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Letters to the Editor

More About Technology-Enhanced Learning in Medical Education

Robin, Bernard R. PhD; Cook, David A. MD, MHPE; McNeil, Sara G. EdD

Author Information
doi: 10.1097/ACM.0b013e318245f426

In Reply:

We agree with Berman and Fall that collaboration is key in the advancement of instructional technologies. To their list of advantages we add two additional opportunities and two remaining concerns.

The growing number and usability of authoring tools make the developing and sharing of instructional products increasingly feasible for educators without advanced computer skills. For example, the MedBiquitous consortium has published a standard for defining virtual patients ( Such standards permit educators to share their virtual patients with colleagues at other institutions. Virtual patient “players” are also now available, many of them (such as OpenLabyrinth1) at no cost. We expect that the technical aspects of developing virtual patients and other high-quality instructional technology products will soon be no more difficult than creating a PowerPoint presentation, and educators will be able to freely share such creations with others. MedEdPortal ( and eViP ( already facilitate such sharing.

Multiinstitutional collaborations also facilitate research to advance our understanding of learning and assessment.2 Two recent reviews of virtual patients have outlined gaps in our current understanding that would benefit from programmatic collaborative research.3,4 This research will be particularly salient for educators aspiring to academic advancement because, for better or worse, the coin of the realm for tenure at most institutions remains peer-reviewed publication.

Yet, even if authoring tools ameliorate technical barriers, educators will still need to learn how to use these powerful tools effectively. Indeed, teachers themselves often realize that they have much to learn about using new technologies and that just converting their lecture notes to digital format is not enough. Academic health leaders and policy makers should focus on how faculty members can be supported to become more efficient and effective technology-savvy instructors. As we discussed in the article that prompted Berman and Fall's letter, such strategies might include hiring instructional designers with expertise in various technologies, providing time for faculty to learn new skills, and maintaining up-to-date authoring tools and infrastructure.

Finally, while we recognize the importance of centralized hosting and maintenance, those currently equipped to perform such tasks often have a financial stake in the game. This presents an unavoidable conflict of interest between marketing one's skills or products and sharing with others the wisdom that comes from experience in a field. Fortunately, there are alternative solutions. As relevant authoring tools, sharing standards, research and teaching networks, and faculty development become widespread, educators will be less reliant on third parties for technology tools and resources that meet the needs of current and future learners.

Bernard R. Robin, PhD

Associate professor of instructional technology, University of Houston, Houston, Texas;

David A. Cook, MD, MHPE

Professor of medicine and medical education and director, Office of Education Research, College of Medicine, Mayo Clinic, Rochester, Minnesota.

Sara G. McNeil, EdD

Associate professor of instructional technology, University of Houston, Houston, Texas.


1. Ellaway RH. OpenLabyrinth: An abstract pathway-based serious game engine for professional education. In: Digital Information Management (ICDIM), 2010 Fifth International Conference on Digital Information Management; 2010:490–495. Accessed November 28, 2011.
2. Triola MM, Cook DA. Virtual patients: Are we in a new era? Acad Med. 2011;86:151.
3. Cook DA, Triola MM. Virtual patients: A critical literature review and proposed next steps. Med Educ. 2009;43:303–311.
4. Cook DA, Erwin PJ, Triola MM. Computerized virtual patients in health professions education: A systematic review and meta-analysis. Acad Med. 2010;85:1589–1602.
© 2012 Association of American Medical Colleges