scaling the next phase of evolution in medical education
TRANSCRIPT
Scaling the Next Phase of Evolution in Medical
Education ASSOCIATE PROFESSOR ALFRED KOW WEI CHIEH
A S S I S T A N T D E A N ( E D U C A T I O N ) S E N I O R C O N S U L T A N T
Y O N G L O O L I N S C H O O L O F M E D I C I N E & D I V I S I O N O F H P B S U R G E R Y & L I V E R T R A N S P L A N T A T I O N
N A T I O N A L U N I V E R S I T Y O F S I N G A P O R E D E P A R T M E N T O F S U R G E R Y
N A T I O N A L U N I V E R S I T Y H E A L T H S Y S T E M
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Background
The Fourth Industrial Revolution heralds a series of social, political, cultural, and economic upheavals that will unfold over the 21st century.
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Background
Building on the widespread availability of digital technologies that were the result of the Third Industrial, or Digital, Revolution The Fourth Industrial Revolution will
be driven largely by the convergence of digital, biological, and physical innovations.
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Background
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Innovative learning tools such as serious games are gaining much attention in the past decade, particularly in medical education.
Serious games: Games developed for a purpose other than entertainment, such as teaching a specific knowledge or skill1.
Wang et al2: Activity to be labelled as Serious games challenging goals, scoring and an engaging design.
Serious games have been shown to increase learner satisfaction and knowledge gains over traditional teaching methodologies.
1. Olszeqski AE, Wolbrink TA. Sim Healthcare 12: 240 – 253, 2017 2. Wang et al. Simul Healthcare 2016; 11(1): 41 – 51.
Content
Background
Why Technology in Medical Education?
Current Trend of Technology in Medical Education
Framework for Implementation of Technology in Medical Education
Our Digital Transformation Experience
Examples of Technology in Education
Conclusion
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Why Technology in Medical Education?
Current problem in medical education.
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Why Technology in Medical Education?
To meet the needs of the Internet generation, both preclinical and clinical medical training need to evolve beyond traditional approaches to infuse new tools and media into curriculum
Current generation of students to be successful: Skills in digital literacy, complex thinking and creativity.
Students entering medical training with various experiences in video gaming, mobile applications, instant messaging, social networking etc – Educational games, mobile applications and electronic simulations may be useful in this generation of medical students.
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Learning Gaps
Traditional teaching methods: Lectures, group tutorials, bedside teaching, internship
Gaps: Difficulty in achieving universal exposure – dare say that every medical student’s exposure to clinical experience is different
Content that will be too ‘dry’ to deliver via conventional methods such as lectures – patient safety – where everyday principles of safe medical practices should be emphasized – too boring to deliver this topic via lecture alone
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Learning Gaps Harness the subconscious level of memory and skills of the learners eg gaming that does not require rote learning – but analytical thinking process, with visual ques, and instant feedback to the responses
Building habits through gaming
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Changing Healthcare Scene
Genomics – personalised medicine
Big data – Impact on healthcare and on education (learning analytics)
Impact of technological advances both in treatment and health management by patients
Focus on safety, quality, outcomes and efficiency of health care
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Changing Healthcare Scene Orthotics vs rehabilitation robotics
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Big Data and Data Analytics
Exponential role in big data and data analytics
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Changing Healthcare Scene
Implications for Education Medical education will need to respond to a world that is increasingly
globalised, complex, diverse and uncertain, requiring an educational system that is flexible and responsive to change
Solutions to problems will need to be sought through transformation rather than incremental growth
Changes will be required at the level of curriculum, delivery and the system of education
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Current Trend TECHNOLOGY IN MEDICAL EDUCATION
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Current Trend in Medical Education
Lancet Report – Vision All peoples and countries are tied
together in an increasingly interdependent global health space and the challenges in professional education reflect this interdependence
Our vision calls for a new era of professional education that advances transformative learning and harnesses the power of interdependence in education
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Current Trend in Medical Education
Lancet Report – Transformative Learning
Transformative learning is about developing leadership attributes; its purpose is to produce enlightened change agents
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Current Trend in Medical Education
Proposed reformation structure for future medical professionals
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Current Trend in Medical Education
Carnegie Report – Findings/ Challenges
Inflexible curriculum
Not learner-centered
Poor connections between formal knowledge and experiential learning
Clinical education overly focused on inpatient clinical experience
Inadequate longitudinal clinical experiences
Inadequate attention to patient populations and health care delivery systems
Limited understanding of non-clinical physician roles
Limited focus on professionalism
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Current Trend in Medical Education
Carnegie Report – Goals of Reform
Standardization of learning outcomes and
individualization of the learning process
Integration of formal knowledge and clinical experience
Development of habits of inquiry and innovation
Professional identity formation
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Current Trend in Medical Education
Skilled clinicians
Able to adapt to new knowledge & changing patterns of illness as well as new interventions, personalised therapeutics and rapidly changing medical science and health care systems.
