E-learning in Gerontology and

Geriatric Education

Jorge G. Ruiz, MD, FACPAssociate Director for Education/Evaluation, VA GRECC,

University of Miami Miller School of Medicine and Stein Gerontological Institute

Miami, Florida

E-learning in Gerontology and Geriatric Education - Objectives

To discuss the rationale for the use of e-learning and the educational theories, principles, or features that should be considered when developing effective e-learning

To recognize the most significant gaps in the e-learning literature

To discuss the role of e-learning in scholarship To describe some e-learning initiatives in

gerontology and geriatric education

Advances in Geriatric E-learningGeriatrics Education

Definitions and Classification Rationale Indications Geriatric E-learning Research

Virtual Patients in geriatrics

Definitions and Classification

Definition

E-learning refers to the use of Internet technologies to deliver a broad array of solutions that enhance knowledge and performance

Web-based learning, online learning, distributed learning, computer-assisted instruction, or Internet-based learning.

Multimedia E-learning: the use of words and pictures in e-learning

Rosenberg M. E-Learning: Strategies for Delivering Knowledge in the Digital Age. New York: McGraw-Hill, 2001.

Classification

Methodologies Tutorials Simulations – animations

to virtual patients Hypermedia-Hypertext Games Computer-based

assessment-practice Collaborative learning

(blogs, wikis)

Access & Management

Portals Databases, repositories LMS Search engines ePortfolios

Delivery CBT, recording media,

networks, PDA, eBooks, broadcasting media

Rationale

Why E-learning?

Effective – at least as good as traditional instruction (multimedia e-learning?)

Efficient – Obvious Cost-effective - may be Accessible – definitely Deliberate Practice

Chumley-Jones HS, Dobbie A, Alford CL. Web-based learning: sound educational method or hype? A review of the evaluation literature. Acad Med. 2002;77(10 Suppl):S86-93.

Deliberate Practice

The repeated performance of a particular task where feedback on performance is available and the purpose is to improve performance

Geriatrics: Seeing lots of patients Case-mix: May not be possible E-learning approaches may offer alternatives

for the acquisition of expertise

Ericsson, K.A., Krampe, & Tesch-Romer. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3). pp. 363-406

Cognitive Learning Framework

Predominant framework: Many theories? Explain how the brain processes and stores new

information Working memory: limited Long-term memory: virtually unlimited

A growing body of empirical evidence Theories:

Dual-coding theory Cognitive Theory of Multimedia Learning

Cognitive Theory of Multimedia Learning

Principle: Words + Pictures = better learning1. Dual-channel 2. Limited capacity 3. Active processing (selection, organization,

integration)

Learning Outcomes from Words and Animations and Words Alone

Words + Animations

Words

0

20

40

60

80

100

Per

cen

t C

orr

ect

on

Pro

ble

m S

olv

ing

Mayer RE, Anderson R. Animations Need Narrations: An Experimental Test of a Dual-Coding Hypothesis. Journal of Educational Psychology. 1991;83:484-490.

Isolating the Effects of Words and Pictures by Comparing 4 Treatment Groups

0

10

20

30

40

50

60

70

80

90

100

Control Words only Animationsonly

Words withanimations

Mayer RE, Anderson R. Animations Need Narrations: An Experimental Test of a Dual-Coding Hypothesis. Journal of Educational Psychology. 1991;83:484-490.

Per

cen

t C

orr

ect

on

Pro

ble

m S

olv

ing

Indications

Curriculum DevelopmentKern 6 Steps:

1. Problem identification and general needs assessment

2. Needs assessment for targeted learners

3. Goals and objectives (competencies)

4. Educational Strategy = e-learning?

5. Implementation

6. Assessment and Evaluation

Indications

Instructional gaps (competencies): Attitudes: Evidence for motivation Knowledge: Efficient Skills: It depends

Psychomotor Social Clinical Reasoning

What is the critical skill?

Critical Skills (Norman)Competency/

Skill/Knowledge

Critical element E-learning method

Gross anatomy Dynamic 3D visualization

3D animations

Physiology Cardiac conduction

Simulation

Auscultation Heart sounds Tutorial, simulation

Cystoscopy Manipulating the instrument

Virtual reality simulation?

Laparoscopic surgery

Touch/haptic feedback

Virtual reality

Pain Management Clinical reasoning Virtual patients?

Matsumoto 2002

Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol. 2002;167(3):1243-7.

Matsumoto 2002

Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol. 2002;167(3):1243-7.

