Abstract
This article reports the latest development in e-learning in Korean medical education. The Korean Consortium for e-Learning in Medical Education was formed for collaboration in providing quality online learning resources for medical schools around the nation. This e-learning strategy is aimed at improving the quality of medical education at the national level by providing students with equal access to quality learning resources and fostering students’ self-directed learning and, in doing so, enhancing the effectiveness and efficiency of developing online learning resources by sharing necessary resources among the medical schools. The consortium also plans to share e-learning content with medical schools in other countries by engaging more medical schools in the consortium and also by sharing e-learning content developed by other institutions or consortiums. The consortium is also dedicated to the research and development of effective online learning strategies for medical education, including interactive virtual patient cases and other innovative pedagogies using Web 2.0 technologies.
Introduction
E-Learning has garnered significant attention from virtually every education and training sector due to the many benefits it can provide to the community of teachers, learners, and schools. The significant impact that e-learning can make on medical education is also well-recognized in the literature (Ruiz et al. 2006b). In particular, e-learning makes it plausible to enhance learning for medical students by providing them with self-directed and individualized learning environments (Harden & Hart 2002). This article reports the current efforts of Korean medical schools to collaborate in the development of e-learning for undergraduate medical education. We also share insights we have gained from this experience and our future directions to expand the sharing of e-learning content with wider communities.
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Recent developments in e-learning: Web 2.0 and OpenSourceWare
There have been new developments in the World Wide Web (Web, henceforth) since the turn of the century, due in large part to recent advancements in Internet technology. When the first Web browser was released in the mid-1990s, the general public was largely restricted to reading content created by a relatively small group of people who had the knowledge and skills to create Web pages, thereby making the roles of the producer and consumer of the information on the Web distinctive. However, this trend has changed with the development of new Internet technologies such as weblogs (or blogs), wikis, and podcasts, which enable users to create and publish online content easily without an in-depth knowledge of Web technology (Boulos et al. 2006). In such ways people are connected through social networks in which they freely share the knowledge and collaborate. Such Web technologies that allow for easy knowledge sharing and collaboration are often called Web 2.0 (Sandars & Schroter 2007). Discussions on the innovative use of Web 2.0 technologies to facilitate student learning are actively occurring (McGee & Begg 2008). Second Life is another educational tool that is gaining much attention from educators today. Second Life is a web-based virtual reality system where learners are immersed in an interactive virtual reality setting. Some medical schools have developed virtual hospitals and virtual wards in Second Life, in which medical students can apply their knowledge and skills in a virtual setting (Boulos et al. 2007).
With the advancement of Web 2.0 technologies, it has become ever easier for the general public to create and share content online. This has made an impact on the open source movement, where institutions and individuals participate in sharing online content for free. An example is the OpenCourseWare consortium, which was initiated by MIT. Now over 100 institutions of higher education around the world are participating in it (Carson 2007). In lieu of such movements, many medical schools, especially in Europe and North America, are sharing online materials that they have developed (Ruiz et al. 2006b).
E-Learning in higher education and medical education in Korea
E-Learning has become widespread in various education and training sectors around the world, and countries in the Asia-Pacific region, such as Korea and Japan, are no exception. South Korea, as one of the top 10 countries in Information Technology (IT) infrastructure according to the World Economic Forum (Dutta & Mia 2008), is known to be an early adopter of latest technologies and its efforts to use e-learning to foster learning throughout society have become a model for other countries (Latchem et al. 2008). A recent survey of Korean institutions of higher education shows that over a half of 4-year colleges and universities in Korea – especially, 90% of those with student enrolments of more than 10,000 – were offering e-learning courses in 2006 (Lim et al. 2006). Yet, such a widespread adoption of e-learning did not take place in Korean medical education. According to a survey of Korean medical schools in 2006, only 6% of them were offering some forms of web-based instruction; 94% used departmental or school websites and bulletin boards to post course-related information and did not have a learning management system (Kim & Shin 2006). They further report that only 7 out of the 41 medical schools in Korea answered that they had plans to use e-learning in their curriculum.
Several factors might have contributed to this trend in medical education. The key barrier would be the vast amount of medical information that needs to be developed into e-learning content, which is often insurmountable by one individual or institution. This situation has been confounded by the mounting pressure on medical faculty to increase research and clinical productivity. Additionally, the lack of faculty support, particularly in terms of the budget and personnel dedicated to e-learning, deterred them from embracing e-learning (Kim & Shin 2006). Moreover, medical faculty staffs had few opportunities for professional development to enhance their understanding of how to use e-learning in medical education. Thus, Korean medical schools were facing significant challenges in adopting e-learning.
