Communication and information technology in medical education
Identifieur interne : 000558 ( Istex/Corpus ); précédent : 000557; suivant : 000559Communication and information technology in medical education
Auteurs : Jeremy Pt Ward ; Jill Gordon ; Michael J. Field ; Harold P. LehmannSource :
- The Lancet [ 0140-6736 ] ; 2001.
Abstract
The past few years have seen rapid advances in communication and information technology (C&IT), and the pervasion of the worldwide web into everyday life has important implications for education. Most medical schools provide extensive computer networks for their students, and these are increasingly becoming a central component of the learning and teaching environment. Such advances bring new opportunities and challenges to medical education, and are having an impact on the way that we teach and on the way that students learn, and on the very design and delivery of the curriculum. The plethora of information available on the web is overwhelming, and both students and staff need to be taught how to manage it effectively. Medical schools must develop clear strategies to address the issues raised by these technologies. We describe how medical schools are rising to this challenge, look at some of the ways in which communication and information technology can be used to enhance the learning and teaching environment, and discuss the potential impact of future developments on medical education.
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DOI: 10.1016/S0140-6736(00)04173-8
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Communication and information technology in medical education</title><author><name sortKey="Ward, Jeremy Pt" sort="Ward, Jeremy Pt" uniqKey="Ward J" first="Jeremy Pt" last="Ward">Jeremy Pt Ward</name><affiliation><mods:affiliation>Department of Respiratory Medicine and Allergy, 5th Floor, Thomas Guy House, Guy's Hospital, London SE1 9RT, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence to: Dr Jeremy Ward</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: jeremy.ward@kcl.ac.uk</mods:affiliation></affiliation></author><author><name sortKey="Gordon, Jill" sort="Gordon, Jill" uniqKey="Gordon J" first="Jill" last="Gordon">Jill Gordon</name><affiliation><mods:affiliation>Faculty of Medicine, University of Sydney, Australia</mods:affiliation></affiliation></author><author><name sortKey="Field, Michael J" sort="Field, Michael J" uniqKey="Field M" first="Michael J" last="Field">Michael J. 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Lehmann</name><affiliation><mods:affiliation>Johns Hopkins University School of Medicine, Baltimore, MD, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">The Lancet</title><title level="j" type="abbrev">LANCET</title><idno type="ISSN">0140-6736</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2001">2001</date><biblScope unit="volume">357</biblScope><biblScope unit="issue">9258</biblScope><biblScope unit="page" from="792">792</biblScope><biblScope unit="page" to="796">796</biblScope></imprint><idno type="ISSN">0140-6736</idno></series><idno type="istex">7844D014EA2232C4D5EEC682597B93D1340DF05B</idno><idno type="DOI">10.1016/S0140-6736(00)04173-8</idno><idno type="PII">S0140-6736(00)04173-8</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0140-6736</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">The past few years have seen rapid advances in communication and information technology (C&IT), and the pervasion of the worldwide web into everyday life has important implications for education. Most medical schools provide extensive computer networks for their students, and these are increasingly becoming a central component of the learning and teaching environment. Such advances bring new opportunities and challenges to medical education, and are having an impact on the way that we teach and on the way that students learn, and on the very design and delivery of the curriculum. The plethora of information available on the web is overwhelming, and both students and staff need to be taught how to manage it effectively. Medical schools must develop clear strategies to address the issues raised by these technologies. We describe how medical schools are rising to this challenge, look at some of the ways in which communication and information technology can be used to enhance the learning and teaching environment, and discuss the potential impact of future developments on medical education.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Jeremy PT Ward PhD</name><affiliations><json:string>Department of Respiratory Medicine and Allergy, 5th Floor, Thomas Guy House, Guy's Hospital, London SE1 9RT, UK</json:string><json:string>Correspondence to: Dr Jeremy Ward</json:string><json:string>E-mail: jeremy.ward@kcl.ac.uk</json:string></affiliations></json:item><json:item><name>Jill Gordon MS</name><affiliations><json:string>Faculty of Medicine, University of Sydney, Australia</json:string></affiliations></json:item><json:item><name>Michael J Field Prof MD</name><affiliations><json:string>Faculty of Medicine, University of Sydney, Australia</json:string></affiliations></json:item><json:item><name>Harold P Lehmann MD</name><affiliations><json:string>Johns Hopkins University School of Medicine, Baltimore, MD, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Review and Opinion</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Series</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Medical Education</value></json:item></subject><language><json:string>eng</json:string></language><abstract>The past few years have seen rapid advances in communication and information technology (C&IT), and the pervasion of the worldwide web into everyday life has important implications for education. 