E-learning for a medical undergraduate curriculum: a successful Swiss programme
Marc Sohrmann, François Saucy, Pierre-Antoine Dubois, Salomé Machut, Géraldine Paratte
The fast and continuous evolution of medicine is progressively overwhelming the structure of the undergraduate curriculum in medical studies. More and more topics must be covered, but time is short. To enhance information given in lecture-based classes, we developed an e-learning programme.
Since the 1990s, e-learning programmes have been shown to be a valid alternative to classic lecture-based teaching [1–3]. The advantages of e-learning are various . For students, the use of new technologies permits more interaction and flexibility in learning, as there is no limitation of time or space [1, 4, 5]. Knowledge is no longer restricted to industrialised countries, but can be spread all around the world [6, 7]. For educators, updates are easier, faster and less expensive than with books [1–7]. The initial financial investment is quickly recovered . In addition to ease of access, e-learning has proved to provide better learning achievements and quicker mastery of learning objectives [1–9] when adequately integrated into the curriculum so as to foster clinical reasoning.
As underlined by many educational specialists, medicine evolves much faster than curricula, which leads to old-fashioned and inadequate teaching programmes [10–12]. To meet this need for a constantly growing curriculum, teaching hours are proportionately reduced. In our institution, during the whole undergraduate programme only 6 hours are given to vascular surgery, including interventional radiology and angiology. Therefore, future general practitioners may manage patients inadequately because of their lack of general surgical knowledge on more recent minimally invasive approaches, resulting in inappropriate care.
The development of an undergraduate e-learning programme in vascular surgery and its integration into clinical teaching practice was expected to enrich and complete traditional ex-cathedra classes. Five frequent vascular pathologies were identified:
- Abdominal aortic aneurysm
- Abdominal aortic dissection
- Peripheral arterial occlusive disease
- Carotid stenosis
- Varicose veins
For each condition, an identical schema was developed. The student follows a fictitious patient throughout his/her medical history, and a voice-over narrates the main elements, offering a continuum. Students can watch each video separately and at their own speed, thanks to a play button. In order to facilitate maintenance, potential fast evolving elements were excluded from videos. They are integrated in the e-learning programme under html codes, which are easily modifiable, without complex videos.
Construction of each scenario was identical, with four phases (fig. 1). Between each phase, a summary table gave the main pertinent information. At the end of each script, a multiple-choice question allowed the student to test his/her knowledge.
The five modules were used as a source of information in solving a case-based problem during the practical weeks in the surgical department (first year of Master’s degree).
In 2017, 18 students (n = 64, 28%) completed a written survey containing six questions.
- 94% (17/18) of students were globally satisfied by the e-learning.
- 89% (n = 16/18) found the platform pleasant and easy to use.
- 94% (n = 17/18) agreed that the content of the five modules allowed them to acquire basic knowledge of the vascular pathologies described.
- 83% (n = 15/18) agreed that the content of the five modules was adapted to their level of knowledge.
- 94% (n = 17/18) agreed that the various scenarios permitted them to place pathologies in the context of clinical practice.
- 94% (n = 17/18) found that the information given was sufficient to solve problem-based cases.
Creation and implementation of e-learning in the undergraduate medical curriculum at Lausanne University proved to be successful, despite the need for initial investments in time and money. The known limitations of e-learning programmes – lack of a firm conceptual framework, the need for a high level of self-discipline, the absence of a learning atmosphere, a distance-learning format and often reduced efficiency [4, 13, 14] – were solved by means of various techniques. Identically structured scripts and narratives dealt with the problem of a weak framework. The voice-over became the main thread, which depicted the five medical histories in real situations. Incorporating the e-learning programme into clinical practice with a face-to-face teaching session with an expert in vascular surgery complemented the individual learning.. By this means, students “intrinsic motivation” was stimulated [15, 16]. The new knowledge could be directly applied when following the physician in charge, with a unique opportunity to put into practice newly acquired skills, thanks to the case-based problem. The social and emotional support reinforced by team spirit  was provided by working in groups of two. Critical thinking can be achieved using an e-learning system .
