assisted instruction. Distance learning uses information technologies to deliver instruction to learners who are at remote locations from a central site. Computer-assisted instruction (also called computer-based learning and computer-based training) uses computers to aid in the delivery of stand-alone multimedia packages for learning and teaching.7 These two modes are subsumed under e-learning as the Internet becomes the integrating technology.
A concept closely related to e-learning but preceding the birth of the Internet is multimedia learning. Multimedia uses two or more media, such as text, graphics, animation, audio, or video, to produce engaging content that learners access via computer. Blended learning, a fairly new term in education but a concept familiar to most educators, is an approach that combines e-learning technology with traditional instructor-led training, where, for example, a lecture or demonstration is supplemented by an online tutorial.8
Faculty, administrators, and learners find that multimedia e-learning enhances both teaching and learning. These advantages can be categorized as targeting either learning delivery or learning enhancement.
Learning delivery is the most often cited advantage of e-learning and includes increased accessibility to information, ease in updating content, personalized instruction, ease of distribution, standardization of content, and accountability.4,5 Accessibility refers to the user's ability to find what is needed, when it is needed. Improved access to educational materials is crucial, as learning is often an unplanned experience.5,7 Updating electronic content is easier than updating printed material9: e-learning technologies allow educators to revise their content simply and quickly. Learners have control over the content, learning sequence, pace of learning, time, and, often, media, which allows them to tailor their experience to meet personal learning objectives.10 Internet technologies permit the widespread distribution of digital content to many users simultaneously anytime and anywhere.
An additional strength of e-learning is that it standardizes course content and delivery; unlike, for instance, a lecture given to separate sections of the same course. Automated tracking and reporting of learners' activities lessen faculty administrative burden. Moreover, e-learning can be designed to include outcomes assessment to determine whether learning has occurred.11
Advantages in learning enhancement are a less well recognized but potentially more revolutionary aspect of e-learning than are those related to learning delivery. E-learning technologies offer educators a new paradigm based on adult learning theory, which states that adults learn by relating new learning to past experiences, by linking learning to specific needs, and by practically applying learning, resulting in more effective and efficient learning experiences.11 Learning enhancement permits greater learner interactivity and promotes learners' efficiency, motivation, cognitive effectiveness, and flexibility of learning style. Learning is a deeply personal experience: we learn because we want to learn. By enabling learners to be more active participants, a well-designed e-learning experience can motivate them to become more engaged with the content.12 Interactive learning shifts the focus from a passive, teacher-centered model to one that is active and learner-centered, offering a stronger learning stimulus. Interactivity helps to maintain the learner's interest and provides a means for individual practice and reinforcement. Evidence suggests that e-learning is more efficient because learners gain knowledge, skills, and attitudes faster than through traditional instructor-led methods. This efficiency is likely to translate into improved motivation and performance.12 E-learners have demonstrated increased retention rates and better utilization of content, resulting in better achievement of knowledge, skills, and attitudes.12 Multimedia e-learning offers learners the flexibility to select from a large menu of media options to accommodate their diverse learning styles.12
Components of E-Learning
Creating e-learning material involves several components: once content is developed, it must be managed, delivered, and standardized.
Content comprises all instructional material, which can range in complexity from discrete items to larger instructional modules. A digital learning object is defined as any grouping of digital materials structured in a meaningful way and tied to an educational objective.13 Learning objects represent discrete, self-contained units of instructional material assembled and reassembled around specific learning objectives, which are used to build larger educational materials such as lessons, modules, or complete courses to meet the requirements of a specified curriculum.14 Examples include tutorials, case-based learning, hypermedia, simulations, and game-based learning modules. Content creators use instructional design and pedagogical principles to produce learning objects and instructional materials.
Content management includes all the administrative functions (e.g., storing, indexing, cataloging) needed to make e-learning content available to learners. Examples include portals, repositories, digital libraries, learning-management systems, search engines, and ePortfolios. A learning-management system, for example, is Internet-based software that facilitates the delivery and tracking of e-learning across an institution.15,16 A learning-management system can serve several functions beyond delivering e-learning content. It can simplify and automate administrative and supervisory tasks, track learners' achievement of competencies, and operate as a repository for instructional resources twenty-four hours a day.15,16 Learning-management systems familiar to medical educators are WebCT® or Blackboard®, but there are more than 200 commercially available systems, a number that is growing rapidly.
Content delivery may be either synchronous or asynchronous.5 Synchronous delivery refers to real-time, instructor-led e-learning, where all learners receive information simultaneously and communicate directly with other learners. Examples include teleconferencing (audio, video, or both), Internet chat forums, and instant messaging. With asynchronous delivery, the transmission and receipt of information do not occur simultaneously. The learners are responsible for pacing their own self-instruction and learning. The instructor and learners communicate using e-mail or feedback technologies, but not in real time. A variety of methods can be used for asynchronous delivery, including e-mail, online bulletin boards, listservs, newsgroups, and Weblogs.
