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  • The original iPad. To highlight the even changing nature of technology and the costs therein. Technology for education changes all the time yet clearly the change is happening at an ever increasing rate.
  • Projectors, standard stand-alone microscopes, were the emerging technologies of the day. An example of changing methodologies will be mentioned again, but the UIUC Vet Med school has stopped using physical microscopes and replaced the method of viewing slides with virtual slides. Real physical slides are sent to the company Aperio to be converted to high-resolution images and then made available for students to view via a computer.Correspondence courses have been around for a long time and have adapted to newer technologies. While they once incorporated solely the printed word that was sent to students via postal mail, today they incorporate more efficient modes of delivery. An example of this is the University of Wisconsin-Madison Continuing Studies for the Aging and Long-Term Care Administration certificate. Today the program consists of 12 hour long lectures on CD, accompanied by corresponding outlines, readings and assignments. Another example is University of North Carolina and their Nurse Refresher Program.Distance learning via correspondence course using postal mail was used even in the past couple of decades for subjects like respiratory care.
  • Robin, B. R.; McNeil, S. G.; Cook, D. A.; Agarwal, K. L.; and Singhal, G. R. (2011). Preparing for the changing role of instructional technologies in medical education. Academic Medicine, 86(4), 435-439.The quickly changing trends in higher education require us to completely rethink and restructure the way we deliver educational content. It will be a transformation, and it will occur in many ways. Much of it will involve new technologies, both as the object of instruction and for the purpose of facilitating and assessing learning.Five recommendations for supporting faculty in using instructional technologies were developed from a conference that was held in February 2010 “A 2020 Vision of Faculty Development Across the Medical Education Continuum.” First, here are the trends:1: The explosion of new information / The world’s body of knowledge doubled between 1800 and 1900. By 1940, the doubling rate was every 20 years. It’s been estimated that by 2015, the body of knowledge in the world will double every 35 days. Similar to this, the amount of new medical information has been estimated to double every 3 years. Rather than having education end at the completion of school, internships and residency, new physicians face a lifelong task of processing, understanding, and using a dizzying amount of new medical information.2. Digitization of all information / Futurists suggest that the next gen of computer users will be able to access any information at any time and from any place. This has already begun for the most part. Some hindrances: concerns about legal, ethical, privacy issues3. New generation of learners / Medical educators usually fall into one of three categoriesDigital Natives – born into a digital world and speak the language of technology fluently, as a native tongue. Their use of and attitude towards technology is dramatically different than those of their parents and teachers. They expect their education to reflect various levels of tech integration.Digital Immigrants – those who learned to use technology after finishing a formal education without continuous access to computers. Most of these people now use digital technologies, but with “an accent” – similar to someone who learned a new language as an adult.Digital Settlers – those who were not born digital but who live digital anyway. They feel comfortable using technology for professional and personal use and their “accent” is less pronounced than that of the digital immigrantsTraditionalist – these people grew up without technology and have not embraced it as part of their teaching.4. Emergence of new instructional technologies – The digital natives and the instructors who teach them are faced with an ever-increasing set of technological tools and resources designed to complement teaching and learning. While this is exciting, it’s also stressful. The task for educators is to learn how to use these technologies effectively. With technologies like video, users are not passive anymore. They are creators of content. Instructors can use the various technologies today like blogs, wikis, podcasts, virtual environments, etc. to offer both educators and students new ways of teaching and learning. Virtual patients and high-fidelity simulations were unimaginable just a few years ago.5. Accelerating change – Forecasts – by 2020 there will be no need for a keyboard and mouse. This might be happening even quicker as Apple is allegedly working on a version of their operating system that will work with touch screens for desktops – following the success of touch technology like iPads and smartphones, and Microsoft created Surface – their version of a computer without a mouse or keyboard but extremely rich visualizations and interactive elements.More trends: http://chronicle.com/blogs/wiredcampus/new-media-consortium-names-10-top-metatrends-shaping-educational-technology/35234Economic pressures and new models of education are bringing unprecedented competition to the traditional models of higher education.
  • Robin, B. R.; McNeil, S. G.; Cook, D. A.; Agarwal, K. L.; and Singhal, G. R. (2011). Preparing for the changing role of instructional technologies in medical education. Academic Medicine, 86(4), 435-439.RecommendationsUse technology to support learning – faculty should use technology to provide and support experiences for learners that are not otherwise possible. Not as a replacement for f2f, but as a supplement to them. It’s been well-established that instructional tech like e-learning can facilitate effective learning. This seems to be true for other tech like simulations. This is not to say that all learning should be e-learning. E-learning as an example has its disadvantages. It just makes learning possible to overcome the barriers of time and distance. Often the most effective instructional designs include both traditional and technology-enhanced methods. The question is not whether to use technology to enhance education, but when and how.Focus on fundamentals – faculty should not try to stay abreast of every technological change in gadgets, software programs, etc. They should focus on the learners’ needs and course objectives. Then try to tie in technology to support their approach. Technology is a tool and faculty can work with instructional designers to help select the correct tools with which to use for the outcome desired.Allocate a variety of resources – schools should educate faculty about the technologies being used by students and help them to learn how to use technologies as they need. Faculty members should be content experts, but they do not have to be technology experts.Support and recognize faculty as they adopt new technologies – Schools should support faculty as they adopt new technologies and enable them to become comfortable with the technologies that students use.Foster collaboration – faculty should be able to share and discuss innovations, best practices, and implementation plans for the use of instructional technologies with other faculty. An example of this is MedEdPORTAL
  • Analog  DigitalThe primary format of information capture and dissemination has changed from analog to digital. Try to find music recorded on vinyl or movies recorded on VHS tapes because MP3 (for music) and DVDs (for video) are the most widely used formats – and even these formats are giving way to truly digital formats – no physical mediaMusic, phones, tv, newspapers, movies, journals, communications, defense/intelligenceOne area at Rush where this probably has made an impact are programs like Audiology and Speech Pathology, but certainly has impacted all areas of education – being able to record on vinyl – to being able to record for CD/DVDs to being able to record via purely digital formats.Tethered  MobileBeing tied physically to a specific place has given way to activities becoming more spatially accommodating. Wireless devices allow us to do many of the activities we used to need to do on a laptop or desktop computer. Battery technologies are getting better and better, allowing us to be less tethered to a wall by a power cord.Phones, Internet Access, EmploymentAll areas of education have been impacted by mobile technologies – from apps that could be useful for students in a Clinical Nutrition program to devices with extremely high resolution for ultrasound or imaging.Closed  OpenOpen source software has freed organizations from having to use closed services like Microsoft Office. Data that was once unavailable to the general public, like GIS data now flows freely. Software, operating systems, applicationsData (GIS) – can impact research – being able to see more specific demographic information in mapping applications, brings to light a whole different way of looking at dataContent (blogs, wikis, etc.)Isolated  ConnectedAn example of this is reference lists at the end of research articles. In the very recent past, they were simply lists of articles meant to be looked up at the library by the student. Today, digital articles have similar reference lists – and the references are now hyperlinks which directly connect the student to the sources they cite. Services like Facebook, Skype, texting, connect people in real time. People are more connected to people, content is more connected to