Learning Management Systems and Lecture Capture in the Medical Academic Environment
Larry F. Chu, MD, MS (BCHM), MS (Epidemiology) Chelsea A. Young, BS Lynn K. Ngai, BS Tony Cun, BS Ronald G. Pearl, MD, PhD Alex Macario, MD, MBA Stanford University School of Medicine Palo Alto, California
Historically, the use of computers in medical education has been limited to supporting the work of traditional classroom learning through tasks such as word processing, displaying slides, and recording grades. With the advent of worldwide networks of computers (The World Wide Web) and the more recent emergence of web 2.0 and streaming media technology, medical educators today have important new tools that could transform modes of traditional medical education. This review will discuss two of these technologies: learning management system (LMS) and lecture capture (LC), explaining the advantages and disadvantages associated with each in the context of medical resident education. Commercial products that enable LMS and LC available today will be discussed. We will subsequently present an actual application of LMS/LC for an online, blended-learning course designed to enhance preparedness of interns to begin anesthesia residency. This case study of the Successful Transition to Anesthesia REPRINTS: LARRY F. CHU, MD, MS (BCHM), MS (EPIDEMIOLOGY), ANESTHESIA INFORMATICS AND MEDIA LAB, DEPARTMENT OF ANESTHESIA, (HTTP://WWW.AIM.STANFORD.EDU), STANFORD UNIVERSITY SCHOOL OF MEDICINE, 300 PASTEUR DRIVE, ROOM H3580, MC5640, STANFORD, CA, E-MAIL:
[email protected] INTERNATIONAL ANESTHESIOLOGY CLINICS Volume 48, Number 3, 27–51 r 2010, Lippincott Williams & Wilkins
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Residency Training (START) program implemented at Stanford will illustrate the potential of Web 2.0 technology to advance graduate medical education. ’
LMS What is an LMS?
An LMS can be thought of as a four classroom that stays open 24 hours a day and seven days a week (Fig. 1; Panel A). An LMS may be broadly defined as a software application that automates the administration, tracking, and reporting of training events.1 The most basic form of LMS simply serves as a storage space for course materials into which students must log in to obtain access. More advanced LMS products offer additional features, including test and quiz options, audio or video
Figure 1. Panel A, Diagram of learning management system (LMS). The learning management system functions as a virtual classroom enabling interactions between students and the classroom (1), student-student peer interactions (2), student-teacher interactions (3) and teacher-teacher interactions (4). The LMS provides core services that support the four key principles of onlinelearning best practices: presentation of learning objects, facilitating interactions, collaborative learning, and providing prompt feedback. Panel B, Schematic of lecture capture (LC) system. A typical lecture capture system utilizes a personal computer with audio (and/or video) recording capabilities and special software to record a lecture presentation to a hard drive. The data is then transmitted via the internet to a cloud computing application (e.g. Panopto CourseCast) where the data is transcoded to various proprietary and open platform media formats and provided to students as Podcasts, video files, audio files, and/or integrated as a learning object into an LMS. www.anesthesiaclinics.com
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materials, interactive forums, advanced search capabilities, and grade books. The instructor may grant access to specific aspects of the course to students or to other instructors. Students may be divided into groups to work competitively or collaboratively. Materials or activities may be preprogrammed and hidden until they are ready to be used. To reach its full potential, an LMS should facilitate more effective and efficient dissemination of material and receipt of feedback, thereby optimizing the learning process.2–4 In graduate medical education specifically, LMS’s can help the program director to achieve the Accreditation Council for Graduate Medical Education (ACGME)’s goal of providing documentation for students’ learning progress in various stated objectives.5
Advantages of LMS
Allows Students to Time Shift and Place Shift While traditional classroom styles of learning require students to meet in the same geographic location at the same time of day for a specified period of time, an LMS is a virtual classroom allowing students to access information and participate in a structured, comprehensive curriculum while time shifting or place shifting. Time shifting is the recording of programming to a storage medium so that it can be viewed or listened to at a time more convenient to the consumer. The phrase time shifting was originally coined in the context of television programming.6 Place shifting is watching or listening to live, recorded, or stored media on a remote device through the internet or over a data network.7 Curricula implemented through an LMS can use one or both of these concepts. Thus, LMS’s have created a more convenient way of learning, overcoming the physical and temporal barriers associated with traditional classroom learning. While maintaining the ability to track students’ progress and facilitate interaction among faculty and residents, LMS’s grant students independence and flexibility. These characteristics are particularly advantageous in medical residency programs because residents often work odd and long hours while needing to adhere to the ACGME’s 80-hour workweek cap, as well as being scattered across multiple hospital environments and facilities.8 For instance, a resident who misses a meeting of journal club could still locate the relevant journal article online, participate in virtual discussion with his peers through forums and chat rooms, and receive instantaneous feedback from instructors.
