Running head: VISION FOR E-LEARNING

Assignment 1: A Vision for E-Learning for the University of British Columbias Distributed Medical Undergraduate Program Diana Ng ETEC 520 65A The University of British Columbia Total word count (excluding references): 2493

VISION FOR E-LEARNING The Context In 2004, the Faculty of Medicine at the University of British Columbia launched its

distributed medical undergraduate program, the first of its kind in North America. In partnership with the BC government, the University of Victoria, the University of Northern British Columbia and 6 regional health authorities, a province-wide curriculum is distributed in 4 geographically distinct sites within BC including the Island Medical Program at the University of Victoria, the Northern Medical Program at the University of Northern British Columbia, the Southern Medical Program at the UBCs Okanagan campus, and the Vancouver Fraser Medical Program at the UBCs Vancouver campus. In 2011, 288 students were admitted to the program, 192 to the VFMP and 32 each respectively for the IMP, NMP and SMP. Additionally, students and residents are trained at more than 80 hospital and clinical sites within British Columbia in partnership with 6 regional health authorities. In 2011/12, the average age of students was 24, with a greater female to male ratio and a majority of students had a Bachelor of Science degree. Full-time faculty teach basic sciences in years 1 and 2 of the program but also have responsibilities for research and service-based activities. Part-time clinical faculty are practicing clinicians who are responsible for teaching clinical skills, and may also work as tutors for problem-based learning and doctor, patient and society tutorials. According to the UBC Faculty of Medicine (2012), from 2011/12 there were 633 full-time faculty, 4860 clinical faculty, 1069 MD undergraduate students, 1142 postgraduate medical residents, 1287 graduate students 225 post-doctoral fellows, 253 clinical fellows, 6050 continuing medical education students, and 13722 alumni. Considering the size and magnitude of UBCs distributed medical program, this report will provide an environmental scan, discuss the

VISION FOR E-LEARNING vision for e-learning in this context, and examine its future implications. The Environmental Scan An environmental scan of internal and external factors at work resulted in the following observations: e-learning technologies have been widely adopted and implemented through the use of synchronous communication platforms namely videoconferencing technology. This has enabled students to participate interactively across program sites, meet accreditation standards, allowed more students to learn from fewer clinical instructors, increased productivity and reduced travel costs for students and instructors. Moreover, this has developed f2f and virtual communities of practice, and increased inter-professional interaction across regional health authorities. In the next five years, from 2013-2018 it is anticipated that several internal and external factors will likely affect the potential use of e-learning within the UBC Faculty of Medicines distributed medical program. One of the major internal forces at play is curriculum renewal which is currently underway. This will affect the future use of e-learning as there will be

significant changes to the curriculum design with a move towards a competency-based, spiralled curriculum. The proposed timeline of activities by the UBC Deans task force (2010) outlines an evaluation and implementation plan from 2010-17. Working groups and pilots will help develop and evaluate this new curriculum structure. Additional internal factors include changes in the UBC Faculty of Medicines strategic plan (2012) which runs from 2011-16. Although the executive summary provides an overview of the vision, mandate, values and goals; the action plan on implementation is still currently under development. Likewise, there is an absence of a strategic plan for e-learning. Furthermore, the expansion of the distributed medical program with the recent addition of the Southern Medical

VISION FOR E-LEARNING Program in 2011/12 and the continued growth of students, faculty and staff is another factor to consider. Since appropriate pedagogy informs the use of technology, there may be faculty who resist embracing e-learning technologies in their teaching due to a lack of incentives and rewards. Currently, there is a technology enabled learning committee and mobile learning working group where innovative e-learning ideas can be vetted through, however, perhaps the internal infrastructure of this support may change over time to a more senior academic or administrative position overseeing e-learning activities. Conversely, there are several external factors at play. For example, the rapid changes in technology, adoption of emerging telecommunication, simulation and information technology impacts the use of e-learning in undergraduate, postgraduate and continuing medical education. Furthermore, changes in the provincial government may affect funding support to the medical program, economic factors may affect budgetary constraints, and the changing demographics of the Canadian population with an influx of baby boomers retiring over the next few years may place additional stress to the Canadian health care system. There is also a national call for competency-based, patient outcome-oriented training across the continuum of education and the evolution of healthcare environment including the electronic health record, advances in the management and delivery of healthcare services will undoubtedly play a key role in shaping the potential use and adoption of e-learning within the medical curriculum. Vision for E-Learning at the UBC Distributed Medical Program As future practicing physicians, graduates will need to stay up to date with the latest medical advancements and breakthroughs to provide the best patient care possible and optimal clinical outcomes. As students, residents and physicians will be distributed throughout the province of BC and possibly beyond, there is a real need to meet the demands of flexible access