In addition to establishing, managing, and delivering content, a fourth component is part of the e-learning equation. It is becoming increasingly clear that standards are needed for the creation of new e-learning material.17 Such standards promote compatibility and usability of products across many computer systems, facilitating the widespread use of e-learning materials. Several organizations have been engaged in creating broad e-learning standards.17 Although not specifically designed for medical education, these standards offer medical educators important advantages. The most well-known set of standards is the Advanced Distributed Learning: Sharable Content Object Reference Model (SCORM). SCORM is a group of specifications developed through a collaborative effort of e-learning organizations funded by the United States Department of Defense.17 SCORM specifications prescribe the manner in which a learning-management system handles e-learning products.17 E-learning material built to SCORM specifications will interact with a conformant learning-management system, allowing for the prescription of the learning experience and tracking of learner performance. In medical education, MedBiquitous, a consortium of academic, government, and health care industry organizations, is working to develop SCORM-compliant specifications and standards for medical education.18
The Evidence for Effective and Efficient E-Learning
The effectiveness of e-learning has been demonstrated primarily by studies of higher education, government, corporate, and military environments.11,19 However, these studies have limitations, especially because of the variability in their scientific design.19,20 Often they have failed to define the content quality, technological characteristics, and type of specific e-learning intervention being analyzed. In addition, most have included several different instructional and delivery methodologies, which complicates the analysis.21 Most of these studies compared e-learning with traditional instructor-led approaches.15,19
Yet three aspects of e-learning have been consistently explored: product utility, cost-effectiveness, and learner satisfaction. Utility refers to the usefulness of the method of e-learning. Several studies outside of health care have revealed that most often e-learning is at least as good as, if not better than, traditional instructor-led methods such as lectures in contributing to demonstrated learning.5,11 Gibbons and Fairweather11 cite several studies from the pre-Internet era, including two meta-analyses that compared the utility of computer-based instruction to traditional teaching methods. The studies used a variety of designs in both training and academic environments, with inconsistent results for many outcomes. Yet learners' knowledge, measured by pre-post test scores, was shown to improve. Moreover, learners using computer-based instruction learned more efficiently and demonstrated better retention.
Recent reviews of the e-learning (specifically Web-based learning) literature in diverse medical education contexts reveal similar findings.22 Chumley-Jones and colleagues22 reviewed 76 studies from the medical, nursing, and dental literature on the utility of Web-based learning. About one-third of the studies evaluated knowledge gains, most using multiple-choice written tests, although standardized patients were used in one study. In terms of learners' achievements in knowledge, Web-based learning was equivalent to traditional methods. Of the two studies evaluating learning efficiency, only one demonstrated evidence for more efficient learning via Web-based instruction.22
A substantial body of evidence in the nonmedical literature has shown, on the basis of sophisticated cost analysis, that e-learning can result in significant cost-savings, sometimes as much as 50%, compared with traditional instructor-led learning.11 Savings are related to reduced instructor training time, travel costs, and labor costs, reduced institutional infrastructure, and the possibility of expanding programs with new educational technologies.11 Only one study in the medical literature evaluated the cost-effectiveness of e-learning as compared with text-based learning. The authors found the printing and distribution of educational materials to be less costly than creating and disseminating e-learning content.22
Studies in both the medical and nonmedical literature have consistently demonstrated that students are very satisfied with e-learning.11,22 Learners' satisfaction rates increase with e-learning compared to traditional learning, along with perceived ease of use and access, navigation, interactivity, and user-friendly interface design.11,22 Interestingly, students do not see e-learning as replacing traditional instructor-led training but as a complement to it, forming part of a blended-learning strategy.11,22
Availability of E-Learning Resources
Thanks to the growth of educational technologies and the Internet, the number of e-learning resources available to educators has dramatically increased. Within medical education, repositories or digital libraries have been established to manage access to e-learning materials. Although few at this time, such repositories offer a vision of expanded access to a large number of high-quality, peer-reviewed, sharable e-learning materials (see Table 1). Examples include the Association of American Medical Colleges' (AAMC's) MedEdPortal, a repository for curriculum and assessment materials organized around core competencies in medical education and populated with up-to-date, peer-reviewed teaching and assessment materials.23 The End of Life/Palliative Education Resource Center is a free-access repository of digital content for health profession educators involved in palliative care education.24 The Health Education Assets Library (HEAL) provides high-quality digital materials for health sciences educators25 and promotes the preservation and exchange of useful educational assets such as individual graphic, video, or audio elements, while respecting ownership and privacy. HEAL has begun a peer-review process for all e-learning materials submitted to the library.25 The Multimedia Educational Resource for Learning and Online Teaching (MERLOT) is designed primarily for faculty and students of higher education.26 The service collects links to online learning materials, along with annotations such as users' reviews and assignments. MERLOT contains a growing science and technology section that includes health care education e-learning materials.26 The International Virtual Medical School (IVIMEDS) is an international organization whose mission is to set new standards for e-learning in medical education through a partnership of medical schools and institutions, using a blended-learning approach. IVIMEDS hosts a repository for use by its member medical schools.27 Most of the materials in this repository are free to use, although some materials have clearly defined conditions for use. In the future, these and other repositories may require a membership or other fees to cover the ongoing expenses of Web-site maintenance.
Evaluating E-Learning Processes and Outcomes
Adopting e-learning and its technology requires large investments in faculty, time, money, and space that need to be justified to administrators and leadership. As with other educational materials, there are two major approaches to the evaluation of e-learning: process and outcomes.
