Computer assisted learning as an effective way of

Computer assisted learning as an effective way of teaching and learning

L Guo, et al

Computer assisted learning as an effective way of teaching and learning in medical education L Guo1, G Sandercock2, YM Qiao1, DA Brodie1 Research Centre for Society & Health, Faculty of Society & Health, Bucks New University, Chalfont Campus, Gorelands Lane, Chalfont St Giles HP8 4AD

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Department of Biological Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ

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Keywords: computer assisted learning; medical education; information technology; multimedia Abstract The purpose of this paper is to investigate how computer connected multimedia and computer assisted learning (CAL) provides academics with various teaching information when educating medical students. This review reflects recent changes in CAL in medical education. The major source of original research material was the Blackwell Synergy, an electronic database of randomised trials and systematic reviews. The results show that the concepts, research and practices of CAL in medical education are becoming more essential and important. CAL has the potential to help medical students develop skills and knowledge. In the future we will see more sophisticated software with virtual medical education which can communicate and interact with the medical students in a very realistic way.

Introduction Computers have expanded human potential in virtually every possible arena1. Multimedia technology has reached a level of sophistication that allows academics to design and create programs themselves and to allow medical students to adapt the programs to their individual learning needs2. The complex and high volume of information presented in medical education today has resulted in an ever-increasing number of computer assisted learning (CAL) programs being incorporated into medical education curricula during the last two decades1-3. CAL describes an educational environment where a computer program, or an application as they are commonly known, is used to assist the user in learning a particular subject1. The number of articles on the use of CAL in medical education has also increased considerably during the last 20 years1,5. Articles that demonstrate, rather than evaluate, dominate the medical CAL literature2,5. Demonstration or descriptive studies can be useful to inform colleagues of innovative uses of computer technology. However, as they describe rather than evaluate CAL applications, they contribute little to our understanding of the impact of CAL in medical education. Funding constraints, demands for improved efficiency and low staff to student ratio all combine to produce a situation where alternative forms of medical education are needed6. Survey studies conducted during the 1980s demonstrated significantly different results than those made during the 1990s7-9. In the 80s students considered CAL to offer an advantage and be time-saving in comparison to more traditional medical education7,8. In the 90s the students were significantly more positive and used computers more for learning purposes than they did earlier9.

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CAL systems aim to provide medical students with a rich set of resources and tools to help their learning10. The configuration of a typical CAL system is shown in Figure 1. The advent of high quality graphics and multimedia has enabled learning styles that were previously impractical to be developed and supported by state-of-the-art CAL systems. The purpose of this paper is to investigate how computer connected multimedia and CAL provides academics with various teaching information when teaching medical students.

Modem/network interface

Graphic interface Display

Sound interface

High speed multimedia oriented CPU

Main memory (RAM) HDD

Speak. mic.

Pointer device

Keyboard

CD-DVD

Figure 1. Configuration of a typical CAL system5

Search methods This review reflects recent changes in CAL in medical education. The major sources of original research material were the PubMed/MEDLINE, EMBASE, the Cochrane Library and Wiley-Blackwell electronic databases of randomised trials and systematic reviews. This was supplemented as necessary, by direct contact with users throughout the UK. Results CAL as an alternative resource for teaching and learning Analytical articles, reviewing the literature on CAL in medical education, have called for better research design, but the advice has not been generally heeded. Keane et al11 noted that CAL research studies have usually evaluated CAL as a supplement or alternative to traditional teaching resources, and have invariably shown CAL to be as effective as or superior to the alternative resources. However, they recommended academics to be sceptical about the utility of such CAL packages, as the design of evaluative studies often limits their value. Several authors11-13 have raised concerns about the internal validity of media comparative studies. This is because when CAL offers novel features not replicated in traditional methods, study groups receive different content. Comparing CAL to alternative teaching resources may be different because of different medical educational strategies, knowledge content and presentation features. Keane et al11 recommended researchers to conduct well designed CAL − CAL (CAL-comparative) studies that test the novel features CAL can offer, and to identify teaching and learning environments where CAL can be used most effectively.

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Factors influencing teaching and learning The results on recent progress and advances in practical methods, research and education issues are summarised as follows. According to Oblinger and Rush14, researchers believe that some factors are forcing a revolution in the current learning system: ¬¬

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Volume of information: knowledge doubles every seven years, ten thousand scientific articles are published every day15. A medical student in the class of 2009 will be exposed to more new data in a year than their grandparents encountered in a life time. Technological competence: adequate use of technological tools has become a basic skill for medical students. In 1995, 65% of all medical students used some type of information technology in their reports or projects. In 2000, this number increased to 95%14. Distance learning: telecommunication and e-learning have made it possible to receive courses online from home and this number increases every year both in the UK and worldwide.