Logically Organizes Material for Spiral Learning An LMS provides a virtual structure for the storage of information, such as presentation slides, lectures, and quizzes. Depending on the nature of the www.anesthesiaclinics.com
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course, information may be categorized by module or topic. This organization allows students to quickly and easily locate and review material from previous modules to create a strong foundation on which to build new knowledge. For example, before beginning the second module in a lesson about induction agents, students could review previous lessons about induction agents, re-watch previous lectures, and retake previous quizzes to test their retention of knowledge. Thus, an LMS naturally lends itself to the development of a ‘‘spiral curriculum,’’ in which topics are revisited in greater depth and complexity over time. ‘‘Spiral curriculums’’ have been shown to be effective in medical education.9 Allows Material to be Easily Archived and Searched LMS’s allow material to be easily archived for later usage. Search functions allow students to sort materials by date or relevance. A well-implemented LMS, like a teaching assistant who has been teaching a course for many years and has a flawless understanding of the subject, helps students to locate the requested material at a moment’s notice. Again, reviewing previous materials as needed will help the student to develop a better understanding of the topics at hand. Allows Educators to Maximize Their Efforts (Scalability) The traditional style of teaching, which require one to manually design curricula, collect course materials, prepare and present lectures, and prepare and grade tests and quizzes, is very time and resource-intensive process. An LMS can enhance efficiency by allowing instructors to reuse course materials, reassign quiz questions to different tests, and easily share course content with colleagues. Long-term Investment may have Significant Returns Even though LMS’s require initial outlay, the long-term efficacy returns from such an investment can be significant. LMS can avoid expenses arising from printing materials, reserving classrooms, or paying instructors to give lectures and hold office hours. In addition, lunchtime lectures can be replaced with a supplementary online curriculum.10 Allows for Monitoring of Student Effort and Progress An LMS may be used to measure the efficacy of an institution’s instruction as well as overall student performance and satisfaction. As grading quizzes and tracking student progress is instantaneous, administrators may revise the curriculum at any time as needed to enhance learning. Feedback from the students takes on new importance. Finally, LMS’s may provide a viable solution to the ACGME’s requirement that residency programs be able to quantitatively assess and demonstrate student www.anesthesiaclinics.com
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learning in each of its stated six core competencies and to document residents’ participation in annual required substance abuse and fatigue tutorials.5 Disadvantages of LMS
Installation may Require Technical Expertise and Additional Expense Although vendors market LMS’s as user-friendly, LMS technology may in fact be challenging for a layperson to implement and maintain. Depending on the size and nature of the course, implementation and maintenance of an LMS may prove expensive. Institutions seeking to implement an LMS must have access to a technology department with LMS experience or a person with time to dedicate to setting up the system, creating usernames and passwords for students, and importing material. Of course, one can transfer the burden of installation and maintenance to an outside party for a fee. Some LMS products are simple to use and require minimal or no outside support (Table 1). For example, over 200 universities currently use Sakai, which has many different options for support. Some choose to garner support from the community through shared forums, whereas others choose to work with commercial enterprises that provide Sakai services (http://sakaiproject.org). Longsight’s Sakai as a Service provides a fully hosted solution for Sakai users for a baseline cost of $12,500 per year for installation, branding, hosting, and comprehensive support. Additional costs depend on the scale of use (www.longsight.com). Students may Initially Require Assistance Although LMS products aspire to simplicity, students sometimes encounter problems when using the technology. For example, students may experience difficulty locating course activities or materials, may be confused by the concept of online forums, or may require support from administrators to understand how to appropriately use the LMS to suit their educational needs.11 An initial tutorial may prove effective to address this obstacle. Students and Staff may Resist Implementation LMS implementation is sometimes met with resistance from students and staff. Students may feel that an LMS is too cumbersome and wastes their time.12 Students may also be unenthusiastic about interacting with their peers and instructors in an online environment. Instructors may feel that an LMS increases their workload, at least initially. Both students and instructors may be attached to traditional styles of learning and teaching and feel that an LMS depersonalizes the learning process.13 www.anesthesiaclinics.com
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Manila Moodle
Educator-centric LMS
LMS indicates learning management system.