content.People, content, systemsConnected: You can’t connect to something if you don’t have access to itGeneric  PersonalPersonalization of everything. Instead of purchasing a laptop off the shelf as is, today we can customize it completely online before purchase, to the point of choosing the color the outside of the computer.Cars, computers, mobile phonesPersonal: You can’t adapt or make something local if you don’t have the rights to modify itConsuming  CreatingCreating books, movies, music, and today podcasts, were once not available to the general public. The costs of producing and distributing information has almost disappeared. On-demand print publishing, Apple’s iBook creator as examples have made publishing a book much easier than ever and putting the regular joe in competition with publishers. Almost all mobile phones on the market today come with cameras – making it easier to take photos and video. Hosting sites like YouTube and Flickr or Instagram allow anyone to distribute images. “We no longer simply read and watch – we now write, produce and publish, too.”Radio/podcasting, screencasting/vodcasting, newspapers/blogs, moviesCreate: You can be creative but if there is no outlet for your work, what’s the point?To do some research on the effects of educational technology and the impact on medical or health sciences education, I did a search in PubMed using the following MeSH terms: “Educational Technology” and “Education, Medical.” I focused on the free-full text results (433 of them) but there were 3556 total results (3/2/2012)Educators know that millennial students, those born between 1980 and 1994, are technologically adept, stressed, high-achieving, confident and self-assured. They demand convenience.Higher education should include increases in connectedness, personalization, participation and openness. Examples of how this affects education: If a student wants to review material from an online course they took the previous semester, which is located in the university CMS, he probably cannot, because they are not registered for that course this semester. If the professor for the current semester relies on the student knowing material they learned in a previous semester, this will be challenging because the connectedness has been shut down.Another hindrance – will professors be more open to students creating content for coursework such as videos?
  • Not only has the design of lecture halls changed, but the technology that they are equipped with has changed dramatically.College of Pharmacy at UIC-Rockford – brand new classroom with blended learning capabilities. i.e. Ability to teach face-to-face as well as via distance education at the same time. This is becoming more the norm and other UIC health sciences colleges are following suit. Colleges of Dentistry and Pharmacy are two of them (Chicago) An example of the College of Pharmacy is the way the streaming video portion works. If the professor is standing in a particular spot in the front of the room, the camera stays closer onto the professor. If the professor moves out of the particular spot, the camera goes to a more wide-angle view. This allows the students watching the video to see if the prof is perhaps writing on a whiteboard or demonstrating something at the front of the classroom. This computer lab has no dedicated computers, but students can bring in their own mobile devices (whether that is a laptop, smartphone, tablet, etc) and hook it up to power and the wireless connection.Some other examples of innovations in classrooms: http://www.steelcase.com/en/products/category/educational/learnlab/pages/learnlab.aspx. Classrooms today must support frequent collaboration and communication, easy transfer of information between individuals and groups, the effective display of content and the need for teams to constantly reconfigure and switch between different ways of working. These are the demands that the LearnLab environment was designed to meet. Interesting concept – a triangulated room where students can see each side of the room easily. Each wall of the triangulated room can come with whiteboards and smartboards for collaboration. Rather than the standard model of having a white board at the front of the room, this makes the walls of the room essentially a giant white board. The UIC College of Dentistry has built a Learn Lab based on this model. http://www.uic.edu/htbin/cgiwrap/bin/uicnews/articledetail.cgi?id=16119“Students can complete group work on moveable whiteboards at their tables, then attach them anywhere in the room to show the class. Copy-cam technology can take a snapshot of students’ whiteboard notes and post it online. Retractable power cords near each table provide outlets for students’ laptops.”Most lectures have been eliminated in favor of more active learning, based on small groups and patient scenariosNOTE: Add info about was it the UIC School of Dentistry and the pods? Also the info from UW Whitewater (EDUCAUSE) and the SMART board etc.How do they impact education? It allows for more direct collaboration with fellow students as well as instructors for optimal learning.Flipped ClassroomsFlipping the classroom refers to the practice of posting pre-recorded lectures online for students to view at their own pace before attending class in person – thereby dedicating class time to active learning.Shifts the instructor from the ‘sage on the stage’ to the ‘guide on the side.’ This is something Vanderbilt University Medical College is exploring.Institutions that adopted the flipped classroom model have already seen significant positive results, including significant decreases in the number of students who earned failing grades.New models of blended and online coursesiTunes UOpen UniversityThe concept of the Open University is not to be an alternative to degree or credit courses, but to augment learning. Carnegie Mellon University offering open and free courses via their Open Learning InitiativeSample course: Statistics – not led by an instructor but according to Carnegie Mellon, comparable to classes offered for credit and taught by a professor. The modules are web-based where you progress from screen to screen. The courses are continuously being updated by not only the instructors who create the courses, but via feedback from the students. Instructors can use the Open Learning Initiative to augment their pre-existing classes.Another example is MIT. They have over 2000 open courses of which some are in the Health Sciences and Technology subject area and include topics like Biomedical Computing and other Informatics courses. An off-shoot of this is the Khan Academy. They include 3000 + videos on almost anything from arithmetic to physics. In the Healthcare and Medicine area, they have videos including topics like: Glucose Insulin and Diabetes, Bacterial Meningitis, Ritual of the Bedside Exam and more. These are not full-fledged courses, more just small bursts of information.For ProfitExample: Western Governors University WashingtonFor-profit – which in the face of lower funding being offered to state schools is looking more attractive to some students. State schools losing funding means the quality of the educational technologies available might be falling down compared to private institutions or for-profit schools.In their College of Health Professions, they offer Bachelors degrees in Nursing with RN to BSN Online and BS in Health Informatics and Masters Degrees.Additional changes to the classroom:Creating a culture of collaboration – collaborating with other departments if your department doesn’t have a way to fully produce a course.Example of this – Professor A decides to create a podcast for their class, but doesn’t really have a way to capture the podcast and then produce it. Their department may have the technology to capture the podcast, and then they can collaborate with department B on producing it. Be sure to mention upgrades to 303 and incorporating student/audience micsOther examples of lecture capture include Echo360University of Wisconsin – Whitewater created a technology sandbox or what they call a Collaboratory. It includes SMARTboards, an LCD Gaming Space, a flexible classroom for “pod” work (revisit UIC Dentistry article), CISCO technology to enable two-way videoconferencing. They also have a wall whiteboard using whiteboard paint so if someone accidentally uses the wrong marker for the wall, they can easily paint over it. Something else from SMART they have incorporated is the SMART Table Interactive Learning Center which can be used with wall hanging SMART boards.Blended Learning in the allied health program at Virginia Commonwealth UniversityUsing distance education as the sole delivery method for doctoral work has been an ongoing debate in academia. One main reason is that student-faculty interaction is considered critical for building concrete research skills. VCU introduced blended learning, or hybrid education which integrates distance and traditional face-to-face instruction with reduced in-class seat time for students. BL environments typically involve a portion of a class that is delivered on-sties with instructor present, and another part that is delivered through electronic means. Blended learning is being used more often to overcome the weaknesses that strictly distance education sometimes have…Some of the departments that have incorporated it at VCU: Nurse Anesthesia, Occupational Therapy, Patient CounselingSeveral courses had to be improved, including those involving statistics (NOTE: Personal Experience)Blended / Hybrid continuing education at University of Washington for nursing education – online static modules vs live modules, etc.
