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A vision of the use of technology in medical education after the COVID-19 pandemic

DOI:10.15694/mep.2020.000049.1
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Poh-Sun Goh
Poh-Sun Goh
Poh-Sun Goh
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John E. Sandars at Edge Hill University
John E. Sandars
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Abstract

Medical education across the world has experienced a major disruptive change as a consequence of the COVID-19 pandemic and technology has been rapidly and innovatively used to maintain teaching and learning. The future of medical education is uncertain after the pandemic resolves but several potential future scenarios are discussed to inform current decision-making about the future provision of teaching and learning. The use of emergent technology for education, such as artificial intelligence for adaptive learning and virtual reality, are highly likely to be essential components of the transformative change and the future of medical education. The benefits and challenges of the use of technology in medical education are discussed with the intention of informing all providers on how the changes after the pandemic can have a positive impact on both educators and students across the world.
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Personal view or opinion piece Open Access
A vision of the use of technology in medical education
after the COVID-19 pandemic
Poh-Sun Goh[1], John Sandars[2]
Corresponding author: Dr Poh-Sun Goh dnrgohps@nus.edu.sg
Institution: 1. National University of Singapore, 2. Edge Hill University Medical School, Ormskirk, UK
Categories: Teaching and Learning, Technology
Received: 25/03/2020
Published: 26/03/2020
Abstract
Medical education across the world has experienced a major disruptive change as a consequence of the COVID-19
pandemic and technology has been rapidly and innovatively used to maintain teaching and learning. The future of
medical education is uncertain after the pandemic resolves but several potential future scenarios are discussed to
inform current decision-making about the future provision of teaching and learning. The use of emergent
technology for education, such as artificial intelligence for adaptive learning and virtual reality, are highly likely to
be essential components of the transformative change and the future of medical education. The benefits and
challenges of the use of technology in medical education are discussed with the intention of informing all providers
on how the changes after the pandemic can have a positive impact on both educators and students across the world.
Keywords: technology; medical education; transformative change; coronavirus, COVID-19
Introduction
The purpose of this Personal View is to offer a vision of the use of technology in medical education after the
COVID-19 pandemic begins to resolve. Both authors have a keen interest in the innovative use of technology in
medical education and an awareness of the current and future trends in the use of technology to enhance teaching
and learning. We will begin by a reflection on the current increased use of technology as a major factor in enabling
the continuation of medical education during the pandemic. This reflection will be followed by a discussion of
several potential future scenarios that are based on the emergent trends in the use of technology but also an
understanding of how complex social systems respond over time to the trigger of major events. We will also discuss
the benefits and challenges of the future use of technology in medical education after the pandemic resolves.
A transformative change in the current approach to medical education across the world is inevitable and although the
full extent is unknown at the current time it is essential to consider potential future scenarios to begin the process of
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preparing for the future (Chermack, 2004). We fully appreciate the difficulty that many medical educators will
experience in considering the future at a time when most educators across the world are deeply engaged in
responding to the current enormous challenges, both personal and professional as clinicians and educators. However,
it is essential that all educational policy makers, curriculum planners and educators across the continuum of medical
education, from basic to continuing, can begin to critically reflect on the present situation and make appropriate
decisions about the future of medical education for when the pandemic resolves.
The impact of the COVID-19 pandemic
The pandemic has resulted in the widespread disruption of medical education and professional training (Ahmed
et al., 2020; Murphy, 2020). Examples include reduced teaching with redeployment of medical educators to clinical
care and the quarantine and impact of illness on medical educators and students. Measures to ensure social
distancing have included closure of medical schools and working from home for both educators and students. Local
and international travel, and attendance at training programs has been halted. Physical attendance at workshops and
symposia, conferences, clinical attachments and visiting fellowships has ceased. Tragically, there have also been an
increasing number of deaths that include doctors and other healthcare professionals.
The current response to the COVID-19 pandemic
Overall, the current response to the pandemic has been the increased awareness and adoption of currently available
technologies in medical education, and also in the wider education sector (Iwai, 2020). These changes across the
continuum of medical education have been mainly to replace existing approaches for the provision of medical
education, driven by the urgency to implement a feasible and practical solution to the crises, with educators using
familiar technology.
Medical schools and other medical education providers, including commercial organizations and professional bodies,
have rapidly scaled up the provision of educational content and training online, as well as faculty development in the
use of technology, especially by online courses. Large group in-person lectures have been replaced by streamed
online lectures, using technologies for screen capture and online dissemination. Small group sessions and tutorials
have been replaced with interactive Webinars using web conferencing platforms. All of these learning resources can
be easily accessed from mobile devices.