Sakai LRN
Open source enterprise-wide LMS
GeoLearning
Blackboard (ANGEL Learning, WebCT) Desire2Learn eCollege
Both commercial (ie, Manila) and open-source (ie, Moodle) educator-centric LMS solutions focus on the needs of the individual instructors and their courses, and not on the enterprise Customizable, similar to the open-source enterprise-wide LMS Cost little or nothing to implement Do not require high-end computer servers Can be managed by a single individual who does not have to be an IT expert Can easily implement learning communities into the LMS solution
Assembled using compatible software from many different sources, allowing for collaboration in software development among users Easy integration with other applications Modifiable so that users are not overloaded with unnecessary features; can tailor the software to their own needs May cost nothing to license, better foresight into yearly costs
Ability to facilitate the delivery and tracking of multimedia course content from one centralized application
Benefits
Requires work by instructor to customize software, which can lead to inconsistent interfaces between courses depending upon the individual teacher’s approach to customizing the LMS for their course Studies have indicated that faculty resistance to implementation might stem from a degree of unwillingness to take the time to learn how to use the new software Differences between software implemented by instructors may be a source of confusion or disconnect for students
Requires high-end computer servers and a team of skilled IT specialists, leading to ongoing maintenance costs
Expensive to license Requires high-end computer server and a team of skilled IT specialists, leading to ongoing maintenance costs Interface is often too complicated because the software is developed with the intent of reaching out to a large audience; too many features Users may feel that the systems are too intricate and vendors are slow or unable to implement suggestions for improvement
Disadvantages
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Commercial enterprise-wide LMS
Main Distributors
Table 1. A Comparison of Commercial Lecture Management System Products Available by Type
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LMS Products
Commercially available LMS’s can be divided into three categories: commercial enterprise-wide LMS, open source enterprise-wide LMS, and educator-centric LMS (Table 1).12 Commercial Enterprise-wide LMS A commercial enterprise-wide LMS is one solution for an entire university, corporation, or other institution. This usually means that the system encompasses features that will accommodate the needs of all and different types of users in a large organization (Table 2). In 1995, WebCT pioneered the start of commercial enterprise-wide LMS software development and became one of the dominant LMS solutions. The ability to track and facilitate the delivery of course content was revolutionary. Since then, numerous other companies have developed competing products. However, the complexity of the software and the costs of maintaining such an enterprise-wide system, because of the requisite high-end nature of the computer servers, may not correctly meet the needs of education providers, who may prefer less expensive, more customized LMS alternatives (Table 2). Open Source Enterprise-wide LMS Open source is a development practice that allows open access to a product’s source materials or code. It promotes collaboration among various companies during development of a software product, which is ultimately free to the public.14 An open source enterprise-wide LMS is a customizable enterprise-wide solution to online learning, released under open source licenses. The LMS can be tailored to the needs of the specific sector in which it is used, so that the entire LMS does not need to be used by all users at all times. Sakai is probably the most familiar example of an open-source enterprise-wide LMS. Created through collaboration between the University of Michigan, Stanford, Indiana University and the Massachusetts Institute of Technology, the Sakai Project refers to its product as ‘‘community source’’ because many of its developers are from institutions that actually use Sakai.15 Sakai is referred to as Coursework at Stanford University. dotLRN is a similar service that was developed at MIT (dotlrn.org). These LMS’s usually cost nothing for the department to license, although they may require the institution to pay a yearly subscription fee (sakaiproject.org). Although they are usually more modifiable than commercial enterprise-wide options, these systems still require sophisticated computer servers and specialist technicians. Educator-centric LMS’s An educator-centric LMS is either a commercial or open source system that is customized by educators to www.anesthesiaclinics.com
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X
X
X
X
GeoLearning* X
X
X X X
eCollege*
Learn.com
Manila Moodle Sakai
X X
X
X
X} X
X
X
X
X
X X
X X
X
X
X
X
X X
X X X
X
X
X
X X
X X
X
X
X
X
X X
Quizzes Forums Search
X}
X
X
X
X
X
X
X} X
X} X
X} X
X
X
X
X} X
Chat/ Peer Content MessaRating ging
Bookmarking
X} X
X
X
X X X
X
X
Declined to state Declined to state B$50,000/y Declined to state $499/y Free Free
Free Declined to state
Media ExtensiSharing bilityw Costz
Prices shown represent those for the minimum possible package, that is, minimal number of students, courses, storage space, and installation costs. If free, the only costs that will be incurred are hardware and the time needed to set up and configure the software. *The representatives did not respond to an invitation to verify this information. wExtensibility: ability to accommodate third-party plug-ins. zCost: extremely variable—dependent on the number of learners, the number of courses, length of time the learning management systems is used for, the type of installation (local or hosted), inclusion of licensing fees, and maintenance fees (http://brandon-hall.com). } Can be achieved with a plug-in or separate installation. X indicates that a feature is offered by a particular provider.
X X
X
X
X
X X
X X
Grade Archive Audio Video Book
Lecture Management System Functionality Matrix by Product
’
LRN X Blackboard X (ANGEL, WebCT)* Desire2Learn* X
Table 2.
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fit the needs of their own courses. These systems are not only used for classrooms, but also for continued online education, with the intent that instructors can amass content and create one great source of information stored on an LMS. Educator-centric LMS solutions combine multiple online software technologies—they offer integration of academic content, testing, and collaborative software like blogs and discussion forums. One of the primary benefits of educator-centric LMS solutions is that they do not need complex computer servers or technical personnel; a computer-educated person with a standard computer can single-handedly manage the educator-centric LMS. An IT department will still be necessary to initially install and maintain the software, although ongoing maintenance is minimal for these types of applications. In addition, members of ‘‘learning communities,’’ groups of people with shared educational interests, are able to interact easily by implementation into educator-centric LMS solutions. ’
LC Review What is LC?
