Contents

Background

The goal of Instructional Design is to utilize technology and multimedia to design, produce, and deliver appropriate instructional products.  Instructional Design in the medical community has been making headway in great strides. Among its humble beginnings is the website known as WebMD. WebMD was established in 1996, and has slowly begun to incorporate varied media in order to enhance the user’s experience. Having been created for the layperson without a medical background, WebMD has been used primarily for self-diagnosis and/or familiarizing oneself with a doctor’s diagnosis. As Instructional Design has evolved in medicine, it is now utilized for the dissemination of medical information intended for audiences more diverse than the typical curious or concerned layperson who visits WebMD. By 2002, instructional design was being widely used in the instruction of medical students. However, in 2013, John Sweller and Jeroen J. G. van Merriënboer pointed to the Instructional Design products available to medical students, indicating a deficit for the considerations of empirical evidence in design methods. They argued that evidence-based practice is a widely accepted norm in the healthcare industry, yet, according to Sweller and Van Merriënboer (2013), “ironically, the same rule is almost routinely flouted when dealing with issues of instructional design in medical education.” It is asserted that the lack of adherence to the principles of Instructional Design (which are based on empirical evidence) can have effects that are at best random, at worst detrimental. 

Designing for Medical Students

While there are many principles of Instructional Design that are relatively ubiquitous, of utmost importance is the necessity to identify one’s audience and their needs. Knowing these factors can help determine the flexibility and depth of material in the learning program. For example, experienced learners can be successful at online learning when the program allows for learner control.  

Principle of Learner Control

Medical students would definitely fall into the category of experienced learners. As such, the best approach to ID in medical education would be to provide students with control over their online learning environment. Learner control in an asynchronous environment can take many forms. Some examples include but are not limited to:

• Pacing Control: Allow the learner to tab through screens or repeat at their own pace.
• Default Mode: Allow the learner to control their pace or select the level at which they enter a lesson, but important lessons remain set as a default.
• Adaptive eLearning: Gauge a starting point by providing a few questions, the answers to which determine the level of entry into the lesson or the necessary topics to cover.  

Principle of Modality

The Modality Principle states that Instructional Design products should present either text or audio along with pertinent graphics. However, because the content of medical education is, by nature, complex, it is important to remember the limitations of the modality principle. When material presented is new, complex, or highly technical, it may be necessary to provide both written text and audio in order to support initial salience. Written text should remain available for access.  

Learning Objectives and Delivery Platform

As Instructional Designers strive to meet the principles of best design methods, they must also consider the objectives of an E-learning program for medical students in order to determine the optimal platform for delivery.

Better preparation

Instructional Design can be used in conjunction with the traditional lecture classroom in order to transform the classroom into a more interactive and meaningful learning setting. Lectures and videos are delivered online, where students may view and review the content asynchronously in order to prepare themselves for a coming class meeting.  In 2012, professors at Stanford University's School of Medicine implemented ID in hopes that it would be a solution to a trend of low attendance at lecture sessions.   

Reconcile geographic challenges  

Students who must do hospital rotations in remote locations are faced with unique challenges. Geographic distance may preclude them from being able to continue the traditional formal classroom education, also known as the “didactic” portion of the studies, at the same time period. Distance learning with ID can make it possible to alleviate this problem. For example, the field of perfusion (where artificial pumps are used to pump a patient’s blood out of and into a patient during open heart surgery) had experienced this geographic challenge and opted for distance learning via several modes of delivery: 

1)  asynchronous online programs for didactic coursework

2)  synchronous didactic lectures 

2)  communication forums between faculty, students, and the clinicians assigned as on-site mentors 

3)  small group problem-based learning modules 

 Wider Collaboration

Online Corporate Training

While separated physically, students can still gain valuable insight from peers and mentors by connecting synchronously in online conference rooms such as Adobe Connect or Go to Meeting. In a study (Wiecha & Barrie, 2002), English general practitioners stationed across the world participated in an online asynchronous program for continuing medical education in the field of diabetes. The program was designed to promote reflection and discussions as facilitated by a faculty member. Practitioners reported changes in practice habits due to the shared online learning. These changes ranged from screening practices, to the prescribing of medications and the tracking of and follow up on diabetic patients. 