The following factors impact on the use of CAL in medical education: ¬¬

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the quantity of applied research design and production of CAL application in the medical field is growing rapidly and the quality is improving; there is good evidence supporting the use of CAL in medical education in lowering all costs related to production and use; guidelines and consensus statements issued by conventional medical organisations have recommended CAL applications in medical education; CAL is increasingly practised in comparison to conventional teaching settings; and there is a more open attitude to CAL application in medical education among conventional health professionals – this is partly explained by the rise of the problem-based learning environment.

Comparisons between CAL and traditional teaching methods in medical education Traditional book and lecture teaching represents a one-way communication with the student16. These resources may not stimulate the medical student sufficiently. This implies that there is limited possibility for interaction with the teaching resources. CAL, on the other hand, encourages the student to learn more effectively by providing the possibility for interaction with the media, at a personally chosen level11. For example, many of the programs often demand that the student ask for relevant information about the current situation in order to proceed. CAL also supports the student to go through the material at their own pace and repeat chosen parts, without involving an academic or other students. CAL is especially valuable when the program contains the possibilities of direct contact with on-site academics. There are several advantages in comparison to the more traditional teaching methods, in particular the standard lecture and text book14. The comparison between CAL and traditional teaching methods in medical education is shown in Table 1. For example a web page may be accessed at any time and over any distance – unlike a library book there are no limits over access. The entire content of the course – the lecturer’s perception of the topic – is completely available and the content can be easily modified and updated. Multimedia appeals to students with different learning styles and CAL systems can be used in the privacy of the student’s home at a convenient time determined by them. However such advantages are in the main concerned with resources rather than actual learning.

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Tradition Model

Alternative Model

CAL Implications

Classroom lectures

Individual exploration

Networked PCs with access to information

Passive absorption

Apprenticeship

Requires skills development and simulations

Individual work

Team learning

Benefits from collaborative tools and e-mail

Omniscient work

Academic as guide

Relies on access to experts over the network

Stable content

Fast changing content

Requires networks and publishing tools

Homogeneity

Diversity

Requires a variety of access tools and methods

Table 1.

Comparison between CAL and traditional teaching methods in medical education15,17

One of the big advantages of CAL is that it allows one to proceed at one’s own pace, making any number mistakes – all without the pressure of being observing directly. The feedback provided by the package on progress helps identify weaknesses. Some packages are more basic – taking the form of multiple choice questions, especially at examination time. There is evidence that CAL is effective and is best undertaken through material provided in the form of teaching simulation10. What is less certain, is the value of CAL in the early years of medical student education, particularly in curricula which do not have strong integration between the medical education and teaching components of the course8,17. Advantages of CAL in medical education ¬¬

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the computer provides the student with unlimited time; the computer is not judgmental if the student makes a mistake – the student dares to answer the computer’s question without risking feeling stupid if they provide the wrong answers; and CAL can be repeated frequently without the computer becoming impatient.

CAL has been promoted for student teaching, with differing degrees of proof of its worth. It has been advocated for problem-based curricula, teaching basic anatomy, supplementing the tutorial and replacing the lecture. Disadvantages of CAL systems’ use in medical education First it must be recognised that most of the disadvantages do not have a direct relation to the CAL systems themselves. In fact they are often related to incorrect and excessive usage of CAL tools. The most important disadvantages of CAL systems can be listed as: ¬¬

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declining academics’ role – the idea of substituting CAL systems instead of academics is illogical and irrational; poorer social behaviour – group working is a necessary skill for everyone in the work place; and losing academic traditions – conventional education has been used as a tool for training students for society for centuries.

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Discussion and future recommendations Until recently, very few medical students have tried multimedia software with animations during their medical education18. This may be because until recently many students had insufficient computer knowledge and did not feel comfortable with computers. However, students willingly use other sophisticated methods for learning18. In addition, if they participate in the development of the software, they will become more motivated to use it. Software that is developed in house could contain structured, actual and concrete information and is more likely to contain exam-relevant material. Since medical students adapt to a learning style which favours the exam results, they will be more motivated to use this software. The software is designed in a way that forces the student to think and concentrate toward the prescribed learning objectives, thus stimulating deeper thinking. Future developments of CAL in medical education The development of CAL systems in future years will be concentrated on the following areas: ¬¬

