Information technology in medical education: a nationwide project on the opportunities of the new technology

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1 Information technology Information technology in medical education: a nationwide project on the opportunities of the new technology Virpi Slotte, 1 Michael Wangel 2 & Kirsti Lonka 3 Context The aim of the national `IT Culture in Medical Education' project in Finland is to enhance the opportunities new technology may provide for medical education. The project focuses on attitudes towards information technology (IT) and on its current use among teachers and students. Method This survey was part of a Finnish nationwide project in medical education. Data were collected by means of a questionnaire designed to gather information about IT use in medical education, sent to teachers and students. The questions were 5-point Likert-type. The participants were medical teachers (n ˆ 196) and medical students (n ˆ 392) at two medical schools. Results In both universities, it appeared that medical teachers and students had a very positive attitude toward the advances in modern technology. In addition to the favourable attitudes, computer-related technology was also widely applied. Teachers, however, used information technology more in their research work than in teaching. Conclusions The results pose challenges to medical education and underline the importance of educational and psychological knowledge in combination with new technical skills. Keywords Attitude to computers; education, medical, undergraduates, methods; Finland; information services, *organization; questionnaires; *teaching. Medical Education 2001;35:990±995 Introduction Many universities are rapidly moving towards using the Internet, telecommunication technologies and multimedia programmes as part of education. Finland, as an example of a high-tech country, has followed a similar path. Being one of the leading countries in IT resources, our rate per inhabitant of mobile phones (65/ 100) and Internet hosting (111/1000) is the highest in the world. 1 The total estimated number of people who use the Internet at home is in a population of approximately 5á2 million (on 16 May 2000). The availability of technology is, however, only a necessary condition for its meaningful use in education, not a suf cient one. The current changes in information and communication technology coincide with two related developments: (i) the revolution of advances in modern technology in medical education, and (ii) profound paradigm shifts in our concept of learning. 2 1 Nokia Learning Center, Beijing, China 2 University of Kuopio, Kuopio, Helsinki, Finland 3 University of Helsinki, Helsinki, Finland Correspondence: K Lonka, Development and Research Unit, Faculty of Medicine, PO Box 63, University of Helsinki, Finland The new technical venues function more like workshops and laboratories, emphasizing the students' active role in learning. 3,4 Students are supposed to take responsibility for their own learning, to collaborate and to build knowledge with others. 5 This challenges them to study in a new way. Modern technology is also challenging teachers' roles and attitudes, including traditional pedagogy and instructional techniques. 6 Teachers need to shift their role from lecturer to mentor or facilitator, someone who is present, albeit not always physically. 7 Furthermore, they need to know how to integrate technology into the curriculum. Teachers are the central gures who essentially decide whether to use computers in learning, and they therefore need to have basic skills concerning the opportunities computer technology provides. 6 Not much, however, is known about medical teachers' attitudes towards computer technology and about their current use of it. 8 For example, having a personal computer does not guarantee that information technology is applied in teaching and learning. To what extent do teachers want to invest in computer technology in their teaching? 990

2 IT in medical education V Slotte et al. 991 Key learning points There is enthusiasm for using information and communication technology in medical education in Finland. Both teachers and students have a very positive attitude toward the advances in modern technology. Computer-related technology is also widely applied. Teachers use information technology more in their research work than in teaching. There is an obvious need for more computerbased learning material in medicine. Most teachers are interested in knowing more about computer technology but many of them have too little time to participate in IT courses. The aim of this study is to nd out what attitudes medical teachers and medical students have towards IT, and further, how information and communication technology is currently used in medical education. Do teachers' and students' attitudes differ? Are there any differences between two universities of different size? Our aim is also to nd out the areas where further education is needed. (96%) had used a computer before, and 59% had done so on a regular basis. Most students thought that computer skills were important for doctors (93%) and that computers could be very useful in many areas in health care (85%). One important observation was that these gures were not lower than those found in more industrialized countries at that time. The effect of an IT course on attitudes to IT was studied in the medical school at Leeds University in 1993± The participants were rst-year medical students, who were randomly allocated to two groups. One group took an IT course, the goal of which was to ensure that they had the necessary knowledge and skills in personal computing for professional work. After this course 95% of the students were able to use word processing, and 17% could use . Most students (91%) felt that IT competence was important. In the United States in 1997, an AAMC Medical School Graduation Questionnaire revealed that use of computers had increased from 37 to 71%, over 9 years. 12 Graduates reported that computer-based instructional programs had been used as study aids by 83%, by 74%, internet or intranet resources by 32% and computerized bibliographic searches by 60%. The most recent survey showed that most graduates used (96%), medical information databases (92%) and the worldwide web (85%), especially for health care information, in the United States in Previous studies Few studies have been published concerning IT in medical education. As time goes by, it becomes more dif cult to compare previous results with recent ones, especially when development in the IT eld is so rapid. Third-year medical students (n ˆ 144) were tested on computer skills and attitudes to computer-aided learning (CAL) in Edinburgh in Of these students, 31% had not used a computer during the previous year and 38% of these had not used a computer outside supervised laboratory work. Their computing skills were not very impressive: 54% needed help in regular printing and 69% did not know how to copy a le into a diskette. Most students (74%) could not independently create a simple graph within a document. Their attitude to CAL depended on their computing con dence. The computer skills and attitudes to IT in medicine of 140 rst-year medical and dental students were evaluated in a study in Portugal in Of these students, 14% classi ed their computer literacy as negligible and 49% as de cient. Almost all students Methods This survey was part of a Finnish nationwide project in medical education. Data were collected by means of a questionnaire designed to gather information about IT use in medical education, sent to teachers and students. The questions (36 in the teachers' and 33 in the students' questionnaire) were 5-point Likert-type. Subjects The subjects were medical teachers (n ˆ 196) and medical students (n ˆ 392) at two medical schools (Helsinki and Kuopio). The overall response rate among the medical teachers was 54% and among the students it was 66%. Results Teachers' attitudes towards and current use of IT Overall ratings showed that medical teachers had very positive attitudes towards information technology. Table 1 shows that there were only few statements