Physicians will need to: Be independent and critical thinkers,
capable of appraising evidence o free from – personal bias and inappropriate influence
Manage uncertainty, tolerate ambiguity, non-algorithmic work
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Current Trend in Medical Education
Database searches: 958 articles (19 reviews were relevant to the following technology-associated educational modalities: 4 reviews on e-learning, 1 review on multimedia, 6 reviews on virtual patients and simulators, 3 reviews on audience response systems, 2 reviews on mobile devices, and 3 reviews on social media).
Including e-learning, simulators, virtual reality, mobile devices, audience participation, computer based, medical illustration, or social media.
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Current Trend in Medical Education
E-Learning E-learning—a web-based technology that extends teaching past the classroom—permits learners to hear and engage educators in lieu of or in addition to traditional classroom lectures. Flexible and active learning methods
E-learning curricula offer a platform for easy tracking of trainee improvement in knowledge and performance mastery.
Most valuable when associated with real-time feedback, self-assessments, simple interface, extended time for completion, and topic relevance
Time and fiscal costs of initial creation
These qualities make e-learning ideal for exposing trainees to rare and complex medical scenarios. Such training interventions reinforce recognition of clinical patterns and orchestrate trainee reflection on key training points.
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Current Trend in Medical Education
Multimedia A meta-analysis of 266 studies conducted in 2010 revealed that 89% of web-based medical training courses included paragraph-form static written text, in addition to multimedia tools like videos, diagrams, and pictures. Multimedia (such as tutorials and diagrams) and interactive self-assessments (such as patient cases,
quizzes, or other feedback) were incorporated into over half of e-learning courses. Videos simultaneously fuse both auditory and visual information. Videos engage various areas of the trainee’s cognition during lectures.
Video-based lectures enable trainees to harness repetition, self-paced practice, and active learning. As with e-learning, trainees benefit the most from videos containing self-assessments, integrated lecture objectives, images, lecture PowerPoint slides, limited duration (< 15 min), quality design, and reputable featured lectures.
In fact, multimedia transforms the role of medical educators from that of hosting formal lectures to that of leading discussions and creatively maximizing trainee comprehension via media intervention tools.
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Current Trend in Medical Education
Technology in Audience Participation
Audience response systems (ARS) technology has been increasingly utilized to stimulate more active learning in the classroom. ARS may facilitate student in-classroom participation and encourage group problem solving (depending on how the ARS is integrated into the experience).
Anonymity in responses allows the learner to engage without fear of embarrassment or being singled out by peers or the instructor. Regarding the incorporation of ARS into curricula, learners report strong positive acceptance, increased attentiveness, and enhanced engagement and enjoyment of the lecture experience.
One controlled study suggested that immediate feedback after questions (as facilitated by ARS) may improve knowledge condensation.
Unfortunately, ARS have shown weak or equivocal results in long-term knowledge retention and learning outcomes; these inconclusive results have impaired academic institutional implementation of the ARS technology.