A similar study (Wiecha, Vanderschmidt, & Schilling, 2002) among students placed in remote family practice offices found that pre- to post-program gains were greater among asynchronous collaborators as opposed to face-to-face collaborators.   

Further studies by Schellens, Van Keer, DeWever, and Valcke (2009) indicate asynchronous collaboration can be effective in leading to “deeper-level discussions” if the discussions are facilitated by a student peer as opposed to a faculty member. The advantage lies in the assumption that deeper-level discussions lead to better learning.  

(TEDx Talks, 2011)

Self Reflection

As in most professions, self reflection leads to growth. This is also the case among medical students. For this reason it is becoming more and more common to follow didactic coursework with venues through which to self-reflect, often in a collaborative asynchronous forum.

Relationships

Previous to the advent of remote meetings and online instruction, students assigned to remote areas for clinical practice lacked interaction with “the world outside”. The provision of synchronous collaboration and streamed didactic curriculae allow the medical student to stay connected and up-to-date despite their physical distance.   

Reception Among Medical Students

Students report overwhelmingly positive effects of Instructional Design in medical education. They cite the convenience and flexibility of “anytime, anywhere" access and the opportunity to respond to colleagues and superiors given time to consider their answers as reasons for their affinity. Further, there is recognition and appreciation of the rapid dissemination of updates to practice techniques.  

However, even in cases where the performance data indicates no difference, E-learning paramedic students reported better effects than those who learned in traditional settings. E-learning students believed the format was better, even though the content consisted of exactly the same PowerPoint presentation with the same lecture prerecorded (Hubble & Richards, 2006). The same study found that even though students recognize and appreciate the value of Instructional Design for medical education, they still prefer the traditional face-to-face classroom environment.  

Example

Chest X-Ray Interactive Tutorial

Resources

Hubble, M., & Richards, M. (2006, July 1). Paramedic student performance: Comparison of online with on-campus lecture delivery methods. Retrieved April 20, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/17076427  

Mayer, R., & Colvin Clark, R. (2011). 6. Applying the modality principle: Present words as audio narration rather than on-screen text. In E-Learning and the Science of Instruction (3rd ed., pp. 115-129). San Francisco, CA: Pfeiffer.  

Riley, J., Austin, J., Holt, D., Searles, B., & Darling, E. (2004, September 1). Internet-based virtual classroom and educational management software enhance students' didactic and clinical experiences in perfusion education programs. Retrieved April 18, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/15559740 

Schellens, T., Van Keer, H., DeWever, B., & Valcke, M. (2009). Tagging thinking types in asynchronous discussion groups: Effects on critical thinking. Interactive Learning Environments, 17(1), 77-94. Retrieved April 22, 2015, from http://www.tandfonline.com/doi/abs/10.1080/10494820701651757#.VTg0X61Vikp  

Sweller, J., & Van Merriënboer, J. (2013, October 1). Instructional Design for Medical Education. Retrieved April 18, 2015, from http://oxfordmedicine.com/view/10.1093/med/9780199652679.001.0001/med-9780199652679-chapter-7  

TEDx Talks. (2011, April 6). TEDxMaastricht - Lawrence Sherman - Turning medical education inside out and upside down. [Video file]. Retrieved April 23, 2015, from https://www.youtube.com/watch?v=YpSd5u_di9w&t=13m31s

Wiecha, J. & Barrie, J. (2002, September 1). Collaborative online learning: A new approach to distance CME. Retrieved April 16, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/12228097

Wiecha, J., Vanderschmidt, H., & Schilling, K. (2002, September 1). HEAL: An instructional design model applied to an online clerkship in family medicine. Retrieved April 18, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/12228093