VISION FOR E-LEARNING and ongoing training necessary to help lead the way in providing high quality and timely patient services. Thus, the rationale for e-learning is linked to the UBC Faculty of Medicines strategic directions for transformative learning, as well as health care innovation and excellence. UBC FoM is committed to pursuing the highest standards of health education scholarship and innovation, as well as ensuring all educational programs prepare our learners for evidencebased practice, critical reflection, lifelong learning and an ability to deliver service in a highly professional manner (UBC Faculty of Medicine, 2012). Accordingly, learners should be provided high quality e-learning with an emphasis on innovative, enhanced learning materials. The UBC Faculty of Medicine will lead the way in the use of educational technology in innovative ways to enhance teaching and learning. With over 80 videoconferencing facilities throughout the province of BC, the use of videoconferencing and multimedia conferencing for the purposes of collaborative learning, virtual patient simulations, virtual histology/pathology labs and program evaluation will significantly increase throughout the medical program. Thus, the vision for e-learning in the context of UBCs distributed medical undergraduate program is threefold: 1) a blended learning approach (f2f + online) with a gradual transition from a primary focus on traditional lecture-based teaching to fostering a more self-directed approach where students have flexible options to develop their own learning pathways, 2) transforming the role of the teacher from the traditional content expert and disseminator of knowledge to become a

facilitator and assessor of a competency-based curriculum using the constructivist paradigm, and 3) a highly collaborative student learning experience through the use of virtual patient simulators for standardized patient training, online discussion boards, and participation in the International Virtual Medical School. For medical students, e-learning can be linked to core competencies and replace lectures

VISION FOR E-LEARNING and other synchronous modes of instruction. Asynchronous e-learning may be a more effective way for students to learn considering the demands of clinical care rotations. Also, developing adaptive learning materials would help assess learners knowledge and skills at the start of an online training module and provide relevant educational materials at the level suitable to each learner. Learning is adaptive in that tracking, support and assessment will be evaluated based on their proficiency and skill level. This learner-centred approach ultimately provides a customizable learning plan for each student to specifically target their learning needs and aptitudes. Rather than offering pre-recorded lecture materials on the learning management system for students to review, these could be replaced with supplementary online learning modules students could complete during their independent study times. For example, the development of

virtual patient simulations and case-based learning material could offer flexible and customizable content, making use of collaborative learning through groupwork, discussion boards, and eportfolios. A shift towards a blended learning environment will also provide an opportunity for educators to become facilitators of knowledge helping students as a guide through their learning process. Participation in the International Virtual Medical School (IVIMEDS), a global collaboration of medical educators can encourage faculty to work collaboratively to improve the learning experiences of students by appropriate use of technology in support of teaching and learning. Currently, the IVIMEDS consists of more than 30 partners in 15 countries who openly share 1) curriculum maps that link learning content and assessment, 2) learning resources including illustrations, video clips, animated diagrams, medical images, and 3) virtual patients that simulate authentic, high fidelity patient problems.

VISION FOR E-LEARNING Additionally, curriculum management will be important to develop a learning objects repository, and to support educational technologies such as virtual patients, simulators and eportfolios, as well as integrate learner technology initiatives (i.e. wikis, blogs). A single login process will help with the functionality, ease of use and efficiency of accessing various learning and teaching resources. As the existing WebCT Vista platform is upgraded to Blackboard Learn by July 2013, the learning management system can be used in the medical program and other health professional programs as a well-integrated e-learning product. A combination of synchronous and asynchronous modes of learning will offer students and faculty with greater flexibility and as problem-based learning converts to case-based learning, associated learning materials could be accessible for students using their mobile devices by encouraging a bring your own device movement. In this way, e-learning will be used to support the medical curriculum, fostering collaborative learning, encouraging innovation in content development, and offering greater flexibility to complement the existing use of videoconferencing technology. The rationale for using e-learning is to ultimately enhance teaching and learning throughout the medical program.

