Is there a Virtual Medical School on the horizon?

Medicine and Health Rhode Island, Sep 2003 by Smith, Stephen R

Brown Medical School is exploring the feasibility of conducting a pilot test of a case-based, integrated curriculum that will utilize a computer-based curriculum at its core. This article describes the convergence efforces in medical education that have led to the near inevitability of e-learning in medical school in the near future and how an international cooperative approach can make it work.

CONVERGENCE OF FORCES

Harden1 describes a number of trends in medical education in the last several decades that have laid the groundwork for computer-based learning in medical schools. The first trend was the shift from a teacher-centered pedagogical approach to a more student-centered approach. In a traditional teacher-centered approach, the teacher directs nearly all of the learning activities. The teacher's assignments are specific, the resources are chosen by the teacher, and classroom discussions are driven by questions put to the students by the teacher. In a student-centered approach, students are given more leeway in defining their own learning objectives within the broad context of the course. Students choose more of the resources they will utilize for learning. Classroom discussion is predominantly student-to-student with the teacher serving a more facilitative role.

Active learning is more often associated with a student-centered approach to learning, while passive learning, especially lecturing, is more often associated with a teacher-centered approach. Problem-based learning (PBL), which is Harden's second trend, epitomizes both a student-centered and active learning approach to pedagogy. PBL was pioneered at McMaster University in Canada and has been widely replicated around the world. In the classical PBL model, a group of students are presented with a short synopsis of a clinical case, perhaps initially limited only to the history and physical examination. Students begin the PBL process by listing what they know about the elements of the case already and what they don't know. The parts they don't know become part of their learning objectives. Students are expected to hypothesize the medical explanations that could account for the findings. This leads to more learning objectives being defined. Students then leave the group meeting and investigate the learning objectives which have been divided among the students in the group. They reassemble, usually a few days later, to report to each other on what they have learned. The students then revise their original hypotheses based on the new information. The faculty facilitator of the group refrains from telling the students the answers to their questions, usually poses some questions that might highlight areas for inquiry, and occasionally steers the students back on track if they veer too far off course.

Integrated teaching and learning is Hardens third trend. In contrast to the traditional disciplinary approach in which various departmental subjects are taught without much regard for what is being taught in other courses, integrated teaching coordinates the teaching of the different subjects around a common organizing scheme. For example, the anatomy, histology, and physiology of the lung could all be taught at the same time around a case presentation of a lung problem.

While these trends were occurring in medical education, the use of computers to assist teaching and learning was gradually finding its way into higher education. The use of computer-based technologies for teaching and learning, which is more conveniently referred to as e-learning, has become popular in teaching, both in the traditional classroom setting and for off-campus, or distance-learning, arrangements. Examples of how e-learning is used in the classroom include the use of email as a means of communication between the students and the teacher and among themselves, online threaded discussion forums, links to Internet sites related to the course topic, and the use of custom web-pages for the course that can include static text, interactive text, images, audio, and video segments.

Off-campus learning, or distance learning, existed before computer technology came into vogue. However, the power of the Internet has made off-campus learning easier and more effective. All the e-learning modalities just described for on-campus learners can be made available for off-campus learners. Video conferencing can partially compensate for the absence of face-to-face meetings among the off-campus students. Complete courses and even complete degree programs are now available online to off-campus students at places like the University of Phoenix and the University of Maryland, both enrolling tens of thousands of students.

The practice of medicine has easily adapted the computer into the mainstream. Electronic medical records offer an easier and more efficient means of organizing information that can be easily searched, not to mention the benefit of legibility. Electronic medical records can automatically create graphic displays of physiological parameters such as weight and blood pressure and laboratory tests. Physicians are increasingly using computers, especially handheld devices, for reference purposes, allowing rapid access to drug information, medical textbooks, and decision algorithms. Digital imaging allows radiologists to read x-rays in the middle of the night without leaving their homes and pathologists to review slides sent from halfway around the planet in an instant.