USE OF E-LEARNING TECHNOLOGY IN MEDICAL SCIENCE EDUCATION

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1 USE OF E-LEARNING TECHNOLOGY IN MEDICAL SCIENCE EDUCATION L. Montaser Prof. of Clinical Pathology, College of Medicine, Menoufia University, Egypt Abstract Medical science education and training varies considerably across the world. Various teaching methodologies have been utilized in medical science education, which is an active area of educational research. Computers are increasingly used in medical science education. Electronic learning (e-learning) is moving from textbooks in electronic format to a truly interactive medium that can be delivered to meet the educational needs of students and postgraduate learners. Within a clinical context, e-learning is comparable to traditional approaches of medical science education. However, the Clinical Pathology context differs and until now the effect of e-learning among postgraduate students of Clinical Pathology has not been evaluated. The aim of this study was to evaluate the effect of e-learning on knowledge gain as compared to regular lecture-based learning in a course on Clinical Pathology for postgraduate (Master of Science "M.Sc.", Diploma, and Doctor of Medicine "M.D.") students of Clinical Pathology. Within the context of a postgraduate (M.Sc, Diploma, and M.D.) Clinical Pathology course for students, a cross sectional controlled study was conducted. Test assessments of knowledge were made before and after an educational session with e-learning compared to lecture-based learning as control group. The results show that in both groups, a significant gain in knowledge on Clinical Pathology was found (P < 0.05). However, there was no significant difference between the two educational approaches. But; the e-learning group mastered technical skills, such as using computer platforms and Internet systems. The e-learning group experienced greater levels of online engagement. The effect of e-learning on postgraduate (M.Sc., Diploma, and M.D.) students of Clinical Pathology knowledge is comparable to a lecture-based approach. E-learning can be beneficial for the Clinical Pathology students. Keywords: Clinical Pathology, E-learning, medical science education, post graduate course Introduction Medicine comprises a vast collection of knowledge, skills and attitudes. The trainee practitioner must achieve a large number of learning objectives within each of these so called domains of learning to be considered competent to practice. The acquisition of learning objectives in both undergraduate and postgraduate medical education can be achieved by a mixture of modalities including apprenticeship, didactic teaching (lecturing), self-study and small group learning. The recent rapid development of information technology has allowed electronic learning or e-learning to obtain a place in the teaching toolbox (Choules, 2007). Medical education and training varies considerably across the world. Various teaching methodologies have been utilized in medical education, which is an active area of educational research (Wikipedia, the free encyclopedia 2013).

2 It is becoming more and more common for medical education around the world to be supported by online teaching, usually within learning management systems or virtual learning environments. (Ellaway and Masters, 2008; Masters and Ellaway, 2008) Computers are increasingly used in medical education. Electronic learning (e-learning) is moving from textbooks in electronic format (that are increasingly enhanced by the use of multimedia adjuncts) to a truly interactive medium that can be delivered to meet the educational needs of students and postgraduate learners. Computer technology can present reliable, reusable content in a format that is convenient to the learner. (Montaser et al., 2012) It can be used to transcend geographical boundaries and time zones. It is a valuable tool to add to the medical teacher's toolkit, but like all tools it must be used appropriately. The article of Choules endeavors to review the current state of the art2 in use of e-learning and its role in medical education alongside non electronic methods a combination that is currently referred to as blended learning (Choules, 2007). E-learning technologies offer learners control over content, learning sequence, pace of learning, time, and often media, allowing them to tailor their experience to meet their personal learning objectives. In diverse medical education contexts, e-learning appears to be at least as effective as traditional instructor-led methods such as lectures. E-learning presents numerous research opportunities for faculty, along with continuing challenges for documenting scholarship. Innovations in e-learning technologies point toward a revolution in education, allowing learning to be individualized (adaptive learning), enhancing learners interactions with others (collaborative learning), and transforming the role of the teacher (Jorge, 2006). Continuing medical education (CME) is widely acknowledged as an indispensable part of the working life of physicians. With the introduction of the Internet, e-learning, i.e. the use of Internet technologies that enhance knowledge and performance can be integrated into CME programs. Compared to conventional learning, e-learning has the advantage that participants can choose the place and time of education themselves. Within a clinical context, the effect of Internet-based CME programs is comparable to traditional approaches of CME (Wutoh, 2004; Curran, 2005; Nathalie, 2008). The aim of this study was to evaluate the effect of e-learning on knowledge on Clinical Pathology issues as compared to lecture-based learning in a medical science education course on Clinical Pathology for postgraduate (M.Sc., Diploma and M.D.) students of Clinical Pathology. We hope to apply curriculum innovations from our College of Medicine to global health. Methodology The study was a cross sectional controlled study and was conducted and started within a series of two courses for students of M.Sc., Diploma and M.D. at our Clinical Pathology Department (control group on lecture-based approach [n=37] and experimental group on the e-learning approach [n=37]). Both groups were matched for age, sex, and postgraduate degree and equal number of postgraduate students were chosen. The students were unaware that two teaching approaches were compared during these courses. The control group continued their education on traditional educational lecture- based approach while the experimental group was on individual e-learning teaching approach at home and also arranged to prepare papers of selected topics of Clinical Pathology and Hematology and to prepare as 15 minutes PowerPoint Data Show presentation, for each one of them to present the Data Show on the PowerPoint slides in a classroom. Immediately before and immediately after the session, the students completed a knowledge test. Sum scores were converted to a percentage of the possible total score. The students submit their papers and the slideshow via and/or on disc for review. These were used for formative and summative