LC is a tool by which lectures can be recorded and archived for later or real-time viewing through a variety of media players while still preserving the visual and auditory aspects of the original didactic presentation (Fig. 1; Panel B).16 Traditionally, medical education has used the didactic lecture as a means of disseminating large amounts of accumulated information to students.17 Ideally, LC technology allows educators to communicate the exact same quantity and quality of information in a digitized form. Studies are needed to determine whether LC results in better retention or higher student satisfaction than traditional classroom talks by the teacher. The most basic form of LC technology records solely audio information. Other more advanced products capture video, and even more advanced LC technologies capture three-dimensional information.18–20 Instructors can create supplementary slides to be shown during the lecture and students can write and share notes on the lecture itself. For example, students could make notes at places in the lecture where they have questions. A peer or administrator could then respond, at the same time point in the lecture, to the question. Finally, LC systems can either focus on recording only the lecturer or they can incorporate and capture activity of the entire class, based on the setup of the audio and/or video systems, depending on what the students and instructors prefer. If used properly, such technology should minimize confusion and maximize efficiency. Further, LC expands the potential audience. For example, a student in China could watch in real-time a lecture being given in Palo Alto and could even hear the questions and comments www.anesthesiaclinics.com
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from the audience and pose his own questions for the class and instructors to respond to. Similarly, a resident may be unable to attend Grand Rounds while on an ‘‘away rotation’’ at an affiliated off-site hospital. LC would allow this resident to watch missed lectures and participate in other educational activities once his schedule permits him to do so. Furthermore, the resident could do this from the comfort of his own home, which by current rules does not count toward the ACGME duty hour restrictions, and would also avoid commuting time. LC breaks down physical and temporal barriers, encourages global communication and cooperation, and maximizes students’ learning experience. Advantages of LC
Allows for Geographical and Temporal Flexibility As with LMS’s, one of the primary benefits of LC is its ability to provide a geographical and temporal flexibility that is not possible with traditional classroombased learning. If students miss a lecture, LC allows them to watch it at a convenient time and when they feel they will learn the most.21 Students can re-watch lectures to clarify or reinforce important information.21 When watching pre-recorded lectures, students can speed up or slow down the lecture in a way that best suits their learning style. Students can pause lectures to take notes or search the web for additional information. Students can watch the lecture in multiple sittings if they so desire. Students can take breaks. Indeed, the flexibility that LC provides theoretically should improve students’ ability to absorb and retain information.22 Further, as mobile computing technology can now support LC systems, students can now view lectures at any time of day from any location. For example, students can listen to or view lectures on their iPod or iPhone while working out at the gym or while commuting. Access to lectures becomes unlimited with respect to place or time.21 Allows Lectures to be Archived and Searched Lectures can be easily archived and searched by topic or date. Students have the capability to search for specific slides or annotations within the lecture. The LC technology will enhance residents’ ability to act independently to resolve their questions, a key component of adult learning.23 Archived lectures and the ability to search within lectures can help the students to prepare for an examination, and seem to improve the student’s learning and experience.24 The easy availability of lectures online is intended to improve the student’s educational experience by providing flexibility in the way the student learns, allowing specific querying while studying, and reducing stress and anxiety.25,26 One survey of 7000 undergraduates showed that students use LC technology www.anesthesiaclinics.com
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primarily to reinforce material, not as a replacement for attending traditional lecture.27 Therefore, if a student were confused about a particular topic, he could easily search the lecture database for lectures having to do with that topic and re-watch every relevant lecture in an attempt to improve his understanding. The student may replay a single lecture as many times and at whatever speed he desires. LC Technology can be Easily Implemented and Used Hosted LC technologies, which are fairly easy to install and maintain, do not require technical expertise on the part of the instructor. LC is also easy for the student to use, requiring little or no explanation beforehand. Meets Students’ Desires and Expectations Multiple studies have demonstrated that medical students and residents appreciate, use, and expect LC in support of their academic curriculum. One survey of 7000 undergraduates found that students prefer courses that offer recorded lectures over those that do not, citing convenience, flexibility, and enhanced learning ability as the primary advantages.21,27 Radiology residents in one academic radiology program using LC ranked recorded lectures as ‘‘extremely useful,’’ on average, and reported most often viewing lectures to reinforce material.16 Interestingly, the same study showed that two-thirds of students noted an improvement in lecture quality as a result of the LC program. The exact reason for this perceived improvement merits further investigation. Disadvantages of LC
Failure of Students to Watch Lectures The primary concern with the LC paradigm is the risk that students will skip lectures. Lack of attendance at lectures is worrisome to the educational community for several reasons: It may discourage the formation of a sense of community or cohesiveness within the educational institution. As students cannot ask for and receive instantaneous feedback or engage in a discussion (unless watching in real-time with the appropriate technology), the educational value of the lecture experience may decrease.26 Administrators worry that students who skip lecture may lack the motivation to watch lectures on their own. Instructors may be concerned that students do not devote their full attention to the lecture while watching it at home, but instead