3 992 IT in medical education V Slotte et al. Table 1 Teachers' attitudes towards the use of information technology in medical education; range 1 (highly disagree) to 5 (highly agree) Attitude statement Mean SD It is important for teachers to have IT training 4á31 0á89 I feel con dence with my ability to use 4á00 1á07 is an easy way to communicate with 3á97 1á09 students The programmes in my computer are well 3á92 1á07 chosen A tight time schedule is the biggest obstacle to 3á86 1á18 taking part in IT courses My computer is modern enough for the work 3á83 1á33 Ido Students' self-study in a Web environment 3á66 0á96 should be increased I can utilize the opportunities the worldwide web 3á57 2á62 environment provides More teaching materials could be transferred 3á53 1á04 to the Web Updating teaching material on the Web would 3á44 1á12 be easier than renewing paper materials I should use more computer-supported methods 3á33 1á12 in my teaching Computer-supported learning methods could 3á25 1á00 clarify my work Departments offer enough information through 2á68 0á95 the Internet There is enough pedagogical training for teachers 2á67 1á22 Some of the tests could be arranged through the 2á64 1á16 Web There is enough IT training for teachers 2á62 1á20 The Medical Faculty provides enough support in using IT 2á57 1á15 (n ˆ 137) reported using it on a daily basis. The corresponding percentage for teaching work was 12% (n ˆ 24). Although Fig. 1 shows a difference in the regularity of use of IT in teaching and research work, a chi-squared value of 23á8 (d.f. ˆ 16) did not reach a statistically signi cant level (P ˆ 0á09). This is at least partly due to the high value of the degrees of freedom, arising from the number of alternative responses to this question. Overall, the result indicated that teachers apply information technology more in research work than in teaching, but somewhat independently in different tasks. Students' attitudes towards and current use of IT Like their teachers, medical students emphasized the importance in a physician's work of being able to use information technology. They would also be willing to study clinical cases electronically, but considered that the medical faculty should provide more computers for them. Table 2 shows rst-year students' attitudes towards information technology. Some differences in student attitudes were found, however, according to how many years they had studied medicine. First-year students had a more positive attitude (mean 3á16) than fth-year students (mean 2á19) towards the statement that current IT courses are an important part of medical education (v 2 ˆ 26á40, P <0á01). First-year students also thought that they learned new information in IT courses (mean 3á20) which were rated as `somewhat disagree'. Among them were statements concerning the adequacy of support provided by the medical faculty and of general training for teachers. No differences were found between teachers from the two universities. In addition to a positive attitude and con dence in their ability to use , medical teachers also used regularly: 65% many times a day, 25% daily and only 2% never. The correlation between ability to use and regularity of current use was high (r ˆ 0á50, P <0á01). With regard to the Internet, 33% of the teachers reported that they used it many times a day, 32% reported daily use, 28% weekly and 5% monthly. The proportion of those who never visited any websites was 3%. Correspondingly, the correlation between attitudes and current use of the Internet was rather high (r ˆ 0á49, P <0á01). When asked how often they used information technology in their research work, 72% of medical teachers Research Teaching Never 1á7 27á3 Monthly 6á3 35 Weekly 19á6 24á1 Daily 33á6 8á0 More often 38á5 4á2 Figure 1 Medical teachers' current use of information technology (IT) in teaching and research work.