The Korean Consortium for e-Learning in Medical Education (e-MedEdu)
Despite such challenges, Korean medical educators have begun to pay more attention to e-learning to enhance and assure the quality of medical education by providing medical students across the nation with equal access to quality learning resources. This is illustrated by the fact that the use of e-learning in medical education was the theme of the annual meeting of the Korean Society of Medical Education in 2006. In response to these needs, a consortium was suggested in order to facilitate collaboration among medical schools so that they could share their experiences, resources, faculty, other personnel, and IT infrastructure, for effective and efficient development of e-learning content. Accordingly, the Korean Consortium for e-Learning in Medical Education, e-MedEdu, was formed in 2007. Out of 41 medical schools in South Korea, 28 are currently members of the consortium.
Since its inception, the members of the consortium have engaged in the efforts to develop online resources in two groups. One is the content development team, whose main responsibility is to develop online resources by collaborating with colleagues in their schools and developing strategies for effective e-learning content development. The other is the research and development (R&D) team, who is focused on research in the design of effective e-learning in medical education. The R&D team is also developing templates as a guide for faculty to develop online materials. Additionally, the support team provides administrative and technical support for the consortium, which includes IT staff to develop the e-learning portal. As an institution that initiated the consortium, Sungkyunkwan University School of Medicine has primary responsibilities for providing human resources to support the organization, including programmers, instructional designers, and coordinators.
The consortium has developed a portal where the faculty and students associated with the partner schools have access to approximately 500 learning resources at the time of this writing (www.mededu.or.kr). The website was open for use by medical students in the member schools in the fall of 2008. As of September 2008, over 260 faculty members and 8000 students from the member institutions are registered in the e-learning portal. The consortium has chosen to use a home-grown system for the portal to make it easy to tailor the system to the needs of medical students. This e-learning portal provides features for creating and publishing a variety of learning objects suited for medical education including virtual patient cases, image banks, online quizzes, and streaming videos. For easy creation and sharing of online resources, the faculty members can simply upload existing digital documents, such as PowerPoint slides and image files. In addition, users can easily create online material using a built-in authoring tool, by which users can create web pages with text and multimedia (e.g., audio, images, and video clips).
The consortium's e-learning strategies
The online materials developed by the consortium are created using a concept called learning objects, which are a repository of small, self-contained, and reusable instructional content (Wiley 2002; Ruiz et al. 2006a). As exemplified in some cases of e-learning portals such as IVIMEDS (www.ivimeds.org) and Multimedia Educational Resource for Learning and Online Teaching, or MERLOT (www.merlot.org), learning objects can serve a variety of educational purposes. Additionally, the learning objects approach in developing e-learning content is an effective way to create an environment for individualized learning and allows for easy sharing of online content (Martinez 2002). The learning objects developed by the consortium are primarily intended for use by students for self-study. Additionally, faculty members can use the online resources to supplement their classroom teaching, such as by referring to cases when they give lectures or give references to the materials for course assignments. Under such circumstances, it is likely that faculty and students look for online resources to supplement teaching and learning in the formal curriculum. Such a learning environment is similar to a blended learning environment, in which various learning technologies, in particular online learning components, are used to supplement traditional classroom instructions (Harden & Hart 2002). Still, these learning objects can also be reassembled and reused to create an online module or course. Thus, the learning objects can be used to support different learning activities and learning objectives.
Our content development efforts are focused on creating an online repository of virtual patient cases. A variety of virtual patient definitions and types exist (Ellaway et al. 2008) and our virtual patient cases are presented primarily in text with multimedia, which typically includes images, sound, and video clips. Another is a collection of video clips to teach clinical skills. With the clinical skill test component to be added in the Korean Medical Licensing Examination (KMLE), we expect that there is a high demand for students to view demonstrations of clinical skills to supplement hands-on practice. In addition, there is a visual data bank including image files, such as X-ray images, CT images, and pathology slides, with animated annotation on PowerPoint slides providing information on how to interpret such images. Online quizzes are provided for student assessment, and online games are also available to provide students with engaging learning activities. Table 1 lists the types of e-learning content available in the consortium's e-learning portal. All learning objects are stored on a database for easy retrieval using a search engine. The materials can be browsed by medical subject, as well.
Table 1. Types of content in the MEDEDU e-learning portal
Fundamentally, this e-learning portal supports individual learning, wherein students access learning materials based upon their own learning needs. To support such a learning environment, students have an individualized portal service, where they can bookmark the resources of interest or ones recently visited. Additionally, our interviews with several students with an early prototype of this e-learning portal indicates that students want to be able to create online communities in the portal in which they can pose questions and get answers related to the content of online resources or to share information useful for medical students. In response to such needs, the portal supports interaction among users by providing online discussion boards to facilitate collaborative learning.
One of the key challenges for the consortium was to encourage faculty members to take the time and effort to develop learning materials in the midst of the pressure to increase clinical and research productivity. To address this issue, the consortium came up with several strategies to recognize faculty members for their efforts in developing learning resources and to encourage faculty participation. For instance, we have put up a usage data report section on the portal's homepage on which users can check on the amount of online resources submitted by each member school in real time. This encourages each member school to actively participate in efforts to build up the learning resources repository.
