New Technologies and Medical Education: Introduction

My first venture into multimedia education came in 1978, when I was part of a group that produced a series of programs for the American Physiological Society on electrophysiology and electrocardiography that utilized a printed booklet, slides, and a cassette tape. Although versions of the Plato system, a computerized learning program, was developed at the University of Illinois in the 1960s and 1970s, we needed to wait until the development of microprocessor technology and personal computers before widely available, accessible, and personalized computer-assisted or e-learning could take place. I did not become much involved in multimedia education again until 1996, when Dr. Burton Rose, the founder of UpToDate, invited me to help develop the cardiovascular section of this medical database. Since that time, I have learned a great deal about the strengths and limitations of e-learning.

Another hat that I wear with pleasure is that of the Book Review Editor of Perspectives in Biology and Medicine. From time to time, Perspectives publishes special sections on specific topics, so I asked Bob Perlman, the editor of the journal, whether he might be interested in a series of articles on computer-assisted learning. He was, and the result is the following six articles on aspects of computer-assisted learning or e-learning.

David Cook and Furman McDonald from the Mayo Clinic College of Medicine ask whether there is "anything special about the 'e'" in e-learning. They consider basic tenets of learning, delve into a number of instructional methods, and consider theories of multimedia learning. The authors consider cognitive load theory—which involves two types of memory, working and long-term—in some detail. Working memory is of limited capacity, seven ideas or so, and limited temporal retention (about 20 seconds), after which the concept is either lost or stored. Cognitive load is both intrinsic and extraneous. The intrinsic is the complexity of the information itself; the extraneous concerns the environment (noise, distractions), the presentation of material, and things such as hunger or sleepiness. Cook and McDonald point out that cognitive load has particular relevance to e-learning; screen design as well as audio and video fidelity are key considerations. Multimedia e-learning can decrease cognitive load by combining words, sounds, and graphics; can more effectively organize and personalize information; and allows the learner to control the pace of learning. But it can also increase cognitive load by including unnecessary information and distractions through the words, sounds, and graphics, as well.

Scott Stern from the University of Chicago has been integrating traditional with computer-assisted learning in the traditional clinical pathophysiology and pharmacology (CPP) course for second-year medical students at the University of Chicago. This has allowed students to use computer-assisted instruction during the CPP laboratories and later, at their own pace, on a dedicated Web site. The power of the computer allows the use of text and graphics to carefully weave what is relevant in the CPP lab with what is relevant clinically. Stern's view is that the achievement of competency is at the center of medical education and training. Teaching competency requires the provision of and access to factual information and the teaching of critical reasoning. A further obligation is ensuring such competency. Stern extends the obligation to providing a system in which students are actively prompted to review factual material at various times throughout their medical training, a strategy that moves the curriculum "from a linear organization that often provides information at a time when it is not truly useful to a dynamic one in which the information is available exactly when it is most valuable to the students." The computer allows this.

Two articles consider the use of computers in simulation. The first, by S. Barry Issenberg and Ross Scalese of the University of Miami, points out that changes in health care delivery have resulted in shorter hospital stays and clinic visits, which in turn have reduced patient availability for learning as well as faculty time for teaching. Simulators are intended to reproduce clinical conditions and are always available. These authors discuss other issues related to using patients for teaching, including...