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do other activities simultaneously, which could limit the benefit they would receive. However, in one study of LC in a large academic radiology program, 93% of residents reported that having lectures recorded had no effect on their lecture attendance.16 Therefore, it seems that the availability of online lectures does not change the lecture-watching behavior of adult learners such as residents, but instead supplements traditional sources of learning. Resistance from Students and Staff As with an LMS, the implementation of LC may be met with resistance from students and staff.16 The traditional lecture allows for face-to-face interaction between the student and lecturer and helps to establish the teaching philosophy and the organizational structure.26,28 Instructors may worry that this benefit is lost with online lectures. Moreover, LC may disrupt the traditional culture of live lectures, and the development of relationships between students and faculty may be hindered.29 Other disadvantages noted by faculty members include concerns about proprietary rights to recorded lectures, that preparation time may increase, and that the lecturers’ presentation style may be constrained because of physical imitations with recording voice and image.16 For these reasons and others, it may become more difficult to recruit guest lecturers for filmed lectures. However, in a study in which LC was implemented in an academic radiology program, 88% of faculty reported no increase in time required to prepare for lecture.16 A subject requiring more research is whether LC systems actually enhance student learning. Students have noted the perceived usefulness of LC, but there have been no studies to show under what conditions an LC program actually enhances learning.26,29 The utility of LC within medical resident education may be the easiest to imagine because of the house staff ’s disparate schedules and work locations. For example, residents are often forced to miss lectures because of patient-care duties; thus, watching them on their computers at home at a later time seems quite useful.16,30 LC Products
There are a variety of LC systems available on the market; some are free whereas others vary in price (Table 3). Different LC systems offer different applications (Table 4). Free LC Systems The two most common free LC systems are Panopto CourseCast Core and openEyA. Mainly used for educational www.anesthesiaclinics.com
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lectures, CourseCast Core allows users to see the lecturer and presentation slides simultaneously and to type notes directly onto the recorded lecture.31 The latter feature could be of use to residents because they could add their own notes to those of the lecturer to serve as reminders to ask questions at specific points during the presentation. As CourseCast Core automatically transcodes to multiple viewing formats (eg, iTunes, personal computer, and iPod), no technical knowledge is required to make lectures readily available in multiple convenient formats. CourseCast Core is free for educational institutions that qualify for Panopto’s Socrates Program. Panopto also offers CourseCast Premium, which provides additional features for a fee (Table 4). Another free system, OpenEyA, can be used to capture any lecture regardless of the type of visual aids used.32 Although it is simple to use, openEya requires a Ubuntu Linux operating system. Although openEyA may be useful on a small scale, it may not be feasible to implement throughout an entire university or medical center. Non-free LC Systems Many commercial products available replicate features and functions of free systems, but may offer the advantage of improved technical support. Although free LC systems can meet the needs of a variety of programs, in some cases it makes sense for a program to pay for an LC system to obtain specific features or services. Camtasia Relay allows for lectures to be posted on the web, or in formats compatible for an iPod or Windows Media Video.33 This allows for portability, which is highly beneficial for medical residents as they can watch and listen wherever they are and however they want. TechSmith’s Camtasia Relay provides a comprehensive software that only requires a server.33 Tegrity Campus, which primarily serves academic institutions, allows students to view lectures at adjustable speeds and allows lecturers to record lectures from any location.34 Lectures are sorted into a database by the course to allow for easy searching. In general, the LMS’s cost will depend on the number of classrooms and students that use it.34
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A Case Study: Stanford START
To illustrate how LMS/LC technology may be realistically used in a medical education environment, we present a case study of the START program at Stanford University School of Medicine. This 10-month online blended-learning educational and virtual mentorship program was designed by the Anesthesia Informatics and Media Laboratory within the Department of Anesthesia to enhance the preparedness of interns to begin anesthesia residency. Blended learning has been www.anesthesiaclinics.com
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LC indicates lecture capture; LMS, learning management systems.
OpenEyA
Tegrity Campus
Camtasia Relay (TechSmith)
Free for qualifying institutions Content can be recorded anywhere as long as a camera is available Live or archived viewing Notes can be taken and are searchable Can record from multiple angles Can record offline Entirely web based Multi-browser support Searchable content LMS integration Multiple products to suit different needs Able to record whenever and wherever Multiple file formats for viewing Simple interface for faculty recording Can be viewed on web, iPod, and Windows media video Catered toward college students Searchable content Can record anywhere Indexing and storage is automatic No hardware or software to install Web-based Adjustable playback speed Free Automated recording and post-processing Can zoom in on different parts of recording Accommodating for different uses of visual aids Can only record in Flash format Not compatible with Windows or Macintosh
Cannot take notes directly into program Different recorders needed for Windows or Macintosh Must provide own server Encoding of presentation depends on server processing capacity No visual recording of the lecturer’s movements High cost for large campuses Not for use of non-educational lectures
Not open source
Disadvantages
’
CourseCast (Panopto)
Advantages
A Comparison of Commercial LC Products
LC System
Table 3.
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X
Digital Whiteboard
3-D Images X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Did not respond
Declined to state
$40 K for complete one room install
Free
$9995
$4995
Free
*The representatives did not respond to an invitation to verify this information. wCourseCast Premium offers many more features, for a fee. zThis feature is available with windows media player. } Pricing may vary depending on number of classrooms, number of students, different packages, evaluation, support, installation, and maintenance. 3-D indicates 3-dimensional; LMS, learning management systems; Q&A, question and answer.
