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<ul><li><p>Effective Use of EducationalTechnology in Medical EducationColloquium on Educational Technology:Recommendations and Guidelines forMedical Educators</p><p>AAMC Institute for Improving Medical Education</p><p>March 2007</p></li><li><p>To request additional copies of this publication, please contact:</p><p>Chris Candler, M.D.Director of Educational Technology, Medical EducationAAMC2450 N Street, N.W.Washington, D.C. 20037T 202-828-0253 F 202-828-0972ccandler@aamc.org</p><p>2007 by the Association of American Medical Colleges. All rights reserved.</p><p>Case Study 1</p><p>A biochemistry course director receives a grant to develop a Web site for teaching first-year medicalstudents in metabolic pathways. To better understand typical student perception and performance, heholds a student feedback session and analyzes pre-test scores. Before selecting a technical approach, heconsults other basic scientists and clinicians to ensure that the educational objectives are relevant,well-organized, and integral to other elements of the curriculum. A professional educator with technologyexpertise is consulted to carefully analyze the objectives and suggest an appropriate instructional strategy.The decision is made that use of the Web site will be mandatory for all students enrolled in the course.</p><p>The instructor apportions content into topic-based chapters organized around patient cases, which aredesigned to focus learner attention and integrate various concepts. Each chapter begins with a descriptionof the learning objectives and a brief tutorial to stimulate recall of relevant prerequisite information. Thematerial is presented through interactive animation using Mayers ten principles of effective multimedia.Learners are occasionally given advice and tips for learning particularly difficult concepts. Each chapterends with a succinct summary and practice problems. The last section of the Web site offers a sampleexam with multiple-choice questions derived from each of the learning objectives. Learners are providedindividualized feedback based on their performance.</p><p>The instructor provides appropriate basic science and clinical faculty with links to the Web site and helpsthem understand how they can use relevant content. The instructor uses student feedback to furtherrefine the site.</p></li><li><p>Executive Summary</p><p>Medical educators increasingly use technology tosupplement the delivery of learning resources.The advent of multimedia technology, the WorldWide Web and the ubiquitous nature of networkedcomputers, have transformed educational technologiesfrom esoteric legacy applications used by a fewpioneering faculty to mainstream applicationsintegral to the medical school educationalenterprise. This increased use is reflected in thegrowing number of publications and conferencepresentations related to educational technology.</p><p>There is no doubt that educational technologieshave enhanced teaching and learning in medicaleducation. There is also no doubt that technologieswill continue to evolve and become furtherintegrated into all facets of our professional andpersonal settings. The medical educationcommunity must be able to assure itself that theinformation presented to medical students and thevenues through which it is presented are compatibleand optimize learning and justify the substantialinvestment of resources (people, facilities, money)that these resources require. For medical schools tomake the case for such investments it is imperativethat use of technology be linked to what we knowabout learning. Often there is a cultural lag inappropriately pairing novel technology witheffective use, making it essential that medicaleducators be confident that educational theoryguides and supports their use of technology.</p><p>AAMCs Institute for Improving Medical Educationconvened an invited colloquium of national expertsto consider the state of research and documentedefficacy of educational technologies in the medicalschool curriculum. Indeed these participantsconfirmed that more evidence is needed to determineprecisely when to employ technology during themedical education process and how best to use itwhen it is employed. This summary report offers theconsensus of the IIME expert panel around theseissues, suggests recommendations on how best toutilize available technologies in the medicaleducation setting, and proposes research questionsto further guide our understanding and advancethe established literature.</p><p>Carol A. Aschenbrener, M.D.Executive Vice President</p><p>Effective Use of EducationalTechnology in Medical Education</p><p>Association of American Medical Colleges, 20073</p></li><li><p>Background</p><p>Educational technology tools offer compellinginstructional capabilities and provide faculty andstudents with new educational possibilities. Theseresources can portray anatomical and physiologicalprocesses with remarkable clarity, tailor instructionto learner needs, allow learners to practice skills ina safe environment, standardize instruction andassessment activities, and be offered anywhere andanytime. Furthermore, todays learners areaccustomed to technology-enhanced learningenvironments.