Process evaluation examines an e-learning program's strengths and weaknesses and how its results are produced, often providing information that will allow others to replicate it. Peer review is one type of process evaluation. Traditional peer review for journal articles verifies the quality of content. E-learning requires the consideration of additional dimensions. For example, is it easy to “navigate” through the online material? Is the appearance conducive to education? Are multimedia elements used effectively? Is the interactivity appropriate for the level of the learner? Are special computer skills, hardware, or software required? These and other questions place new demands on peer reviewers engaged in process evaluation of e-learning. In fact, the AAMC, at the request of the Council of Deans, has begun a peer-review process of e-learning that recognizes these materials as evidence of scholarly activity for faculty promotion and recognition.28
Outcome evaluation of changes in learners' knowledge, skills, or attitudes allows e-learning developers to gauge program effectiveness. The evaluation framework outlined by Kirkpatrick29 in the 1950s and later adapted to health care education30 can be used to evaluate e-learning interventions.31 The Kirkpatrick model defines four levels of evaluation based on outcome: satisfaction, learning, change in learner behavior, and organizational change/patient outcome.
Satisfaction measures learners' reactions to the material: was it easy to use, hard to use, fun, boring, and so forth. But satisfaction measures alone do not measure learning. For example, excellent content that learners find difficult to use may be rated as poor. Likewise, a module that is highly entertaining in its use of multimedia but superficial in its content may be rated as excellent.
Tracking and monitoring learners' knowledge, attitudes, and skills via a learning-management system can greatly simplify the process of evaluating the gains made through e-learning. An approach that combines assessment of skills and attitudes using e-learning technology with facilitator-mediated observation would allow a more in-depth evaluation of skills and behavior. By contrast, evaluating the direct result of an education program by measuring changes in learners' behaviors, institutional changes, and better patient care is often complex, time-consuming, and costly. E-learning assessments can be one valuable component in such overall evaluation of medical school curricula.
E-Learning as Academic Scholarship
The literature regarding faculty development or promotion of e-learning as evidence of scholarly pursuit is almost nonexistent to our knowledge; however, as noted above, e-learning requires faculty competencies that go beyond traditional instructional activities. Furthermore, by its nature, e-learning offers learners and instructors the possibility of widespread use, access, and sharing unmatched by other types of instruction. Evaluation data from peer review as well as learning-management system tracking and monitoring of e-learning use can provide evidence of its quality and effectiveness. How are faculty members recognized and rewarded for their dedication to this effort? The following activities could be considered evidence of scholarship for faculty promotion:
* Publication of e-learning materials in a national online peer-reviewed repository.
* Faculty and learner evaluations of one's e-learning material.
* Peer-reviewed publications describing the process, impact, and scientific contributions of e-learning to medical education.
* Successful grant awards in e-learning.
* Participation in national (and international) societies concerned with the development, application, and use of e-learning in medical education.
Numerous research opportunities exist in the relatively new field of e-learning. Faculty, administrators, and the public will demand that educators evaluate the impact of e-learning on the quality and efficiency of medical education. Extrapolating methods from other clinical and educational research, including comparative studies, is insufficient because such studies often ignore the complexity of the learning process and the methods of delivery characteristic of e-learning. Potential areas for research include assessing contexts for effective use of e-learning in medical education, the differential use of e-learning in preclinical versus clinical years, the adaptation of e-learning to a wide variety of medical specialties and clinical settings, an exploration of methods for simplifying the e-learning creation process to gain wider acceptance and use, the incorporation of e-learning as part of a blended-learning strategy, and the use of a multimedia instructional design process by medical educators.
Integrating E-Learning into Medical Education
The integration of e-learning into existing medical curricula should be the result of a well-devised plan that begins with a needs assessment and concludes with the decision to use e-learning.32 Although some institutions have tried to use e-learning as a stand-alone solution to updating or expanding their curricula, we believe it is best to begin with an integrated strategy that considers the benefits and burdens of blended learning before revising the curriculum. In undergraduate medical education, e-learning offers learners materials for self-instruction and collaborative learning. In graduate medical education, the Accreditation Council for Graduate Medical Education has established six core competencies toward which e-learning can be applied. E-learning materials suited for each of these competencies can be integrated into the education of residents and fellows, replacing lectures and other synchronous methods of instruction. Asynchronous e-learning can be effectively used during demanding clinical care rotations, especially when duty hours are limited yet curriculum requirements remain high. In continuing medical education, physicians with daily clinical obligations can attend medical “e-conferences” using e-learning.
The complexity and breadth of medical education content, together with the scarcity of experts and resources in e-learning, make the creation of centers of excellence in e-learning a reasonable proposition. The Federal Interagency Working Group on Information Technology Research and Development has recommended the establishment of centers to explore “new delivery modes for educating medical practitioners and providing continuing medical education”33; e-learning clearly fits that description. Such centers could offer a wide range of services, including system deployment and administration, training of faculty and administrators, assistance in content development, the design of learning pathways and programs, marketing and support, supervision, maintenance, research, and consultation.