A major challenge for medical educators at the present time has been to replicate the experience of clinical
encounters. These encounters range from clinic and ward rounds to interactive patient sessions to training in
interpersonal and inter professional communication and clinical skills. Currently available technology, such as
videos, podcasts, simple virtual reality, computer simulations and serious games, are beginning to be used to assist
educators and facilitate student learning and training in these areas. Simple online platforms, such as websites and
blogs, can provide basic information but also offer opportunities to host videos for demonstrating essential skills,
such as procedural clinical skills and communication (Dong and Goh, 2015). Medical educators can remotely coach
students with real time mobile video tools and apps.
The increasing trends of competency based medical education (CBME) and programmatic assessment require
regular assessments of student achievement. Medical schools have creatively responded to the challenge of a lack of
opportunities to observe student performance or to hold large scale examinations. Formative and summative
assessments for core knowledge have started to use a variety of online tools and platforms. The range is from
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websites, discussions forums and online discussion spaces to real-time online chat and communication apps.
Feedback on performance and the assessment of skills acquisition has similarly started to maximize the ubiquitous
availability of video and audio on mobile devices to enable assessment in authentic contexts, either clinical or
simulated. These assessments should be ideally based on high quality evidence and theory informed assessment and
evaluation strategies (Martin et al., 2019).
We are heartened to see greater national collaboration between medical schools to share educational and training
resources (PIVOT MedEd, 2020). Commercial providers are also increasing their engagement and collaboration
with medical schools.
The future after the COVID-19 pandemic
We consider that it will be highly unlikely that there will be a return to the previous approach to the provision of
medical education as existed before the pandemic, especially the contribution of technology for enhancing teaching
and learning. The change will be transformative, with a major change in how individuals and the wider social system
within which each individual lives and works. The uncertainty at the current time is around the extent of this
transformation since it is dependent on the complex interaction between several major factors that are difficult, and
some observers would say almost impossible, to predict. These conversion factors are mainly related to the length of
time that the pandemic is disruptive, since a long disruption is likely to produce significant alteration in several of
the factors. The factors include the number and availability of educators, economic constraints and the need to
rapidly expand the clinical workforce. All of these factors will have a major impact on the future way that educators
and their institutions will provide medical education.
Understanding the transformation
Our framework to understand transformative change is Normalisation Process Theory (NPT). This sociological
theoretical framework has been increasingly used to understand how a new practice, such as the use of technology,
becomes embedded within a social system ("normalisation") through an active process, both individually and
collectively, that occurs over a period of time (Scantlebury et al., 2017). The new practice becomes embedded when
it is routinely incorporated in the everyday work of individuals and groups. The key phases of this dynamic
interactive process between individuals and others in the social system begin with the development of a shared
understanding of the benefits and importance of the change to be achieved, and this is followed by the building and
sustaining of individual and collective commitment around an intervention. Finally, there is ongoing resolution of
any issues around differences in opinions about the new practice and there is increased allocation of resources to
enable the new practice to become embedded. Once the practice is embedded it is considered both individually and
collectively as the usual way of working and the new practice is unlikely to revert back to the original practice,
especially if there have been major conversion factors that have initiated the transformation.
The NPT framework suggests at the present time that the process of transformation in the increased use of
technology in medical education is within the early phases, with what appears to be a rapid and progressive
individual and collective acceptance and commitment to the use of technology to enhance teaching and learning. The
extent to which the transformation leads to embedding of technology will be variable across different providers of
medical education but one future potential future scenario is that only minor transformative change will occur, with
increased use of current technology, especially with a greater emphasis on online learning and mobile devices to
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replace face to face group teaching and meetings.
However, another potential future scenario is that of major transformative change in medical education, especially if
there has been a major disruptive influence on the way that we all live and work after the pandemic resolves. If
there is a major disruptive challenge to medical education, such as a vastly reduced number of educators and the
need to rapidly expand the education of the future workforce across the continuum of medical education, the variety
of current technology being used to augment medical education will be inefficient and inappropriate to meet the high
demand. Educators will need to develop and implement innovative solutions in response to this high demand and an
awareness of future trends in the use of technology is invaluable in beginning to prepare for the future.