3 assessment. (Choules, 2007) The students wanted to e-learn and we allowed them to us with queries, also we arranged a face to face meeting to review progress; consider a blog or virtual group. The effect of both learning approaches on knowledge was evaluated by comparing the change in knowledge between the two groups. At the end of the study, the knowledge of the students was evaluated regarding the teaching techniques. The evaluation of e-learning included an assessment of outcomes such as learner satisfaction, content usability, and demonstration of learning. Results A group of Postgraduate (Master Science, Diploma, and MD) students of Clinical Pathology assigned to the lecture-based approach as control group and another group to the e-learning approach as experimental group. As we allowed the students to submit their papers and the slideshow for review, these services do not provide editing, but they do provide feedback to students to help them identify deficient areas and support the development of critical writing skills. The e-learning group mastered technical skills, such as using computer platforms and Internet systems. The e-learning group experienced greater levels of online engagement. TEACHING Approach -group Lecture- based group (n=37) Total Score Post Test Mean ± SD 64.3 ± 9.0 E Learning group (n=37) 65.1 ± 9.6 T-test = 0.37 P> 0.05 Table 1. Total scores of the e-learning group and the lecture-based learning group at post-test In Table 1, the scores of the two groups are shown. The scores of the two groups differed not significantly between the two teaching approaches. Both learning approaches significantly enhanced Master Science, Diploma, and MD Clinical Pathology students' knowledge. The mean score for the e-learning approach was 65.1 (SD 9.6) at post-test (P < 0.05). For the lecture-based approach, the mean score was 64.3 (SD 9.0) at post-test (P < 0.05). The improvement in knowledge did not differ significantly between these groups. The results of this study show that for postgraduate (M. Sc., Diploma, and M.D.) students of Clinical Pathology, e-learning are just as effective in enhancing knowledge as lecture-based learning. This study was the first to demonstrate that e-learning can be useful for CME in the Clinical Pathology setting. It will enable the students to choose the place and time to educate themselves. Fordis et al. (2005) found that web-based CME can lead to behavior change as well as sustained knowledge gains that are superior to traditional approaches. A next step within Clinical Pathology may be to study the persistence of obtained knowledge over time. Even more important is to study the impact of e-learning on professional practice. Discussion Within the complex setting of Clinical Pathology, postgraduate e-learning is just as effective in enhancing knowledge as lecture-based learning. Increasing numbers of medical schools are using the internet. Students value online lecture notes to supplement their reading. The clinical encounter lies at the heart of medical training. A blended approach to e-learning could be an achievable method. New methods of instruction are being developed to