The Internet2 is a U.S.-based, collaborative, university-led project started in 1996 to develop additional infrastructure for the Internet backbone capable of superhigh bandwidth.34 The Internet2's vision of extremely fast speed, complex real-time multimedia capabilities, and quality of service would provide educators enormous potential to enhance the learning experience.34 Larger bandwidth offers the promise of sophisticated immersive simulations and the use of full-motion video in real time, in both asynchronous and synchronous modes of instruction, delivered to any desktop computer.35 Many medical schools and health care organizations are already producing high-fidelity e-learning materials, such as virtual patient simulations, that could soon be within the reach of any educator and learner.35–37
Directions for the Future
Developments in e-learning and technologies are creating the groundwork for a revolution in education, allowing learning to be individualized (adaptive learning), enhancing learners' interactions with each other (collaborative learning), and transforming the role of the teacher (from disseminator to facilitator).
Adaptive learning uses technology to assess learners' knowledge, skills, and attitudes at the beginning of online training in order to deliver educational materials at the level most appropriate for each learner.11 In the online environment of e-learning, adaptive learning is possible through identification of the learner, personalization of content, and individualization of tracking, monitoring, support, and assessment.11,21 Adaptive learning is the ultimate learner-centered experience because it individualizes a unique learning path for each learner that is likely to target his or her specific learning needs and aptitudes.
The potential for collaborative learning to break the isolation of learners is realized in e-learning technologies. Advances in synchronous distance education and collaborative technologies like Weblogs, message boards, chats, e-mail, and teleconferencing are making such collaborative learning more readily available. Quantitative and qualitative studies of collaborative learning in medicine have shown higher levels of learner satisfaction, improvements in knowledge, self-awareness, understanding of concepts, achievement of course objectives, and changes in practice.38,39
An evolving emphasis within medical education on lifelong learning and competency-based education has forced educators to reevaluate their traditional roles.10 In this changing paradigm, educators no longer serve as the sole distributors of content, but are becoming facilitators of learning and assessors of competency. E-learning offers the opportunity for educators to evolve into this new role by providing them with a set of online resources to facilitate the learning process.10
E-learning refers to the use of Internet technologies to deliver a broad array of learning modes that enhance learners' knowledge and performance. There is evidence for the effectiveness and acceptance of e-learning within the medical education community, especially when combined with traditional teacher-led activities in a blended-learning educational experience. Several digital repositories of e-learning materials exist, some with peer review, where instructors or developers can submit materials for widespread use or retrieve them for creating new materials. The evaluation of e-learning should include a peer-review process and an assessment of outcomes such as learner satisfaction, content usability, and demonstration of learning. Faculty skills in creating e-learning may differ from those needed for traditional teaching; faculty rewards for scholarly activity must recognize this difference and should be commensurate with effort. With technological advancement, the future offers the promise of high-fidelity, high-speed simulations and personalized instruction using both adaptive and collaborative learning. Centers of excellence in e-learning can provide national support for the design, development, implementation, evaluation, collaboration, and sharing of digital e-learning materials. The integration of e-learning into undergraduate, graduate, and continuing medical education will promote a shift toward adult learning in medical education, wherein educators no longer serve solely as distributors of content, but become facilitators of learning and assessors of competency.
The authors would like to acknowledge the support from the D.W. Reynolds Foundation and the State of Florida Agency for Health Care Administration. Drs. Ruiz and Mintzer would like to thank Dr. Bernard Roos for his mentorship.
1Ozuah PO. Undergraduate medical education: thoughts on future challenges. BMC Med Educ. 2002;2:8–10.
2Nair BR, Finucane PM. Reforming medical education to enhance the management of chronic disease. Med J Aust. 2003;179:257–59.
3Leung WC. Competency based medical training: review. BMJ. 2002;325:693–96.
4Rosenberg M. E-Learning: Strategies for Delivering Knowledge in the Digital Age. New York: McGraw-Hill, 2001.
5Wentling T, Waight C, Gallaher J, La Fleur J, Wang C, Kanfer A. E-Learning: A Review of Literature 2000 〈http://learning.ncsa.uiuc.edu/papers/elearnlit.pdf
〉. Accessed 22 November 2005. University of Illinois National Center for Supercomputer Applications, Urbana-Champaign, IL, 2000.
6Moberg TF, Whitcomb ME. Educational technology to facilitate medical students' learning: background paper 2 of the medical school objectives project. Acad Med. 1999;74:1146–50.
7Ward JP, Gordon J, Field MJ, Lehmann HP. Communication and information technology in medical education. Lancet. 2001;357:792–96.
8Masie E. Blended learning: the magic is in the mix. In: Rossett A (ed). The ASTD E-Learning Handbook. New York: McGraw-Hill, 2002:58–63.
9Chu LF, Chan BK. Evolution of web site design: implications for medical education on the Internet. Comput Biol Med. 1998;28:459–72.
10Chodorow S. Educators must take the electronic revolution seriously. Acad Med. 1996;71:221–26.
11Gibbons A, Fairweather P. Computer-based instruction. In: Tobias S, Fletcher J (eds). Training & Retraining: A Handbook for Business, Industry, Government, and the Military. New York: Macmillan Reference USA, 2000:410–42.
12Clark D. Psychological myths in e-learning. Med Teach. 2002;24:598–604.
14Littlejohn A. Issues in reusing online resources. In: Littlejohn A (ed). Reusing Online Resources: A Sustainable Approach to eLearning. London: Creative Print and Design, 2003:1–6.
15Johnson CE, Hurtubise LC, Castrop J, et al. Learning management systems: technology to measure the medical knowledge competency of the ACGME. Med Educ. 2004;38:599–608.