Understanding the emergent technology
The Horizon 2020 Teaching and Learning report was produced by an expert panel to highlight how emergent
technology has the potential to transform future provision of higher education (Brown et al., 2020). There are two
main envisaged changes; adaptive learning and extended reality.
The introduction of adaptive learning offers a personalized approach to enable all students to access a wide range of
learning resources and to provide information to educators about how students are learning from their experience.
Essential for adaptive learning is the integrated application of two types of emergent technology: artificial
intelligence (AI) and learning analytics (Chan and Zary, 2019; Wartman and Combs, 2019). The application of
artificial intelligence creates "thinking machines" to provide learning content and assessments that can adaptively
interact with students using text and voice. These applications range from learning anatomy to complex clinical
diagnostic and management challenges. Robotic tutors that are adaptive to problem-solving have been used alongside
school children to facilitate their individual self-regulated learning (Jones and Castellano, 2018). Learning analytics
collect information about the process and outcomes of learning that are essential to inform educators about the
progress and trajectory of both individual and groups of students. The learning potential of these new approaches is
that students can obtain personalized learning that is tailored to their individual needs and there is also the
opportunity to reduce the time for the development of individual competence and to decrease the time required for
face to face interaction with educators and patients.
Extended reality (XR) provides students with learning experiences that either blends physical and virtual elements
(augmented reality or AR) or provides a totally virtual immersive experience (virtual reality or VR) (Zweifach and
Triola, 2019). The immersive experience has the intention to replicate a real-life experience and this can be
delivered through headsets or mobile devices. An emergent trend in technology is haptic simulation which replicates
the physical sensations of a real-life experience, such as touch. The learning potential is that these sophisticated
experiences can be applied to a range of clinical topics, from communication and clinical skills to deliberate practice
of surgical procedures, and also they can be integrated with adaptive learning to realize additional benefits.
The middle ground future scenario
The potential future scenario for medical education and the contribution of technology to enhance teaching and
learning after the resolution of the pandemic is likely to be in the middle ground between the two extreme ends of
the spectrum that we have presented in the two previous scenarios. It is highly likely that the use of technology will
increase and this also includes an accelerated application of many of the newer types of emergent technology that
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have been described in the Horizon 2020 report. However, the extent to which these types of emergent technology
have become, and continue to be, embedded will be dependent on the complex mix of factors within a particular
context. These factors include the length of time of disruption to previous approaches to medical education and the
available resources, including support from learning technologists and access to the emergent technology. Overall, an
integrated approach that combines elements of both technology and face to face teaching and learning experiences is
likely to characterise the future scenario.
The benefits of change after the COVID-19 pandemic
Whatever the change and extent of transformation in medical education after the pandemic it is inevitable that there
will increased individual and collective awareness and acceptance of the innovative potential that technology,
including emergent technology, can offer to enhance teaching and learning across the continuum of medical
education (Goh, 2016). The ‘anytime anywhere’ aspect of using technology offers new opportunities for specific
groups of students, such as increasing access and participation to part-time students and providing shortened
programmes for gifted or talented students.
It will be interesting to see if the current increased spirit of national collaboration of medical educators to freely
create, share and curate learning content will continue. There is the exciting opportunity for these collaborations to
spread and include educators from across the world. The benefits in meeting the World Health Organisation goals to
provide universal health coverage through an urgent and rapid increase in trained workforce cannot be
underestimated (World Health Organisation, 2015). However, the digital divide between countries, especially
between high and low and middle income countries, is potentially a major challenge to these ventures. Technology
that is appropriate to the local contexts, with lower bandwidth cellular and online networks, will need to be
considered and international collaboration between medical schools will need to be developed.
The challenges of change after the COVID-19 pandemic
We have presented several potential future scenarios of the use of technology, including emergent technology, in
medical education after the pandemic resolves and our overall vision has been positive, with a discussion of the
advantages for teaching and learning. However, it is important to consider the challenges that will need to be
addressed if the expected potential transformative changes are to continue to be embedded and further evolve over
time.
The effective of use of technology for enhancing teaching and learning has been discussed earlier but achieving the
desired outcome and impact will only be realised by continuing to develop all medical educators in how to skillfully
align the various contributory factors, including the learner, the learning objectives, the learning content, the
instructional design, the technology and the context (Zaharias and Poylymenakou, 2009). The Horizon 2020 report
also highlights the essential need to implement ‘learning engineering’ if an emergent technology, such as more
sophisticated virtual reality, is being considered for use in teaching and learning. The components of this approach
includes design thinking, agile and iterative development, user experience evaluation and the application of learning
science to craft the learning experience (Badwan et al., 2018). Many educators are likely to require further
development and training in the effective use of technology for enhancing teaching and learning.