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Most medical schools provide extensive computer networks for their students, and these are increasingly becoming a central component of the learning and teaching environment. Such advances bring new opportunities and challenges to medical education, and are having an impact on the way that we teach and on the way that students learn, and on the very design and delivery of the curriculum. The plethora of information available on the web is overwhelming, and both students and staff need to be taught how to manage it effectively. Medical schools must develop clear strategies to address the issues raised by these technologies. We describe how medical schools are rising to this challenge, look at some of the ways in which communication and information technology can be used to enhance the learning and teaching environment, and discuss the potential impact of future developments on medical education.</p></abstract><textClass><keywords scheme="keyword"><list><head>Article category</head><item><term>Review and Opinion</term></item><item><term>Series</term></item><item><term>Medical Education</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2001">Published</change></revisionDesc></teiHeader></istex:fulltextTEI></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity></istex:docType><istex:document><article docsubtype="rev"> <item-info> <jid>LANCET</jid> <aid>4173</aid> <ce:pii>S0140-6736(00)04173-8</ce:pii> <ce:doi>10.1016/S0140-6736(00)04173-8</ce:doi> <ce:copyright type="full-transfer" year="2001">Elsevier Ltd</ce:copyright> <ce:doctopics> <ce:doctopic> <ce:text>Review and Opinion</ce:text> </ce:doctopic> <ce:doctopic> <ce:text>Series</ce:text> </ce:doctopic> <ce:doctopic> <ce:text>Medical Education</ce:text> </ce:doctopic> </ce:doctopics> </item-info> <ce:floats> <ce:figure id="fig1"> <ce:label>Figure</ce:label> <ce:caption> <ce:simple-para id="spara10" role="caption">Guy's, King's & St Thomas's School of Medicine virtual campus</ce:simple-para> </ce:caption> <ce:link locator="gr1"></ce:link> </ce:figure> <ce:textbox id="box1"> <ce:label>Panel</ce:label> <ce:caption> <ce:simple-para id="spara20" role="caption">Examples of virtual campus sites and medical and biomedical gateways</ce:simple-para> </ce:caption> <ce:copyright type="other" year="2001">Courtesy of King's Collage, London</ce:copyright> <ce:textbox-body> <ce:sections> <ce:para id="para10"> <ce:display> <ce:table id="cetable10" frame="topbot" rowsep="0" colsep="0"> <tgroup cols="3" altimg="si1.gif"> <colspec colnum="1" colname="col1"></colspec> <colspec colnum="2" colname="col2"></colspec> <colspec colnum="3" colname="col3"></colspec> <thead> <row valign="top"> <entry align="left" namest="col1" nameend="col3"><ce:bold>Virtual campus sites</ce:bold></entry> </row> </thead> <tbody> <row valign="top"> <entry align="left"><ce:inter-ref xlink:href="http://www.kcl.ac.uk/gktvc">www.kcl.ac.uk/gktvc</ce:inter-ref></entry> <entry align="left">Guy’s, King's and St Thomas’ virtual campus, King's College, LondonLectureLinks,</entry> <entry align="left" morerows="2">These sites are primarily provided for students and staff working within their respective institutions, and provide a wide range of course-specific resources and other useful information and links. Some areas are restricted to members of the institution.</entry> </row> <row valign="top"> <entry align="left">omie.med.jhmi.edu/LectureLinks</entry> <entry align="left">Johns Hopkins School of Medicine</entry> </row> <row valign="top"> <entry align="left"><ce:inter-ref xlink:href="http://www.gmp.usyd.edu.au">www.gmp.usyd.edu.au</ce:inter-ref></entry> <entry align="left">University of Sydney medical program</entry> </row> <row valign="top"> <entry align="left">medical.faculty.ncl.ac.uk</entry> <entry align="left">University of Newcastle medical faculty</entry> <entry align="left" morerows="1">The Clyde virtual university is a collaborative venture between several universities in the west of Scotland.</entry> </row> <row valign="top"> <entry align="left">cvu.strath.ac.uk</entry> <entry align="left">Clyde virtual university</entry> </row> <row valign="top"> <entry align="left" namest="col1" nameend="col3"><ce:bold>Medical and biomedical gateways</ce:bold></entry> </row> <row valign="top"> <entry align="left"><ce:inter-ref xlink:href="http://www.omni.com">www.omni.com</ce:inter-ref></entry> <entry align="left">OMNI Internet Resources for Medicine and Bioscience</entry> <entry align="left" morerows="3">These sites provide an element of quality assessment and peer review into internet resource discovery. The majority of these services offer browsing facilities and the opportunity to do keyword searches for sites that have been assessed and described by information and health-care professionals.