4 augment traditional teaching. (Thakore and McMahon, 2006) In part, transfer of basic knowledge is mediated by electronic learning materials, replacing several hours of classroom attendance. The Medical University of Graz introduced an e-learning environment in 2002, together with the introduction of reformed curricula in human and dental medicine. The Virtual Medical Campus Graz supports the whole of the curricula and provides learning objects of different kinds. Most of the material is created by teaching staff but also by students of Graz University (Smolle, 2010). A number of studies comparing e-learning to more traditional methods have been carried out. Based on these, it can be concluded that it is another useful tool in the teaching toolbox. (Chumley Jones et al., 2002) Among the staff members at our College, there has been some reluctance to implement e-learning. The most common concerns relate to the fear that e-learning will diminish the importance of traditional textbooks and of face-to-face teaching. It has turned out, however, that in many topics enrichment with e- learning materials has had a positive impact on lectures and clinical practice, while textbooks nevertheless continue to be used as comprehensive reference resources. Moreover, most e-learning formats are very suitable to provide a bridge between systematically oriented textbooks on the one hand and the transfer of knowledge to clinical practice on the other. The most important feature of e-learning in this respect is interactivity, requiring learners to make active decisions and simultaneously enabling scaffolding appropriate to the level of students. We plan to develop an e-learning module for the respective subject domain in our college in the near future. Since computer skills are part of the current vocational training and education, e-learning may play an even more important role in the Continuing medical education (CME) of Clinical Pathologists in the near future. Preparing tomorrow's science teachers to use technology Over the past 25 years, information and communication technologies have had a convoluted but ultimately advantageous impact on science teaching and learning. In science education, designers have tailored instructional resources based on advances in understanding of the learners. Designers have created ways for teachers and students to customize learning tools to specific courses, geological formations, interests, or learning preferences (Linn, 2003). Science and technology education have enjoyed a meaningful partnership across most of the last century. The work of scientists embraces an array of technologies, and major accomplishments in science are often accompanied by sophisticated applications of technology. As a result, a complete science education has, in principle, involved a commitment to the inclusion of technology, both as a tool for learning science content and processes and as a topic of instruction in itself. (American Association for the Advancement of Science-AAAS, 1993; National Research Council-NRC, 1996) Science education has generally involved teaching not only a body of knowledge but also the processes and activities of scientific work. Teaching a set of technology or software-based skills and then trying to find scientific topics for which they might be useful obscures the purpose of learning and using technology in the science classroom to enhance the learning of science. Such an activity supports the development of skills typically addressed in educational technology courses, including using the Internet to locate relevant information and discriminating between useful and non-useful information. It also sets the stage for discussion of the advantages and concerns of student use of the Internet. Where it differs from the

5 traditional approach is that these lessons are situated in the context of learning science. Using technologies in learning science provides opportunities for demonstrating to new teachers the reciprocal relationship between science and technology. Extrapolating from technology applications for classrooms, new teachers can develop an appreciation for how advances in science drive technology, and in turn, how scientific knowledge drives new technologies. (Flick and Bell, 2000) Variety of learning objects Potential application of micro-worlds is laboratory medicine, where certain in vitro techniques can be performed in virtual labs. Learning objects can be focused on individual learners to a greater or lesser extent. From a communication science point of view, they provide individual communication, with the computer program being a student s only partner. This approach renders these types of programs very efficient, once the objects have been created, but they carry the risk of isolating students and impairing the development of interpersonal skills. (Smolle, 2010) Communicative tools have gained increasing importance in addition to the established types of learning objects. (Stromso et al., 2004) Pedagogical impact of medical science e-learning Among our staff members there has been some reluctance to implement e-learning. The most common concerns relate to the fear that e-learning will diminish the importance of traditional textbooks and of faceto-face teaching. It has turned out, however, that in many topics enrichment with e-learning materials has had a positive impact on lectures and clinical practice, while textbooks nevertheless continue to be used as comprehensive reference resources. Moreover, most e-learning formats are very suitable to provide a bridge between systematically oriented textbooks on the one hand and the transfer of knowledge to clinical practice on the other. The most important feature of e-learning in this respect is interactivity, requiring learners to make active decisions and simultaneously enabling scaffolding appropriate to the level of students. Frame-based education At the Medical University of Graz, they have particular experience in using frame-based systems, mostly of the web-based training type. (Smolle, 2007) They have found that this method is very efficient in transferring certain facts and procedural knowledge. They concluded that in the development of e- learning objects the emphasis should be not only on the types of objects and e-learning formats that are used, but also and perhaps even more importantly on the skills and abilities of the authors. How to integrate e-learning in everyday learning Learning in the College of Medicine was still mainly based on face-to-face teaching and on textbooks. In order to deal with this situation, we decided on that only material of immediate relevance to the students should be incorporated into the e-learning system. Egypt has adopted the E-learning initiative to adapt the Arab world s education and training systems to the knowledge economy and digital culture. The E-learning initiative of Egypt seeks to mobilize the educational and cultural communities, as well as the economic and social players in Middle East, in order to speed up changes in the education and training systems for Middle East's move to a knowledge-based society. Egypt has to because the objective of becoming the most competitive and dynamic knowledgedriven economy in the Arab world. (Montaser et al., 2011) In summary, based on our experience with the E-Learning, we think that e-learning has become an indispensable additional learning tool in medical scientific education. Further developments will have to focus on optimizing authoring strategies, on continuous outcome research, on active student involvement in content creation and on open content sharing between institutions. Last but not least e-learning may serve as an ideal tool for stimulating active involvement of students in teaching and learning.

