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Why We Need Better E-Teaching, Not More E-Learning
John Harris Jr. |
Even though the purpose of MELD is to foster an e-learning discourse, I’d like to offer the heretical suggestion that we replace the term “e-learning” with “e-teaching.” It’s not that there’s anything wrong with e-learning. In fact, well-done e-teaching requires that students participate in e-learning. It’s just that e-learning lowers the bar for teaching by assuming that students teach themselves. This distracts our attention from the benefits of good teaching and limits the upside of e-education. If we want to set a tough standard, one that can fundamentally improve medical education, we should ask for better e-teaching, not more e-learning.
E-Learning Means Self-Teaching
The term “e-learning” implies a new educational technology, based on well-designed computer-based courseware, that allows students to teach themselves. By comparison, “e-teaching” is the facilitation of live teaching with streaming lectures, whiteboards, downloadable slide sets, and discussion forums. E-teaching is about the automation of an existing teacher-centered educational approach, while e-learning means a new student-centered approach that is more consistent with adult learning theory.
Because it appears to embody a new approach to education, it’s no wonder that all of the attention is on e-learning. The self-evident benefits of e-learning are the mantra of an entire industry:
“E-Learning is Internet-enabled learning. E-Learning provides faster learning at reduced costs, increased access to learning, and clear accountability for all participants in the learning process. In today's fast-paced culture, organizations that implement e-Learning provide their work force with the ability to turn change into an advantage.” – Cisco Systems. [1]
The real action today is in creating content and deployment (learning management) systems that support e-learning. Teacher-centered education is considered obsolete and, within the e-learning industry, “teaching” is almost a bad word and the word “teacher” is not used.
People who prepare e-learning programs refer to themselves as “instructional designers” or “educational facilitators,” but not as “teachers.” The MedBiquitous Education working group describes a learning management system as the middle layer between “learners” and “content creators/assemblers.” This nomenclature and new breed of educational professionals recognizes that the goal of e-learning is to allow students to become true adult learners, that is to become their own teachers. In this setting, traditional live teaching is superseded by e-learning programs prepared by instructional designers. In the world of e-learning there is little need for formal teaching and teachers are simply content providers for instructional designers (or content assemblers).
The Rise of Learner-Centered Medical Education - A Big Step Sideways
Given the history of medical education, the growing use of medical e-learning materials makes perfect sense. Medical education is based on a model of transferring facts to novices via lectures and books, testing students on the facts, letting them practice their personal factual recall and knowledge synthesis skills on sick people, and castigating them if they do the wrong thing. In other words, medical education has always depended heavily on student self-education, supplemented by external faculty motivation and tolerant, often indigent, patients.
The recognition that this educational model, whatever its merits, is unpleasant for students has recently led to more humane learner-centered educational strategies, such as problem-based learning. Problem-based learning, which still depends on student self-education, is no more educationally effective than the traditional approach, but it is more enjoyable for students.
Enter e-learning. E-learning is not only consistent with a more humane approach to medical education, but probably a more efficient means of self-education. By watching a graphically-rich presentation of cardiac pathophysiology retrieved from an online content library, a medical student can teach herself more about myocardial infarction than she can ever learn in a lecture. Practicing physicians can educate themselves by doing an information search to answer a question that arises in the course of their practice, which is far more relevant than what they will get from a typical continuing medical education program. However, medical e-learning is not a solution to medical education’s shortcomings. While less unpleasant than traditional medical teaching, it avoids the issue that medical education, for whatever reasons, has never depended on good teachers to succeed, it has depended on good learners. Thus, e-learning is not a true step forward, but a step sideways.
What’s wrong with an educational model that expects medical students to teach themselves? People teach themselves new skills all the time, why can’t a person be both a medical student and their own teacher? The answer should be obvious. Schools, even medical schools, exist because self-teaching is inefficient and, sometimes, dangerous. The role of teachers (trainers, coaches, mentors) is to lead (educare L. “to lead forth”). Good teachers shorten the learning process by providing relevant information, as well as assessment, guidance, and examples. If teachers are not doing all of these things, this does not mean that teaching is bad, only that bad teaching is bad. However, good teaching is hard to achieve consistently, even for good teachers. Expecting all 110,000 medical school faculty members to be good teachers all the time is unrealistic. But, replacing bad teaching with good self-education is a reasonable solution only if there is no way to create good teaching.
What Should Medical E-Teaching Do?
Consider these basic concepts:
- Teaching is what teachers do. Good teaching requires customized information-sharing, assessment, guidance, and examples.
- Education is what happens in the middle.
- Learning is what students do. Good learning requires personal memorization, synthesis, and practice.
E-teaching should not refer to the automation of live teaching, as it now does. Instead, it should mean the creation and deployment of computer-based educational tools that deliver all of the elements of effective teaching: customized information, assessment, guidance, and examples, independent of their creator, in much the same way that books deliver information and entertainment independent of their author(s). These types of programs should not require students to extract meaning and teach themselves how and when to apply it, but be true e-teaching programs that do the heavy lifting of education in a tireless and reliable manner.
The untapped promise of information technology is that it can address basic problems in medical education by decoupling teaching and teachers. What we can now do that we could not do previously is vastly extend the reach of good e-teachers.
Obviously, good e-teaching programs, particularly ones that can be shown to be educationally effective, are hard to create. They need more than content assembly. They require a careful understanding of what medical students and physicians need to learn at different times in their careers, how real-world clinical problems unfold, how to best handle these problems, and the common mistakes to be avoided. In short, they need experienced teachers.
The technology and concepts to deliver effective medical e-teaching now exist. It is possible to create realistic e-teaching programs that actually improve medical decision-making skills across international boundaries.[2] We need to raise the bar for e-education so that e-teaching is the standard, not e-learning. The fundamental premise on which e-teaching programs must be built is that education is about improving performance and changing behavior.[3] E-teaching should be informed by research in educational psychology:
- Learning is a process whereby students actively construct knowledge (constructivism).[4] E-teachers should facilitate this.
- Students must practice skills in situations similar to those in which they will be used (contextual/situated learning and problem-based learning).[5] E-teachers should develop robust simulations based on their practical experience.
- Multiple media can enhance learning when different cognitive processes are stimulated (cue summation theory).[6] E-teachers should use the most efficient mix of media for the educational task.
People who design e-education programs that reliably improve medical student and physician performance may be supported by instructional designers, but these people are true e-teachers. We need more of them. We need to set a high standard that fosters the development of medical e-teachers who can lighten the load of the next generation of medical e-learners.
References
- Quoted at the Learnframe Website: http://www.learnframe.com/aboutelearning/page2.asp
[Last accessed 09 October 2008]. - Harris JM, Salasche SJ, Harris RB: The Internet and the globalization of medical education. British Medical Journal . 2001;323:1106.
- Tyler RW. General statement on evaluation. Journal of Educational Research. 1942;35:493-501.
- Mayer RE. Theories of learning and their application to technology. In O'Neil HF, Perez RS. Technology Applications in Education: A Learning View. Mahwah, NJ: Lawrence Erlbaum Associates. 2003:127-158.
- Regehr G, Norman G. Issues in cognitive psychology: Implications for professional education. Academic Medicine. 1996;71:988-1001.
- Severin W.J. Another look at cue summation. Audio Visual Communications Review, 1967(b);15:233-245.