  • Not everyone uses the out of the box solutions like Blackboard or D2L. Some institutions have created their own versions of synchronous and asynchronous learning applications.Sakai: http://sakaiproject.org/community of educators collaborating to create open software that advances teaching, learning and researchSakai Open Academic Environment is an open-source platform that promotes collaboration and sharing between usersCreating, authoring, reuse, presentation, commenting, mashups of content – remixing ideasMoodle: http://moodle.org/CamtasiaBlackboardWimba Voice Tools for Blackboard Learn – now called CollaborateUIC uses Wimba Voice Tools for Blackboard Learn – a suite of audio tools that take in-line mic input and audio file uploads to support: --voice authoring that can be dropped on any BBLearn content area--audio podcasts by faculty, teaching staff and students--voice announcementsDesire2LearnInstructure Canvashttp://www.instructure.com/Pearson's OpenClasshttp://www.joinopenclass.com/open/home/indexOpen Class is a fully cloud-based LMS – and it’s free.InteractyxTopyxUniversity of Chicago Section of Developmental and Behavioral Pediatrics chose Interactyx Limited Topyx LMS as a solution to providing courses around key curriculum required by various accrediting bodies and providing forums for communities of practice to share cases and points of view in real-time. They are testing it out for a 2-year term.http://interactyx.com/social-learning-blog/university-of-chicago-chooses-interactyx-limited’s-topyx-elearning-solution/KnoodleKnoodle provides a cloud-based social presentation, training, and learning management system in a single platform.  Deliver more effective and engaging online training and presentations to your target audience within minutes by using a combination of slides, video, audio, images, surveys, tests, multiple delivery options, and data analytics. Cloud Computing has intersected with all types of learning activitiesStudents can share documents via DropBox or Box.com. A new product called SugarSync is similar to Dropbox but has versioning which could be very useful for group projects. Some students also use Google Docs for group work/collaboration. Some recent issues with Dropbox are apparently ones that involve Homeland Security so in the audience at EDUCAUSE, many institutions have recommended to students to NOT use Dropbox. There are obviously HIPAA concerns with using cloud technologies so the institutions must make proper use guidelines available to students.
  • Whether it is Continuing Medical Education or Continuing Nursing Education or Allied Health CE, ways to obtain CE are available across a wide-variety of topics as well as formats.Continuing Medical EducationRush as an example, has different formats to achieve learning that includes lectures, procedure-oriented seminars, diagnostic case studies, labs and workshops. Some courses are available to be completed online.Other organizations like the American Medical Association offer CME as well and offer live in-person events and what they term Internet Point of Care Learning.Nursing Continuing EducationExample: http://ce.nurse.com/- Gannett EducationOffers continuing education in a variety of formats like text, audio, webinarSample courses: Preventing Medical Errors for Nurses, Domestic Violence Advocacy, etc. – some state specific coursesThey also offer a number of free courses via podcasts which are available in the iTunes store, which can then be downloaded to a mobile device.Other examples include University of Washington Continuing Nursing Education which offers many CE opportunities via face-to-face classes and workshops as well as via streaming media sessions using Adobe Connect – Like other universities, Rush University offers CE on a variety of topics including complementary and alternative medicinesAllied Health Continuing EducationExample: http://www.continuingeducation.com/ - Gannett EducationOffers web-based CE for various professions like Dietician, Nursing, Occupational Therapy, Respiratory Therapy, EMS, physical therapy, pharmacy, etc.Example: Marfan Syndrome - credentialed for Occupational Therapy for 1.0 contact hour.A different take on changes to continuing education – and not necessarily for actual credit, is keeping up with news and innovation. Physical Therapist taking ongoing education classes from Evidence in Motion – one aspect of keeping up with news and innovation – suggested to students to use Twitter to follow vetted Tweeters and to follow specific hashtags. From the literature, radiologic technologists, nurses and other health care professionals use Twitter to connect to their professional communities and to stay abreast of current topics. Accreditation organizations such as the Joint Commission on Accreditation of Hospitals and Organizations regularly tweet about policy changes and other items of interest to followers. Twitter was also used during the 2010 earthquake disaster in Haiti for people to stay abreast of health care needs. Some nurses tweet about clinical best practices and health care educators use Twitter in the classroom, asking students to post comments and questions to the website weekly. Using these tweets, discussions can be help in the classroom based on them. During a nursing conference, attendees were encouraged to use Twitter throughout the conference. The health care community is embracing the enormous potential of Twitter and other social media websites to stay connected and enhance professional knowledge and overall patient care.Mobile Technology in CME: ReachMD is an app available for Blackberry and Apple products, You can listen to podcasts via Android phones only, currently.Free access to the live stream of ReachMD XM Satellite Radio Channel 167, the channel for medical professionalsAccess to over 5,000 searchable podcast of past and present ReachMD audio programs based on your specialty or area of interestEpocrates CME App has over 100 CME activities available for Apple devices, or online.Skyscape is another exampleVirtual Microscopy: http://vetmed.illinois.edu/net/?q=node/316Using newer services like Aperio introduces changes to histology labs. Aperio reduces the need for microscopes and slides. The Vet Medicine school at UIUC got rid of their microscopes in fact, and are using virtual microscopy. **DO other schools use this?**Challenges – Med Schools seem to be really focusing on educational technologies and other programs, less so. A challenge in areas like for Respiratory Therapist training is not offered via distance education as often as other programs. Reasons for this, is that online instruction may not be a good match for certain areas like RT. The challenge is, to be able to reach a viable audience for certain program areas, how to make the topics fit the technology?Instructional DesignersInstructional Designers and Curriculum Design: At Rush, the instructional designers work closely with faculty to help them to create better classes using appropriate technologies. Currently we have one instructional designer on site (interviewing for a second one). She assists faculty with many different types of details surrounding their courses. She helps them to figure out best practices with course design in the virtual environment (Blackboard/RULearning) as well with using the various tools that are available. Ancillary programs that work well with BB that she also assists with: Impatica (PowerPoint narration), Clickers,