</entry> </row> <row valign="top"> <entry align="left"><ce:inter-ref xlink:href="http://www.medic8.com">www.medic8.com</ce:inter-ref></entry> <entry align="left">Medical web site directory and search engine</entry> </row> <row valign="top"> <entry align="left"><ce:inter-ref xlink:href="http://www.medmatrix.org">www.medmatrix.org</ce:inter-ref></entry> <entry align="left">Medical Matrix: guide to internet resources</entry> </row> <row valign="top"> <entry align="left"><ce:inter-ref xlink:href="http://www.biomednet.com">www.biomednet.com</ce:inter-ref></entry> <entry align="left">BioMedNet: collection of resources and gateways for biomedicine</entry> </row> </tbody> </tgroup> </ce:table> </ce:display></ce:para> </ce:sections> </ce:textbox-body> </ce:textbox> </ce:floats> <head> <ce:dochead> <ce:textfn>Series</ce:textfn> </ce:dochead> <ce:title>Communication and information technology in medical education</ce:title> <ce:author-group> <ce:author> <ce:given-name>Jeremy PT</ce:given-name> <ce:surname>Ward</ce:surname> <ce:degrees>PhD</ce:degrees><ce:cross-ref refid="aff1"><ce:sup>a</ce:sup></ce:cross-ref><ce:cross-ref refid="cor1"><ce:sup>*</ce:sup></ce:cross-ref> <ce:e-address type="email">jeremy.ward@kcl.ac.uk</ce:e-address> </ce:author> <ce:author> <ce:given-name>Jill</ce:given-name> <ce:surname>Gordon</ce:surname> <ce:degrees>MS</ce:degrees><ce:cross-ref refid="aff2"><ce:sup>b</ce:sup></ce:cross-ref> </ce:author> <ce:author> <ce:degrees>Prof</ce:degrees> <ce:given-name>Michael J</ce:given-name> <ce:surname>Field</ce:surname> <ce:degrees>MD</ce:degrees><ce:cross-ref refid="aff2"><ce:sup>b</ce:sup></ce:cross-ref> </ce:author> <ce:author> <ce:given-name>Harold P</ce:given-name> <ce:surname>Lehmann</ce:surname> <ce:degrees>MD</ce:degrees><ce:cross-ref refid="aff3"><ce:sup>c</ce:sup></ce:cross-ref> </ce:author> <ce:affiliation id="aff1"> <ce:label>a</ce:label> <ce:textfn>Department of Respiratory Medicine and Allergy, 5th Floor, Thomas Guy House, Guy's Hospital, London SE1 9RT, UK</ce:textfn> </ce:affiliation> <ce:affiliation id="aff2"> <ce:label>b</ce:label> <ce:textfn>Faculty of Medicine, University of Sydney, Australia</ce:textfn> </ce:affiliation> <ce:affiliation id="aff3"> <ce:label>c</ce:label> <ce:textfn>Johns Hopkins University School of Medicine, Baltimore, MD, USA</ce:textfn> </ce:affiliation> <ce:correspondence id="cor1"> <ce:label>*</ce:label> <ce:text>Correspondence to: Dr Jeremy Ward</ce:text> </ce:correspondence> </ce:author-group> <ce:abstract> <ce:section-title>Summary</ce:section-title> <ce:abstract-sec> <ce:simple-para id="spara30">The past few years have seen rapid advances in communication and information technology (C&IT), and the pervasion of the worldwide web into everyday life has important implications for education. Most medical schools provide extensive computer networks for their students, and these are increasingly becoming a central component of the learning and teaching environment. Such advances bring new opportunities and challenges to medical education, and are having an impact on the way that we teach and on the way that students learn, and on the very design and delivery of the curriculum. The plethora of information available on the web is overwhelming, and both students and staff need to be taught how to manage it effectively. Medical schools must develop clear strategies to address the issues raised by these technologies. We describe how medical schools are rising to this challenge, look at some of the ways in which communication and information technology can be used to enhance the learning and teaching environment, and discuss the potential impact of future developments on medical education.</ce:simple-para> </ce:abstract-sec> </ce:abstract> </head> <body> <ce:sections> <ce:para id="para20">Over the past few years, medical schools have substantially altered their attitudes with respect to computer facilities for students. Not so long ago, information technology was a term confined to wordprocessing, and medical informatics, if understood at all, was seen as a niche topic and an unwarranted drain on institutional finances. Within less than two student generations, communication and information technology (C&IT) has been repositioned as an integral component of the medical school environment. Two factors have contributed to this transition: the rapidly falling cost of networked computers and the advent of the worldwide web. Our most recent graduates started training before the internet became easily and universally accessible. Now, ubiquitous access to computers and the web at home and at school means that our new entrants have a degree of computer literacy exceeding that of some faculty members, and high expectations. Medical schools have invested heavily in computing facilities, not only to attract the best students but also because C&IT and informatics skills are seen as essential in a profession that is increasingly dependent on electronic information.</ce:para> <ce:para id="para30">The maelstrom of activity engendered by the web and educational technology has affected every learning institution. Medical education, however, has some unique aspects, not least the learning that takes place during clinical care, and it offers opportunities to test methods of learning not used in other contexts. We outline how C&IT can be used to support learning and teaching in medicine, and discuss how the development of an all pervasive, high-speed information and knowledge network could affect the traditional medical curriculum.</ce:para> <ce:section id="cesec10"> <ce:section-title>Campus networks and the internet</ce:section-title> <ce:para id="para40">Campus-wide computer networks have transformed communications within medical schools. This infrastructure is increasingly being used for the provision of integrated learning and teaching environments, and e-mail is the medium of choice for communication between students and faculty. Most institutions allow unregulated access to the web. The internet provides a vast and rapidly growing source of information on anything imaginable, and some things best left unimagined. In terms of medical education, the web is an extremely important resource. However, the inherent nature of this new resource is largely unstructured and uncontrolled, which means that if students are to reap the most benefit they must learn how to use the web effectively, and manage the plethora of information that it can provide. The provision of a structured local environment from which to start will greatly assist in this task.