4 IT in medical education V Slotte et al. 993 Table 2 Students' attitudes towards information technology use during the rst study year; range 1 (highly disagree) to 5 (highly agree) Attitude statement Mean SD If I had a chance I would use Web services at home It would be useful to read clinical cases via the Internet The opening hours of computer classrooms should be extended The faculty should provide more IT training, e.g. as optional courses Internet connections from computer laboratories are fast enough Getting study material via the Web could improve learning Computer-supported learning would t in medical education Current IT training is an important part of medical education I learn new information in IT training courses Communication between teachers and students works via the Web Students have enough computers in computer laboratories 4á29 4á00 3á94 3á78 3á71 3á59 3á48 3á44 3á42 3á21 2á28 1á04 0á89 1á04 1á11 0á93 1á24 1á09 1á13 1á16 1á01 1á11 communication between medical teachers and students It appeared that electronic mail was widely used among teachers. Interestingly, however, almost half of the teachers reported that they never sent s to their students. The proportion of teachers who said they never received messages from their students in electronic form was exactly the same. The results are summarized in Fig. 2. A chi-squared test was used to compare the internal variation between sending and receiving messages. The calculation gave a value of 547 (d.f. ˆ 16, at P <0á01) indicating that teachers who send electronic messages to students also receive them from students (with g 2 as 0á81 for both variables). Another kind of ratio for sending and receiving messages was found among students (Fig. 3). Overall, more often than fth-year students (mean 2á11) (F ˆ 29á93, P <0á01). With respect to , the majority of medical students used it regularly. Of all students, 76% (n ˆ 250) took part in electronic communication on a daily basis, while the proportion of those who never used was 6% (n ˆ 20). When compared with the proportion of daily use among teachers (89%), a statistically signi cant difference was revealed in favour of teachers (v 2 ˆ 14á30, P ˆ 0á06). Correspondingly, medical students reported using the Internet to some extent less often than teachers. That is, 5% of all students visited websites many times a day, 12% daily, 35% weekly and 34% monthly. The number of students who never read any websites was 14% (n ˆ 52), rather more than the proportion of teachers who never visited them (3%). Again, this difference was statistically signi cant (v 2 ˆ 168á89, P <0á01). Overall, medical students on average used information technology somewhat less often than their teachers. In addition to using IT, teachers considered that was an easy way to communicate with students. But how often did medical teachers use to communicate with their students? Were there any differences between students and teachers in sending and answering messages to each other? Send Received Never 45á4 45á9 Monthly 33á5 33á0 Weekly 16á0 16á0 Daily 5á1 5á1 Figure 2 Regularity with which medical teachers send s to students and receive s from them. Figure 3 Regularity with which students send s to medical teachers and receive s from them.

5 994 IT in medical education V Slotte et al. 73% (n ˆ 286) said they received s from the medical staff once a month or more often, but over half indicated that they never sent any messages themselves to teachers. These results suggest that students share the practice of utilizing in their studies rather substantially, although not in a very active way. Discussion Medical teachers' and students' attitudes towards and current use of IT The results clearly document an enthusiasm for using information and communication technology in medical education in Finland. Both medical teachers and medical students have a very positive attitude towards advances in modern technology. The most important ndings of this survey, however, show that in addition to the favourable attitudes, computer-related technology is also actually applied in medical education. The similarities of the IT culture in two universities of different size show that generally medical teachers face the same problems. For example, most teachers stated that they would like to know more about the opportunities computer technology provides. Many of them also shared the problem of having too little time to participate in information and communication technology courses. The results suggest few differences in IT use by students at the two universities. The similarities in their attitudes may be mostly explained by the availability of computers. At the end of 1998 there was approximately one computer for every 30 students in the University of Kuopio, whereas the ratio at the University of Helsinki was much better, with an availability of one computer per 10 students. Today the ratio at Kuopio has doubled and the situation is almost as good as in Helsinki. Furthermore, several terminals for use are now available in both universities. The need for advice and support was indicated by students from both medical schools, as in previous research. 2 The challenge for training courses is thus to tailor teaching according to the students' differing information technology skills. The positive correlation between ability and regularity of use of is in line with ndings from previous research. That is, the more medical teachers know about information technology, and the more con dent they feel about using it, the more positively they regard it. 14 Some concern may be raised with regard to those who did not return their questionnaires. It is likely that the teachers who did not take part in the study were less con dent with the new technology or had less interest in the opportunities IT will provide for medical education. However, the overall response rate of medical teachers and students was somewhat greater than that found in previous studies on IT use. 8 Similarly to those results, the current ndings showed that the respondents had a desire to further develop their computerrelated technology skills. Also, they shared the view that these skills will be important for the practice of medicine in the future. use Interestingly, the proportion of teachers who said that they could not use at all was somewhat higher than the proportion of those who never used . This indicates that a number of teachers use in spite of their claims that they cannot do so. It is also possible that the teachers are able to use at their university but do not necessarily know how to get access to a computer from home, thus re ecting some insecurity about mastering the system in all circumstances. The results revealed clearly that teachers who send electronic messages to their students also receive s from them. This indicates the opportunity may provide for increasing and deepening reciprocal communication between medical teachers and students. This study did not, however, evaluate the length and quality of the interventions that took place between different parties. Further research is needed to investigate the possibilities electronic mail might offer for collaborative knowledge building. It is common for medical teachers to use lists only to inform students about changes in course times and places. In such cases, it is natural not to expect any responses from the students; teachers would nd it rather time-consuming to read and answer messages from a large number of students. Yet, this means of communication provides an ideal channel for both medical students and teachers who need more time to formulate their thoughts, or who are otherwise shy or less able to communicate in face-to-face situations. Conclusions Increased cooperation between different universities has promoted the use of information and communication technology in medical education in many ways. In particular, we have been able to exploit the knowledge of separate computer-based teaching programmes developed in different universities. As a result, we can