16Phelps C, Michea YF. Learning management systems' evaluation focuses on technology not learning. AMIA Annu Symp Proc. 2003:969.
17Fallon C, Brown S. E-learning Standards: A Guide to Purchasing and Deploying Standards-Conformant E-learning. Boca Raton: St Lucie Press, 2003.
18The MedBiquitous Consortium: Enabling Collaboration for Healthcare Education 〈http://www.medbiq.org
〉. Accessed 22 February 2005. MedBiquitous, Baltimore, MD 2005.
19Bernard R, Abrami PL, Lou Y, Borokhovski E. How does distance education compare with classroom instruction? a meta-analysis of the empirical literature. Rev Educ Res. 2004;74:379–439.
20Letterie GS. Medical education as a science: the quality of evidence for computer-assisted instruction. Am J Obstet Gynecol. 2003;188:849–53.
21Piemme TE. Computer-assisted learning and evaluation in medicine. JAMA. 1988;260:367–72.
22Chumley-Jones HS, Dobbie A, Alford CL. Web-based learning: sound educational method or hype? A review of the evaluation literature. Acad Med. 2002;77 (10 suppl):S86-S93.
24Anderson R, Biernat K, Rehm J. A pathway to advancing end-of-life education. J Palliat Med. 2002;5:428–31.
25Candler CS, Uijtdehaage SH, Dennis SE. Introducing HEAL: the Health Education Assets Library. Acad Med. 2003;78:249–53.
26Malloy TE, Hanley GL. MERLOT: a faculty-focused Web site of educational resources. Behav Res Methods Instrum Comput. 2001;33:274–76.
27Harden RM, Hart IR. An international virtual medical school (IVIMEDS): the future for medical education? Med Teach. 2002;24:261–67.
28Anderson M. Bromwell, senior associate vice president, Division for Medical Education, Association of American Medical Colleges, Washington, DC. Personal communication, March 18, 2005.
29Kirkpatrick D. Evaluating Training Programs. 2nd ed. San Francisco: Berrett-Koehler, 1998.
31Horton W. Evaluating E-learning. Alexandria, VA: American Society for Training and Development, 2001.
32Kern D, Thomas P, Howard D, Bass E. Curriculum Development for Medical Education Baltimore, MD: Johns Hopkins University Press, 1998.
33Reddy R, Wladawsky-Berger I (co-chairs). President's Information Technology Advisory Committee. Transforming Health Care through Information Technology. Arlington, VA: National Coordination Office for Information Technology Research & Development, 2001.
34Internet 2 Web page 〈http://www.internet2.edu
〉. Accessed 22 November 2005. Internet 2 Consortium, Ann Arbor, MI, 2005.
35Walker R, Dieter M, Panko W, Valenta A. What it will take to create new Internet initiatives in health care. J Med Syst. 2003;27:95–103.
36Tidmarsh PJ, Cummings J, Hersh WR, Freidman CP. Distributed medical informatics education using Internet2. Proc AMIA Symp. 2002:787–91.
37Vincent DS, Berg BW, Hudson DA, Chitpatima ST. International medical education between Hawaii and Thailand over Internet2. J Telemed Telecare. 2003;9 (2 suppl):S71–S72.
38Wiecha J, Barrie N. Collaborative online learning: a new approach to distance CME. Acad Med. 2002;77:928–29.
39Wiecha JM, Gramling R, Joachim P, Vanderschmidt H. Collaborative e-learning using streaming video and asynchronous discussion boards to teach the cognitive foundation of medical interviewing: a case study. J Med Internet Res. 2003;5:e13.
This article has been cited 122 time(s).
Journal of Psychiatric and Mental Health NursingCase study of cognitive behavioural therapy awareness educational programme using blended learning, UKJournal of Psychiatric and Mental Health Nursing
Nurse Education TodayContinuing education for primary health care nurse practitioners in Ontario, CanadaNurse Education Today
Journal of the Medical Library Association
A blended training approach using videoconferencing for distance education
Journal of the Medical Library Association, 94(4):
Pain MedicineDevelopment of a Comprehensive E-Learning Resource in Pain ManagementPain Medicine
Journal of Biomedical InformaticsCognitive and learning sciences in biomedical and health instructional design: A review with lessons for biomedical informatics educationJournal of Biomedical Informatics
Medical TeacherKey steps for integrating a basic science throughout a medical school curriculum using an e-learning approachMedical Teacher
OphthalmologeEvaluation of an Internet-based e-learning ophthalmology module for medical studentsOphthalmologe
Anatomical Sciences EducationEvaluation of Computer-Aided Instruction in a Gross Anatomy Course: A Six-year StudyAnatomical Sciences Education
Journal of Nursing Education
Applying the principles of significant learning in the e-learning environment
Journal of Nursing Education, 47(2):
TrialsEvaluation of an online Diabetes Needs Assessment Tool (DNAT) for health professionals: a randomised controlled trialTrials
Medical TeacherComputer-based learning versus practical course in pre-clinical education: Acceptance and knowledge retentionMedical Teacher
Acta Clinica Belgica
Is there a future for scientific medical libraries?
Acta Clinica Belgica, 62(1):
Student decisions about lecture attendance: Do electronic course materials matter?