</ce:para> </ce:section> <ce:section id="cesec20"> <ce:section-title>The “virtual campus”</ce:section-title> <ce:para id="para50">Many institutions have developed virtual campuses on the web (<ce:cross-ref refid="box1">panel</ce:cross-ref><ce:float-anchor refid="box1"></ce:float-anchor>), which are gradually taking over traditional paper-based administrative functions and the dissemination of teaching and learning materials. This development makes administration of large student cohorts increasingly efficient and has the opportunity for reducing costs, but only if carefully planned and not used simply to duplicate existing services. Close cooperation between academic and administrative staff and students is essential, and online feedback is an important component. As an example, the GKT (Guy's, King's, & St Thomas' School of Medicine) Virtual Campus (<ce:inter-ref xlink:href="http://www.kcl.ac.uk/gktvc">www.kcl.ac.uk/gktvc</ce:inter-ref>) was developed as an all-inclusive joint venture (<ce:cross-ref refid="fig1">figure</ce:cross-ref><ce:float-anchor refid="fig1"></ce:float-anchor>). Part of the impetus for the creation of the site was the greatly increased number of students after the merger of the GKT schools. Another consideration was that the new curriculum required most final year students to be off campus for extended periods, while training at district general hospitals and in the community. In the past, such students were disenfranchised from the support and learning resources available on campus.<ce:cross-ref refid="bib1"><ce:sup>1</ce:sup></ce:cross-ref> Initiatives such as the virtual campus can overcome this difficulty by providing an easily accessible and consistent means of support for all students, whether they are on campus, at home, on placements, or on electives abroad.</ce:para> <ce:para id="para60">Web environments are not limited to administration, however, and the most exciting and potentially important facet is the way in which they can be used to enhance the learning process itself. For instance, Johns Hopkins University School of Medicine, Baltimore MD, USA, began with a comprehensive website (LectureLinks, <ce:inter-ref xlink:href="http://omie.med.jhmi.edu/LectureLinks">http://omie.med.jhmi.edu/LectureLinks</ce:inter-ref>) for the curriculum within the first year that the internet was widely deployed.<ce:cross-ref refid="bib2"><ce:sup>2</ce:sup></ce:cross-ref> Features included class schedules, full text lecture notes, and links for each lecture pointing to specific web resources suggested by fellow students or faculty. A recent project at GKT uses this type of functionality to improve students' understanding of how each course element contributes to the core curriculum of essential medical knowledge. For example, selection on the timetable of a clinical module on treatment of asthma will create a thread linking resources directly coupled with this topic to relevant aspects of public health and primary care medicine, therapeutics, and basic science, and vice versa. This information will enhance the students' ability to understand the topic as a whole, and brings true horizontal and vertical integration of the curriculum one step closer.</ce:para> <ce:para id="para70">Structured use of the web is especially suited to problem-based learning and is exemplified by the comprehensive model implemented at the University of Sydney, Australia (<ce:inter-ref xlink:href="http://www.gmp.usyd.edu.au">www.gmp.usyd.edu.au</ce:inter-ref>). At this medical school, the problem-based learning programme is supported by mechanisms that guide students to patients' data, including all clinical investigations (text and images), related lectures and practical classes, and laboratory resources (such as images from anatomy, histology, and pathology). Preliminary assessments of sites such as these show that they are very much appreciated by users and encourage students to adapt resources to their own needs, and tentatively suggest that knowledge is improved with repeated visits.<ce:cross-refs refid="bib3 bib4 bib5"><ce:sup>3–5</ce:sup></ce:cross-refs></ce:para> <ce:para id="para80">The development of such environments goes in two directions. In terms of depth, students want more material within each course. This requirement can be difficult to meet. Not all teachers are happy putting their material on the web (whereas others feel obligated to put as much work into web-based lecture notes as into published chapters) also, teaching content-management to staff is not a trivial matter (easing the process of turning wordprocessed and photocopied material into web-accessible files). Three levels of web-based material should be distinguished. Level one is similar to lecture notes: material that can be placed on the web as it is. Level two requires interactivity, linking multiple-choice tests with feedback or faculty assessments. Level three requires custom programming, such as animations or simulations-eg, the cardiovascular simulator developed at Johns Hopkins, <ce:inter-ref xlink:href="http://omie.med.jhmi.edu/cvsim">http://omie.med.jhmi.edu/cvsim</ce:inter-ref>. In terms of breadth, these websites turn into “portals” that attempt to give students an appropriate perspective of the internet or local resources. LectureLinks, at Johns Hopkins, for instance, provides links to reviewed sites associated with each lecture in the curriculum. Searches on Medline or other databases can be “cached” (stored locally) to provide the user with up-to-the-minute targeted resources.