Elearning in Gerontology and Geriatric Education Jorge G

E-learning in Gerontology and Geriatric Education Jorge G. Ruiz, MD, FACP Associate Director for Education/Evaluation, VA GRECC, University of Miami Miller School of Medicine and Stein Gerontological Institute Miami, Florida

E-learning in Gerontology and Geriatric Education - Objectives l l To discuss the rationale for the use of e-learning and the educational theories, principles, or features that should be considered when developing effective e-learning To recognize the most significant gaps in the elearning literature To discuss the role of e-learning in scholarship To describe some e-learning initiatives in gerontology and geriatric education

Advances in Geriatric E-learning Geriatrics Education l l l Definitions and Classification Rationale Indications Geriatric E-learning Research l Virtual Patients in geriatrics

Definitions and Classification

Definition l l l E-learning refers to the use of Internet technologies to deliver a broad array of solutions that enhance knowledge and performance Web-based learning, online learning, distributed learning, computer-assisted instruction, or Internet-based learning. Multimedia E-learning: the use of words and pictures in e-learning Rosenberg M. E-Learning: Strategies for Delivering Knowledge in the Digital Age. New York: Mc. Graw-Hill, 2001.

Classification Methodologies l l l Tutorials Simulations – animations to virtual patients Hypermedia-Hypertext Games Computer-based assessment-practice Collaborative learning (blogs, wikis) Access & Management l l l Portals Databases, repositories LMS Search engines e. Portfolios Delivery l CBT, recording media, networks, PDA, e. Books, broadcasting media

Rationale

Why E-learning? l l l Effective – at least as good as traditional instruction (multimedia e-learning? ) Efficient – Obvious Cost-effective - may be Accessible – definitely Deliberate Practice Chumley-Jones HS, Dobbie A, Alford CL. Web-based learning: sound educational method or hype? A review of the evaluation literature. Acad Med. 2002; 77(10 Suppl): S 86 -93.

Deliberate Practice l l The repeated performance of a particular task where feedback on performance is available and the purpose is to improve performance Geriatrics: Seeing lots of patients Case-mix: May not be possible E-learning approaches may offer alternatives for the acquisition of expertise Ericsson, K. A. , Krampe, & Tesch-Romer. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3). pp. 363 -406

Cognitive Learning Framework l l Predominant framework: Many theories? Explain how the brain processes and stores new information l l Working memory: limited Long-term memory: virtually unlimited A growing body of empirical evidence Theories: l l Dual-coding theory Cognitive Theory of Multimedia Learning

Cognitive Theory of Multimedia Learning l Principle: Words + Pictures = better learning 1. Dual-channel 2. Limited capacity 3. Active processing (selection, organization, integration)

Percent Correct on Problem Solving Mayer RE, Anderson R. Animations Need Narrations: An Experimental Test of a Dual-Coding Hypothesis. Journal of Educational Psychology. 1991; 83: 484 -490.

Percent Correct on Problem Solving Mayer RE, Anderson R. Animations Need Narrations: An Experimental Test of a Dual-Coding Hypothesis. Journal of Educational Psychology. 1991; 83: 484 -490.

Indications

Curriculum Development Kern 6 Steps: 1. 2. 3. 4. 5. 6. Problem identification and general needs assessment Needs assessment for targeted learners Goals and objectives (competencies) Educational Strategy = e-learning? Implementation Assessment and Evaluation

Indications l Instructional gaps (competencies): l l l Attitudes: Evidence for motivation Knowledge: Efficient Skills: It depends l l Psychomotor Social Clinical Reasoning What is the critical skill?

Critical Skills (Norman) Competency/ Skill/Knowledge Gross anatomy Critical element E-learning method Dynamic 3 D visualization 3 D animations Physiology Cardiac conduction Simulation Auscultation Heart sounds Tutorial, simulation Cystoscopy Manipulating the instrument Touch/haptic feedback Virtual reality simulation? Virtual reality Laparoscopic surgery Pain Management Clinical reasoning Virtual patients?

Matsumoto 2002 Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol. 2002; 167(3): 1243 -7.

Matsumoto 2002 Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol. 2002; 167(3): 1243 -7.