  • Examples: Marquette University – College of MedicineIn the Simulation Lab, nursing students can enhance their learning and professional preparation. They applied creative use of environment, equipment, high tech manikins, as well as actors to develop realistic simulations of patient care events. Regional Partnership to Promote Nursing Instructor Competence and Confidence in Simulation (article)Clinical simulation is an innovative, research-based instructional strategy, and many faculty report not being adequately prepared to use this type of teaching strategy. Instructors in both academia and hospital staff development report reluctance to incorporate this new teaching methodology into the curriculum because they have negative attitudes about their own level of competence and confidence in using the simulators with students. Instructors clearly require training to help them understand the pedagogy, educational theory, and effective use of high- fidelity manikins. To promote simulation as a teaching strategy, a partnership was formed between academia (associate degree in nursing/bachelor of science in nursing) and staff development departments to train their instructors in an efficient, effective, and timely manner. After the initiative, most instructors who were once intimidated by the technology surrounding high-fidelity simulators became more engaged with simulation when exposed to a pedagogical approach that involved varying levels of simulation and types of tools. This became the Gulf Coast Regional Nurse Educators Consortium (gcrnec.org)Photo on right: This is a recent innovation from the University of Pittsburgh Simulation and Medical Technology R&D Center. Their augmented reality model superimposed a multilayer surgical anatomy field onto a mannikin-based simulator.http://clinicalplayground.com/?p=582Other types of simulation which aren’t exactly augmented reality, include products by companies like Laerdal, http://www.laerdal.com/us/nav/36/Medical-Education. There are patient simulators, patient care manikins, venous/arterial access and anatomical models and charts. One of the interesting ones is the Infant Virtual I.V. which is a self-directed learning system for mastering intravenous catheterization in infants. Virtual infants respond with bleeding, swelling, bruising from blown veins, and other complications.
  • IUPUI example: Medical students in their clinical years have to use a mobile tracking system designed by the Educational Technology department to track their clinical encounters, which often means students are coming to visit ET staff at the beginning of their third year. Some examples from two institutions in the Midwest that have incorporated mobile technology into the curriculum:UMN Duluth received a $2.3 million Health Resources and Services Administration grant aimed at increasing electronic learning within the curriculum, and used the money to buy iPads for the 62 first-year med school students as well as the faculty. The iPad was chosen due to the high percentage of medical apps for the device, as well as its portability. The school plans to use the grant to fund iPads for the next four years of new medical school students.Students use the iPad to download digital portions of their courses. Professors encourage students to download free apps and create running lists of their favorites. The school plans to base future guidance for app recommendations on end of the year surveys that will pull from the experiences of this first class of iPad equipped medical students.OSU:Since 2009, the Ohio State College of Medicine has provided students with iPhones and iPod Touches as part of their curriculum. The program was the initiative of a third-year med student. The devices come preloaded with medical software picked by the college, including Epocrates, eResults, and e*Value apps. The school also records podcasts of class lectures for on demand review.The school has been equipping students with mobile devices since as early as 2000, however, legacy PDA devices did not allow students to download and view podcasts of lectures like the Apple devices could.http://mobihealthnews.com/12346/nine-medical-schools-that-support-mobile-learning/
  • Describe my experience with using smartphone technology to read articles for MPH. Last semester, I printed out every article so I could take notes on it, rather than use the iPad. This semester, I tried to not print out any of the articles required for class. There is an app for the iPad called GoodReader. With this app, you can pull pdfs, word docs, ppts, etc. off of various cloud-based storage like Dropbox or Box.net. So I have both Dropbox as well GoodReader on my iPad. First, from Blackboard on my desktop, I can save readings for class to Dropbox. Then I can decide which folders full of readings, etc. to sync between Dropbox and GoodReader. In GoodReader, I can annotate, highlight, etc. and then sync back to Dropbox. If I want to, I can then open up the PDF file from Dropbox, on my laptop or desktop and the annotations will be there. It’s pretty slick and has made it so I have not printed out any articles this semester. The other benefit is I have all of the readings for this semester with me pretty much at all times. I have also been able to use Blackboard on various mobile devices, though the app leaves a lot to be desired. A big “fail” with Blackboard for iPad is that if I want to save PDFs of readings from the course, Dropbox is not one of the options. Save my reading to the Groceries app? Huh? VisualDx Mobile for the iPad: VisualDx Mobile for the iPad takes full advantage of its high-resolution, backlit-LED screen and its versatility to view in both portrait and landscape. The app’s thousands of medical images are strikingly rich and crisp in the iPad environment. With the app’s split-screen pane, users can see the differential changing as they enter each sign and symptom or view multiple images of each disease alongside clinical text such as Best Tests, Management Pearls, and Therapyhttp://www.medicalnewstoday.com/articles/242843.php – section - iPads in Medical EducationAnother environment that seems to have taken the iPad to its bosom is medical education. At first it was just a tool that students brought with them of their own initiative: but more and more medical schools are now switching to iPad as the main platform for delivering the curriculum. But, what starts out as an initiative to make campuses greener, is beginning to deliver other unexpected benefits, such as cost savings and improvements to the learning process itself. Take Yale School of Medicine, for instance. Last fall, they gave each of their 520 medical students an iPad and an external wireless keyboard. They will no longer receive printed course materials. iPads will be the primary source of medical teaching.Assistant Dean for Curriculum, Dr Mike Schwartz, said in an interview for the Winter 2012 issue of the School's Alumni Bulletin Yale Medicine that it costs about $1,000 per student to provide paper copies of course materials. This is about the same cost as providing an iPad and supporting apps.From the article: "We pretty much break even," said Schwartz, "but the iPad is better for the environment - and as an information delivery