Investment in time and money and a multidisciplinary team including physicians, graphic designers, camera-man/-woman and film editor are needed. A professional approach to medical education is mandatory and should be a development priority of the faculty. In the twenty-first century, information technology must be part of the medical curriculum to answer new generation’s needs and learning processes.
We would like to thank our voice-over Mr Grégory Frank for the quality and professionalism of his work, members of the SAM, Mr Numa Luraschi and Mr Marcello Martelli for their help regarding technical issues and Mr Darcy Christen, chief of the SAM, for his constant moral and financial support, which allowed us to finish this project.DISCLOSURE STATEMENT
No financial support and no other potential conflict of interest relevant to this article was reported.
- Capper J. E-learning growth and promise for the developing world. TechKnowLogia, May/June. 2001. <http://techKnowLogia.org>
- Rossier M. A Concept for eLearning postgraduate and continuous education in laboratory medicine. Electronic learning, Theme 17,2009. www.sulm.ch.
- Hadley J, Kulier R, Zamora J, Coppus SFPJ, Weinbrenner S, Meyerrose B, et al. Effectiveness of an e-learning course in evidence-based medicine for foundation (internship) training. J R Soc Med. 2010;103(7):288–94. doi:https://doi.org/10.1258/jrsm.2010.100036. PubMed
- Bouhnik D, Marcus T. Interaction in distance-learning courses. J Am Soc Inf Sci Technol. 2006;57(3):299–305. doi:https://doi.org/10.1002/asi.20277.
- Childs S, Blenkinsopp E, Hall A, Walton G. Effective e-learning for health professionals and students--barriers and their solutions. A systematic review of the literature--findings from the HeXL project. Health Info Libr J. 2005;22(s2, Suppl 2):20–32. doi:https://doi.org/10.1111/j.1470-3327.2005.00614.x. PubMed
- Schoech D. Teaching over the internet: Results of one doctoral course. Res Soc Work Pract. 2000;10(4):467–86. doi:https://doi.org/10.1177/104973150001000407.
- Cohen EB, Nycz M. Learning Objects and E-Learning: an Informing Science Perspective. IJELLO. 2006;2(1):??. learntechlib.org.
- Moore SA. E-learning: Combien ça coûte? (ne dites pas "ça dépend…"!). E learning Forum 2015.
- Woolf B, Regain W. Knowledge-based Training Systems and the Engineering of Instruction. In: Tobias S. and Fletcher D. training and Retraining: A handbook for Business, Industry, Government and the Military. New York: Macmillan; 2001
- Harden RM. Ten key features of the future medical school-not an impossible dream. Med Teach. 2018;40(10):1010–5. doi:https://doi.org/10.1080/0142159X.2018.1498613. PubMed
- Christensen CM, Eyring HU. The innovative university. San Francisco (CA): Jossey-Bass; 2011.
- Hess FM. Same Thing over and over: How school reformers get stuck in yesterday’s ideas. Cambridge (MA): Harvard University Press; 2010.
- Swan K. Virtual interaction: Design factors affecting student satisfaction and perceived learning in asynchronous online courses. Distance Educ. 2001;22(2):306–31. doi:https://doi.org/10.1080/0158791010220208.
- Mayer RE. Applying the science of learning to medical education. Med Educ. 2010;44(6):543–9. doi:https://doi.org/10.1111/j.1365-2923.2010.03624.x. PubMed
- Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Contemp Educ Psychol. 2000;25:54–67. This seems to be a combination of two articles: citation details for the title you have given are Am Psychol. 2000;55(1):68-78; The citation info. you give corresponds to an article entitled Intrinsic and Extrinsic Motivations: Classic Definitions and New Directions. Which article do you want?
- Ericsson KA, Krampe RT, Tesch-Römer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev. 1993;100(3):363–406. doi:https://doi.org/10.1037/0033-295X.100.3.363.
- Haythornthwaite C. Exploring multiplexity: Social network structures in a computer-supported distance learning class. Inf Soc. 2001;17(3):211–26. doi:https://doi.org/10.1080/01972240152493065.
- Anderson-Meger J. Critical Thinking and E-Learning in Social Work Education International Journal of Business. Hum Technol. 2011;1(2):17–27.