6 IT in medical education V Slotte et al. 995 bring together special knowledge and skills from different parts of Finland and further develop appropriate products. A speci c example is an extension programme which has been developed for a collection of radiological images. 15 There is an obvious need for computer-based learning material in medicine. In the future, more attention could be paid to instructional procedures, implementation and evaluation. Universities should, in addition to technical skills, also take care of pedagogical knowledge. This is of great importance because modern technology and digital learning environments allow different kinds of learning processes. 16 Medical teachers need to be able to meet these challenges and act in a appropriate way, using methods which enhance both their own and medical students' ways of learning. Contributors This study is based on the Information Technology in Medical Education project led by Professor Erno Lehtinen and Kirsti Lonka PhD. All the authors were involved in designing the questionnaires. Virpi Slotte PhD collected the data and analysed and interpreted the results at the University of Helsinki. Michael Wangel MD collected the data and analysed and interpreted the results at the University of Kuopio. Virpi Slotte and Michael Wangel wrote the article, and revised it together with Kirsti Lonka. Funding This research was partly funded by the Academy of Finland and the Ministry of Education of Finland. References 1 1á12á1999 Mobile Communications. Internet Software Consortium. 2 Sinko M. Education for the information society ± the state of the art. Lifelong Learning Eur 1998;4:215±19. 3 Bullimore DW. Study Skills and Tomorrow's Doctors. Edinburgh: WB Saunders; Slotte V. Spontaneous study strategies promoting knowledge construction. Doctoral Dissertation. Helsinki: University Press; Jonassen D, Reeves T. Learning with technology: using computers as cognitive tools. In: D Jonassen, ed. Handbook of Research for Educational Communications and Technology. New York, NY: Macmillan Reference Library; Hardy J. Teacher attitudes toward and knowledge of computer technology. Comput Schools 1998;14:119±36. 7 McKeachie WJ. Teaching Tips. Strategies, Research, and Theory for College and University Teachers. 10th edn. Boston, MA: Houghton Mif in Co.; Fox NJ. IT culture in medical education. J Comput Assisted Learning 1996;12:78±88. 9 Osman LM, Muir AL. Computer skills and attitudes to computer-aided learning among medical students. Med Educ 1994;28:381±5. 10 Gouveia-Oliveira A, Rodrigues T, GalvaÄo de Melo F. Computer education: attitudes and opinions of rst-year medical students. Med Educ 1994;28:501±7. 11 Chan M, Fox NJ, Clamp SE, de Dombal FT. An information technology course in the medical curriculum. Med Educ 1996;30:112± Salas A. Computers and medical informatics in the curriculum. Contemporary Issues Med 1998;1:4. 13 Lockwood JH. Keeping up with technology and the changing role of medicine. Contemporary Issues Med 1999;2:2. 14 Pelton L, Pelton T. Using WWW, usenets, and to manage a mathematics pre-service technology course. Comput Schools 1998;14:79± Wangel M, Niemitukia L, Katila T, Soimakallio S. WWW ± an effective way of teaching radiology? Progress in Radiology '98 (Scandinavian-Japanese Radiological Society); Kobe, Japan: November 5± Slotte V, SeppaÈnen I, Lonka K, Hakkarainen K. Approaches to learning: using CD-ROM and print versions of an encyclopedia. Paper presented at the Annual Meeting of AERA99 (American Educational Research Association); Montreal, Canada, May 19± Received 7 June 2000; editorial comments to authors 1 September 2000; accepted for publication 1 March 2001

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