</ce:para> <ce:para id="para90">Both problem-based learning and special study modules contribute to the development of collaborative work-an essential component of clinical practice. C&IT can assist this process by providing the facilities for flexible group work. Most commonly, students contribute to online conference and discussion groups facilitated by a tutor, in order to fulfil a predefined task.<ce:cross-ref refid="bib6"><ce:sup>6</ce:sup></ce:cross-ref> This approach is flexible in terms of time, and can be used between students who might otherwise have to travel to meet. As with traditional tutorials, online contact can assist less forthcoming students by fostering vicarious learning (learning by passively following the discussions of others),<ce:cross-ref refid="bib7"><ce:sup>7</ce:sup></ce:cross-ref> and has the advantage for both students and tutors that the whole discussion, including who contributed what and when, is recorded. Remote group work can be an effective learning tool,<ce:cross-ref refid="bib8"><ce:sup>8</ce:sup></ce:cross-ref> and is likely to be extensively used in medical education as learning becomes more student-centred.</ce:para> <ce:para id="para100">Creation of structured learning environments that include many of the functions discussed above has been made much simpler by use of commercially available systems such as WebCT (<ce:inter-ref xlink:href="http://www.webct.com">www.webct.com</ce:inter-ref>) and Blackboard (<ce:inter-ref xlink:href="http://www.blackcoard.com">www.blackcoard.com</ce:inter-ref>). These sites are designed so that a course organiser with minimal C&IT skills can create a complete web-based module with little training. Such environments are in common use in the USA, and are making an impact in the UK.</ce:para> </ce:section> <ce:section id="cesec30"> <ce:section-title>Learning environments and educational theory</ce:section-title> <ce:para id="para110">Changes of the kind outlined above have turned into action some important theories about students' learning in professional settings. For example, situated learning emphasises the social nature of cognition<ce:cross-ref refid="bib9"><ce:sup>9</ce:sup></ce:cross-ref> and the importance of authentic situations and activities as ways of embedding learning.<ce:cross-ref refid="bib10"><ce:sup>10</ce:sup></ce:cross-ref> C&IT can tailor the learning process to the individual student by providing teaching and support that respond to the learner's immediate needs. It can also be used to bring experts to the learner, demonstrating skills that range from clinical reasoning to carrying our procedures. Learning can be augmented by immediate or delayed repetition and by self testing, which helps the learner to make the new knowledge or skills explicit. These processes, essential to situated learning theory, put the student at the centre of the learning process, with a range of resources on hand to be used as needed, creating a huge number of different learning pathways and possibilities.</ce:para> </ce:section> <ce:section id="cesec40"> <ce:section-title>Training in C&IT and information management</ce:section-title> <ce:para id="para120">Most medical curricula include C&IT training, although content can vary considerably. In the USA, the Association of American Medical Colleges has addressed the professional needs of future doctors as teachers, learners, clinicians, researchers, and managers, and has specified the informatics skills they should learn as students (<ce:inter-ref xlink:href="http://www.aamc.org/meded/msop/informat.htm">www.aamc.org/meded/msop/informat.htm</ce:inter-ref>).<ce:cross-ref refid="bib11"><ce:sup>11</ce:sup></ce:cross-ref> An important aspect is that, increasingly, the clinical interaction itself is instrumented, with IT providing mediation between patient and physician. Whether it is a heart monitor, a digital stethoscope, digital endoscopy, or future “haptic (touch)-based interfaces, students must learn how to evaluate these data, much as a pilot must learn to fly on instruments. They also need the skills to use computerised patient-record systems and medical information resources.</ce:para> <ce:para id="para130">Although online services such as Medline and sites set up by professional medical organisations provide powerful educational tools, the web has vastly increased the ease by which anyone can access published information. As such, the content of some so-called medical sites might be little more than pseudoscientific junk knowledge. This possibility has led to the development of criteria for quality assessment, based on credibility, content, links, design, and interactivity—eg <ce:inter-ref xlink:href="http://hitiweb.mitretek.org">http://hitiweb.mitretek.org</ce:inter-ref> and there are organisations that specifically act as portals to reviewed sites—eg, <ce:inter-ref xlink:href="http://www.omni.com">www.omni.com</ce:inter-ref> and <ce:inter-ref xlink:href="http://www.medic8.com">www.medic8.com</ce:inter-ref>. However, the sheer volume of even reputable sources is a major difficulty. Every year more than two million new articles are published in biomedical journals.<ce:cross-ref refid="bib12"><ce:sup>12</ce:sup></ce:cross-ref> If students are to avoid feeling overwhelmed, they need the tools and training to find and evaluate the relevant data.<ce:cross-ref refid="bib13"><ce:sup>13</ce:sup></ce:cross-ref> The traditional role of the medical librarian is adapting to this challenge, and information specialists play a vital part in medical education by advising and training students in the use of resources and the construction of efficient search strategies.