X
Echo 360*
X
X
X
Live-streaming
X
X
X
X
Interactive (Q&A)
X
X
Mediasite (Sonic Foundry)*
X
X
X
LMS Integration
X
X
X
Minimum Cost}
Accordent*
X
OpenEyA
Audio
X
Video
Tegrity Campus
Note-taking X
Adjustable Playback Speed
X
Note-sharing
X
Post-capture Editing X
Indexing
X
Search
Camtasia Relay (TechSmith)*
X
mp3/mp4 Format
X
Windows Media Format
X
Offline Capture
X
Archiving
X
On-demand Lectures
Xz
Lecture Capture Functionality Matrix by Product
Embedding
CourseCast Core (Panopto)w
Table 4.
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defined as ‘‘learning that is facilitated by the effective combination of different modes of delivery, models of teaching, and styles of learning, and is based on transparent communication amongst all parties involved with a course.’’35 The START program blends e-learning with virtual mentorship and combines different teaching styles (lecture and video-based) and modes of delivery (text, video, and group interaction). To our knowledge, the START program represents the first blended-learning and virtual mentorship program using integrated LMS/LC technology designed for interns in any medical specialty. START runs from September 1 to July 1 of the intern or first postgraduate year after graduation from medical school and is divided into monthly modules, each launched on the first day of each month (Table 5). Each module contains three components: 1. A 30-minute video podcast featuring clinical vignettes and minilectures using a Moodle LMS 2. In-depth lectures accompanied by pre-quizzes and post-quizzes using the Panopto LC system 3. An interactive/collaborative assignment, often involving mentorship. The curriculum was designed based on need assessments conducted through focus groups and surveys of incoming or current residents, in which respondents reported that an online course designed to prepare them for residency would have been beneficial. Therefore, the START curriculum was designed to encourage the acquisition of basic knowledge and skills related to anesthesia. Additional goals were to allow for bonding with classmates and mentors, and to increase confidence and preparedness to begin residency training, while at the same time incorporating each of the six ACGME core competencies. Implementation of START Website
Two co-directors and one course teaching assistant (TA) run the START program, with administrative support from various faculty and staff members within the department. The program has its own website (start.stanford.edu), which links to an educator-centric LMS, a Moodle website that serves as a centralized location housing links to all of the past and current course resources, quizzes, and surveys (Fig. 2). Students have their own login names and passwords. Students can access all course materials, post messages in forums, or view their grades once logged in to the START website. Moodle was selected based on its ease of use and affordability. Although a programmer was not hired to www.anesthesiaclinics.com
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develop the START website, one of the program’s co-directors (L.F.C.) has technical expertise and dedicated a significant amount of time to set up the website. The course TA, who had little to no technical skills before her experience with the START program, is responsible for updating the course website with monthly activities. Programming the website with a new monthly module requires about one and one half hours, with developing the quizzes being the most time-intensive aspect. Moodle was introduced during the first video podcast and students were shown a screenshot of how to use their log in names to access the START website. A few of the interns needed to be reminded to log in to the Moodle website and many of them forgot their passwords and needed to have them reset. However, by the second or third module, the interns seemed to be using Moodle with little to no difficulty. Video Podcasts
A podcast is a series of digital media files (either audio or video) that are released episodically and often downloaded through web syndication. START podcasts are typically half an hour in duration (Fig. 3). Cyberlink PowerDirector Pro was the video editing software used. Initially, podcasts were filmed informally with a handheld Flip Camera. However, because the sound quality was poor, the camera was upgraded with a wireless microphone system. The interns in START were extremely appreciative of this improvement. One intern noted, ‘‘Great video. I wish I could show that clip to my friends and family. The day in the life video’s production value was amazing!’’ Feedback from the interns was considered and implemented before the next month’s module. START used an online media service to distribute the
Table 5.
Monthly Topics Presented in the START Program’s Curriculum
Month September October November December January February March April May June
Curriculum Content Introduction to the START program Induction of General Anesthesia Intraoperative Patient Management Airway Management Postoperative Patient Management Crisis Resource Management Practicum I Practicum II Practicum III Final Video www.anesthesiaclinics.com
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Figure 2. The Successful Transition to Anesthesia Residency Training (START) homepage, hosted through Moodle.
podcast videos (vimeo.com), which allows users to provide links from that website to other websites. All video podcasts were available in high-definition.
Lectures
LC was integrated into the Moodle LMS using Panopto CourseCast (Fig. 4). Even faculty with relatively limited technical experience in using LC found it easy to create lectures using CourseCast software. The program automatically uploads the completed lectures to panopto.com. The course TA subsequently inserts a link to the lecture onto the START website. The slides are synchronized with the lecture so that students may process information through both auditory and visual learning. After the first lecture, on the basis of student feedback, PDF files with content from the lecture were included. CourseCast allows course instructors to audit and confirm that the interns are viewing the lectures (Fig. 5). This information shows how long the interns watch, and/or when they lose interest, allowing lecturers to potentially tailor their lectures specifically to suit students’ preferences. Although the podcasts generally contained summaries of important information, the lectures provided interns with more detailed information about one or two specific topics mentioned in the podcasts. www.anesthesiaclinics.com
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Figure 3. A Successful Transition to Anesthesia Residency Training (START) program podcast about crisis resource management.