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Current Trend in Medical Education
Virtual Reality and Simulations
To enhance knowledge application, educators have developed virtual patient (VP) encounters (realistic, animated clinical scenarios portraying a broad array of pathologies) to exercise the medical decision-making skills. Virtual reality has been frequently employed by procedural specialty trainees to improve skill development.
Research has yielded mixed reviews of the efficacy of simulations in medical training. A meta-analysis involving various medical professionals across 4 controlled trials compared simulation-based interventions to
non-technological interventions. Except for 1 trial, each of the other 3 trials revealed that high-fidelity simulations lacked superiority in areas of trainee
confidence, performance, and knowledge. In contrast, two meta-analysis studies comparing simulations to other non-technology-based interventions concluded that
simulations yielded significant advantages in knowledge improvement, skill mastery, time to skill acquisition, and trainee satisfaction.
If designed and selected properly, simulation usage may bring specific advantages to medical education. Trainees have identified feedback, opportunities for repeated practice, realism, and team-focused communication skills as predictive variables contributing to a simulation’s success rate and acceptance. Although data regarding actual patient outcome improvement was not found, the use of simulators in medical education appears effective in engaging a medical trainee in active learning.
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Current Trend in Medical Education
Mobile Devices Mobile devices have evolved to accommodate the numerous demands of the highly mobile clinician and trainee.
As of 2006, 85% of healthcare providers have adopted mobile devices in patient care.
Smartphones enable trainees the ability to multitask, while instantly refreshing knowledge on diagnoses, medical management, patient health information, medical calculations, or the most contemporary literature.
Now able to receive real-time, point-of-care computation, trainees can employ idle time and maximize learning by utilizing web-based study material and current literature. Mobile device apps offer improved accessibility to clinical literature, continued medical education, and error prevention tools. Additionally, these devices also permit faster clinical communication and subsequent response times to patient’s needs.
Mobile devices remain limited in areas of battery life, malware risks, potential privacy breaches, or erroneous information in searches. Trainees express concern about smartphone usage appearing disrespectful to patients, attendings, or coworkers.
No current studies exist regarding mobile devices improving actual patient outcomes.
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Current Trend in Medical Education
Challenges in medical education in the future
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Framework for Implementation TECHNOLOGY IN MEDICAL EDUCATION
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Framework for Implementation
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Systematic, Institutional Adoption
METE -- Medical Education, Technology & Enterprice
Adoption & Implementation
• Aligned with Digital Transformation strategy
• Active encouragement of adoption of technology in education
• Strategic funding and resource allocation
• Broad review of areas to develop
• To drive innovation in technology for medical education
• To motivate educators • As a central body to study and
approve innovative education projects which deploy advanced technology
• As a body to review the outcomes of pilots etc. of projects before proposing it to UGCC for incorporation into the main curriculum
• To collaborate with industry
• Allow pilot projects to study feasibility
• Ensure the process of new technology development is aligned with curriculum
• Complete triangulation process of new technology development, implementation and review and feedback – including assessment
Framework for Implementation
Interdependence in education and transformative
learning
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Framework for Implementation
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Identify gaps in education
Explore potentials to adopt technology in education pedagogy
Encourage educator to take the lead in the
project -- Project development
Piloting the project and evaluate feasibility and
outcomes
Upgrading and potential enterprise opportunities
Spectrum of Technology
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Scopes of Development
Clinical Reasoning Learning
Virtual Integrated Patient
Med2Lab
AI Clinical Analysis Tool
AI project
Basic Science Learning Platform
Pathweb
Anat/ Surgical Web
Gaming
PASSED
HEALING
Avatar Learning
CREATIVE
VR/ MR/ AR
VIHA
VISE
PASS-IT
RESCUE
Mobile Apps
Translation app for Hx taking
eBook
CVS (Prof Hooi)
Psycholgical Medicine (A/P
Roger Ho)
Curriculum Implementation
Platform (Entrada)
• Manual for Procedural Skills • Attendance taking app
VIHA
Currently standalone project – piloting