system, it's much more versatile.”With the new iPads, teachers will be able to change the course materials as often as necessary, and the graphics should be much clearer too.The School trialled the iPads with a handful of students in a pilot program in the Spring 2011 semester. They used their touchscreen tablets to download course curricula, take notes in class, and update course material."It's hard to think of anything else that has had such a profound and rapid impact," said Schwartz.Med student Vicki Bing, described herself as "paper-person" when she was invited to take part in the pilot scheme. Before the iPad came along, she would have to have everything printed out. After one semester with an iPad, she became a convert. She appreciates having all the material at her fingertips when she is attending a lecture, and she welcomes the iPad's portability:"I travel a lot, and I used to bring paper copies of everything with me to study on the road. With the iPad it's so much easier. It's all right there with the touch of a finger.”And the Yale administrators are also starting to see other unexpected benefits: in the ways courses are taught.Dr Robert L. Camp teaches pathology. He said the iPad is an ideal tool for teaching small groups."Computer screens, which we used to use, create a barrier between you and the person you are talking to. It's not interactive. But the iPad is more like a piece of paper. You hold it more like a book and you can pass it around. It tends to engender more group thinking and group discussion," said Camp.The signs of how much more the iPad could deliver were visible even at the pilot stage.Nicholas Bergfeld was in his first year at Yale School of Medicine when he took part in the pilot scheme. "Using it to take notes in class was their baseline goal, but we quickly exceeded that," said Bergfeld, explaining how for instance in the pathology lab the iPads allowed for greater collaboration between the instructor and students, who were able to answer survey questions and draw on slides in real time, "It made the class a lot more interactive, a lot more fun.”Yale is not the only medical school introducing iPads. The trend is taking off in Medical Schools all over the US, including at Brown; the University of California, Irvine; Stanford; and the University of Minnesota.But Yale's program is different in that it is giving iPads to all its med students, not just first and second years. And to allow third and fourth years to use them in clinical settings, the School has encryped their iPads so they are security and privacy-compliant. Harvard is undergoing a similar revolution, in a different way. They aren't providing a specific tablet device, so they are not insisting on iPads; instead they have chosen to focus on providing apps support. They are testing pilot apps that students can use on other platforms such as the iOS and Android. One example is an app they can use to track patients on their smartphones. Another example from NYU’s School of Medicine: Using iPads in Anatomy 2.0. They have a bank of iPads for use by students. The students first put each iPad into a protective plastic bag to keep the iPads clean from germs. They also have nifty glasses that work with a 3D imaging system. With this system, they get a 3D view of the anatomy of a human and can really get ‘into’ the body – navigating the virtual body. – BioDigital Human. If you want to find a specific blood vessel, you can click on it and not only told the name of it, but given a paragraph of info about it (supplies such and such a region, drains into xyz) compared to tableside where you are limited. It augments physical learning. The repitition for the student is invaluable.http://www.theatlantic.com/video/archive/2012/04/anatomy-lab-20/254306/http://www.biodigital.com/
  • University of Chicago and others use of EHRs: http://www.imedicalapps.com/2011/07/implement-ipad-medicine-residency-chicago-medicine-program-blueprint/http://mobihealthnews.com/16671/ipads-make-university-of-chicago-medical-residents-more-efficient/In a trial of 115 internal medicine residents who were issued iPads to access the hospital’s Epic Systems EHR through a Citrix client, 78 percent reported that they felt more efficient when carrying tablets through hospital wards, believing that they saved about an hour per day. More than two-thirds of the residents said that iPads helped them avoid delays in delivering patient care.Almost 90 percent of the medical residents studied indicated that they used their iPads for performing clinical responsibilities and about 75 percent said that they used their iPads every day while on duty.University of Chicago’s iPad Initiative: http://medchiefs.bsd.uchicago.edu/iPad.htmlExamples of use in hospitals:Washington DC area hospital testing mobile app to speed up diagnosis of heart attacks - http://www.imedicalapps.com/2012/01/washington-area-hospital-testing-mobile-app-to-speed-diagnosis-of-heart-attacks/CodeHeart was developed with AT&T Business Solutions to speed up the diagnosis of heart attacks. Press Release: http://www.att.com/gen/press-room?pid=21775&cdvn=news&newsarticleid=33117Here’s how it works: http://www.youtube.com/watch?v=w_8U2BFE5gcFlagstaff Medical Center in Arizona: yearlong pilot (as of Jan 2012) that remotely monitors patients via Android and Bluetooth technologies in efforts to reduce their chance of being readmitted to the hospital. It’s aimed a populations that often skip or miss checkups or lack money or transportation to get Rx. 50 people are sent home with an Android phone and equipment to check their blood pressure, weight, heart activity, and O2 levels. http://www.flagstaffmedicalcenter.com/OurServices/Telemedicine/SuccessStories/congestiveheartfailureEMR2/2012 - Kaiser Permanente offers patients Android App for EMR Access http://mobihealthnews.com/16047/kaiser-permanente-offers-patients-android-app-for-emr-access/Nearly 9 million patients can access (securely) EMR from a new free mobile app for the Android (Apple coming soon). KP patients can access lab results, and PHR. They can also securely email doctors, schedule appointments, refullrx and find KP med facilities. It’s called KP Locator.One of the best features of the iPad for example is for looking at images and viewing video which translates into the operating room. It can be used as an enhancement to resident teaching for instance in reviewing relevant anatomy at the point of care.http://www.imedicalapps.com/2010/12/the-ipad-in-the-operating-room-a-surgeons-perspective-part-i/#comments
  • iAnatomy was one of the winners of the National Library of Medicine’s “Show Off Your Apps” contest in 2011. It is a mobile app example that is a portable, simple anatomy atlas of the face, neck, chest, abdomen and pelvis. There are 75 images with 60 actual CT scans of the chest, abdomen and pelvis. Other examples of useful apps: Oxford Concise Medical DictionaryPubMed Mobile5-minute clinical consult999 Anatomy Terms (quiz yourself on anatomy terms)Insulin Dose CalculatorNursing specific: Handbook of Nursing DiagnosisNursing CentralNurse’s Pocket Drug GuideNursing PharmacologyTo be able to discover decent apps out there, where to go?Medical App Journal is one place: http://medicalappjournal.com/ - there is a category for Reference for instance that directs to EmPharmD, Nursing Reference Central, and 830 other apps.
