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  • E-learning is a really large topic and it is expanding constantly, I will focus on some points relevant to geriatric education
    I will present a couple of Definitions for e-learning and an attempt at a classification, which by the way is a moving target given the rapid pace of advance of educational technology
    I will present a rationale for the use of e-learning in geriatric education
    I will then discuss some general Indications for considering the use, creation or selection of e-learning approaches
    We’ll see some examples of what’s going on in the field of Geriatric E-learning
    And I will end with some ideas for research in this area followed by an example of we can do to advance the field with the…
    Virtual Patients in geriatrics
  • What is the rationale for the use, selection or creation e-learning? Why do we need it?
  • Deliberate practice is the repeated performance of a particular task where feedback on performance is available and the purpose is to improve performance
    Deliberate practice is what makes an expert. In sports, music, chess. Medicine or geriatrics are not different.
    Teaching geriatrics will mean for trainees must see large number of complex patients with multiple comorbidities, medications and functional impairments in diverse settings of care.
    However, we all know that in the limited amount of curricular time, lack of qualified faculty and limited training settings, it is not always possible to get trainees to practice with a number of patients that will guarantee an adequate exposure to the case mix and number patients required to achieve some level of expertise.
    E-learning, and more specifically simulations may offer an alternative approach to expose trainees to a large number of cases and allow the safe practice of diagnostic and therapeutic decisions or performance of procedures under supervision and with adequate feedback.
    I will spend few minutes discussing the basic science in educational technology supporting the use of multimedia e-learning in health care education
  • In response to the high cost of purchase and maintenance of high-fidelity simulators, researchers have begun looking for alternatives.
    According to Matsumoto and colleagues, the key to designing models to teach surgical skills, does not necessarily lie in the ability to reproduce anatomy accurately.
    Instead, researchers must identify the constructs (critical skills) essential to a procedure and incorporate these critical skills into workable models.
    To this end, a low-fidelity model was constructed from a Penrose drain, inverted cup, and two embedded straws in a molded latex portable plastic case as substitutes for the urethra, bladder dome, and ureters, respectively (Fig. ).
    The total cost of the simulator was US$17, or 185-fold less than the cost of a high-fidelity model, large machine with a computer-based imaging system, a example of a sophisticated e-learning approach
    To assess the instructional effectiveness of this novel model, Matsumoto and colleagues randomized 40 medical students to receive either didactic teaching alone or hands-on training involving a low- or high-fidelity ureteroscopy bench model.
    Training sessions were supervised by experienced endourologists. Testing involved removal of a midureteral stone using a semirigid ureteroscope and a basket.
    Blinded examiners using a validated global rating scale checklist evaluated subject performance. Can you guess the outcomes of this experiment?
  • The Association of American Medical Colleges (AAMC) MedEdPortal project recently incorporated the Glassick criteria in its peer review form for educational materials and e-learning materials.
    This group has developed guidelines and a standardized peer review instrument using the consensus of experts in the field—an important step to ensure a coherent and rational peer review process
    About XX geriatric educational resources have been peer reviewed. As part of this process this seal is attached to the product and a suggested format for citation of the peer review resources is provided.
    Furthermore, the AAMC would sent a letter to your dean describing your accomplishments
    The POGOe and CELGI groups have been instrumental in ensuring the success of this process by coordinating and organizing the recruitment of about 70 geriatric peer reviewers.
    Most recently, after Rosanne’s discussions with Dr. Thomas Yoshikawa, chief editor of JAGS as well as Dr. Ouslander as deputy editor and Ken Shay as Associate Editor for the Education and Training Section, an initial decision has been made regarding the possibility of creating a column within the education and training section of JAGS highlighting educational resources which would probably appear as actual citations in the journal enhancing the value of submission for educational scholarship purposes.
    Employee Education Innovation Grant Announcement
  • Transcript

    • 1. 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
    • 2. E-learning in Gerontology and Geriatric Education - Objectives  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 e- learning literature  To discuss the role of e-learning in scholarship  To describe some e-learning initiatives in gerontology and geriatric education
    • 3. Advances in Geriatric E-learning Geriatrics Education  Definitions and Classification  Rationale  Indications  Geriatric E-learning  Research  Virtual Patients in geriatrics
    • 4. Definitions and Classification
    • 5. Definition  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: McGraw-Hill, 2001.
    • 6. Classification Methodologies  Tutorials  Simulations – animations to virtual patients  Hypermedia-Hypertext  Games  Computer-based assessment-practice  Collaborative learning (blogs, wikis) Access & Management  Portals  Databases, repositories  LMS  Search engines  ePortfolios Delivery  CBT, recording media, networks, PDA, eBooks, broadcasting media
    • 7. Rationale
    • 8. Why E-learning?  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):S86-93.