</ce:para> <ce:para id="para140">Information management skills are a pivotal component of evidence-based medicine. Evidence-based medicine had become a key strand of the curriculum in Sydney, GKT, and Johns Hopkins, as elsewhere, and is incorporated into many aspects of the course. Students are required to develop sufficiently sophisticated skills to meet the final objective: “to interpret results from clinical and population research, and decide how to apply these results to individuals or groups of people.” They are supported by information specialists and face-to-face tutorials, backed up by online access to locally produced guides, critical reviews of third party resources, the Cochrane database of systematic reviews, and evidencebased medicine reviews. The breadth-oriented resources mentioned earlier show the continuum between resources for problem-based learning, traditionally associated with early medical education, and sites for evidence-based medicine, associated with ongoing, clinical learning. In particular, the current “holy grail” of medical education development is an environment that uses the student's or clinician's interaction with the computer-based patient record system to afford a “teachable moment”.</ce:para> </ce:section> <ce:section id="cesec50"> <ce:section-title>Computer-assisted learning</ce:section-title> <ce:para id="para150">The term computer-assisted learning is usually reserved for stand-alone teaching packages. Computer-assisted learning and so-called multimedia packages are often not found especially helpful by students. A large part of the problem stems from a failure to concentrate on good educational practice in the design of even technically sophisticated packages. Well designed computer-assisted learning can, however, be useful for conceptually difficult topics through use of interactive animations, video, and simulations. It is also suited to topics with a high visual (histopathology, anatomy) or aural (heart sounds)<ce:cross-ref refid="bib14"><ce:sup>14</ce:sup></ce:cross-ref> component, and has been used to supplement or replace traditional methods where the logistics for large student numbers are otherwise prohibitive. Key criteria for successful use of computer-assisted learning are that it closely approximates the course content, and that it is fully embedded and supported within the course. Proper assessment, not just on grounds of usability, is also essential to the design process.<ce:cross-ref refid="bib15"><ce:sup>15</ce:sup></ce:cross-ref></ce:para> <ce:para id="para160">By contrast with classical computer-assisted learning packages, computer-based models for problem-oriented learning and clinical reasoning are simpler and cheaper to produce, and can be extremely effective. A good example has been developed at Sydney, with a simple “stepthrough” design, which uses a series of adjacent frames linked to a database. The program was chosen, in consultation with students, to represent the learning process as they experience it in clinical settings. Students can call up information to match the stages of the case described by clinical reasoning prompts. A complete case record, including students' responses, can be generated at any stage. This type of development is both technically straightforward and student-centred, and variations on this theme have been shown to be effective in several institutions.<ce:cross-refs refid="bib16 bib17"><ce:sup>16,17</ce:sup></ce:cross-refs></ce:para> <ce:para id="para170">The advent of inexpensive high-power workstations is making possible the potentially extremely powerful method of interactive virtual-reality simulations.<ce:cross-ref refid="bib18"><ce:sup>18</ce:sup></ce:cross-ref> Virtual emulations of clinical procedures (catheterisation, laparoscopy, bronchoscopy, &c) are already used in some centres, and the development of haptics (tactile feedback) coupled with algorithms describing life-like tissue deformation make these all the more powerful, as for example, used in an angioplasty simulation.<ce:cross-ref refid="bib19"><ce:sup>19</ce:sup></ce:cross-ref> There are as yet relatively few controlled assessments of the benefits of training with virtual reality, though a recent study has shown that it can improve laparoscopic surgery skills.<ce:cross-ref refid="bib20"><ce:sup>20</ce:sup></ce:cross-ref> By contrast, there was no additional benefit recorded over traditional methods for training in venous catheter placement.<ce:cross-ref refid="bib21"><ce:sup>21</ce:sup></ce:cross-ref> Further research and development is needed before this relatively expensive technology becomes a mainstream teaching aid.</ce:para> <ce:para id="para180">An example of computer-based teaching that is not web-based, and lies somewhere between virtual reality and the real thing, is the Harvey project,<ce:cross-ref refid="bib22"><ce:sup>22</ce:sup></ce:cross-ref> which links a computer with a mannequin for teaching cardiorespiratory medicine. Students can hear a heartbeat, measure blood pressure, and virtually inject medication, to see physiological responses in a close to real-life environment.