Quizzes, Activities, and Grade Book
Moodle LMS technology simplifies the process of assessing and documenting learning in the ACGME’s six stated core competencies. In the START program, students take monthly pre-lecture and postlecture quizzes based on content in the lecture to measure gains in anesthesia-related knowledge and understanding of the six core competencies (Fig. 6). Moodle offers: Different types of quizzes and questions (eg, multiple choice and essay). www.anesthesiaclinics.com
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Figure 4. The lecture is accompanied by slides and links to PDF files.
The ability to shuffle the order of questions and answers. Option for students to make single or multiple attempts at the same quiz. Different options for grading (eg, partial credit for specific answer choices).
Figure 5. CourseCast allows viewing of students’ lecture-watching habits. www.anesthesiaclinics.com
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Option for students to view their grades and receive feedback instantaneously. Feedback for specific answer choices or specific grade ranges can be preprogrammed. Quiz questions are entered into a question bank and then assigned to specific categories and quizzes (Fig. 6). Entire quizzes or single questions can be reused in multiple courses. Quizzes can be output as Sharable Content Object Reference Model (SCORM) compliant files, which allow quizzes and lessons to be shared with colleagues. Other types of activities are available: Students can chat in forums, upload media files, view text or web pages, take surveys, or contribute to wikis. Scores for completed quizzes and activities are automatically entered into a grade book. Grades for external activities are entered manually by a TA. Instructors can leave comments for the students about each grade received. The grade book allows for easy documentation of students’ learning progress (Fig. 7). Preliminary Results
Although the START program is currently finishing up its first year, student and faculty responses have been encouraging. The START
Figure 6. An example of a quiz from the Successful Transition to Anesthesia Residency Training (START) program. www.anesthesiaclinics.com
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Figure 7. The grade book is viewable by the instructors and the course TA (student names are blocked out to maintain privacy). START indicates Successful Transition to Anesthesia Residency Training.
program has achieved 100% participation every month and residents consistently rank the program’s podcasts and activities as extremely useful. Our preliminary results suggest that an online educational program using LMS/LC technology is both enjoyable and useful for incoming anesthesia residents. The START program’s success suggests that an integrated LMS/LC system may be implemented by medical educators, but does require a significant degree of technical expertise in initial setup. However, less technically knowledgeable educators may interact with the system as content experts without difficulty once the system has already been established. On account of its flexibility, accessibility, and ease of use, LMS/LC technology provides an ideal learning environment for medical residents who are motivated to supplement their clinical experiences with a comprehensive, structured course designed to enhance their proficiency. In the future, the traditional classroom setting will be augmented, if not replaced, by LMS and LC.
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Summary
As residents work disparate schedules at multiple locations and because of workweek hour limits mandated by the ACGME, residents may be unable to attend lectures, seminars, or other activities that would enhance their skills. Further, the ACGME requires that residency programs document resident learning in six stated core competencies and provide proof of completion for various other requirements. www.anesthesiaclinics.com
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LMS/LC is a promising technology to provide a means by which residency programs may overcome these obstacles. More studies are needed to show under what conditions an LMS/LC program actually enhances learning, and which elements are most useful to the new generation of learners comfortable with Web 2.0 technologies.
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Acknowledgment
The authors would like to thank Scott Seki for his contributions to the development of this article. This article is intended as a review of commercial LMS and LC products that are currently available. None of the authors of this article are employed by, have financial ties to, or are receiving incentives from the companies mentioned in this article.
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References
