In Context

126 www.thelancet.com/neurology Vol 11 February 2012

ebrain brings the e-learning revolution to the neurosciencesDavid Holmes reports on the launch of the world’s largest and most comprehensive online training resource in the clinical neurosciences.

Over 450 authors from every clinical neuroscience specialty were needed to come up with the more than 550 lessons that make up the 23-module ebrain curriculum—the world’s largest, most comprehensive web-based training resource in clinical neuroscience. At ebrain’s launch at the end of 2011, John Pickard, Chairman of the UK’s Joint Neurosciences Council (JNC), described it as “the key to taking neurosciences forward in this country”, a resource that could transform the way in which both clinical trainees and trainers are supported throughout their continuous professional devel-opment. But had it not been for the perseverance of the project’s small team of clinical and technical leads, ebrain might never have seen the light of day after cuts to the UK Department of Health’s e-learning budget plunged the programme into crisis.

The concept of ebrain was originally commissioned under the aegis of the Department of Health’s e-Learning for Healthcare programme, which approached the JNC to collaborate on the project. The idea of e-Learning for Healthcare was to create an e-learning programme that would cover all aspects of medicine—an ambitious

undertaking funded from the department’s capital budget and one with a large attendant bureaucratic machinery. But when the then new coalition government announced its capital spending review in 2010, the e-learning programme was an obvious candidate for cutbacks. “This was meant to be a revolution in health-care training in the UK”, says Simon Shorvon, from the University College London Institute of Neurology (London, UK) and a clinical lead on ebrain since 2009. Instead the whole project was cut “almost overnight” in June, 2010.

“It was really quite a crisis period”, says Shorvon. “The contractors for the programme who were contracted by e-learning for health had their contracts terminated overnight.” The eff ect, Shorvon recalls, was “a pretty devastating blow”. Only those programmes that were almost ready for launch were spared. “The rest were cut”, adds Shorvon, and “most of them disappeared”, taking millions of pounds of public money that had already been invested, and most of the educational material that had been paid for with it.

Out of this wreckage came the ebrain project itself. Shorvon, his colleague Simon Thomson (Leeds Teaching Hospitals NHS trust, UK), and the JNC decided to try to rescue the programme “even though we didn’t have any funding for the technical development”, recalls Shorvon. Together they approached

the various professional societies that make up the JNC’s membership for short-term funding, and the JNC took over ownership of the concept for the project from e-Learning for Healthcare. Extra funding from University College London, the European Federation of Neurological Societies, and the European Neurological Society put the project on a fi rmer footing, and the team was expanded to include a further two clinical leads: Hannah Cock from St George’s University (London, UK) and European representation in the form of Thomas Berger from the Clinical Department of Neurology at Innsbruck Medical University (Innsbruck, Austria). “Without bureaucratic interference”, says Shorvon, the small team was able to get the project ready for launch in just over 12 months at “something less than a tenth” of the £2·4 million that the Department of Health had said it would cost.

In the 12 months that it took to develop the 23 modules of the ebrain curriculum, the project evolved from being a UK-based resource to something that has the potential to spread worldwide. ebrain is already available throughout Europe because of the involvement of the European Federation of Neurological Societies and the European Neurological Society, while all British members of organisations affi liated with the JNC get automatic access, “even on an NHS computer”, jokes Cock. And this accessibility goes much further than the technical specifi cations and wide availability: the incorporation of a rich array of multimedia material adds another dimension to the learning experience. “One of the fantastic things about e-learning is that you can use video for demonstrations”, enthuses Cock. “Many of the how-to

For ebrain see http://www.ebrainjnc.com/

“[ebrain is] a resource that could transform the way in which both clinical trainees and trainers are supported throughout their continuous professional development.”

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In Context

www.thelancet.com/neurology Vol 11 February 2012 127

technical assistance is in the form of very easy-to-follow video, rather than pages of written instructions.” The programme is also fl exible enough to allow users to customise the curriculum to their own needs, Cock explains: “An individual can enrol on self-selected courses. You might decide that all you want to do is brush up on your epilepsy skills, so you can just do the epilepsy modules.”

The fl exibility of the platform is something that Thomson is very keen to emphasise. “This is not an electronic textbook, this is completely diff erent from a textbook”, he says. And one of the features that sets ebrain apart from more traditional learning resources is its ability to be updated on a constant basis. “It can update a little bit at a time”, explains Thomson, “and in fact what we have within the platform is a feedback system”. Users are awarded electronic certifi cates when they successfully complete every session, but to get the certifi cate they must fi rst leave feedback. This feature, says Thomson, “means we’re going to get bucket loads of feedback on every single session”.

Thomson hopes that this rapid feedback system will enable the team to quickly identify which sessions are working and which need more work. And as soon as a session that needs more work is identifi ed, “the fi rst thing we’ll do is look at these comments, send them to the author, and say these are the comments from your peers, this needs to be updated”, explains Thomson. This feedback is a “very powerful way of going through and updating all of these sessions and continuously improving them”, he says. “We will probably go through every session on a 4-yearly cycle as well. But the point is to identify the ones that particularly need sorting out, and the feedback is a very powerful mechanism”, he adds.

The editors had their work cut out in pruning what were initially going to be over 900 sessions down to the just over 550 sessions that make up

the ebrain resource in its present form, although Thomson stresses that more sessions can be added at any time. “We know that some topics are a little bit thin in some spots”, he says. “For example, there’s a lot of neuropsychiatry. But because the neuropsychiatrists have become quite excited about it they now want more sessions.” Producing a session is fairly easy according to Thomson, and he invites users who “can fi nd an author who can write a session, who can deliver that content to us, then, providing it’s of a certain standard we will put it on. And there’s no reason why sessions can’t overlap”.

Thomson also wants users with specialty knowledge to help index the sessions into learning pathways. At the moment users might be overwhelmed by the large number of sessions available, but Thomson says that the development of learning pathways will make it easier for trainees to fi nd the content best suited to them: “Someone will come in looking for subjects relevant to neurophysiology, or neurosurgery, or stroke medicine, and all we need is for the specialists

within those subjects to be able to go into the whole curriculum and say ‘that’s relevant to me, that’s not’. That way we can index the whole thing.”

The fi rst 6 months of the project going live will see this kind of user-generated refi nement rapidly re-shaping the user experience, but Thomson has even more ambitious plans for the long term. “We’re not that far away from concurrent learning, where you video a lecture and transmit it live at the time it’s being videoed”, he explains. “Essentially you could have a conference in Timbuktu and show it around the world through this e-learning platform. We’re not quite able to do this yet, but it’s really not very far away, and it’s quite a powerful way of transmitting very specialist lectures around a widely dispersed group of people.” Looking even further ahead, says Thomson, “the next point is when you can have the viewers talking back to the lecturer somehow. We’re not there yet but when you get that you’re starting to talk about seminars, you’re starting to talk about tutorials through this sort of system, and you’re starting to build potentially a global community of neuroscience clinicians. We’ve only just started, there’s a long way to go”.

David Holmes

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“...the project evolved from being a UK-based resource to something that has the potential to spread worldwide.”