In parallel to faculty motivation, we have also provided faculty members with pedagogical and technical support. Some faculty members are not experienced in developing online resources. For example, some of our faculty members had little experience in developing virtual patient cases. Therefore, we needed to provide guidelines, examples, and just-in-time informal training on how to create virtual patients. Additionally, some faculty members needed training on how to use the content authoring tool in the portal. After the faculty members had begun to receive training, the amount of virtual patient materials submitted to the portal increased noticeably. The need for faculty development in e-learning is supported by the results of a recent survey by Sandars and Schroter (2007), which shows that medical educators are aware of Web 2.0 technologies, but are not familiar with how to use such tools.
To assure the quality of learning resources, the consortium adopted a peer review policy for all the resources submitted for publication in the portal. The consortium's peer review process emulated the one typically adopted by scholarly journals. The faculty member is required to revise the materials that he has developed and the reviewers should give such feedback before it is accepted for publication in the portal. Only the content that has been accepted by the review board can be published on the portal for student's access. Peer reviews in e-learning can generally emulate peer reviews of printed materials, but there are aspects that are unique to e-learning (Ruiz et al. 2007). The consortium has developed criteria for peer review that considered the unique aspects of online materials, such as the quality and usability of multimedia and the format of multimedia presentations, and has made them available to any user who has access to the portal as well as the members of the review board.
Future directions of the consortium
The consortium aims to expand its scope by collaborating with other institutions in a variety of ways. First, it is planning to collaborate with consortiums in other countries to share learning resources that each one has developed. That way, each consortium can benefit from the others by enriching its repository of online materials. Second, the consortium is arguably the first in medical education in the Asian region, and it aims to expand its memberships to include medical schools in the Asian countries and share the benefits of e-learning with a wider community. The consortium's portal and the online content available on this web site are set to be translated into English for multinational users.
Additionally, the consortium plans to develop innovative instructional strategies for e-learning in the context of medical education. For instance, we are planning to move the current virtual patient database forward and create a more interactive virtual patient model. The virtual patient is an effective tool to enhance students’ clinical reasoning skills and to assess it in authentic contexts (Cook 2008). In particular, interactive virtual patients allow students to develop clinical reasoning skills by building experience through interacting with simulated patients. Yet, developing an interactive virtual patient system is a complex task, and we hope to take the advantage of the experiences and insights we have gained in developing e-learning content to develop the interactive virtual patient system. We are also planning on the research of the effective use of such Web 2.0 technologies, thereby providing empirical guidelines for the effective use of e-learning in medical education.
Conclusion
The consortium's efforts have proven that collaboration in creating online materials and sharing them among medical schools is an effective and efficient method for providing medical students with e-learning content on a scale that could not be achieved through the efforts of one institution. With the opening of the e-learning portal, the consortium is expected to gain more publicity among Korean medical schools, and we expect that the number of member schools will increase, encompassing the majority of Korean medical schools. It is vital for the success of the consortium that students find the online resources useful for their learning. Therefore, research is warranted to evaluate the effectiveness and usefulness of online resources in the portal and to make constant efforts to improve it. To that end, we conducted a formative evaluation on the usability of the e-learning portal site in its development phase. We are also going to provide user satisfaction surveys to faculty members and students using the portal.
We expect that the integration of e-learning into medical education will change the landscape of how students learn. For instance, recent developments in virtual environments, such as virtual reality and virtual microscopy, will enable us to supply a virtual learning environment that supplements or replaces traditional settings. Additionally, we envision that students will be assessed in a more authentic setting with rich material resources and interactive tools, instead of printed materials. To that end, faculty members need to devise ways for integrating e-learning into their curricula. For any technology, including e-learning, to make a real impact on education, faculty members need to consider how the technology can be integrated into the curriculum (AAMC 2007). With such strategies in place, e-learning innovations in medical education can take place successfully.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
| Practice points |
|
| Type | Description |
|---|---|
| Virtual patients (or clinical case bank) | A repository of information on real patient cases with multimedia, such as text, images, and video and audio clips. |
| Visual database | A repository of clinical images, typically including animated annotations on PowerPoint slides to describe and highlight key information related to the images. |
| Image bank | A set of images relevant to a clinical case from pathological labs and imaging studies. |
| Virtual microscope | Web-based simulation of a microscope to view high-resolution image datasets. |
| Video clips | Video presentations of clinical skills. |
| Online quizzes | Multiple choice questions (MCQ) and short-essay-type quiz items for self-assessment. |
| Learning modules/courses | Self-directed courses or modules on medical subjects. |
| Link bank | A list of URLs to external online learning resources or web sites that have information related to medical education. |
| Others | Game-based learning modules, CPC (clinical pathology conference), etc. |