1. Ellis RK. A field guide to learning management systems. In: Circuits L. ed. American Society for Training and Development; 2009. http://www.astd.org/NR/rdonlyres/ 12ECDB99-3B91-403E-9B15-7E597444645D/23395/LMS_fieldguide_20091.pdf. [Accessed March 20, 2010]. 2. Burnette K, Ramundo M, Stevenson M, et al. Evaluation of a web-based asynchronous pediatric emergency medicine learning tool for residents and medical students. Acad Emerg Med. 2009;16(suppl 2):S46–S50. 3. Criley JM, Keiner J, Boker JR, et al. Innovative web-based multimedia curriculum improves cardiac examination competency of residents. J Hosp Med. 2008;3: 124–133. 4. Chenkin J, Lee S, Huynh T, et al. Procedures can be learned on the Web: a randomized study of ultrasound-guided vascular access training. Acad Emerg Med. 2008;15:949–954. 5. ACGME. ACGME Program Requirements for Graduate Medical Education. [Text Page] 2003 April 16, 2003 [cited 2010, March 27, 2010]. 6. Wikipedia. Time Shifting. 2010 [cited 2010, March 29, 2010]; Available from: http:// en.wikipedia.org/wiki/Time_shifting. 7. Wikipedia. Placeshfiting. 2010 [cited 2010, March 28. 2010]; Available from: http:// en.wikipedia.org/wiki/Placeshifting. 8. ACGME. Duty Hours. 2007 [cited 2010, March 14]; Available from: http://www.acgacwebsite/dutyhours/dh_lang703.pdf. 9. Harden RM, Stamper N. What is a spiral curriculum? Med Teach. 1999;21: 141–143. 10. FitzGerald JD, Wenger NS. Didactic teaching conferences for IM residents: who attends, and is attendance related to medical certifying examination scores? Acad Med. 2003;78:84–89. 11. Blaisdell M. Course Management Systems: It’s the Support, Stupid – Campus Technology! in Campus Technology. 2010. http://campustechnology.com/Articles/ 2004/12/Course-Management-Systems–Its-the-Support-Stupid. [Accessed March 20, 2010]. www.anesthesiaclinics.com
50
’
Chu et al
12. Sparacia G, Cannizzaro F, D’Alessandro DM, et al. Initial experiences in radiology e-learning. Radiographics. 2007;27:573–581. 13. Siemens G, Tittenberger P. Handbook of emerging technologies for learning. 2009. http://umanitoba.ca/learning_technologies/cetl/HETL.pdf. [Accessed March 20, 2010]. 14. Wikipedia. Open source. 2010 March 29, 2010 [cited 2010, March 29, 2010]; Available from: http://en.wikipedia.org/w/index.php?title = Open_source&action = history. 15. Unicon. Sakai Collaboration and Learning Environment. 2010 [cited 2010, April 8, 2010]; Available from: http://www.unicon.net/opensource/sakai. 16. Kircher MF, Hines-Peralta A, Boiselle PM, et al. Implementation of screen-capture video recordings of resident conferences in an academic radiology department: pilot experience. Acad Radiol. 2010;17:255–263. 17. Chu LF, Chan BK. Evolution of web site design: implications for medical education on the Internet. Comput Biol Med. 1998;28:459–472. 18. Sonicfoundry. Today’s richest online presentation experience. [cited 2010, March 25, 2010]; Available from: http://www.sonicfoundry.com/mediasite/player/ 19. DiMaria-Ghalili RA, Ostrow L, Rodney K. Webcasting: a new instructional technology in distance graduate nursing education. J Nurs Educ. 2005;44:11–18. 20. Accordent. Accordent. [cited 2010, March 25, 2010]; Available from: http://www. accordent.com/products/presenterpro.aspx. 21. Veeramani R, Bradley S. U-W Madison online-learning study: insights regarding undergraduate preferences for lecture capture. 2008. http://www.uwebi.org/news/ uw-online-learning.pdf. [Accessed March 20, 2010]. 22. Briggs LL. Can classroom capture boost retention rates? In Campus Technology. 2007. http://campustechnology.com/articles/2007/10/can-classroom-capture-boostretention-rates.aspx. [Access date: March 21, 2010]. 23. Nguyen L, Brunicardi FC, Dibardino DJ, et al. Education of the modern surgical resident: novel approaches to learning in the era of the 80-hour workweek. World J Surg. 2006;30:1120–1127. 24. Briggs LL. Classroom capture: lecture recording system draws devotees at temple, in campus technology. 2007. http://campustechnology.com/articles/2007/02/ classroom-capture-lecture-recording-system-draws-devotees-at-temple.aspx?sc_lang=en. [Access date: March 21, 2010]. 25. Deal A. Lecture webcasting: a teaching with Technology White Paper. Carnegie Mellon Office of Technology for Education; 2007. http://www.cmu.edu/ teaching/resources/PublicationsArchives/StudiesWhitepapers/LectureWebcasting_ Jan07.pdf. 26. Traphagan T. Class Lecture Webcasting. Fall 2004 and Spring 2005. Program Evaluation Report. University of Texas at Austin; 2005:7. http://www.utexas.edu/ academic/diia/research/reports/webcasteval_report_fl04-spr05.pdf. [Accessed March 19, 2010]. 27. Zhu E, Bergom I. Lecture Capture: A Guide for Effective use, in CRLT Occasional Papers. Center for Research on Learning and Teaching; http://www.crlt.umich.edu/ publinks/CRLT_no27.pdf. [Accessed March 19, 2010]. 28. Masters K, Gibbs T. The spiral curriculum: implications for online learning. BMC Med Educ. 2007;7:52. 29. Cardall S, Krupat E, Ulrich M. Live lecture versus video-recorded lecture: are students voting with their feet? Acad Med. 2008;83:1174–1178. 30. Geurts S, Rutte C, Peeters M. Antecedents and consequences of work-home interference among medical residents. Soc Sci Med. 1999;48:1135–1148. 31. Panopto. The Socrates Program. [cited 2010, March 25, 2010]; Available from: http:// www.panopto.com/solutions_education_socrates.aspx. www.anesthesiaclinics.com
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’
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32. OpenEyA. Using openEyA automated recording system. Available from: http:// www.openeya.org/. 33. TechSmith. Camtasia Relay. [cited 2010, March 25, 2010]; Available from: http:// www.techsmith.com/camtasiarelay/pricing.asp. 34. Tegrity. Tegrity Campus 2.0 How to Buy. 2010 [cited 2010, March 25, 2010]; Available from: http://www.tegrity.com/tegrity-campus/10-how-to-buy.html. 35. Heinze A, Procter C. Reflections on the Use of Blended Learning. Education in a Changing Environment. University of Salford, Salford, Education Development Unit. 2004.
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