The development of emergent technology, especially when specifically for teaching and learning, is often costly and
requires a range of different expertise. However, the Horizon 2020 report also highlights the increasing trend for
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open educational resources (OER) that are available without restriction, including financial cost, to both educators
and students across the world. We consider that the opportunity for all medical education providers to offer OER
has never been more appropriate and we urge all providers to continue their current collaborative ventures.
Finally, at this time of transformative change in the use of technology in medical education, we recommend that the
opportunity is grasped to increase the development of an educational scholarship related to the use of technology and
to increase the implementation of global benchmarking standards (Goh and Sandars, 2019). Both of these ventures
have the future potential to ensure that the transformative change continues to benefit medical education across the
world.
Take Home Messages
The COVID-19 pandemic has been a major disruptive change to medical education across the world and the use of
technology has been rapidly and innovatively used in an attempt to maintain teaching and learning. When the
pandemic resolves, transformative change is likely to occur in the way that technology will be used in medical
education, especially with the integration of emergent technology. There are significant benefits to this
transformative change but there are important challenges that need to be addressed if the future and continuing use
of technology in medical education is to be effective and have a positive impact on both educators and students
across the world.
Notes On Contributors
Poh Sun Goh, MBBS, FRCR, FAMS, MHPE, FAMEE, is an Associate Professor and Senior Consultant Radiologist
at the Yong Loo Lin School of Medicine, National University of Singapore, and National University Hospital,
Singapore. He is a graduate of the Maastricht MHPE program, a member of the AMEE TEL committee, and a
Fellow of AMEE. ORCiD: http://orcid.org/0000-0002-1531-2053
John Sandars MB ChB (Hons), MSc, MD, MRCP, MRCGP, FAcadMEd, CertEd, FHEA is Professor of Medical
Education at Edge Hill University Medical School, Ormskirk, UK, and is Co-Chair of the AMEE Technology
Enhanced Learning Committee. ORCiD: http://orcid.org/0000-0003-3930-387X
Acknowledgements
None.
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Appendices
None.
Declarations
The author has declared that there are no conflicts of interest.
This has been published under Creative Commons "CC BY 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)
Ethics Statement
This is a Personal Opinion piece and does not require Ethics Approval.
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Full-text available
  • Sep 2023
Introducción: la pandemia por COVID-19 produjo cambios abruptos en la educación médica. La educación virtual se convirtió en una estrategia indispensable para dar continuidad a la formación médica. Sin embargo, aún no se cuenta con evidencia de sus resultados.Objetivos: identificar diferencias entre la metodología de enseñanza presencial y virtual en estudiantes de medicina del último año medidos por autoevaluación de competencias.Métodos: estudio observacional de la distribución natural en estudiantes del último año de Medicina. Se evaluó la autoevaluación de competencias y resultados de evaluación sumativa en tres diferentes grupos (presencial, virtual y bimodal). Se aplicó una encuesta para evaluar percepciones de la metodología virtual.Resultados: 83 estudiantes aceptaron participar. Dos terceras partes presentaron dificultades técnicas en la modalidad virtual. Se encontraron diferencias de medianas estadísticamente significativas a favor de la metodología presencial para las competencias en visitas domiciliarias (p = 0,03), ronda clínica (p = 0,021) y anticoagulación (p = 0,002); a favor de la metodología bimodal para la competencia en el manejo de la osteoartrosis (p 0,031) y a favor de la metodología virtual en la competencia de tamización de cáncer de pulmón (p = 0,02). Si bien la nota final presentó diferencias estadísticamente significativas en un curso, esta no fue académicamente relevante.Conclusiones: considerando la autoevaluación de competencias, es posible adquirir la mayoría de las competencias clínicas en cáncer y vejez a través de metodologías virtuales de forma similar a lo que se obtiene en la metodología presencial en un ambiente educativo emocionalmente seguro.
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... Além disso, a pandemia do coronavírus levou a maioria das cidades do mundo a aplicar ensino a distância para todas as instituições de ensino, para garantir a continuidade do processo educacional regularmente, sem afetar educação dos alunos por causa desse fator (Aljarrah et al., 2020). Devido a esse motivo, educação através da internet é fortemente aplicada em tais circunstâncias, especialmente pela presença de tecnologia que se desenvolve regularmente dia a dia (Goh & Sandars, 2020). ...