Envisioning the end result, five years from now a student in the UBC distributed medical program will be using e-learning to engage in self-directed learning modules, connect with their colleagues via discussion boards, chats, and complete their competency-based assessments. Elearning will change the program by instilling a sense of lifelong, continued learning for students, faculty and physicians to help them stay up to date with their practice. By combining online and face-to-face components, students will learn at their own pace, depth and range with minimal guidance. For example, students and faculty could attend online medical conferences or

VISION FOR E-LEARNING workshops which could help save on travel time and associated costs especially if they are located in rural parts of the province. Another aspect to consider within this vision is leveraging the learners technical expertise. Students will play a pivotal role in helping integrate educational technology into the

medical curriculum. Medical students at all levels will be encouraged to participate in e-learning development. Possible incentives include developing innovation awards and grants, internship programs, or work/study positions to make use of the technical expertise of learners while encouraging them to use technology in a professional manner within the medical program. Implications for the UBC Distributed Medical Program The integration of e-learning into undergraduate, graduate and continuing medical education will promote a shift towards adult, self-directed learning in medical education where educators no longer are the sole distributors of content but become facilitators of learning and assessors of a competency-based curriculum. Thus, the role and work of faculty and clinical faculty would be impacted as they no longer offer curriculum dominated by traditional lecturebased content and instead they will utilize their content expertise to develop online learning modules with the aid of instructional designers and educational technology support team. In order to encourage and support this transition, innovation among faculty members will be recognized and supported through awards and grants to provide opportunities to create e-learning content. Faculty will peer-review the content and it will be recognized for merit and tenure processes. A dedicated educational technology support team can provide support for the design, development, implementation, evaluation, collaboration and sharing of digital e-learning materials and repositories.

VISION FOR E-LEARNING

It is acknowledged that adopting e-learning will require large investments in faculty time, money and space and these proposed changes will need to be justified to the executive team and administrators. Also, considerations of how to evaluate e-learning programs will be beneficial for ongoing improvements and updates. Such questions may include whether the interface and layout is easy to navigate through the online course material, whether the layout and content is conducive to learning and meets its stated objectives, whether multimedia elements are used in an effective manner to enhance learning, whether the interactivity is appropriate for various learners, and whether special technical skills, additional hardware or software is required. Also, the teaching philosophy will shift as educators adapt to a constructivist paradigm. In partnership with the UBC Centre for Teaching and Learning, training workshops on pedagogy and educational technology skills will be provided to faculty. Additional changes to consider include differences in the way students study in the program. By promoting self-directed learning students will be able to develop content expertise in areas that are of interest to them. This will be particularly advantageous during their 3 rd and 4th years when they complete their clinical clerkships. With the heavy demands of rotation based clinical shifts, students will have the flexibility to engage in asynchronous learning online. By learning on-demand, this will contribute to the convenience in time and ease of use. In some respects, a blended learning approach is already in existence within the medical program albeit in its early stages. There are some faculty innovators who have developed online learning modules in psychiatry and clinical skills. However, more is needed. Currently students do not have options to develop their own learning pathways and by their clerkship years they need to decide what types of postgraduate residency training they will apply and compete for. By offering students supplementary online training modules, this can help guide them towards their

VISION FOR E-LEARNING interests and also provide remedial learning for students who require more time to develop their content expertise. Furthermore, a promising future venture includes the active participation in the International Virtual Medical School. Medical educators from around the world can work collaboratively which will help ease the burden of developing local content, as they share learning object repositories, curriculum materials, and other tools to minimize the unnecessary duplication of efforts. Because of this, students will ultimately be rewarded with a highly collaborative learning experience through the use of innovative online learning including virtual patient simulators for standardized patient training, and online discussion boards. Thus, this report examined the UBCs distributed medical program by providing an environmental scan to determine what internal and external factors would affect the implementation of e-learning, discussed the vision for e-learning in this context, and examined its future implications. With curriculum renewal already underway, this is an excellent

opportunity to develop, adopt and implement an appropriate e-learning strategy that will address the needs of medical students, and ultimately shape the future physicians of tomorrow.

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