E-learning has been widely utilized in medical education and suggested by some proponents to represent a fundamental advance in educational methodology. We challenge this conclusion by examining e-learning in the context of broader learning theories, specifically as they relate to instructional design and methods. Core tenets of educational design are applied to e-learning in a unified model for instructional design, and examples of e-learning technologies are examined in the context of medical education, with reflections on research questions generated by these new modalities. Throughout, we argue that e-learning is a tool that, when designed appropriately, can be used to meet worthy educational goals.
Medical education remains a time-consuming and complex task whose goals are to provide students with sufficient factual information and the clinical reasoning tools to ensure the competency of its graduates. Today, this task is especially challenging because of the exponential growth in biomedical information and the ever-increasing time pressure placed upon medical educators. Electronic tools have the capacity to facilitate medical education, as well as to fundamentally improve our ability to ensure the competency of our graduates. This article reviews some of the approaches to electronic education developed at the University of Chicago.
During the past 15 years there has been widespread adoption of simulation in health care education as a method to train and assess learners. Multiple factors have contributed to this movement, including reduced patient availability, limited faculty teaching time, technological advances in diagnosis and treatment that require a new skills set, greater attention to patient safety with the need to reduce medical errors, and a focus on outcomes-based education. In this discussion, simulation refers broadly to any device or set of conditions that attempts to present the patient authentically. While simulation offers many advantages over traditional methods of teaching, there are several challenges that must be addressed to ensure its effective use. This article presents the range of available simulation technologies, explores the challenges that health care educators face when using this method, provides an example of a successful program that has integrated simulation into the culture of learning at its institution, and discusses an approach to maximizing the effectiveness of simulation as a means to learning and practicing skills in a safe, interactive environment.
Medical simulation is a new method to facilitate skill training and assessment. Simulation has achieved a high degree of sophistication in aviation and other fields. However, the complexity of health care, the numerous stakeholders, and the lack of central control of medical education have been barriers to the development and broad implementation of medical simulation. Acceptance by the medical community is growing, with the publication of scientific validation studies, the development of economic models and funding, and the integration of simulation into existing curricula and training programs. The major forces for implementing simulation will most likely come from the medical device industry and from institutions with mandates to improve the quality of health care and enhance patient safety. Certification boards are expected to increase their utilization of simulation technology to objectively assess proficiency of skills relevant to physicians and the health care system. Medical simulation has made the transition from an experimental technology to the clinical world, and the next five to 10 years may be viewed as the golden age of medical simulation.
The Internet is revolutionizing medical education and medical practice by enabling teachers and students to utilize and integrate many forms of data in ways that cannot be done via classic textbooks. In cardiovascular medicine, dynamic images are essential for understanding cardiac function, coronary anatomy, and myocardial perfusion, as well as for learning cardiovascular pathophysiology and the typical and atypical presentations of disease states. Cardiosource, an educational Web site developed by the American College of Cardiology, illustrates the ways in which the Internet is being used to improve medical education and practice.
Female genital cutting (FGC) is an ancient tradition unbounded by religion and practiced primarily in Africa and the regions to which Africans have immigrated. All types of FGC involve cutting neural innervation to the vulva: the clitoris, labia majora and minora. Most types include excision of the clitoris. Since the tissue of the vulva is highly innervated by nerves and their endings, I postulate here that the brain and spinal cord will respond to FGC as it would to any loss of neural targets or inputs: by rearranging neural networks. This, in turn, would affect neural signaling to target structures and modify sensory perception. Most scientific investigations of FGC have focused on its reproductive consequences. To fully appreciate its effects on the lives of women, however, an understanding beyond the reproductive system is necessary. Exploring the potential neural changes of FGC may help explain the mixed responses of the women themselves and identify new directions for research to understand their lives. A neurobiological analysis may also help us understand how cultural practices inscribe meaning on central nervous system structures, affecting mind as well as body.
As part of a mid-1940s malaria research program, U.S. Public Health Service researchers working in South Carolina chose to withhold treatment from a group of subjects while testing the efficacy of a new insecticide. Research during World War II had generated new tools to fight malaria, including the insecticide DDT and the medication chloroquine. The choices made about how to conduct research in one of the last pockets of endemic malaria in the United States reveal much about prevailing attitudes and assumptions with regard to malaria control. We describe this research and explore the ethical choices inherent in the tension between environmentally based interventions and the individual health needs of the population living within the study domain. The singular focus on the mosquito and its lifecycle led some researchers to view the humans in their study area as little more than parasite reservoirs, an attitude fueled by the frustrating disappearance of malaria just when the scientists were on the verge of establishing the efficacy of a powerful new agent in the fight against malaria. This analysis of their choices has relevance to broader questions in public health ethics.