</ce:para> </ce:section> <ce:section id="cesec60"> <ce:section-title>Computer-based assessment</ce:section-title> <ce:para id="para190">Most computer-based assessment is still formative and based on little more than extended multiple-choice questionnaires. Although useful when coupled to instant feedback and learning resources, it is best suited to assessment of factual knowledge rather than understanding. Computer-based assessment is limited for summative assessment by difficulties concerning authentication of the candidate, and the number of workstations available at one place and time for formal exams. Nevertheless, there is keen interest in how computer-based assessment can be developed for medicine, as the technology could both reduce staff assessment load and, more importantly, increase consistency and objectivity of assessment. Hurley Myers from the University of Illinois has spent more than 10 years working towards a semi-automated method of evaluating students' progress through a case. His most recent work is the clinical competency exam.<ce:cross-ref refid="bib23"><ce:sup>23</ce:sup></ce:cross-ref> A form of assessment that can really only be done properly with computers is computerised adaptive testing. In this powerful method, the selection of each question depends on the answer to its predecessors, so that the difficulty of the test adapts to each student. The student can thus be challenged without feeling frustrated by questions that are too easy or too difficult for their ability. An assessment of computerised adaptive testing for medical in-course purposes has shown that it not only maintains measurement precision of ability compared with traditional paper tests but is better received by students and takes half the time.<ce:cross-ref refid="bib24"><ce:sup>24</ce:sup></ce:cross-ref></ce:para> </ce:section> <ce:section id="cesec70"> <ce:section-title>Implications and dangers</ce:section-title> <ce:para id="para200">As C&IT becomes central to the activity of the medical school, and as student expectations increase, failure can have disastrous consequences. Such failure is not limited to hardware, but includes failure of content, poor security and protection against malicious attacks (hackers), and insufficient protection of patient confidentiality<ce:cross-ref refid="bib25"><ce:sup>25</ce:sup></ce:cross-ref> and of intellectual property rights. There is also the very real danger that we could disenfranchise less affluent students. There is a corollary here concerning developing nations. Although the web allows global access to information, the cost of this information, and the technology required to make best use of it, could lead to a widening of the gap between the quality of medical education available to the haves and have nots.</ce:para> <ce:para id="para210">In 1996, Friedman<ce:cross-ref refid="bib26"><ce:sup>26</ce:sup></ce:cross-ref> identified potential dangers for C&IT in medical education. He used as examples poor educational design, failure to integrate IT with curricula (and to keep it up to date), failure to link teaching and assessment, and failure to exploit the problem-solving and visual aspects of the medium. All of these aspects relate to the skills and attitudes of the teaching staff themselves. To make the most of C&IT in medical education, great efforts must be made to overcome faculty resistance to changes in the way they work-ie, investment in staff training in these novel educational methods is needed. Interestingly, an assessment of the use of WebCT has shown that the teachers' own approach evolved towards a more reflective style in response to the way their students used the system.<ce:cross-ref refid="bib27"><ce:sup>27</ce:sup></ce:cross-ref> In contrast to staff, feedback from our students suggest that they do not perceive computer use as a major component of the programme, but see computers and the web as just another means of supporting their learning, as it should be.</ce:para> </ce:section> <ce:section id="cesec80"> <ce:section-title>The future: surfing the shockwave</ce:section-title> <ce:para id="para220">We all recognise that C&IT has the potential for making fundamental changes in medical education. What we do not (yet) know is how to divert and manage the torrent of information and technology so that future generations of health-care providers, as well as our future patients, all benefit to the greatest extent. The rate of technological advancement is frighteningly fast. The combination of handheld computers and mobile phones already allow connection to the internet from nearly any location, and within a year or so instant and unlimited personal access to web-based resources will be commonplace. Peterson and Facemyer<ce:cross-ref refid="bib28"><ce:sup>28</ce:sup></ce:cross-ref> have argued, with some evidence, that such instant access could lead to a loss of demarcation between what is personally known or understood (personal knowledge) and what can be retrieved from the web (extrasomatic knowledge). As they discuss, this has profound implications for education. Once intelligent software retrieval agents and more sophisticated diagnostic support systems become a reality,<ce:cross-ref refid="bib29"><ce:sup>29</ce:sup></ce:cross-ref> the challenge for medical education will be to identify what kinds of information practitioners need to carry in their heads for everyday practice and what kinds of information are better accessed with evidencebased medicine tools. There is the inherent danger that if this challenge is not met then the latter will predominate, giving rise to a “just-in-time” knowledge culture.