INSERÇÃO DA INTELIGÊNCIA ARTIFICIAL NOS CURSOS A DISTÂNCIA
Article
Full-text available
  • Sep 2023
O Ensino à Distância é um método de educação que promoveu melhorias significativas no sistema educacional. A Inteligência artificial é um sistema que utiliza de métodos quantitativos para executar tarefas, aprimorar as informações e solucionar problemas. A inserção de Inteligência Artificial na Educação à Distância inserção inclui a personalização, avaliação, previsão e sistematização, e possui vantagens e desvantagens em sua implementação. Dentre as vantagens, pode ser citado a alocação, custo e flexibilidade. Dentre as desvantangens, pode ser citado a comunicação e manutenção. O objetivo deste paper foi compreender a inserção da inteligência artificial nos cursos à distância. O método de pesquisa adotado foi revisão qualitativa da literatura. Conclui-se que a inserção da Inteligência Artificial nos Cursos à distância pode promover qualidade de ensino por meio do engajamento e interação, através de um ambiente de atendimento personalizado.
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... (2021), is a multi-dimensional digital portrayal of an authentic or fictional location. Goh and Sandars (2020) acknowledged that VR immersive experiences are intended to replicate real-life experiences while being disseminated through headsets or mobile technologies. Sarkady et al. (2021) determined that perceived usefulness had a hand in determining participant's behavioral intentions of using VR as a travel substitute during the pandemic. ...
HEARING In Practice
Conference Paper
Full-text available
  • Feb 2023
HEARING In Practice
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... Hence, it is important to consider any potential limitations and take precautionary action to minimize the same if technology is to allow the effective dissemination of knowledge (Chen, 2009;Christensen, 2002). Nevertheless, during the recent halt in academic activities that took place globally as a result of the COVID-19 pandemic, academics were warranted to relook at how technology can be used at all levels of education, thus allowing education to be continued amidst the social shutdown (Ali, 2020;Chick et al., 2020;Daniel, 2020;Ferdig et al., 2020;Goh and Sandars, 2020). Hence, under the prevailing social circumstances, it has become an immediate necessity to understand the efficacy as well as learner perception of including technology in facilitating education, specifically for areas where online delivery is seldom practiced. ...
AAOU2021 Volume2 Final Online Published
Conference Paper
Full-text available
  • Aug 2023
Abstract Like the other open and distance learning (ODL) institutions in the world, The Open University of Sri Lanka (OUSL) experiences low completion and high student dropout rates. If institutions are to act against the increasing student dropout rates, they need to determine the reasons for this student behavior. Studies carried out in other ODL institutions have demonstrated that learner drop outs may depend on variables such as, motivation, adaptation to the system, congruence of expectations and individual interests. Previous research studies have tested various student support models which focus on individual student needs to tackle this issue. Specifically, ‘proactive motivational support’ systems were identified to support individual students through praising their effort and strengths, allowing increased interaction with teachers and encouraging students to be involved in studies with high levels of motivation. At present, OUSL mostly practices a ‘reactive support’ system, where students initiate and request support. With the recent rates of low completion and high dropouts, it would be a timely endeavor to develop an effective learner support system as identified through literature. The aim of this study was to identify the factors that affect students’ performance, their motivation and retention. A questionnaire was designed based on a comprehensive review of similar studies in other ODL institutions and by using researchers’ experience. It was pilot tested, and the revised questionnaire was administered to students from the Faculties of Natural Sciences, Health Sciences, Engineering Technology and Humanities and Social Sciences at OUSL and around 10% responses were collected. Factors such as adjustment to the ODL system, balancing workload and student’s commitments, quality of the course material, flexibility in scheduling academic activities, effective course delivery, staff student interactions, peer and family support were identified as significant in developing a proactive support mechanism.
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... The analysed survey highlights that a combination of in-person and online elements is preferred in future educational frameworks in CMR-a vision that is reflected by many key opinion leaders describing the future of education in general and medical education in particular. [9][10][11][12][13] This approach addresses the often-neglected advantages of in-person training. The German CMR Academy, an institution with long-standing experience in cardiovascular (CV) imaging education, had a 38.6% response rate from invited alumni, including both in-person and online course attendees. ...