Geriatric E-learning Content Animation Virtual Patients Animations Simulation-Game Tutorials

Geriatric E-learning Content Blog Wiki Digital Video Computer-based testing

Geriatric E-learning Access GEC Clearinghouse CELGI AAMC Med. Ed. PORTAL Family Medicine Digital Resources Library

Geriatric E-learning Access GRECC audioconferences LTC Geri. U Florida The Geriatric. Web POGOe

Educational Scholarship l AAMC Med. Ed. Portal: Peer Review l l l JAGS Education & Training Section l l l AAMC Seal Letter to your Dean Educational Resources Column JAGS Citation Employee Education Innovation Grant Announcement

Research

AAMC 2006 Colloquium Findings l l Educational technology is widely used in medical education & has many advantages The current evidence base is anemic There are research-based guidelines for multimedia and human-patient simulation We should not ask “Does it work? ” but rather, “How and when is it most effective? ” From Chris Candler MD presentation during the Med. Biq 2007 meeting in Baltimore

Comparative ET research l Avoid media comparatives studies l l Can be controlled (minimize confounding) Help us know how to use, improve the new technology (clarification) Quantitative studies: RCT or quasiexperimental, surveys, systematic reviews Qualitative studies l l Data collection: focus groups, interviews, observation Data analysis: thematic, grounded theory

Key questions for future research – When to? l l l l Replace or augment existing course? Use specific modalities? facilitate learning in clinical practice (just-in-time learning)? Use group vs. individual work? Use real pt vs. simulation? Use mandatory vs. optional? Get instructors to have additional training? Use in postgraduate training / CME? From David Cook, MD presentation The Research Agenda: The failure of research in educational technology to inform practice, and what we can do about it. Med. Biq 2007 Annual Meeting

Key questions for future research - How to? l l l to teach effectively? l Cog. process method design to match design to objectives? to effectively use multimedia and fidelity? can e-learning courses be individualized? l (adaptation vs. autonomy) can design be automated? do we assess learning? From David Cook, MD presentation The Research Agenda: The failure of research in educational technology to inform practice, and what we can do about it. Med. Biq 2007 Annual Meeting

Key questions for future research Matching method to Critical Skill Lectures, small groups, & CAI / WBL Core knowledge Small group, VP SP HFS History, exam, counseling Procedure, team, emergency ? Clinical reasoning From David Cook, MD presentation The Research Agenda: The failure of research in educational technology to inform practice, and what we can do about it. Med. Biq 2007 Annual Meeting

Geri. VIP: Geriatrics Virtual Patient Aims l l l To collaboratively develop geriatric virtual patients to address key content and competency areas in geriatric education. To share geriatric virtual patient as part of a VP “bank” To investigate the effectiveness, efficacy and efficiency of virtual patients in geriatric education

Geri VIP: Virtual Patients Problem identification Chronic pain in the elderly Needs Assessment of Target learners Internal medicine residents Goals and objectives: Competencies The resident will assess and manage chronic pain in older outpatients with chronic conditions Educational Strategy Implementation Assessment and Evaluation Virtual Patients Primary Care blended e-learning curriculum Assessment: Chart Review, script concordance test, clinical vignettes Evaluation: Effectiveness, efficiency, feasibility, features

Geri. VIP: Geriatrics Virtual Patient Project Authoring tool l Web. SP (Karolinska) Initial Themes l Geriatric pharmacology, chronic pain, patient safety Geriatrics and Gerontology Educators l Author, Content Expert, Reviewers, Contributors What institutions get: 1. Access to bank of virtual patients 2. Assistance with submission of VPs to Med. Ed. PORTAL 3. Participation in VP multi-institutional research

Conclusions l l l l E-learning: effective, efficient, accessible Deliberate practice especially relevant Cognitive psychology-learning basis Accumulating evidence-base Geriatrics E-learning: content and access Research: Wide open – when and how to use elearning in geriatrics education Virtual patients: Research & Education opportunities for collaboration

Gerontology and Geriatrics Web Sites l l l l l LTC Geri. U: http: //ltc. geriu. org POGOe: http: //www. pogoe. org CELGI: http: //www. celgi. org Geriatric. Web: http: //geriatricweb. sc. edu/ GRECC Audioconferences: http: //www. pogoe. org/GRECC Med. Ed. PORTAL: http: //www. aamc. org/mededportal GEC Clearinghouse: http: //www. nagec. org/resources/ FMDRL: http: //www. fmdrl. org/ HEAL: http: //www. healcentral. org/