e learning is it an effective learning modality for clinical years of medical education
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E-Learning: Is it an effective learning modality for clinical years of Medical Education?. Asad J. Raja MBBS MHSc FRCS Professor of Surgery King Khalid University Saudi Arabia. IMRAD. Introduction/Background Material & Methods Results Discussion & Conclusion. Introduction.

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e learning is it an effective learning modality for clinical years of medical education

E-Learning: Is it an effective learning modality for clinical years of Medical Education?


Professor of Surgery

King Khalid University

Saudi Arabia

  • Introduction/Background
  • Material & Methods
  • Results
  • Discussion & Conclusion

Medical educators are facing immense challenges today

Over stretched faculty with diverse commitments

Shifting of emphasis from acute care to community-based settings

Difficult to accommodate emerging “new” fields

Change from traditional instructor-centered teaching to a learner-centered model

New competency-based curricula emphasize on learning outcomes and not on the process of education

Ozuah PO. Undergraduate medical education: thoughts on future challenges. BMC Med Educ. 2002; 2: 8-10.

Nair BR, Finucane PM. Reforming medical education to enhance the management of chronic disease. Med J Aust. 2003; 179:257-259.

Leung WC. Competency based medical training: review. BMJ. 2002; 325:693-696.

pedagogical c hallenges
Pedagogical Challenges

Traditional Model is teacher-centered method - rote learning and memorization – top down – external – coercion

Progressive/Modern/Alternative Model is learner centered with real-world experiences and learner driven – internal – with slogans of "Learn by Doing" and "Learn by Discovery“

In this challenging environment e-learning offers educators a new paradigm based on adult learning theory that may result in a more effective and efficient learning experience

e learning
  • E- Learning refers to the use of internet technologies to enhance knowledge and performance and historically has two common e-learning modalities:
  • Distance learning, takes place at locations remote from the point of instruction
  • Computer-assisted instruction,(also called computer-based learning and computer-based training) uses stand-alone multimedia packages for learning and teaching
  • Blended learning,a fairly new term in education, is an approach that combines e-learning technology with traditional instructor-led training

Ward JP et al. Communication and information technology in medical education. Lancet. 2001;357:792-796.

Masie E. Blended learning: the magic is in the mix. In: Rossett A, ed. The E-Learning Handbook. New York: McGraw-Hill; 2002:58-63.

e learning advantages
E-Learning Advantages

Active and learner-centered

Learning delivery - accessibility, easy updating, personalized instruction, distribution, standardization and accountability

Learners control - content, learning sequence, pace of learning, location and time

Multimedia menu - accommodate diverse learning styles and objectives

Automated tracking and reporting

Learner assessment

Chodorow S. Educators must take the electronic revolution seriously. Acad Med. 1996;71:221-226.

Gibbons A et al. Computer-based instruction. In: Tobias S, Fletcher J, eds. Training & Retraining: A Handbook for Business, Industry, Government, and the Military. New York: Macmillan Reference USA; 2000:410-442.

Clark D. Psychological myths in e-learning. Med Teach. 2002;24:598-604.

designing and experience blended e learning course
Designing and Experience Blended E-Learning Course
  • A Blended surgery course (70% + 30%) for final year class was developed on LMS of BB
  • LMS was supported by Tegrity; Question Mark; Elluminate; YouTube; and links accessible to collaborating Medical School
  • Course details were available to the students before the start
  • Electronic Communication only
  • Regular Group emailing; Discussion Board; and Quizzes
  • Student activity and tracking
  • In the end a Questionnaire based on line survey
questionnaire based study
Questionnaire based Study


  • BB based electronic Questionnaire Survey


  • Determine students access to electronic resources
  • Understand their perspective about e-learning
  • Document their experience with e-learning
  • Document barriers/suggestions from e-learners
material method
Material & Method

Study Population:

Surgery 3 Course – 473, Class of 2010, 6th Year Class (1+5), College of Medicine, KKU

Sample Size:

Total 140 - Boys 102 & Girls 38

Study Period:

May 1 - June 30, 2010 (8 weeks)

Study Design:

An electronic questionnaire based survey was conducted at the end of 8 weeks Course. Twenty five questions were framed as Either/Or; Opinion Scale/Likert; and Short Answers/Qualitative

response rate
Response Rate

Surgery 3 Course - 473Class of 2010

Total Students: 140

Boys: 102

Girls: 38

Boys response rate: 90/102 = 88%

Girls response rate: 34/38 = 90%

internet access
Internet Access

Do you have internet access at home?