Virtual CMR training proves feasible and effective: Survey data from international participants of the CMR Academy Berlin, Germany
Article
Full-text available
  • Jul 2023
Aims This study aims to evaluate the success of the CMR Academy Berlin's transition from in-person to online cardiovascular magnetic resonance imaging (CMR) training during the global pandemic 2020 and to gather recommendations for future courses. Methods and results We conducted an online survey targeting CMR course participants from both the pre-pandemic, in-person era and the pandemic, online era of the CMR Academy Berlin. The survey primarily used Likert-type questions to assess participants’ experiences and preferences. A total of 61 out of 158 invited participants (38.61%) completed the survey, with 31 (50.82%) being in-person alumni and 30 (49.18%) being online alumni. Both in-person (83.87% [26/31]) and online (83.33% [25/30]) participants rated the course as either ‘very good’ or ‘excellent’, and both groups found the course either ‘extremely helpful’ or ‘very helpful’. However, a higher percentage of in-person participants (96.77% [30/31]) felt comfortable asking questions compared to online participants (83.33% [25/30]; p=0.025). The majority in both groups preferred a written exam (total: 75.41% [46/61]; in-person alumni: 77.42% [24/31]; online alumni 73.33% [22/30]). In terms of course format preferences, in-person courses were preferred by both in-person alumni (38.71% [12/31]) and online alumni (60% [18/30]), almost as much as a hybrid format combining in-person and online elements (in-person alumni: 41.94% [13/31], online alumni: 30% [9/30]). Conclusion The transition from in-person to online CMR training at the CMR Academy Berlin was successful in maintaining overall satisfaction. However, there is room for improvement in terms of increased interaction, particularly for online participants. Future CMR- and potentially also cardiac CT-courses should consider adopting a hybrid format to accommodate participants’ preferences and enhance their learning experience, especially to gain level II competency, whereas for level I virtual only might be sufficient.
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Student-Centered Learning with Large Student Groups: Rationale, Organization, and Experiences in Problem-, Project-, and Team-Based Learning
Chapter
  • Aug 2023
Student-centered educational approaches are increasingly being implemented in undergraduate institutions. With the rising number of students and lack of resources, institutions need to gather students in large classes. This study investigated the implementation and adjustment of Problem-Based Learning (PBL) with large student groups. Professionals having experience with PBL with large student groups were interviewed to answer the following questions: (1) What was the rationale behind the implementation of PBL with large groups? (2) How was it organized? and (3) What were the experiences? Results showed that an increasing interest in student-centered methods combined with a lack of sufficient resources was put forward as the rationale for implementing PBL for large student groups. In terms of organization, all interviewees mentioned small group discussions within the large classrooms. Moreover, the integration of technology within and in addition to the class aimed to facilitate the management of large student groups and to enhance students’ collaborative learning. Students’ and tutors’ experiences with large group PBL were mainly positive. These findings suggest that PBL can be applied to large student groups as a small-scale, student-centered educational approach. Small group discussions can still be kept as a critical aspect and technology can help class management and collaborative learning.KeywordsProblem-based learningStudent-centered learningLarge student groupsTechnology
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The Value of Service-Learning in Chinese Language Teacher Preparation
Chapter
  • May 2023
As both a frontline Chinese language teacher in the U.S. and a Ph.D. student, the author wanted to better combine practice and theory so that the two were more beneficial to pre-service teachers. For the role of a Chinese language teacher, the author would like to serve the teacher community with proficiency and communicative-oriented teaching methods. Being able to combine the mentoring process while reflecting on teaching theories in this field enabled the author to further explore the field as a Ph.D. student. Because COVID-19 segregated different countries with rigorous quarantine policies, the distance between language learners and the target language environment was further. Such a situation made it more urgent to undertake the responsibility to serve the subject. The two roles led the author to this dual service-learning project. The data and feedback received from both the pre-service teachers and the community proved the success of this project. At the end of this chapter, some suggestions and changes in the training of future Chinese international teachers were provided for teacher education programs.