Academic Medicine, 82():
PediatricsAchieving Success Connecting Academic and Practicing Clinicians Through TelemedicinePediatrics
British Journal of Hospital Medicine
How is multi-professional training optimized in the acute environment?
British Journal of Hospital Medicine, 70(1):
Journal of Surgical ResearchDevelopment of a tool for evaluating multimedia for surgical educationJournal of Surgical Research
Emergency Medicine AustralasiaEducation initiative improves the evidence-based use of metoclopramide following morphine administration in the emergency departmentEmergency Medicine Australasia
Journal of Dental Education
E-Teaching and Learning Preferences of Dental and Dental Hygiene Students
Journal of Dental Education, 74(1):
Graduate medical education and the Residency Review Committee: History and challenges
American Surgeon, 73(2):
EpilepsiaE-learning courses in epilepsy - Concept, evaluation, and experience with the e-learning course "Genetics of epilepsies"Epilepsia
Zeitschrift Fur Kinder-Und Jugendpsychiatrie Und PsychotherapieDocs'n Drugs - an E-learning program for medical students; feasibility and evaluation of the acceptance in student training in child and adolescent psychiatry at the University Hospital in UlmZeitschrift Fur Kinder-Und Jugendpsychiatrie Und Psychotherapie
Anadolu Kardiyoloji Dergisi-the Anatolian Journal of Cardiology
E-learning and problem based learning integration in cardiology education
Anadolu Kardiyoloji Dergisi-the Anatolian Journal of Cardiology, 9(3):
Family PracticeThe effect of reminder letters on the uptake of an e-learning programme on dementia: a randomized trial in general practiceFamily Practice
American Journal of Pharmaceutical EducationAn instructional seminar for online case-based discussionsAmerican Journal of Pharmaceutical Education
Medical TeacherNew horizons for e-learning in medical education: ecological and Web 2.0 perspectivesMedical Teacher
Journal of Computer Assisted LearningTechnology-assisted learning: a longitudinal field study of knowledge category, learning effectiveness and satisfaction in language learningJournal of Computer Assisted Learning
Archives of Internal Medicine
Web-based education in systems-based practice - A randomized trial
Archives of Internal Medicine, 167(4):
Medical TeacherUsing medical knowledge sources on handheld computers - A qualitative study among junior doctorsMedical Teacher
Archives of Surgery
Whither goest general surgery?
Archives of Surgery, 143(5):
Medizinische KlinikPrimary care physicians, internet and educational media. Preferences, usages and appraisal in a 6-year comparisonMedizinische Klinik
Journal of Dental Education
A Blended Learning Course Taught to Different Groups of Learners in a Dental School: Follow-Up Evaluation
Journal of Dental Education, 72(9):
Journal of AsthmaA Randomized Controlled Trial to Evaluate the Effectiveness of a Distance Asthma Learning Program for PediatriciansJournal of Asthma
Postgraduate Medical JournalMedical education via the internet: not just the preserve of exam takersPostgraduate Medical Journal
American Journal of Infection ControlE-learning may improve adherence to alcohol-based hand rubbing: A cohort studyAmerican Journal of Infection Control
Emergency Medicine JournalPotential and limitations of e-learning in emergency medicineEmergency Medicine Journal
Implementation ScienceKnowledge transfer for the management of dementia: a cluster-randomised trial of blended learning in general practiceImplementation Science
Effectiveness of an Online Pediatric Primary Care Curriculum
Academic Pediatrics, 10(2):
Breastfeeding MedicineA Breastfeeding e-Learning Project Based on a Web ForumBreastfeeding Medicine
Kaohsiung Journal of Medical Sciences
Infusing Cultural Competence Training Into the Curriculum: Describing the Development of Culturally Sensitive Training on Dementia Communication
Kaohsiung Journal of Medical Sciences, 25(9):
Advances in Electrical and Computer EngineeringInformation Structuring and Retrieval with Topic Maps for Medical E-LearningAdvances in Electrical and Computer Engineering
Bmc BioinformaticsThe implementation of e-learning tools to enhance undergraduate bioinformatics teaching and learning: a case study in the National University of SingaporeBmc Bioinformatics
Emergency Medicine JournalAn intervention trial increases the evidence-based use of bupivacaine in hand injuriesEmergency Medicine Journal
Anatomical Sciences EducationAn Explorative Learning Approach to Teaching Clinical Anatomy Using Student Generated ContentAnatomical Sciences Education
Journal of the American Geriatrics SocietyThe consortium of e-learning in geriatrics instructionJournal of the American Geriatrics Society
Medical TeacherTeaching medical professionals online: A cross-discipline experienceMedical Teacher
Bmc Family PracticeDiffusion of an e-learning programme among Danish General Practitioners: A nation-wide prospective surveyBmc Family Practice
E-Learning as Evidence of Educational Scholarship: A Survey of Chairs of Promotion and Tenure Committees at US Medical Schools
Academic Medicine, 84(1):
Academic Emergency MedicineAlternatives to the Conference Status Quo: Summary Recommendations from the 2008 CORD Academic Assembly Conference Alternatives WorkgroupAcademic Emergency Medicine
Quality and use of websites presenting public health education and training opportunities
Sante Publique, 20(5):
Advances in Health Sciences EducationComputer-assisted instruction in clinical education: a roadmap to increasing CAI implementationAdvances in Health Sciences Education
Jama-Journal of the American Medical Association
Internet-based learning in the health professions - A meta-analysis
Jama-Journal of the American Medical Association, 300():