</p><p>Educational technologies are used extensively at allpoints on the medical education continuum and varywidely in complexity, degree of realism, and cost.Such resources include relatively straightforwardonline multimedia tutorials; high-fidelity virtualpatient applications that ask learners to diagnoseand manage simulated patients; and immersive,team-based simulations designed around lifelikemannequins. Many institutions have purchasedcommercial products developed for the medicaleducation market, while others have created in-house development teams of educators, illustrators,Web designers, programmers, and other multimediaspecialists, who create excellent products for theirown use.</p><p>The widespread adoption of information technologieshas led to a corresponding growth in the develop-ment of sophisticated, realistic teaching resources.However, our understanding of how these resourcesmight best be incorporated into the curriculum isinadequate, as advances in what could be createdoften outpace our ability to understand how theyshould be developed or used. While a variety ofcompelling studies in the medical educationliterature have described new applications andoccasionally compared their effectiveness withtraditional instructional approaches such as lectures,they generally do not examine which technologyapproaches are best suited for a given educationalgoal. Fortunately, several studies in the educationaland cognitive sciences offer evidence-based principlesthat might be used to guide the effective use oftechnology in medical education.</p><p>The AAMC Educational Technology ColloquiumThe Association of American Medical Colleges(AAMC) has a longstanding interest in the use ofeducational technology by its institutional members.To facilitate the use of effective educationaltechnologies in medical education, the AAMCsInstitute for Improving Medical Education chargeda panel of experts to consider the current use ofcertain educational applications at medical schools,and to examine the relevant literature in order todevelop recommendations that could be used tohelp medical schools select, develop, and useappropriate technologies.</p><p>In April 2006, the institute convened recognizedexperts in educational technology to participate ina one-day colloquium, charged with three specificgoal;</p><p>1. Identify the advantages that educationaltechnologies provide over traditional approaches</p><p>2. Recommend the educational theories, principles,and features that should be considered whendeveloping or purchasing educational technologies</p><p>3. Suggest directions for future research</p><p>Because the overall technology topic is so broad,colloquium participants were charged to focusconsideration on interactive instructional andassessment applications: namely, those that teach orassess understanding of biomedical concepts,patient diagnosis and management, and proceduralskill training. Resources with little interactivitysuch as those that only enable basic learnernavigation of text and imageswere consideredless relevant to the colloquiums scope. Likewise,the group did not discuss delivery systems such asteaching management systems (e.g., BlackBoard),pod-casting, computer-based testing, digitizedlecture dissemination, and distance learning.</p><p>With a few notable exceptions, the bulk ofeducational technology research in the medicaleducation literature has been criticized as deficientin either methodological approach, conceptualframework, or both. However, scores of rigorousstudies have been published in the fields of</p><p>Effective Use of EducationalTechnology in Medical Education</p><p>Association of American Medical Colleges, 20075</p></li><li><p>educational psychology, cognitive science, informationscience, military and aviation training, andeducational technology. The colloquium participantsagreed to consider the seminal literature from eachof these fields and suggest principles that may bereasonably inferred from them.</p><p>This report summarizes the findings of the April2006 Colloquium on Educational Technology heldin Washington, D.C. The report does not prescribea single educational technology approach that canbe adopted in all learning environments, nor is it aformal analysis of the literature. Instead, it offersprinciples and recommendations derived frommultiple disciplines and perspectives. Notably, thisreport highlights the essential role of instructionaldesign principles to promote the effective use ofeducational technology.</p><p>The primary audience for this report is medicalschool teaching faculty members who develop,purchase, or use educational technology to enhancelearning. A secondary audience is staff memberswho support the development, procurement, andimplementation of these applications.</p><p>Advantages of Educational TechnologiesEducational technologies provide instructors withnumerous advantages in the areas of contextuallearning, active and individualized learning, andautomation.