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increasing the performances of systems – this includes higher speed of processing capacity and improved computer software; more distributed systems – nowadays modern world wide networks and high speed digital and mobile communications create a strong context for design and implementation of more distributed CAL systems. In the near future teleconferencing and non-centralised classrooms will be common. simulation and virtual reality – new technology allows us to create three-dimensional near-to-real environments for simulator systems. In practice, current applications of such systems are only on flight or sailing training systems. However, in the near future they will have a more important role, especially for blind and nearly blind people’s education19. This would help the General Medical Council (GMC) in developing guidance on encouraging people with disabilities into medicine20; and intelligent CAL systems – an intelligent CAL system, which is beyond the scope of this paper, will have many advantages compared to conventional ones. They are direct results of artificial intelligence methods.

Conclusion The use of CAL enhances medical education and provides learning opportunities that cannot be taught by traditional methods. CAL provides an exciting opportunity to support traditional methods and to develop innovative approaches. In the future we will see more sophisticated software with virtual medical education which can communicate and interact with the medical students in a very realistic way. However, for academics the challenge is not only to integrate CAL into the curriculum, but also to evaluate its impact on learning in the real world of medical education. References 1. Guo L, Osonnaya K, Abdi M, Osonnaya C. The Application of Computer Assisted Learning in Medical Education. British Computer Society Health Informatics Forum HC2007, Harrogate, March 2007. 2. Osonnaya C, Osonnaya K. New Technology in Medical Education. International Journal of Medicine, 2003, 4:239-284. 3. Guo L, Osonnaya K, Abdi M. and Osonnaya C. Information Technology in Medical Education and Practice: An Interactive Workshop. Association of Health Care Professionals 17th Annual Scientific Conference, London, August 2006.

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4. Laurillard D. Rethinking University Teaching: A Framework for the Effective Use of Educational Technology. Routledge, 1993. 5. Hudson JN. Computer-aided Learning in the Real World of Medical Education: Does the Quality of Interaction with the Computer Affect Student Learning? Medical Education, 2004, 38:887-895. 6. Letterie G.S. Medical Education as a Science: The Quality of Evidence for Computer Computer-assisted Instruction. Am J Obstet Gynecol, 2003, 188:849-53. 7. Godfrey D, Sterling S. The Elements of CAL: The How to Book on Computer Aided Learning. Simon & Schuster, 1984. 8. Levine RS, Harold JJ, Morgan C. Comparison of Computer-assisted Learning with Tutorial Teaching in a Group of First-year Dental Students. Med Educ, 1987, 21:305-309. 9. Wenzel A, Gotfredsen E. Students’ Attitudes towards and Use of Computer Assisted Learning in Oral Radiology over a 10-year Period. Dentomaxillofac Radiol, 1997, 26:132-136. 10. Osonnaya C, Osonnaya K. Design and Implementation of a Computer Aided Learning Facilities for Medical Education. ASME Conference in Medical Education, Cardiff, September 2000. 11. Keane DR, Norman GR, Vickers J. The Inadequacy of Recent Research on Computer-assisted Instruction. Acad Med, 1991, 66:444-8. 12. Adler MD, Johnson KB. Quantifying the Literature of Computer-aided Instruction in Medical Education. Acad Med, 2000, 75:1025-8. 13. Friedman CP. The Research We Should Be Doing. Acad Med, 1994, 69:455-7. 14. Oblinger DG, Rush SC. The Learning Revolution: The Challenge of Information Technology in the Academies. Anker Publishing, 1997. 15. Holt RIG et al. Computer Assisted Learning is an Effective Way of Teaching Endocrinology. Clinical Endocrinology, 2001, 55:537-542. 16. World Federation for Medical Education (WFME). Available at: www.sund.ku.dk/wfme/Activities/WFME_report.pdf Accessed 20th March 2006. 17. Vichitvejpaisal P et al. Does Computer-assisted Instruction Really Help to Improve the Learning Process? Med Educ, 2001, 35:983-9. 18. Plasschaert AJ, Wilson NH, Cailleteau JG, Verdonschot EH. Opinions and experiences of dental students and faculty concerning computer-assisted learning. J Dent Educ, 1995, 5:1034–1040. 19. Lancioni G.E et al. Promoting Independent Task Performance by Persons with Severe Developmental Disabilities through a New Computer Aided System. Behav Modif, 2000, 24:700 – 718. 20. General Medical Council. The Gateways Disability Project. Available at: www.gmc-uk.org/education/undergraduate/news_and_projects/the_gateways_disability_project.asp Accessed on 30th November 2008.

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