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The Challenges of Developing Distance Learning for Surgeons

2014; Elsevier BV; Volume: 49; Issue: 3 Linguagem: Inglês

10.1016/j.ejvs.2014.09.001

1532-2165

Nikolaos Patelis, Seàn Matheiken, Jonathan Beard,

Innovations in Medical Education

e-Learning (electronic media learning or eL) and m-Learning (mobile learning or mL) are increasingly utilised in medical and surgical specialties to deliver education and training via the World Wide Web, accessed using a computer or a mobile device (smartphone, tablet), respectively. Both these educational mechanisms fall under the general term Technology-Enhanced Learning (TEL). Certain advantages of TEL are readily appreciated, such as eliminating the need for travel, accommodation, and time away from work, thus reducing costs for both provider and learner, and affording greater individual flexibility of learning opportunity, timing and location. Instructional designers and curriculum administrators recognise the value of eL in facilitating the receipt and recording of feedback and in enhancing the ergonomics of repeating a teaching course.1A framework for technology enhanced learning. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215316/dh_131061.pdf [accessed 10.08.14].Google Scholar As with most educational methodologies, a number of requirements must be met for the successful delivery and utilisation of an eL product. Tutors must acquire, retain, and implement the technical and technological skills necessary for instructional design, development, and delivery. Certain tasks are of a more administrative nature: creation of the online learning environment, enrolment of trainees, resolution of technical issues, logging and ranking of trainees' scores and issuing of certification. Several 'virtual learning environment' packages are available to facilitate these tasks and smooth the learning curve for instructors, such as the open source content management system moodle. Regardless of the learning environment utilised, the educational value of the eL or mL product is influenced by definition of a suitable online curriculum, selection of appropriate delivery mechanisms commensurate with intended learning outcomes, implementation of valid online assessment methods, and evaluation of course efficacy. Providing TEL to surgeons comes with its unique set of requirements and restrictions.2Maddaus M.A. Chipman J.G. Whitson B.A. Groth S.S. Schmitz C.C. Rotation as a course: lessons learned developing a hybrid online/on-ground approach to general surgical resident education.J Surg Educ. 2008; 65: 112-116Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar These include the impact of clinical interruptions, working hours regulations, and rota patterns on learning opportunities; concern about the well-described isolation that negatively affects electronic learners; the surgical trainee's preferential focus on acquisition of practical skills; and the difficulties in online assessment, as well as in evaluation of such practical instruction on the occasions that it has been provided. Conversely, certain aspects of the surgical persona are advantageous to the pursuit of TEL. These include a high level of individual motivation, a spirit of competitiveness, and a problem-solving approach. The eL team of the Education and Training Committee of the ESVS explored the application of eL to the practical skill of sizing and planning aortic aneurysm repair. A fully online course based on the open source OsiriX 3D reconstruction software program was devised and implemented. A variety of multimedia content was utilised in keeping with the principles of eL design; these included descriptive PDF files, targeted instructional videos, open forums for discussions and comments, and CT scan DICOM files of real aortic aneurysms for download and practice. Objective online assessments tested participants' grasp of concepts and their ability to accurately size and plan for an endovascular stent graft repair. The course design was modular, with the collation of structured user feedback at the conclusion of each week's instalment over a 2-month period. Although the ESVS OsiriX course demonstrated the ability to successfully deliver practical training for a surgically relevant skill by online means, it also threw many limitations into sharp focus. Almost half of the initial registrants dropped out, although those who did complete the course had a high pass rate. The online forums were poorly utilised, yet feedback from trainees commented on their perceived individual isolation. The human and material resources required for creating the curriculum were substantial; these were vindicated by the ability to host subsequent instalments of the program without additional investment, as well as the spin-off interactive iBook created for commercial sale from the multimedia content developed for the course.3Rielo Arias F. Bertoglio L. Matheiken S.J. Planning and sizing with OsiriX in vascular surgery. iTunes Store, Nov 2013https://itunes.apple.com/gb/book/planning-sizing-osirix-in/id746223427?mt=11Google Scholar Course effectiveness could not be quantified by means of the instructional design used; similarly, certification of successful candidates did not represent an unequivocal endorsement of their ability to size and plan all aortic aneurysms of varying difficulty levels. These findings reinforce existing evidence regarding the receptiveness of surgeons to TEL. The innate motivation levels of surgeons – which are regarded as being high – do not always overcome the bane of insufficient learning time. Provision of instructional material that is of practical benefit attracts the interest of trainees and its value increases further if the learner can access content using mobile devices during brief interludes of clinical work. The accreditation of online learning remains a key factor in generating user interest; eL or mL courses that offer certification or Continuing Professional Development (CPD) points increase their attractiveness to surgeons. Technology-Enhanced Learning for surgeons is in its nascency, showcasing both the immense promise and the unsolved problems inherent in this early phase of growth. Enthusiasts continue to demonstrate its technical feasibility. There are a number of hurdles to hyperlink over; these include the relative isolation of surgical eLearners; the delivery of practical instruction for just-in-time learning at points of care; mechanisms for standardised accreditation of courses; and methods to evaluate the efficacy of TEL for surgeons. Potential solutions for each of these, respectively, could include the wider application of social media; better encryption on mobile devices coupled with improved Wi-Fi accessibility in the workplace; legal, academic and educational consensus agreements for TEL development and certification; and a greater accommodation of evaluation methodology into eL and mL instructional design.