Boys n = 90 Girls n = 34

67% Yes 71% Yes

33% No 26% No

3% NR

Around 1/3 did not have access at home

internet use
Internet Use

Are you a regular internet user?

Boys n= 90 Girls n = 34

62% Yes 71% No

38% No 26% Yes

wi fi access at kku ach
Wi-Fi Access at KKU/ACH

Did you get access to wireless internet anywhere in the KKU boys campus or in the Girls Teaching  building at Aseer Central Hospital?

Boys n= 90 Girls n = 34

84% No 93% No

16%% Yes 7% Yes

access to computer labs
Access to Computer Labs

Did you have access to computer labs at KKU boys campus or at Girls Teaching building at Asser Central Hospital?

Boys n = 90 Girls n = 34

22% Yes 6% Yes

78% No 91% No

e learning facilities support
E-learning Facilities & Support

How would you rate the e-learning facilities (enough computers, internet access, support etc)?

Boys n = 90 Girls n = 34

Excellent 11% 6%

Good 29% 24%

Average 43% 26%

Poor 17% 41%

define e learning
Define E- learning
  • Majority correctly defined it and knew its strengths and limitations
  • They were all clear that it should compliment and not replace traditional teaching
  • Majority were critical that it takes away the teacher student contact
  • Only beneficial if internet resources, support system and time available; waste of time as not ready yet; difficult and weak learning modality; lot of limitations; average; should never replace the traditional model
acceptance of e learning
Acceptance of e-learning

Do you think necessary change has occurred at the university in terms of acceptance of e-learning?

Boys n = 90 Girls n= 34

64%Yes 56% Yes

36%No 31% No

learning style and needs
Learning Style and Needs

Every one has their own learning style. How well does e-learning support your learning style and needs?

Boys n =90 Girls n=34

Excellent 9% 3%

Good 40% 29%

Average 41% 59%

Poor 9% 6%

e learning is time effective
E-learning is time effective

Do you think e-learning is time effective i.e. do you learn effectively and in shortest possible time?

Boys n =90 Girls n =34

50% Yes 29% Yes

50% No 68% No

e learning user friendly
E-learning – user friendly

Do you think e-learning resources i.e. Black Board, Tegrity and other components within the programs are user friendly?

Boys n =90 Girls n=34

Strongly Agree 17% 0%

Agree 46% 65%

Neither Agree/Disagree 27% 18%

Disagree 8% 15%

Strongly Disagree 3% 0%

e learning skills training
E-Learning Skills Training

How would you rate the e-learning skills training provided to you at the start  of the course?

Boys n= 90 Girls n = 34

Excellent 16% 9%

Good 42% 35%

Average 31% 41%

Poor 11% 12%

access of kku edu sa
Access of kku.edu.sa

How would you rate your experience with access of kku.edu.sa website?

Boys n = 90 Girls n = 34

Excellent 14% 12%

Good 40% 29%

Average 33% 44%

Poor 12% 12%

preference of learning style
Preference of Learning Style

What learning style would you prefer?

Boys n =90 Girls n =34

Traditional Learning 27% 41%

E – Learning 12% 3%

Blended 61% 53%

course information provided on black board
Course Information Provided on Black Board

How would you rate the course information provided to you on Black Board?

Boys n =90 Girls n =34

Excellent 18% 24%

Good 39% 41%

Average 29% 24%

Poor 12% 5%

NR 2% 6%

postings of quizzes
Postings of Quizzes

How would you rate the quizzes posted regularly?

Boys n =90 Girls n =34

Excellent 27% 26%

Good 39% 47%

Average 23% 21%

Poor 11% 3%

discussion forum postings
Discussion Forum Postings

How would you rate the Discussion Forum on Black Board?

Boys n=90 Girls n=34

Excellent 22% 18%

Good 37% 44%

Average 23% 26%

Poor 18% 9%

tegrity sessions
Tegrity Sessions

How would you rate the experience with recorded Tegrity Sessions?

Boys n=90 Girls n=34

Excellent 10% 3%

Good 34% 30%

Average 31% 41%

Poor 24% 23%

skills development video links
Skills Development Video Links

How would you rate the experience with skills development video links provided to you?