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Applications and Challenges of Implementing Artificial Intelligence in Medical and Healthcare Education: An Integrative Review (Preprint)
Article
Full-text available
  • Mar 2019
Background: Since the advent of artificial intelligence (AI) in 1955, the applications of AI have increased over the years within a rapidly changing digital landscape where public expectations are on the rise, fed by social media, industry leaders, and medical practitioners. However, there has been little interest in AI in medical education until the last two decades, with only a recent increase in the number of publications and citations in the field. To our knowledge, thus far, a limited number of articles have discussed or reviewed the current use of AI in medical education. Objective: This study aims to review the current applications of AI in medical education as well as the challenges of implementing AI in medical education. Methods: Medline (Ovid), EBSCOhost Education Resources Information Center (ERIC) and Education Source, and Web of Science were searched with explicit inclusion and exclusion criteria. Full text of the selected articles was analyzed using the Extension of Technology Acceptance Model and the Diffusions of Innovations theory. Data were subsequently pooled together and analyzed quantitatively. Results: A total of 37 articles were identified. Three primary uses of AI in medical education were identified: learning support (n=32), assessment of students' learning (n=4), and curriculum review (n=1). The main reasons for use of AI are its ability to provide feedback and a guided learning pathway and to decrease costs. Subgroup analysis revealed that medical undergraduates are the primary target audience for AI use. In addition, 34 articles described the challenges of AI implementation in medical education; two main reasons were identified: difficulty in assessing the effectiveness of AI in medical education and technical challenges while developing AI applications. Conclusions: The primary use of AI in medical education was for learning support mainly due to its ability to provide individualized feedback. Little emphasis was placed on curriculum review and assessment of students' learning due to the lack of digitalization and sensitive nature of examinations, respectively. Big data manipulation also warrants the need to ensure data integrity. Methodological improvements are required to increase AI adoption by addressing the technical difficulties of creating an AI application and using novel methods to assess the effectiveness of AI. To better integrate AI into the medical profession, measures should be taken to introduce AI into the medical school curriculum for medical professionals to better understand AI algorithms and maximize its use.
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Digital Scholarship – rethinking educational scholarship in the digital world
Article
Full-text available
  • Apr 2019
Medical education is increasingly becoming a digital world, with a range of new technologies that are transforming and challenging our current activities as a medical educator. The purpose of this article is to highlight how technology not only supports teaching and learning but also offers new opportunities for demonstrating the educational scholarship of medical educators.
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Extended Reality in Medical Education: Driving Adoption through Provider-Centered Design
Article
Full-text available
  • Apr 2019
Simulation is a widely used technique for medical education. Due to decreased training opportunities with real patients, and increased emphasis on both patient outcomes and remote access, demand has increased for more advanced, realistic simulation methods. Here, we discuss the increasing need for, and benefits of, extended (virtual, augmented, or mixed) reality throughout the continuum of medical education, from anatomy for medical students to procedures for residents. We discuss how to drive the adoption of mixed reality tools into medical school’s anatomy, and procedural, curricula.
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Reimagining Medical Education in the Age of AI
Article
Full-text available
  • Feb 2019
Available medical knowledge exceeds the organizing capacity of the human mind, yet medical education remains based on information acquisition and application. Complicating this information overload crisis among learners is the fact that physicians' skill sets now must include collaborating with and managing artificial intelligence (AI) applications that aggregate big data, generate diagnostic and treatment recommendations, and assign confidence ratings to those recommendations. Thus, an overhaul of medical school curricula is due and should focus on knowledge management (rather than information acquisition), effective use of AI, improved communication, and empathy cultivation.
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Adaptive Robotic Tutors that Support Self-Regulated Learning: A Longer-Term Investigation with Primary School Children
Article
Full-text available
  • Jun 2018
Robots are increasingly being used to provide motivating, engaging and personalised support to learners. These robotic tutors have been able to increase student learning gain by providing personalised hints or problem selection. However, they have never been used to assist children in developing self regulated learning (SRL) skills. SRL skills allow a learner to more effectively self-assess and guide their own learning; learners that engage these skills have been shown to perform better academically. This paper explores how personalised tutoring by a robot achieved using an open learner model (OLM) promotes SRL processes and how this can impact learning and SRL skills compared to personalised domain support alone. An OLM allows the learner to view the model that the system holds about them. We present a longer-term study where participants take part in a geography-based task on a touch screen with adaptive feedback provided by the robot. In addition to domain support the robotic tutor uses an OLM to prompt the learner to monitor their developing skills, set goals, and use appropriate tools. Results show that, when a robotic tutor personalises and adaptively scaffolds SRL behaviour based upon an OLM, greater indication of SRL behaviour can be observed over the control condition where the robotic tutor only provides domain support and not SRL scaffolding.