    • 9. Deliberate Practice  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
    • 10. Cognitive Learning Framework  Predominant framework: Many theories?  Explain how the brain processes and stores new information  Working memory: limited  Long-term memory: virtually unlimited  A growing body of empirical evidence  Theories:  Dual-coding theory  Cognitive Theory of Multimedia Learning
    • 11. Cognitive Theory of Multimedia Learning  Principle: Words + Pictures = better learning 1. Dual-channel 2. Limited capacity 3. Active processing (selection, organization, integration)
    • 12. Learning Outcomes from Words and Animations and Words Alone Words + Animations Words 0 20 40 60 80 100 PercentCorrectonProblemSolving Mayer RE, Anderson R. Animations Need Narrations: An Experimental Test of a Dual-Coding Hypothesis. Journal of Educational Psychology. 1991;83:484-490.
    • 13. Isolating the Effects of Words and Pictures by Comparing 4 Treatment Groups 0 10 20 30 40 50 60 70 80 90 100 Control Words only Animations only Words with animations Mayer RE, Anderson R. Animations Need Narrations: An Experimental Test of a Dual-Coding Hypothesis. Journal of Educational Psychology. 1991;83:484-490. PercentCorrectonProblemSolving
    • 14. Indications
    • 15. Curriculum Development Kern 6 Steps: 1. Problem identification and general needs assessment 2. Needs assessment for targeted learners 3. Goals and objectives (competencies) 4. Educational Strategy = e-learning? 5. Implementation 6. Assessment and Evaluation
    • 16. Indications  Instructional gaps (competencies):  Attitudes: Evidence for motivation  Knowledge: Efficient  Skills: It depends  Psychomotor  Social  Clinical Reasoning  What is the critical skill?
    • 17. Critical Skills (Norman) Competency/ Skill/Knowledge Critical element E-learning method Gross anatomy Dynamic 3D visualization 3D animations Physiology Cardiac conduction Simulation Auscultation Heart sounds Tutorial, simulation Cystoscopy Manipulating the instrument Virtual reality simulation? Laparoscopic surgery Touch/haptic feedback Virtual reality Pain Management Clinical reasoning Virtual patients?
    • 18. 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.
    • 19. 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.
    • 20. Geriatric E-learning Content Tutorials Virtual Patients Animations Simulation-Game Animation
    • 21. Geriatric E-learning Content WikiBlog Digital Video Computer-based testing
    • 22. Geriatric E-learning Access GEC Clearinghouse AAMC MedEdPORTAL CELGI Family Medicine Digital Resources Library
    • 23. Geriatric E-learning Access GRECC audioconferences LTC GeriU Florida The GeriatricWeb POGOe
    • 24. Educational Scholarship  AAMC MedEdPortal: Peer Review  AAMC Seal  Letter to your Dean  JAGS Education & Training Section  Educational Resources Column  JAGS Citation  Employee Education Innovation Grant Announcement
    • 25. Research
    • 26. AAMC 2006 Colloquium Findings  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 MedBiq 2007 meeting in Baltimore
    • 27. Comparative ET research  Avoid media comparatives studies  Can be controlled (minimize confounding)  Help us know how to use, improve the new technology (clarification)  Quantitative studies: RCT or quasi- experimental, surveys, systematic reviews  Qualitative studies  Data collection: focus groups, interviews, observation  Data analysis: thematic, grounded theory
    • 28. Key questions for future research – When to?  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. MedBiq 2007 Annual Meeting
    • 29. Key questions for future research - How to?  to teach effectively?  Cog. process  method  design  to match design to objectives?  to effectively use multimedia and fidelity?  can e-learning courses be individualized?  (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. MedBiq 2007 Annual Meeting
    • 30. Key questions for future research Matching method to Critical Skill Lectures, small groups, & CAI / WBL Small group, VP SP HFS Core knowledge Clinical reasoning History, exam, counseling Procedure, team, emergency ?? 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. MedBiq 2007 Annual Meeting
    • 31. GeriVIP: Geriatrics Virtual Patient Aims  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
    • 32. Problem identification Needs Assessment of Target learners Goals and objectives: Competencies Educational Strategy Implementation Assessment and Evaluation Chronic pain in the elderly Internal medicine residents The resident will assess and manage chronic pain in older outpatients with chronic conditions Virtual Patients Primary Care blended e-learning curriculum Assessment: Chart Review, script concordance test, clinical vignettes Evaluation: Effectiveness, efficiency, feasibility, features Geri VIP: Virtual Patients
    • 33. GeriVIP: Geriatrics Virtual Patient Project Authoring tool  WebSP (Karolinska) Initial Themes  Geriatric pharmacology, chronic pain, patient safety Geriatrics and Gerontology Educators  Author, Content Expert, Reviewers, Contributors What institutions get: 1. Access to bank of virtual patients 2. Assistance with submission of VPs to MedEdPORTAL 3. Participation in VP multi-institutional research
    • 34. Conclusions  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 e- learning in geriatrics education  Virtual patients: Research & Education opportunities for collaboration
    • 35. Gerontology and Geriatrics Web Sites  LTC GeriU: http://ltc.geriu.org  POGOe: http://www.pogoe.org  CELGI: http://www.celgi.org  GeriatricWeb: http://geriatricweb.sc.edu/  GRECC Audioconferences: http://www.pogoe.org/GRECC  MedEdPORTAL: http://www.aamc.org/mededportal  GEC Clearinghouse: http://www.nagec.org/resources/  FMDRL: http://www.fmdrl.org/  HEAL: http://www.healcentral.org/