  • Tews, M.; Brennan, K.; Begaz, T.; Treat, R. (2011). Medical student case presentation performance and perception when using mobile learning technology in the emergency department, Medical Education Online, 16.The use of just-in-time learning strategies allows students and educators to choose the timing, location and amount of learning needed for each scenario or patient encounter. With mobile devices like smartphones and tablets, students have the ability to review information at the point of need. One of the challenges for medical students during their education is learning how to perform a history and physical exam. They are taught a standard approach to history and physical exam usually during their early years in medical school – they do need further instruction in how to perform a focused assessment of an undifferentiated, acutely ill patient with a chief complaint in the emergency department. They need to quickly assimilate the data they have gathered and present the case information from the patient encounter. The Medical College of Wisconsin participates in iTunesU, so the use of iPod Touch devices worked well They distributed these devices to every student as the platform to educate their students and evaluate the effects. They created five-minute videos that focused on the initial approach to patients who report one of three common chief complaints like chest pain, difficulty breathing, and abdominal pain. Each of the videos began with an introduction and then sections describing what to look for, think about, and do before entering the room with the patient, while in the room, and after leaving the room. The students liked using the videos and appreciated that the quality of the videos was professional. A concern that the students had was that the patient would think they were playing video games or listening to music rather than paying attention to the patient. It’s been dubbed the “iPhone Attribution Error.”Medical College of WisconsinMethods: Twenty-two fourth-year medical students were randomized to receive or not to receive instruction by video, using the iPod Touch, prior to patient encounters. After seeing a patient, they presented the case to their faculty, who completed a standard data collection sheet. Students were surveyed on their perceived confidence and effectiveness after using these videos.Results: Twenty-two students completed a total of 67 patient encounters. There was a statistically significant improvement in presentations when the videos were viewed for the first time (p=0.032). There was no difference when the presentations were summed for the entire rotation (p=0.671). The reliable (alpha=0.97) survey indicated that the videos were a useful teaching tool and gave students more confidence in their presentations.Conclusions: Medical student patient presentations were improved with the use of mobile instructional videos following first time use, suggesting mobile learning videos may be useful in medical student education. Clinical educators should consider whether, in an instance where live bedside or direct interactive teaching is unavailable, using just-in-time educational videos on a handheld device might be useful as a supplemental instructional strategy.
  • There have been studies which show that gaming, virtual environments and social networks have been effective for K-12 and college students as preferred learning mechanisms, but there is not a lot of research on medical student’s attitudes toward it. Kron, F. W.; Gjerde, C. L.; Sen, A.; and Fetters, M. D. (2010). Medical student attitudes toward video games and related new media technologies in medical education, BioMed Central Medical Education, 10(50).Cross-sectional survey with 217 medical students from two universities (University of Wisconsin-Madison and University of Michigan), addressing their game play experience and attitudes on using new media technologies in medical education. 80% felt that video games can have educational value and 77% would use a multiplayer online healthcare simulation on their own, as long as it provided that it helped them accomplish a goal. To be clear, we are not talking about video games like Angry Birds here. This study presented 8 game genres and the three most popular were puzzles, strategy and role-play. The authors of this article felt that this suggested students may have an affinity for cognitively challenging games. Role-playing games allow students to envision what their life would be like in different types of professional practice. An example: the students were most interested in multiplayer online healthcare simulations being “fun,” “helpful for developing skills and comfort in patient interactions,” and “helpful for modeling the economics of different healthcare systems”One of the features the students would like to have situated into digital domains is skill and comfort in patient interactions. Game-Based Learning from Horizon: http://horizon.wiki.nmc.org/Game-Based+Learning
  • Wiecha, J.; Heyden, R.; Sternthal, E.; and Merialdi, M. (2010). Learning in a virtual world: experiences with using Second Life for medical education, Journal of Medical Internet Research, 12(1), e1.This article talks about Boston University School of Medicine and the World Health Organization’s project on using Second Life in post-graduate CME. The article mentioned other virtual worlds that are also being used in educational technology like Forterra’s OLIVE, The Croquet Consortium, Sun Microsystem’s Project Wonderland, ProtonMedia’sProtosphere. SL is a flat-earth simulation of roughly 1.8 million square meters. You create avatars, you can buy land and create buildings. In this particular study, the organizers worked with a faculty member to create an instructional design for an hour-long session on insulin-therapy. They used two age-appropriate overweight avatars as mock diabetes patients in order to apply the session content to a real-world scenario. Impact on learning: the physicians indicated that it was a positive and engaging experience that could meet their CME needs and fit their busy schedules. All of the study participants agreed it was superior to other methods of actual online CME. The investigators felt that based on the participants responses, this study had a positive impact on learner self-efficacy and suggested a positive impact on clinical competence as well. The participants appreciated the fact that no travel was required and that they could participate from the comfort of their own homes. Questions about this – there are other online delivery methods for education – what makes this one so different? The added sense of presence afforded by their own avatar, and the added real-life element provided by the mock patients. An example closer to home, the UIC College of Medicine’s Graham Clinical Performance Center has used Second Life to work with students on diagnostic interviewing skills.Other examples: Nursing students at Tacoma (Wash.) Community College (TCC) went into the virtual world to learn how to work with real-life patients. For 2nd year nursing students, instructors created a 3-D virtual ER simulation in Second Life, an online virtual reality network. In 2007-2008, 54 students at TCC donned headsets, created their own computer-generated avatars (on-screen representations of themselves), and entered the ER simulation in Second Life. During the simulation, students role-played using their avatars to select interventions for a patient suffering chest pain and cardiac dysrhythmia. The patient's vital signs were projected on the back wall of the ER bay and were updated throughout the session. Students chose from a group of simulated real-life interventions, including oxygen hookups, medication, CPR, defibrillation, or IV therapy, with their avatars doing the work on screen. Then the simulated patient, controlled by either the instructor or another student, responded realistically to what the students chose. The virtual simulation allows students to