</ce:para> <ce:para id="para230">Other challenges must also be met. As C&IT infiltrates and influences the medical curriculum, we should ensure that each new methodology is rigorously assessed for educational effectiveness, and, because money is important, for its cost-benefit ratio. Various centres are already examining the former, although wide variation in design and ethos often makes direct comparison difficult. Analysis of cost-benefit ratios should theoretically be easier, if only in terms of savings (or otherwise) in staff time. Currently, however, there are few published reports in this area. Moreover, apparent savings could be obfuscated by transfer of costs to other areas—eg, C&IT departments—and in the case of course materials placed on the web, the cost of photocopying could be transferred from the school to the student,<ce:cross-ref refid="bib4"><ce:sup>4</ce:sup></ce:cross-ref> the desirability of which is open to question.</ce:para> <ce:para id="para240">C&IT can provide powerful tools for learning and teaching in medicine, and will alter the way in which the subject is taught. However, the pace of technological development and the drive to incorporate such technologies into the curriculum threatens to outstrip our understanding of how they can be used most effectively, and indeed the ability of our teachers to use them at all. 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<sb:title> <sb:maintitle>Med J Aust</sb:maintitle> </sb:title> <sb:volume-nr>168</sb:volume-nr> </sb:series> <sb:date>1998</sb:date> </sb:issue> <sb:pages> <sb:first-page>340</sb:first-page> <sb:last-page>343</sb:last-page> </sb:pages> </sb:host> </sb:reference> </ce:bib-reference> </ce:bibliography-sec> </ce:bibliography> </tail></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Communication and information technology in medical education</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Communication and information technology in medical education</title></titleInfo><name type="personal"><namePart type="given">Jeremy PT</namePart><namePart type="family">Ward</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Department of Respiratory Medicine and Allergy, 5th Floor, Thomas Guy House, Guy's Hospital, London SE1 9RT, UK</affiliation><affiliation>Correspondence to: Dr Jeremy Ward</affiliation><affiliation>E-mail: jeremy.ward@kcl.ac.uk</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jill</namePart><namePart type="family">Gordon</namePart><namePart type="termsOfAddress">MS</namePart><affiliation>Faculty of Medicine, University of Sydney, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Michael J</namePart><namePart type="family">Field</namePart><namePart type="termsOfAddress">Prof</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Faculty of Medicine, University of Sydney, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Harold P</namePart><namePart type="family">Lehmann</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Johns Hopkins University School of Medicine, Baltimore, MD, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="review-article" displayLabel="Review article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">2001</dateIssued><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>The past few years have seen rapid advances in communication and information technology (C&IT), and the pervasion of the worldwide web into everyday life has important implications for education. Most medical schools provide extensive computer networks for their students, and these are increasingly becoming a central component of the learning and teaching environment. Such advances bring new opportunities and challenges to medical education, and are having an impact on the way that we teach and on the way that students learn, and on the very design and delivery of the curriculum. The plethora of information available on the web is overwhelming, and both students and staff need to be taught how to manage it effectively. Medical schools must develop clear strategies to address the issues raised by these technologies. We describe how medical schools are rising to this challenge, look at some of the ways in which communication and information technology can be used to enhance the learning and teaching environment, and discuss the potential impact of future developments on medical education.</abstract><note type="content">Section title: Series</note><note type="content">Figure: Guy's, King's & St Thomas's School of Medicine virtual campus</note><subject><genre>Article category</genre><topic>Review and Opinion</topic><topic>Series</topic><topic>Medical Education</topic></subject><relatedItem type="host"><titleInfo><title>The Lancet</title></titleInfo><titleInfo type="abbreviated"><title>LANCET</title></titleInfo><genre type="Journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">20010310</dateIssued></originInfo><identifier type="ISSN">0140-6736</identifier><identifier type="PII">S0140-6736(00)X0231-0</identifier><part><date>20010310</date><detail type="volume"><number>357</number><caption>vol.</caption></detail><detail type="issue"><number>9258</number><caption>no.</caption></detail><extent unit="issue pages"><start>731</start><end>816</end></extent><extent unit="pages"><start>792</start><end>796</end></extent></part></relatedItem><identifier type="istex">7844D014EA2232C4D5EEC682597B93D1340DF05B</identifier><identifier type="DOI">10.1016/S0140-6736(00)04173-8</identifier><identifier type="PII">S0140-6736(00)04173-8</identifier><accessCondition type="use and reproduction" contentType="">© 2001Elsevier Ltd</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Elsevier Ltd, ©2001</recordOrigin></recordInfo></mods></metadata><enrichments><istex:catWosTEI uri="https://api.istex.fr/document/7844D014EA2232C4D5EEC682597B93D1340DF05B/enrichments/catWos"><teiHeader><profileDesc><textClass><classCode scheme="WOS">MEDICINE, GENERAL & INTERNAL</classCode></textClass></profileDesc></teiHeader></istex:catWosTEI></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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