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What's the Pathophysiology of E-learning in the Medical Community?

Greg Long
Chief Learning Architect
Accelera

Ugly Babies

It seems that everyone has a favorite reason why e-learning hasn't really taken hold. Some claim that the technology still isn't ready. Some hold the position that the medical community is so unique that e-learning just won't work; that medical professionals still learn "the old fashioned way," which usually means "in a classroom."

But maybe there's an answer that's closer to home and harder to accept. Maybe we in the medical community who are developing learning are doing a poor job. Maybe it's because we're making "ugly babies" and then wondering why no one admires them.

You know the story. A mother or father proudly holds up their newborn son or daughter and says "isn't it beautiful?" The answer, of course, is usually no. But we ooh and aah and say nice complimentary things to avoid any hurt feelings. But we all know the truth. Most newborn babies aren't beautiful.

So it is with most e-learning. We develop it. Then we hold it up for the world to see and admire. The problem is, it's only beautiful to the one who created it. But most of us are too polite to tell the proud parent the truth - it's ugly.

If It's Plentiful, It Must Be Good

First, let's consider the context within which medical learning takes place.

The information overload situation facing the medical community is staggering:

  • 10,000 Clinical trials published each year in over 20,000 medical journals
  • Half-life of treatment guidelines is now two years and shrinking
  • Physicians spend less than one hour per week reading medical journals

So the challenge clearly is how do we deliver much needed information and ongoing learning into a community so severely time starved. Traditionally, we fall back to what we knew and loved(?) - classroom training. Sometimes we disguise it as a conference or a meeting. But it's still the same thing. We grew up with it so it must be good.

The numbers, however, tell a different story. Traditional style, professional training does a poor job at conveying information that is retained by the learner. And if it isn't retained, it won't change behaviour or performance.

According to the Research Institute of America:

33 minutes after a lecture: 58% retention
2 days later: 33% retention
3 weeks later: 15% retention

The Silver Bullet

So now we turn to technology to provide the silver bullet that will solve the continuing education dilemma. But the numbers there don't seem to be much better.

Technology to the Rescue?

Is technology the answer? Here are the figures:

  • Over 19,000 hours of eCME are now available online
  • Over 230 websites offer eCME
  • 78% of physicians use the web as part of their practice (precise use not defined in study)
  • Average web usage per physician is 9.6 hrs/week (precise use not defined in study)
  • Dropout rate for e-learning is over 70% (is this good or bad?)
  • Only 5-10% of physicians who access eCME request CME credit

Here's the real problem. The education community has known for years what works and what doesn't.

Forty one education reviews conducted between 1966 and 1998 show the following:

  • Active learning works (these include case studies, simulations, and other 'engaging' techniques)
  • Passive learning does not (pPage-turning, didactic, and other 'non-engaging' techniques)

The problem is that we steadfastly refuse to implement what we all know works. If active learning works, of course we use it.

Right?

Wrong.

What we actually deliver:

  • Only 17% of available eCME courses are interactive
  • 28% are text only

When you consider what makes e-learning "active" and "engaging" there are a few general principles to consider:

"Good" = Learner Engagement, which means:

  • Elicit emotional response
  • Provide freedom to fail
  • Create situational fidelity
  • Build unpredictability
  • Allow learner control

MELD's Role

These general principles, and the more general topic of what constitutes "good" e-learning, is what the MedBiquitous E-Learning Discourse (MELD) will tackle. Our purpose is to be a provocative, thoughtful, evidence-based forum for professionals in the medical community to share, learn, debate, and, ultimately, shape the quality of technology-based learning for the medical community.

Some specific things we plan:

  1. Provide a forum for discovering what really works (evidenced-based learning?)
  2. Provide an information resource for those developing e-learning for the medical community. This resource will include:
    • Primers on various aspects of developing e-learning for the medical community
    • Examples of processes that work
  3. Provide a place for discourse on key issues affecting learning in the medical community. For example:
    • How could technology enable non-seat time-based CME credit?
    • How to select the most appropriate media type for conveying a topic?
    • What navigation schema work best for medical audiences?

Your Role

To be successful, we need you to be part of the discourse. Your role in MELD will be:

  • Contribute articles
  • Submit examples (good and bad)
  • Pose questions
  • Be part of the discourse

We look forward to engaging with you.

Best,


Greg Long
Chief Learning Architect
Accelera

References
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