practice their critical-thinking skills in an environment where there are no real patients who can be harmed. A nursing student related that she enjoyed the simulations and found them easy to navigate but partly because she grew up with computers.Sidenote to this – they gave faculty 1000 linden dollars to get nice hair and a nice suitSimulations like Second Life can help to make connections with distance education students – sometimes more so than with strictly DE appsSome other ancillary examples I’ve heard of: for presentations on folk medicines through the ages, or for poster sessionsChallenges with SecondLifeTypically no good support mechanism at institutions for SLFaculty want to use it but don’t want to build it themselvesFrequents updates to the SL program itself in computer labs cause headaches for support staffScripting of new areas in SL is very much like programming A key person who has an interest in SL ends up supporting and assisting faculty, but in doing so, the faculty can then help studentsTo train faculty how to use itSet up computer lab w/SL installed and do 1.5 hr training sessions1 on 1Instructional Designers need to then help faculty with how to integrate it into curriculum.UW- Milwaukee got a grant to a full-day intensive training for faculty
  • Augmented reality (AR) is a term for a live direct or an indirect view of a physical, real-world environment whose elements are augmented by computer-generated sensory input, such as sound or graphics or GPS. It is related to a more general concept called mediated reality, in which a view of reality is modified (possibly even diminished rather than augmented) by a computer. As a result, the technology functions by enhancing one’s current perception of reality. By contrast, virtual reality replaces the real world with a simulated one.http://neneknowles.wordpress.com/2011/04/25/integrating-augmented-reality-into-the-classroom/Abdominal Surgery and Augmented Realityhttp://www-sop.inria.fr/epidaure/research.phpThis is a recent innovation from the University of Pittsburgh Simulation and Medical Technology R&D Center. Their augmented reality model superimposed a multilayer surgical anatomy field onto a mannikin-based simulator.http://clinicalplayground.com/?p=582
  • Inkling  AccessMedicine is available on Inkling – this is Harrison’s Principles of Internal Medicine, but via the tabletPubMed for Handhelds - in fact PubMed is available via multiple mobile apps and websites as an example. Multiple vendors have made their content available (for a fee, of course) via PDF for quite a while now, but are just now getting into making their content available on mobile devices. Seismic shifts in publishing – more content is being made available online. Recent example: Wolters Kluwer released the first medical journal iPad app in Pathologyhttp://www.newswise.com/articles/wolters-kluwer-health-releases-first-medical-journal-ipad-app-in-pathologyPathology for the iPad uses optimized digital technology to provide a fully portable and enhanced print-like reading experience. It is the first iPad app available that offers access to the very latest original scientific research and reviews into pathology.
  • Ohio State University Recently completed: a 15,000 square feet expansion of the Clinical Skills Education and Assessment Center. The ground level space of 8,000 remains for standardized patients and the new space on the 6th floor of the library building with a large procedures lab, an Operating Room, three critical care bays, Ultrasound room, surgical tech lab room, seminar room for sixty and four debriefing rooms. All spaces have recording capabilities for review/creation of learning objects.
  • Poll EverywhereAccording to this company, their product replaces expensive proprietary audience response hardware by allowing students to respond to polls using their own mobile phone. Respondus: http://www.respondus.com/http://www.turningtechnologies.com/Multiple ways to use services like Turning PointMobile & Distance LearningCan poll via laptops and even smartphones via apps (iPod Touch, iPhone, Blackberry)Clickers - known by other names like Classroom Response Systems (CRS)Students can respond quickly and individually to a question using a wireless connection and a device.Polling in PowerPoint/Keynote and other programs – even remotely via video conferencing or satellite broadcastsWorks also with learning management systems like WebCT, Blackboard, Sakai, Moodle http://www.turningtechnologies.com/studentresponsesystems/lmscontentintegration/Learning AnalyticsExperimentation with various models to asses and measure learning outcomes Starfish Solutions?Is this being used in health science education?ePortfolios – students can reflect on their learning experience – a repository of their thoughts about what they have learned - Typhon
  • Horizon ReportMobile apps – creation of apps is slowly becoming easier. Mobile apps are low-cost. Allows the start of a shift from high-priced software. Textbook readers, note-taking in textbooks, etc.Tablet Computing – high resolution screens, the ability to share information via bluetooth connections, most recently in cnet, there were 67 different tablet computers.Tablet initiatives – Buena Vista University, Creighton University, Duke, OK State U, Loyola, Scottsdale Community College, Binghamton UInitiative – Seek Evidence of Impact (EDUCAUSE) – look upGame-based learning – evolution of games on our mobile devices, games that are goal-oriented, etc. Learning Analytics – (2-3 years) – analysis of wide range and/or large volume of data, data produced by learners, data gathered on behalf of learnersGoals – assess academic progress, predict future performance, identify potential issues, identify learner trends, enable interventionsScopeFaculty – facing: what are my students doing? How are my students doing?Student-facing: how am I doing? What should I do next?Institution facing: are we improving course and degree completion rates?, Are improving retention rates? What might be the causes? Etc.New learning modelGesture-Based Computing (4-5 adoption horizon) – Gesture type: touch (touch motion, direction of fingers), motion detection (shaking, rotating, tilting, moving in space)More trends:http://thelearninglot.blogspot.ca/2012/03/five-trends-to-watch-in-educational.html?m=1
  • Despite the Horizon Report, and other speculation about where educational technology is headed, change happens at an increasingly-alarming rate. We simply don’t know what’s going to happen. The best thing we can do is to remain open-minded and keep up as best as possible with trends and research.Does this mean we will see the integration of Google Glasses in the OR? Who knows.There is a Lumus OE-31 optical engine that could add augmented reality to any eyewear, for instance. Their beta UI includes text messages, games and a web browser. Low-hanging fruitSimply making sure PDFs of articles are available from everywhere – desktop computers to mobile devicesUsing mobile devices to stimulate engagement in context – making some or all aspects of learning available via mobile devices
  • Where do we keep up with the fast-changing pace of technology? Especially for educational technology? One great source is EDUCAUSE. It’s not specific to health sciences education, but there are usually items of interest that can be applied to it. Another is HackEducation, http://hackeducation.com/Wired Campus from the Chronicle of Higher Education.eduGuruTwitterBlackboard and Behind the BlackboardMany other sources – these are just a few of them.
  • IAECT 2012

    1. 1. How EducationalTechnology Can ImpactHealth Sciences EducationMax Anderson, MLISDirector, McCormick Educational Technology CenterRush University Medical CenterIAECT 2012 – Malcolm X College26 October 2012
    2. 2. What I’ll talk about…• Trends in educational technology• Changes in methods and formats• Distance Education• Mobile technology/Augmented Reality in Health Sciences Education• What’s on the horizon?