</p><p>Technology can reproduce an object or concept in aform that may be manipulated by the designer and,ideally, the user for educational purposes. Theseadvantages are particularly clear in simulationtechnologies and can also exist with computer-based models of real-life processes. Exploration in arealistic environment provides multiple benefits tolearners: opportunities to practice rare and criticalevents, safe and controlled environments thateliminate risk to patients, enhanced visualization,and authentic contexts for both learning andassessment. In these environments, assessment oflearner behavior and outcomes can be documented.</p><p>Modern educational technologies can processlearner decisions and present realistic responses toprovide an individualized learning experience.Educational technologies attuned to the characteristicsof adult learners promote active, student-centeredlearning. Instruction can also be tailored to individualneeds by empowering learners to control theireducational experience, including opportunities forrepetition and deliberate practice with structuredguidance. These principles apply to both group andindividual instructional settings.</p><p>Because of their automated nature, educationaltechnologies provide perpetual resources thatuncouple instruction from physical space constraintsor instructor availability. These tools can facilitatestandardized instruction and assessment and offernew economies of scale, despite the higher initialinvestment likely to be required.</p><p>Effective Use of EducationalTechnology in Medical Education</p><p>Association of American Medical Colleges, 20076</p><p>Educational technologies are advantageous in providing:</p><p> safe, controlled environments that eliminate risk to patients enhanced, realistic visualization authentic contexts for learning and assessment documentation of learner behavior and outcomes instruction tailored to individual or group needs learner control of the educational experience repetition and deliberate practice uncoupling of instruction from place and time standardization of instruction and assessment perpetual resources and new economies of scale</p></li><li><p>Common Technologies in Medical EducationThere are numerous frameworks that may be usedto characterize and classify educational technologyapplications. Colloquium participants consideredthree broad categories based on the predominantusage in medical education. While these applicationsoverlap in terms of technology components andinstructional possibilities, they are sufficientlydistinctive to consider independently:</p><p>1. Computer-aided Instruction (CAI)Instructionin which computers play a central role as themeans of information delivery and directinteraction with learners (in contrast to applicationssuch as PowerPoint); to some extent humaninstructors are replaced. These programs maymake use of Internet technologies (Web-basedlearning), and include a wide variety ofstandalone applications or online materials.</p><p>2. Virtual Patients (VP)A specific type of com-puter-based program that simulates real-life clinicalscenarios; learners emulate the roles of healthcare providers to obtain a history, conduct aphysical exam, and make diagnostic andtherapeutic decisions.</p><p>3. Human Patient Simulation (HPS)The use ofmannequins or models to simulate patient careenvironments for instructional or assessmentpurposes. Tools in this category include task-basedtrainers that simulate specific procedural tasks(e.g., virtual reality colonoscopy trainers).</p><p>Each of these approaches has advantages anddisadvantages (see Table 1) based on its inherenttechnical capabilities.</p><p>Effective Use of EducationalTechnology in Medical Education</p><p>Association of American Medical Colleges, 20077</p><p>Type of Instruction</p><p>Computer-aidedInstruction</p><p>Virtual Patients</p><p>Human PatientSimulation</p><p>Advantages</p><p> Useful for visualizing complex processes Independent exploration of complex phenomena Easy access Relatively low-cost of production</p><p> Encompasses multiple aspects of clinical encounter Longitudinal and multidisciplinary care lessons Easy access Readily customized</p><p> Immersive, active experience Engages emotional and sensory learning Fosters critical thought and communication Animates basic science in clinical context</p><p>Disadvantages</p><p> Limited physical interactivity Limited fidelity</p><p> Limited physical interactivity Limited fidelity High production costs</p><p> Cost and space requirements Limited to simulator and staff availability Engineering limitations</p><p>Table 1. Advantages and disadvantages of various educational technologies.</p></li><li><p>Effective programs match instructional approacheswith educational goals. The medical educationenvironment may include any combination ofcognitive, perceptual, and psychomotor educationalgoals. Each type of goal may be achieved throughthe use of at least one educational technology. Table2 suggests how the various technologies might beused, based on a combination of available research,perceived benefits, and technical capabilities:</p><p>The Role of FidelityWhen designing an application that simulates abiomedical or patient care phenomenon...</p></li></ul>