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Exploring the implementation of an electronic record into a maternity unit: a qualitative study using Normalisation Process Theory
Article
Full-text available
Background To explore the benefits, barriers and disadvantages of implementing an electronic record system (ERS). The extent that the system has become ‘normalised’ into routine practice was also explored. Methods Qualitative semi-structured interviews were conducted with 19 members of NHS staff who represented a variety of staff groups (doctors, midwives of different grades, health care assistants) and wards within a maternity unit at a NHS teaching hospital. Interviews were conducted during the first year of the phased implementation of ERS and were analysed thematically. The four mechanisms of Normalisation Process Theory (NPT) (coherence, cognitive participation, collective action and reflexive monitoring) were adapted for use within the study and provided a theoretical framework to interpret the study’s findings. Results Coherence (participants’ understanding of why the ERS has been implemented) was mixed – whilst those involved in ERS implementation anticipated advantages such as improved access to information; the majority were unclear why the ERS was introduced. Participants’ willingness to engage with and invest time into the ERS (cognitive participation) depended on the amount of training and support they received and their willingness to change from paper to electronic records. Collective action (the extent the ERS was used) may be influenced by whether participants perceived there to be benefits associated with the system. Whilst some individuals reported benefits such as improved legibility of records, others felt benefits were yet to emerge. The parallel use of paper and the lack of integration of electronic systems within and between the trust and other healthcare organisations hindered ERS use. When appraising the ERS (reflexive monitoring) participants perceived the system to negatively impact the patient-clinician relationship, time and patient safety. Conclusions Despite expectations that the ERS would have a number of advantages, its implementation was perceived to have a range of disadvantages and only a limited number of ‘clinical benefits’. The study highlights the complexity of implementing electronic systems and the associated longevity before they can become ‘embedded’ into routine practice. Through the identification of barriers to the employment of electronic systems this process could be streamlined with the avoidance of any potential detriment to clinical services.
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Award-winning faculty online teaching practices: Course design, assessment and evaluation, and facilitation
Article
The purpose of this study was to identify the course design, assessment and evaluation, and facilitation practices from the perspectives of award-winning online faculty. Aligned with this purpose, we developed a conceptual framework focused on online course design, assessment and evaluation, and facilitation; and review relevant literature in light of this framework. We interviewed eight award-winning online faculty members from across the United States. These faculty received online teaching awards from one of the following professional associations: Online Learning Consortium (OLC), Association for Educational Communications and Technology (AECT), or United States Distance Learning Association. Based on the interviews, it was found that online instructors use a systematic design process, backwards design, considered learner needs, and designed learner interaction during the design process. Faculty recommended using a variety of assessments, using traditional and authentic assessments and used rubrics to assess students, course templates and quality assurance process and surveys, learning analytics, and peer reviews for assessment and evaluation. Timely response and feedback, availability and presence, and periodic communication were some facilitation strategies the award-winning instructors used. We discuss these findings and provide suggestions for future research and practice. These findings can add to what is known about effective online teaching best practices, standards, and competencies.
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eLearning or technology enhanced learning in medical education—Hope, not hype
Article
  • Mar 2016
This Personal View elaborates on my strong conviction that the excitement and positive feelings that many of us have for eLearning or Technology enhanced learning (TeL) is well founded, and will argue why our hopes are justified, and not misplaced. In a nutshell, I believe that eLearning or TeL is a significant advance from previous generations of educational innovation, and offers benefits for students, educators and administrators; by synergistically combining the capabilities of digital content, the Internet, and mobile technology, supported by software and applications or “Apps”.
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Twelve tips for the effective use of videos in medical education
Article
  • Aug 2014
Abstract Videos can promote learning by either complementing classroom activities, or in self-paced online learning modules. Despite the wide availability of online videos in medicine, it can be a challenge for many educators to decide when videos should be used, how to best use videos, and whether to use existing videos or produce their own. We outline 12 tips based on a review of best practices in curriculum design, current research in multimedia learning and our experience in producing and using educational videos. The 12 tips review the advantages of using videos in medical education, present requirements for teachers and students, discuss how to integrate video into a teaching programme, and describe technical requirements when producing one's own videos. The 12 tips can help medical educators use videos more effectively to promote student engagement and learning.
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Improving decision-making with scenario planning
Article
Decision makers struggle with four important contributors to decision failure, namely, 1) bounded rationality, 2) a tendency to consider only external variables, 3) the stickiness and friction of information and knowledge, and 4) mental models that include decision premises or policies. Whether independent or combined, these decision problems can form the ultimate in decision error—folly. The four problems in decision-making are reviewed in detail and scenario planning is posited as a tool for preventing the impact of each, ultimately with an aim of avoiding folly.
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