But must have a solid pedagogy to merge this with the main Anatomy content and package it effectively as a tool to augment anatomy teaching
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Learning anatomy using VR technology
VISE
In progress
Using VR to teach mass casualty responses by healthcare workers
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Learning mass casualty response using VR technology
CREATIVE
Ongoing – Interprofessional multidisciplinary rounds
Medical students, nursing students, allied health students, pharmacist etc come to perform a ward round – can log on at various location including home
Need to enhance the fidelity of the program if intend to commercialise it
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Virtual ward round using Avatar technology
Path Web
Created by A/P Nga Min En
Digitalised pathology pots and allow close-up visualization of the specimens
Widely use in the region
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Anat-Surg App
Enhance spiral-learning from anatomy, pathology to surgery
Also to include Ortho, ENT, O&G, Neurosurgery, Urology, Vascular and CVTS
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Ph
ase
I An
ato
my
Basic Anatomy (Prosected specimens/ Histology)
Ph
ase
II Pa
tho
logy
Path pots/ Specimens
Ph
ase
III &
V S
urg
ery
Videos of Surgery
Using surgical videos (Open/Lap) to correlate with basic anatomy
Enhance clinical application of basic science knowledge with real life materials
Second Generation PASSED Supported by LIFT funding, we developed 2nd
Generation PASSED game to further enhance the learning experience – S$45,000
Touchscreen device
Mobile application
Wifi connection
Focusing on patient safety – selecting correct equipment for resuscitation
Summary of learning objectives at end of each act
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Second Generation PASSED
Potential to roll out into inter-professional education with other healthcare professionals
Combining with other teaching pedagogies – Patient Safety Day (where nursing, pharmacy, dental and medical students spent 1 day to learn consolidated concepts of patient safety)
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PASS-IT Project using Virtual Reality
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The highlight of using VR technology in the PASS-IT project is to allow the students to immerse into the operating theatre scenario and see the flow of patients within the peri-operative setting from dental clearance prior to surgery, to anaesthesia evaluation and procedure to handling of sharps during surgery and safe conduct of performing operations.
At each stage of the learning encounter, key concepts of patient safety will be emphasized as detailed below.
Combining Dentistry, Anaesthesia and Surgery
HEALING (Healthcare Economics Awareness LearnING)
Currently funded by LIFT – S$70,000
Work with healthcare economics content expert to craft out course content to deliver to medical students – conduct scholarly studies and package it for enterprising
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Response in Emergency, Safety and Civil strUcture Evaluation (RESCUE)
Inter-faculty VR training using mass casualty incident (SGD310,000 funding)
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Civil Engineering Paramedic and Emergency Medicine Building and Safety
Advantages and Disadvantages Development considerations
Identify learning objectives first
Avoid ‘focusing on the technology’
Establish a plan to measure effectiveness
Identify stakeholders for development: Content experts Game designers Target audience Teaching faculty
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Advantages and Disadvantages
Development considerations Select game platform/technology requirements based on learning objectives
Target audience feedback during development
Integrate with medical literature/ other resources
Pair with specific curriculum content to augment learning experience
Leverage the mobility of games for location agnostic learning
Plan for ongoing content management and maintenance
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Advantages and Disadvantages
Development cautions Don’t overemphasis on technology, and neglect the pedagogy Weigh learning value against game complexity Potential high development cost Potential lengthy development time Inclusion of too many learning objectives Balance difficulty and playability
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Disadvantages of Technology
Robotics and advanced technology cannot teach compassion, empathy, respect, and many other
professional values & skills in medicine.
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Technology in Medical Education is not meant to replace the human
interactions between educators and students
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Conclusion
4th Industry revolution is here – Technology, AI and big data is going to come in a big way.
Healthcare delivery is undergoing rapid changes and education of healthcare professionals must follow closely.
Students of the millennium – future healthcare professional has different learning habits – adoption of technology is inevitable.
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