2008 3Rd International Conference on Information and Communication Technologies: From Theory to Applications, Vols 1-5
The Using of E-Learning Techniques to Improve the Medical Education
2008 3Rd International Conference on Information and Communication Technologies: From Theory to Applications, Vols 1-5, ():
2Nd European Conference on Games Based Learning
An Architectural Model for the Design of Game-Based Learning Activities for Virtual Patients in Second Life
2Nd European Conference on Games Based Learning, ():
Behaviour & Information TechnologyUser interface evaluation of a multimedia CD-ROM for teaching minor skin surgeryBehaviour & Information Technology
Medical Teachere-Learning in medical education: Guide supplement 32.5-ViewpointMedical Teacher
Medical EducationAccessing e-learning and e-resourcesMedical Education
Academic Emergency MedicineEmbedding medical student computer tutorials into a busy emergency departmentAcademic Emergency Medicine
RadiographicsInitial experiences in radiology e-learningRadiographics
Bmc Health Services ResearchGeneral Practitioners' preferences and use of educational media: a German perspectiveBmc Health Services Research
Journal of Geography in Higher EducationE-learning for geography's teaching and learning spacesJournal of Geography in Higher Education
Medical TeacherExperiences with different integration strategies of case-based e-learningMedical Teacher
Nurse Education TodayDeveloping an e-learning education programme for staff nurses: Processes and outcomesNurse Education Today
Journal of General Internal MedicineThe Reflective Writing Class Blog: Using Technology to Promote Reflection and Professional DevelopmentJournal of General Internal Medicine
Patient Education and CounselingEvaluation of different delivery modes of an interactive e-learning programme for teaching cultural diversityPatient Education and Counseling
Academic Emergency MedicineA Four-Year Perspective of Society for Academic Emergency Medicine Tests: An Online Testing Tool for Medical StudentsAcademic Emergency Medicine
Proceedings of the 4Th International Conference on E-Learning
E-teaching, the Other Side of the e-Learning Equation: The Medical 21(st) Century Educator
Proceedings of the 4Th International Conference on E-Learning, ():
Computers & EducationDo students need teacher's initiation in online collaborative learning?Computers & Education
Journal of General Internal MedicineWorking with patients with alcohol problems: A controlled trial of the impact of a rich media web module on medical student performanceJournal of General Internal Medicine
Lab AnimalThe AALAS Learning Library and its effectiveness as a tool for technician trainingLab Animal
American Journal of Industrial MedicineOccupational Health Crossing Borders-Part 1: Concept, Teaching Methods, and User Evaluation of the First International Summer School in Munich, GermanyAmerican Journal of Industrial Medicine
New Directions in Intelligent Interactive Multimedia Systems and Services - 2
Multimedia Elements for Medical e-Learning Improvement
New Directions in Intelligent Interactive Multimedia Systems and Services - 2, 226():
Medical TeacherIntegration of e-learning technologies in an interprofessional health science courseMedical Teacher
Teaching and Learning in MedicineRandomized comparison between traditional and traditional plus interactive web-based methods for teaching seizure disordersTeaching and Learning in Medicine
Medicine Meets Virtual Reality 15
A Serious Gaming/Immersion Environment to Teach Clinical Cancer Genetics
Medicine Meets Virtual Reality 15, 125():
Medical TeacherMedical education in Korea: The e-learning consortiumMedical Teacher
Reseaching Learning in Virtual WorldsDesign and Delivery of Game-Based Learning for Virtual Patients in Second Life: Initial FindingsReseaching Learning in Virtual Worlds
Medical TeacherVirtual patients for assessing medical students - important aspects when considering the introduction of a new assessment formatMedical Teacher
Journal of Psychiatric and Mental Health NursingImpact of eLearning course on nurses' professional competence in seclusion and restraint practices: 9-month follow-up results of a randomized controlled study (ISRCTN32869544)Journal of Psychiatric and Mental Health Nursing
Explore-the Journal of Science and HealingResearch Training in Integrative Medicine: How Can We Make Teaching and Learning in Research Methods More Sustainable and Engaging?Explore-the Journal of Science and Healing
Journal of Advanced NursingExploring the underlying factors influencing e-learning adoption in nurse educationJournal of Advanced Nursing
Behaviour & Information TechnologyAn effective online teaching method: the combination of collaborative learning with initiation and self-regulation learning with feedbackBehaviour & Information Technology
Telemedicine and E-HealthA Global Model for Effective Use and Evaluation of e-Learning in HealthTelemedicine and E-Health
Teaching in Higher EducationHow the usage of learning management systems influences student achievementTeaching in Higher Education
Journal of Manipulative and Physiological TherapeuticsEvaluation of E-Learning As An Adjunctive Method for the Acquisition of Skills in Bony Landmark Palpation and Muscular Ultrasound Examination in the Lumbopelvic Region: A Controlled StudyJournal of Manipulative and Physiological Therapeutics
Australasian Journal of Educational Technology
Blended learning and curriculum renewal across three medical schools: The rheumatology module at the University of Otago
Australasian Journal of Educational Technology, 28(7):
Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie
Continuing Education To Go: Capacity Building in Psychotherapies for Front-Line Mental Health Workers in Underserviced Communities
Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 58(6):
Academic RadiologyTeaching Radiology in the Millennial EraAcademic Radiology
American Journal of SurgeryKnowledge and usability of a trauma training system for general surgery residentsAmerican Journal of Surgery
European Journal of Dental EducationUsing e-learning to train dentists in the development of standardised oral health promotion interventions for persons with disabilityEuropean Journal of Dental Education
Psychotherapy Training e-Resources (PTeR): On-Line Psychotherapy Education
Academic Psychiatry, 37(1):
Rural and Remote HealthSupporting international medical graduates in rural Australia: a mixed methods evaluationRural and Remote Health
5Th International Conference of Education, Research and Innovation (Iceri 2012)
Nutrition and Ageing: A Subject Taught By the Campus Andaluz Virtual-5 Years' Experience
5Th International Conference of Education, Research and Innovation (Iceri 2012), ():
Postgraduate Medical JournalThe development and validation of an internet-based training package for the management of perineal trauma following childbirth: MaternityPEARLSPostgraduate Medical Journal
Medical TeacherE-learning and deliberate practice for oral case presentation skills: A randomized trialMedical Teacher
Medical TeacherAvailable, intuitive and free! Building e-learning modules using web 2.0 servicesMedical Teacher
Bmc Medical EducationEducating on professional habits: attitudes of medical students towards diverse strategies for promoting influenza vaccination and factors associated with the intention to get vaccinatedBmc Medical Education
Sao Paulo Medical Journal
E-Learning: from useful to indispensable tool
Sao Paulo Medical Journal, 130(6):
Clinical Chemistry and Laboratory MedicineA position paper of the EFLM Committee on Education and Training and Working Group on Distance Education Programmes/E-Learning: developing an e-learning platform for the education of stakeholders in laboratory medicineClinical Chemistry and Laboratory Medicine
Revista Chilena De Cirugia
Continuing medical education (CME) as a permanent tool for learning
Revista Chilena De Cirugia, 65(2):
Bmc Medical EducationEffective or just practical? An evaluation of an online postgraduate module on evidence-based medicine (EBM)Bmc Medical Education
Advances in Chronic Kidney DiseaseOnline CKD Education for Medical Students, Residents, and Fellows: Training in a New EraAdvances in Chronic Kidney Disease
Revista Brasileira De Oftalmologia
E-learning as a complement to presential teaching of blindness prevention: a randomized clinical trial
Revista Brasileira De Oftalmologia, 72(1):
Journal of Evaluation in Clinical PracticeA novel Internet-based blended learning programme providing core competency in clinical researchJournal of Evaluation in Clinical Practice
Proceedings of the 8Th International Conference on E-Learning
Lessons Learnt: Building a Foundation for e-Learning in Medical Education in Botswana
Proceedings of the 8Th International Conference on E-Learning, ():
Education and Training in Autism and Developmental Disabilities
Impact of Online Training Videos on the Implementation of Mand Training by Three Elementary School Paraprofessionals
Education and Training in Autism and Developmental Disabilities, 48(1):
European Journal of RadiologyA pilot study to evaluate the use of virtual lectures for undergraduate radiology teachingEuropean Journal of Radiology
Anatomical Sciences EducationDesign for learning: Adapting the microscopic anatomy laboratory to adult learnersAnatomical Sciences Education
Anatomical Sciences EducationHistoViewer: An interactive e-learning platform facilitating group and peer group learningAnatomical Sciences Education
Genetics ResearchLet's get real about virtual : online health is here to stayGenetics Research
Edulearn10: International Conference on Education and New Learning Technologies
Online Writing Assignment As A Delivery Tool for Self-Directed, Reflective Learning: Learners' Perspectives
Edulearn10: International Conference on Education and New Learning Technologies, ():
TrialsImproving the application of a practice guideline for the assessment and treatment of suicidal behavior by training the full staff of psychiatric departments via an e-learning supported Train-the-Trainer program: study protocol for a randomized controlled trialTrials
VaccineUpgrading Public Health Programs for Human Papillomavirus Prevention and Control is Possible in Low- and Middle-income CountriesVaccine
International Journal of Morphology
Use of Clinical Cases in a Virtual Learning Environment as an Approach to Teaching Human Embryology
International Journal of Morphology, 30(4):
Educational Technology & Society
A Comparative Evaluation of E-learning and Traditional Pedagogical Process Elements
Educational Technology & Society, 16(3):
Anatomical Sciences EducationThe development and assessment of an online microscopic anatomy laboratory courseAnatomical Sciences Education
Anatomical Sciences EducationTransforming clinical imaging and 3D data for virtual reality learning objects: HTML5 and mobile devices implementationAnatomical Sciences Education
Anz Journal of SurgeryEvaluation of teaching methods for students on hernias: an observational studyAnz Journal of Surgery
Bmc Medical EducationReinforcing outpatient medical student learning using brief computer tutorials: the Patient-Teacher-Tutorial sequenceBmc Medical Education
Academic MedicinePeer Reviewing E-Learning: Opportunities, Challenges, and SolutionsAcademic Medicine
Journal of Occupational and Environmental MedicineCase Based e-Learning in Occupational Medicine—A European ApproachJournal of Occupational and Environmental Medicine
© 2006 Association of American Medical Colleges