    3. 3. “Students today cannot prepare barkto calculate their problems. Theydepend on slate which is moreexpensive. What will they do whenthey drop the slate and it breaks?They will be unable to write!” (Anon– 1709) http://www.objectlessons.org
    4. 4. “X-rays will prove to be a hoax.” -William Thomson (Lord Kelvin), an English physicist and inventor, said in 1899 Trends 1. Explosion of new information 2. Digitization of all information 3. New generation of learners • Digital Natives • Digital Immigrants • Digital Settlers • Traditionalists 4. Emergence of new instructional technologies 5. Accelerating changeRobin, B. R.; McNeil, S. G.; Cook, D. A.; Agarwal, K. L.; and Singhal, G. R. (2011). Preparing for the changing role of instructionaltechnologies in medical education. Academic Medicine, 86(4), 435-439.
    5. 5. "The abdomen, the chest, and the brain will forever be shut from the intrusion of the wise and humane surgeon." -- Sir John Eric Ericksen, British surgeon, appointed Surgeon-Extraordinary to Queen Victoria 1873. Recommendations 1. Use technology to support learning 2. Focus on fundamentals 3. Allocate a variety of resources • Faculty members should be content experts, but they do not have to be technology experts 4. Support and recognize faculty as they adopt new tech 5. Foster collaboration • MedEdPORTAL, https://www.mededportal.org/Robin, B. R.; McNeil, S. G.; Cook, D. A.; Agarwal, K. L.; and Singhal, G. R. (2011). Preparing for the changing role of instructionaltechnologies in medical education. Academic Medicine, 86(4), 435-439.
    6. 6. 6 Trends for the Digital Age Analog Digital Tethered Mobile Closed Open Isolated Connected Generic Personal Consuming CreatingSource: David Wiley: Openness and the disaggregated future of higher education
    7. 7. On the Ground (F2F) andBlended Learning
    8. 8. Distance EducationOccupy Learning Image Source: http://www.flickr.com/photos/74033365@N02/
    9. 9. Changes to Distance and Continuing Education• Podcasts• Web Meetings• Live “on ground”• Blended• Diagnostic Case Studies• Labs/Lectures• Open Nursing Continuing Education from Gannett University/MOOCS• Mobile!
    10. 10. Simulation Technology• Managing the airway of an infant struggling to breathe• Assessing and intervening with a woman whose pregnancy is at risk• Identifying the danger signs of a young adult planning suicide and deciding what to do• Managing post-operative respiratory distress in an elderly male
    11. 11. Mobile is the Future of Learning
    12. 12. Intuitive Handheld Devices• Smartphones/Tablets• Natural gesture interface – ‘touch screen’• Connection to learning networks like Blackboard, Adobe Connect, etc.
    13. 13. Mobile Devices at the EnterpriseLevel• University of Chicago Internal Medicine Program blueprint • More than 100 residents were assigned iPads • Full EHR available via iPad • *not all EHR software is supported via tablets • UC iPad Initiative: http://medchiefs.bsd.uchicago.edu/iPad.html• Kobe University (Japan) • Tablets used in lectures (enlarge images by touching screen, etc.) • OsiriX (educational system) • Johns Hopkins • VA Healthcare system…just to name a few…though hospitals are typically slow to adoptmobile technology
    14. 14. Example: iAnatomy
    15. 15. 4th Year Med Students and theiPod Touch• Medical College of Wisconsin study• Augmenting traditional bedside learning in clinical settings with mobile devices• Challenge for med students – learning how to perform a history and physical exam• (One possible) solution – short instructional videos focusing on presentation skills in a busy clinical setting
    16. 16. Augmented RealityAR in Anatomy AR in Abdominal Surgery
    17. 17. Innovations in Research andPublishing• Inkling• PubMed for Handhelds, etc.
    18. 18. Impact on the Health SciencesLibrary• Library space giving way to SimLabs (UIC), Clinical Skills Education & Assessment Centers (OSU)• Librarians being embedded into specialties taking them out of the physical library• Continued education of library resources available
    19. 19. Assessment Are You Paying Attention?
    20. 20. What’s on the horizon?
    21. 21. “We are educating for careers that have not been created, usingtechnology not yet invented to solve problems that havent beendiscovered.” – Shift Happens
    22. 22. Keeping Up
    23. 23. ReferencesColeman, P. A.; Dufrene, C,; Bonner, R. J.; Martinez, J.; et al. (2011). A regionalpartnership to promote nursing instructor competence and confidence insimulation. Journal of Professional Nursing, 27(6), e28-e32.Dubose, C. (2011). The social media revolution. RadiologicTechnology, 83(2), 112-119.Goldberg, D. G.; Clement, D. G.; and Cotter, J. J. (2011). Development and alumniassessment of an interdisciplinary PhD program offered through a blendedlearning environment. Journal of Allied Health, 40(3), 137-142.Kron, F. W.; Gjerde, C. L.; Sen, A.; and Fetters, M. D. (2010). Medical studentattitudes toward video games and related new media technologies in medicaleducation, BioMed Central Medical Education, 10(50).
    24. 24. ReferencesRobin, B. R.; McNeil, S. G.; Cook, D. A.; Agarwal, K. L.; and Singhal, G. R. (2011).Preparing for the changing role of instructional technologies in medical education.Academic Medicine, 86(4), 435-439.Smith, R. A.; Cavanaugh, C.; and Moore, W. A. (2011). Instructional multimedia: aninvestigation of student and instructor attitudes and student study behavior. BMCMedical Education, 11(38).Tews, M.; Brennan, K.; Begaz, T.; Treat, R. (2011). Medical student casepresentation performance and perception when using mobile learning technologyin the emergency department, Medical Education Online, 16.Wiecha, J.; Heyden, R.; Sternthal, E.; and Merialdi, M. (2010). Learning in avirtual world: experiences with using Second Life for medical education, Journal ofMedical Internet Research, 12(1), e1.Wiley, D.; and Hilton, J. H. (2009). Openness, dynamic specialization, and thedisaggregated future of higher education, International Review of Research inOpen and Distance Learning, 10(5),
    25. 25. Thank youMax AndersonDirector, McCormick Educational Technology CenterAssistant Library Director for Educational Technology, LibraryRush University Medical Centere. max_anderson@rush.edut. 312-942-6832