Boys n=90 Girls n=34

Excellent 22% 32%

Good 38% 41%

Average 32% 15%

Poor 8% 9%

email communication
Email Communication

Did you find group email useful as a communication tool between instructor and your class fellows?

Boys 90/102 Girls 34/38

61% Yes 53% Yes

38% No 47% No

barriers to e learning boys
Barriers to E-Learning (Boys)
  • NR 17; 10 No barriers; 6 cost issues as expensive
  • 52 - Accessibility issues; problems of KKU website; and speed
  • 17 - would prefer traditional teaching as teacher student interaction essential and better; time consuming with

little benefit

  • 11 - poor computer literacy; slow typing speed; no

training programs; wasted lot of time; no motivation

  • 3 - wanted subsidized laptops and internet connections; separate computer lab for medical college; Wi-Fi availability all over campus
  • 2 – found BB boring and wanted the get up changed
barriers to e learning girls
Barriers to E-Learning(Girls)
  • NR - 8;5 - cost issues as expensive
  • 22- Accessibility issues; problems of KKU website; and speed; access at home and ACH not at all possible
  • 18 – Verytime consuming; lot of effort without benefit
  • 5 – want traditional teaching as it takes away the student teacher interaction
  • 5 – Besides teething problems it is a good learning source for the future; exciting & useful if everything worked well; easy and good but not used to it; not good for clinical side as we need to be with patients; needs improvement
  • 4 – Many faculty members did not support e-learning and discouraged students; neither students nor doctors are used to such a modality of learning
e learning component of surgery 3 course
E- Learning Component of Surgery 3 Course

Did you enjoy the e-learning component of your Surgery 3 course?

Yes 55% 65%

No 45% 35%

instructor experience
Instructor Experience
  • The courses organized for faculty were excellent and very informative with hands on training
  • Whole faculty in e-learning deanship is just excellent and very cooperative
  • Their eagerness and endless desire to help is commendable – ‘they really know what they are doing’
  • Mr. Feras; Dr. Khaled Mohanna; Ms. Mariam Awaji,

Instructor ExperienceFrom: Asad J. RajaSent: Fri 5/7/2010 10:06 PMTo: [email protected]: Surgery - 3 Course and E - learning experience

  • Technical Issues between e-learning Deanship and KKU Server -reliability
  • Access –Wi-Fi issues at KKU; need for more labs in different colleges in KKU; access at Aseer Central Hospital; Labs compatible for examinations
  • Availability of skills development tools; support for development of interactive sessions
  • Tegrity is crucial – slow speed; only 500MB space = +/- 5 lectures
  • Question Mark/Question Bank
  • Course access to all faculty and not just Course Coordinator
  • Permanent repository and access to course

The main barriers identified 57 studies reviewed: requirement for change; costs; poorly designed packages; inadequate technology; lack of skills; need for a component of face to-face teaching; time intensive nature of e-learning; computer anxiety

A range of solutions can solve these barriers. The main solutions are: standardization; strategies; funding; integration of e-learning into the curriculum; blended teaching; user friendly packages; access to technology; skills training; support; third party paying e-learning costs; dedicated work time for e-learning

Childs et al. Effective e-learning for health professionals and students—barriers and their solutions. A systematic review of the literature Health Information and Libraries Journal 2009;22(Suppl. 2):20–32


Developments in e-learning and technologies are creating the groundwork for a revolution in education

Individualized learning (adaptive learning), interactions with each other (collaborative learning), and transforming the role of the teacher from distributors of content to facilitators of learning and assessors of competency

The integration of e-learning into UG, PG & CME promotes a shift toward adult learning in medical education – Self Directed Learning

CONCLUSION (contd.)Is e-learning an effective learning modality for clinical years of Medical Education?
  • E-learning for clinical medical education will always be blended and an excellent tool
  • Clinical component will mostly remain f2f but lectures can certainly be done much better through e-learning. Skills lab will also become obsolete as it is better done through video technology – 3D
  • There may be technical problems, access issues and training & development issues – internal teething problems -nothing to do with e-learning

E- learning is a revolution and a reality and very much here to stay. We need to innovate, exploit & harness this technology in order to compliment & enhance learning to improve our standards of education