6 Conclusions Within the complex setting of Clinical Pathology; Master Science, Diploma and MD e-learning to students is just as effective in enhancing knowledge as lecture-based learning. Although our e-learning module enhanced the knowledge of the Clinical Pathology students, the persistence of obtained knowledge over time and the impact of e-learning on professional practice should be further explored. References American Association for the Advancement of Science Benchmarks for science literacy. Oxford University Press, New York. Available at: Accessed: August 15, National Research Council National science education standards. National Academy Press. Washington, D.C. Flick L., Bell R Preparing tomorrow's science teachers to use technology: Guidelines for Science educators. Contemporary Issues in Technology and Teacher Education. Available at: Accessed: August 15, Chumley Jones H., Dobbie A., Alford C Web based learning: Sound educational method or hype? A review of the educational literature. Academic Medicine 77(10Suppl): S Linn M Technology and science education: Starting points, research programs, and trends. International Journal of Science Education 25(6): Stromso H.I., Grottum P., Hofgaard Lycke K Changes in student approaches to learning with the introduction of computer-supported problem-based learning. Medical Education 8(4): Wutoh R., Boren S.A., Balas E.A ELearning: a review of Internet-based continuing medical education. Journal of Continuing Education in the Health Professions 24: Curran V.R., Fleet L A review of evaluation outcomes of web-based continuing medical education. Medical Education 39: Fordis M., King J.E., Ballantyne C.M Comparison of the instructional efficacy of Internet-based CME with live interactive CME workshops: a randomized controlled trial. Journal of the American Medical Association 294: Thakore H., McMahon T Virtually there: e-learning in medical education. The Clinical Teacher 3: Choules A.P The use of elearning in medical education: a review of the current situation. Postgraduate Medical Journal 83(978): Smolle J Computer-based training (CBT) in an undergraduate medical curriculum: content analysis in a cohort study concerning gernal tumor pathology. GMS Zeitschrift für Medizinische Ausbildung German Journal for Medical Education 24(2):Doc110. Available at: Accessed: August 12, Ellaway R., Masters K AMEE Guide 32: e-learning in medical education Part 1: Learning, teaching and assessment. Medical Teacher 30(5): Masters K., Ellaway R E-Learning in medical education Guide 32 Part 2: Technology, management and design. Medical Teacher 30(5): Smolle J Virtual medical campus: the increasing importance of E-learning in medical education. GMS Zeitschrift für Medizinische Ausbildung German Journal for Medical Education 27(2):Doc29. Available at: Accessed: August 15, Montaser L., Mortada M., Fawzy Sh Fostering E-learning in Egypt and Arab World. Proceedings of the 3 rd International Conference on Education and New Learning Technologies EDULEARN11 Conference, , 4-6 July 2011, Barcelona, Spain.

7 Montaser L., Mortada M., Fawzy Sh Impact of Technology on the Future of Education. Proceedings of the International Conference on Education and New Learning Technologies, 2 nd -4 th July, 2012, , Barcelona, Spain. Wikipedia, the free encyclopedia Medical education. Available at: Accessed: August 17, 2013.