Geriatric E-learning Content

Tutorials

Virtual Patients

Animations

Simulation-Game

Animation

Geriatric E-learning Content

WikiBlog

Digital Video Computer-based testing

Geriatric E-learning Access

GEC Clearinghouse AAMC MedEdPORTAL

CELGIFamily Medicine Digital

Resources Library

Geriatric E-learning Access

GRECC audioconferences LTC GeriU Florida

The GeriatricWeb POGOe

Educational Scholarship

AAMC MedEdPortal: Peer Review AAMC Seal Letter to your Dean

JAGS Education & Training Section Educational Resources Column JAGS Citation

Employee Education Innovation Grant Announcement

Research

AAMC 2006 Colloquium Findings Educational technology is widely

used in medical education & has many advantages

The current evidence base is anemic

There are research-based guidelines for multimedia and human-patient simulation

We should not ask “Does it work?” but rather, “How and when is it most effective?”

From Chris Candler MD presentation during the MedBiq 2007 meeting in Baltimore

Comparative ET research

Avoid media comparatives studies Can be controlled (minimize confounding) Help us know how to use, improve the new

technology (clarification) Quantitative studies: RCT or quasi-

experimental, surveys, systematic reviews Qualitative studies

Data collection: focus groups, interviews, observation

Data analysis: thematic, grounded theory

Key questions for future research – When to?

Replace or augment existing course? Use specific modalities? facilitate learning in clinical practice (just-in-time

learning)? Use group vs. individual work? Use real pt vs. simulation? Use mandatory vs. optional? Get instructors to have additional training? Use in postgraduate training / CME?

From David Cook, MD presentation The Research Agenda: The failure of research in educational technology to inform practice, and what we can do about it. MedBiq 2007 Annual Meeting

Key questions for future research - How to?

to teach effectively? Cog. process method design

to match design to objectives? to effectively use multimedia and fidelity? can e-learning courses be individualized?

(adaptation vs. autonomy) can design be automated? do we assess learning?

From David Cook, MD presentation The Research Agenda: The failure of research in educational technology to inform practice, and what we can do about it. MedBiq 2007 Annual Meeting

Key questions for future research Matching method to Critical Skill

Lectures, small

groups, & CAI / WBL

Small group, VP

SP HFS

Core knowledge

Clinical reasoning

History, exam,

counseling

Procedure, team,

emergency

??

From David Cook, MD presentation The Research Agenda: The failure of research in educational technology to inform practice, and what we can do about it. MedBiq 2007 Annual Meeting

GeriVIP: Geriatrics Virtual Patient Aims

To collaboratively develop geriatric virtual patients to address key content and competency areas in geriatric education.

To share geriatric virtual patient as part of a VP “bank”

To investigate the effectiveness, efficacy and efficiency of virtual patients in geriatric education

Problem identification

Needs Assessment of Target learners

Goals and objectives: Competencies

Educational Strategy

Implementation

Assessment and Evaluation

Chronic pain in the elderly

Internal medicine residents

The resident will assess and manage chronic pain in older outpatients with chronic conditions

Virtual Patients

Primary Care blended e-learning curriculum

Assessment: Chart Review, script concordance test, clinical vignettesEvaluation: Effectiveness, efficiency, feasibility, features

Geri VIP: Virtual Patients

GeriVIP: Geriatrics Virtual Patient Project

Authoring tool WebSP (Karolinska)Initial Themes Geriatric pharmacology, chronic pain, patient safety Geriatrics and Gerontology Educators Author, Content Expert, Reviewers, ContributorsWhat institutions get:1. Access to bank of virtual patients2. Assistance with submission of VPs to MedEdPORTAL 3. Participation in VP multi-institutional research

Conclusions

E-learning: effective, efficient, accessible Deliberate practice especially relevant Cognitive psychology-learning basis Accumulating evidence-base Geriatrics E-learning: content and access Research: Wide open – when and how to use e-

learning in geriatrics education Virtual patients: Research & Education

opportunities for collaboration

Gerontology and Geriatrics Web Sites LTC GeriU: http://ltc.geriu.org POGOe: http://www.pogoe.org CELGI: http://www.celgi.org GeriatricWeb: http://geriatricweb.sc.edu/ GRECC Audioconferences:

http://www.pogoe.org/GRECC MedEdPORTAL: http://www.aamc.org/mededportal GEC Clearinghouse:

http://www.nagec.org/resources/ FMDRL: http://www.fmdrl.org/ HEAL: http://www.healcentral.org/