eResources
Digital Learning in Transplantation Leonardo V. Riella, MD, PhD1
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hysicians are lifetime learners in a world of rapidly changing information. Understanding the science of learning well and using the best available tools to achieve long-term and effective learning is therefore critical. Standard texts and peer-reviewed articles are wonderful; however, online resources including UpToDate, blogs, webinars, and social media have become essential. Indeed, online education material seems to be the preferred online learning method for most fellows.1 This article collates online resources with relevance to the readership of Transplantation. Texts or handbooks have been the traditional tools for learning in transplantation. However, e-learning has provided a paradigm shift allowing continuous updates on rapidly changing subjects and an ongoing communication between reader and author, all contributing to a constant improvement of content. Among the most used online learning tools in transplantation is UpToDate [A]. Founded by Burton D. Rose in 1992, UpToDate is an online evidencebased, peer-reviewed website that has dominated medical education at all levels by delivering practical information with critical review of individual topics with significant detail and expert interpretation. Although a very useful resource, this platform lacks interactive content, meaning users are unable to highlight, comment, or take notes; and the material is predominantly delivered in text format with few images, rare videos, and no questions associated with them. Despite those limitations, UpToDate is a very useful resource for point-of-care consulting and remains one of the best learning tools available. Scientific journals have also improved the listing of their publications to facilitate the retrieval of relevant articles of a selected topic while delivering the message in alternative formats. Transplantation offers Online First alerts for articles being published and a video collection that highlights key publications in a video format narrated by the author [B]. Pubcrawler [C] is a service that provides weekly updates of PubMed articles that have just been published online according to preselected criteria and keywords. Signing up for this service will provide weekly email alerts with all articles relevant to a particular area of interest. Lastly, Twitter and 1
Brigham and Women's Hospital, Boston, MA.
The author declares no funding or conflicts of interest. Special feature: Link library Correspondence: Leonardo V. Riella, MD, PhD, Brigham and Women's Hospital, Boston, MA 02115. (
[email protected]). Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0041-1337/16/10004-701 DOI: 10.1097/TP.0000000000001174
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Links [A] http://www.uptodate.com [B] http://journals.lww.com/transplantjournal/ Pages/videogallery.aspx [C] http://pubcrawler.gen.tcd.ie [D] https://www.tts.org/education [E] http://renalfellow.blogspot.com [F] http://www.apple.com/ibooks/ [G] https://www.inkling.com [H] http://www.leoriella.com/book/
Facebook can also be useful platforms to stay up to date, since the user can customize his/her “feed” by following authors, medical journals, societies, or groups. Academic societies including The Transplantation Society [D] have also embarked on novel online learning platforms by delivering monthly webinars, and online journal clubs. Blogs have become commonly used learning tools, with a fantastic component of interactivity between users. In brief, blogs (short of weblogs) are websites run by individuals or small groups that post short texts on a regular basis with commentaries on a specific topic, interesting clinical cases, medical questions, useful resources, and/or physician perspectives. These entries are archived in reverse chronological order and contain in general multiple links, images, and/or videos to illustrate concepts. Writing a blog is one of the most effective learning tools available, since the writer must really understand the topic and condense it in 1 paragraph, interpreting the data and linking it to supporting references. Owing to the interactive nature of blogs, tracking the frequency of visits to a blog page in addition to comments left by readers allows the assessment of the general interest of the provided information while permitting a direct feedback channel between readers and writers. The Renal Fellow Network [E] is an educational nephrology/ transplantation blog that was created in 2008 by Nathan Hellman, a wonderful and inspiring nephrologist who unfortunately passed away too early. His legacy has continued and this blog has now more than 10 active contributors from all over the United States and more than 50 000 page visits per month from readers around the world (open for anyone to contribute). Currently, there are multiple other exciting blogs available,2 some of which are patient-authored, physician-driven, and university-based blogs. Limitations of these platforms include the accumulation of outdated material over time, the variable accuracy between blogs, and the risk of violating Health Insurance Portability and Accountability Act (HIPPA, protecting privacy and security of health information). Online books deliver contents in different and interactive formats, with broader accessibility through mobile phones or tablets. Apple has pioneered the potential of tablets with the iBooks app [F]. This excellent platform provides userfriendly software to generate the content without the requirement of any advanced programming skill. Limitations of iBooks are predominantly related to the overall closed www.transplantjournal.com
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
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ecosystem philosophy of Apple that limits the availability of the iBooks App only to Apple devices such as iPads, iPhones, or Mac computers. Its closest competitor is Inkling [G], a company founded by a former Apple employee, Mat MacInnis. One of the main advantages of Inkling is the opportunity to purchase individual chapters; downsides include a less smooth operation with figures and videos, as many publishers have not adapted their books to the Inkling platform. Of note, it is not possible to simply convert a PDF file into the online Inkling format, since it will lose all the interactive features available on this platform. If you have not experienced an interactive iBook yet, start with E.O. Wilson's Life on Earth Unit 2, which is free on iBooks3; try the interactive image 5.1. that zooms into a human hand down to the cell level. In transplantation, there is the Kidney Transplant eBook [H] that was published in May 2015 and contains 265 pages, 253 images (including illustrations, biopsy slides, and radiology images), 60 questions, and 10 videos. This e-book presents content in various ways, integrating different types of media to deliver the richest learning experience for each topic while providing interactive learning tools including problem-based case collections. Clearly, e-learning provides many advantages wonderfully illustrated in Peter C. Brown's book Make it Stick. 4 Pillars of successful learning, according to the author, include the capacity to retrieve and reflect on learning the material. In addition, cultivating the habit of asking questions, and retelling the material in your own words as you go through a subject are very effective strategies of learning
www.transplantjournal.com
(eg, What were the key concepts that you learned? How do they relate to other subjects you already know? What are the new ideas to you?). Lastly, effective learning techniques should be taught. Zaromb et al5 illustrated this on an experiment in which they compared 2 methods of learning involving rereading the material (4 times) or performing 3 repetitive tests after a first read with an assessment of the their learning abilities a few days later. To their surprise, the majority of students felt that they learned much more by rereading than doing the tests. However, the recall probability was completely opposite, with much better performance for those that performed increased testing rather than rereading. In summary, the digital tools available to create content and make learning more effective continue to expand exponentially. Therefore, it is critical for the transplant physician to learn what resources are available and how to best implement them into our daily routines to obtain the most effective results while keeping learning fun and exciting. REFERENCES 1. Desai T, Stankeyeva D, Chapman A, et al. Nephrology fellows show consistent use of, and improved knowledge from, a nephrologist-programmed teaching instrument. J Nephrol. 2011;24:345–350. 2. Woods M, Rosenburg ME. Educational Tools: Thinking Outside the Box. Clin J Am Soc Nephrol. November 4, 2015. [Epub ahead of print]. 3. E. O. Wilson’s Life on Earth Unit 2, 2014; Wilson Digital, Inc; Apple Inc. 4. Brown PC, Roediger HL, Mark A, et al. Make it Stick: The Science of Successful Learning. Cambridge, MA: The Belknap Press of Harvard University Press; 2014. 5. Zaromb FM, Roediger HL, 3rd. The testing effect in free recall is associated with enhanced organizational processes. Mem Cognit. 2010;38: 995–1008.
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