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In Medical Education, Should Technology Lead or Follow?

Futuristic EducationEditor’s Note: In September, we began a series on active learning in medical education. Since then we’ve been highlighting different aspects of collaborative learning. We’ve examined topics ranging from the importance of physical space to the role of team-based and large group learning. We’ve also explored how community service plays an important role in educating doctors.

Today we delve into the role of technology in medical education.

by Terence P. Ma., Ph.D.

In July, I began an exciting role at Einstein: assistant dean for educational informatics. One of my main objectives is to optimize the use of technology to advance and deepen learning. But as much as I welcome it, technology alone will not achieve our educational goals.

Recently, David J. Hefland, the president and vice chancellor of Canada’s Quest University, characterized the model of contemporary education as “students as empty vessels that must be filled by pouring in knowledge from the (full) professor.” One might posit that with the introduction of many new electronic and digital methods of teaching, this model must be disappearing. To the contrary, many of the new technologies enable entrenchment of the “sage on the stage.”

With the use of lecture capture, many students opt to stay home and review videos of the instructor’s lecture and the slides used in the lecture. This focuses on the faculty member’s instruction and de-emphasizes any interactive participation designed for the class session. It minimizes the students’ interaction with faculty members and peers.

The latest rapidly expanding trend in online education is MOOCs (Massively Open Online Courses). These courses provide a forum for excellent lecturers to teach a large number of students simultaneously. The same virtual class can have thousands or even hundreds of thousands of students.

MOOCs generally rely on lectures and frequent assessments. While MOOCs do encourage communities of students to participate and work with each other to learn the materials, most do not require such interactivity to complete the course. And, significantly, the objectives are those set and assessed by the instructors.

In other words, MOOCS are a new way to reach a lot of people so that we can do what we’ve always done.

Another trend in many medical schools is to provide iPads to students when they arrive on campus. While the practice may be effective at recruiting students and attracting media attention, a closer look reveals that students tend not to use the iPads to take notes or produce materials, and often abandon using them in courses that are not image intensive.

One might ask why someone who is seemingly so negative about new technologies is leading the educational informatics effort at a medical school.

Without question, I believe that new technologies are critical and essential elements of contemporary medical education. However, the technologies should not define the education we provide students; they should help the learning take place.

These are tools—important tools that will help us educate future generations of physicians who must be digitally literate—but still, tools only.

Let us revisit lecture capture. It’s a useful convenience for students who want to review information before an examination or to consolidate information. I suggest, however, that “reusable learning objects” (short instructional materials that can be used again and again) are more helpful for most students. (Think Khan Academy.) The learners can revisit specific materials to review them, so the students can grasp the concepts on their own.

Online education can be highly effective. Typical online instruction requires more faculty time and energy than traditional lectures because content development is separated from instruction. Content is developed by an expert; the instruction is done by a faculty mentor and guide, who provides more instructional time per student than in traditional face-to-face instruction. Thus, online education typically provides feedback that is more frequent, complete and individualized.

Tablets may not be effective tools for writing or producing new materials. But they are incredibly useful for looking up information, demonstrating information to patients in the clinical setting and gaining access to electronic medical records. Medical students across the country often complain that they do not know how to use these tools effectively; addressing that need ought to be one of our educational objectives.

Technology must be used to provide support for effective education. Educational objectives need to be clearly defined and the appropriate tools selected to meet those objectives. Our medical education ought not to be digital simply because it is digital at other institutions. The digital format needs to serve a greater purpose—the goal of helping students develop educational competencies.

In order to train highly skilled future doctors, we need to select the right technologies to meet our educational objectives, not define educational objectives based on the technologies that are available.

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