Appendix 1

DISTANCE EDUCATION IN MEDICINE

Reynaldo O. Joson, MD, MHPEd

Introduction

Distance education (DE) is one of the many developments in

medical education that have taken place during the last two
decades (1 - 4). At present, it is most frequently seen in the
form of a postgraduate continuing medical education program. The
recognition of the importance of continuing medical education and
the presence of constraints on the part of the practicing
physicians to go to a center for such an activity are the forces
behind the development of DE in medicine.

In the Philippines, DE is becoming popular. The government

has voiced out the thrust on DE for its public educational
program. The University of the Philippines has created another
autonomous university called the University of the Philippines
Open University. This Open University shall take care of all the
DE programs in the whole university starting 1995.

DE is, thus, a current tendency in education in the

Philippines, medical education included. For it to become a
trend, for sure there must be some usefulness that come with it.

All medical educators in the Philippines must, therefore, be

familiar with what DE is and can offer. It is only after being
familiar with it can decisions be made as to whether and when to
use DE in the teaching of medicine.

This paper will explain the concept of DE and identify its

usefulness in medicine.

Learning objectives

After studying this paper, the reader is expected to be able

to:

1. Explain the concept of distance education.

2. Identify in which among the four components of a distance

education curriculum (objectives, content, activities,
and assessment) will planning and implementation be very
challenging to the medical educators who are not used to
distance education.

3. Identify the benefits that distance education can offer

in the field of medicine for the students, teachers,
teaching institutions, and pubic health administrators.
33
Definition of Distance Education

Distance education is a structured program of instruction in

which majority of the teaching occurs while the educator and the
learner are at a geographic distance from one another.

The key elements in this definition are the following:

1. Structured program of instruction

2. Geographic distance
3. Majority

Structured program of instruction

Distance education, as the word "education" would

imply, contains a structured program of instruction, meaning
it has a curriculum, instructional design, and lesson plans,
formulated by the educators of a teaching institution or
organization. As such, DE has set learning objectives,
content, learning strategies, and methods of assessment.

Geographic distance

In distance education, as the word "distance" would

imply, teaching and learning take place with the educator
and the learner being at a geographic distance from each
other.

Majority

Majority and not all of the teaching and learning take

place at a distance. An intermittent face-to-face
interaction between the educator and the learner is still
necessary to facilitate learning as well as assessment.

Conceptual Framework of Distance Education

Fig. 1 shows the structural and functional frameworks of

both residential education (or in-campus study) and distance
education (or off-campus study). The essential difference in the
two frameworks is the geographic distance between the teacher and
the student, which is greater in DE. Both modes of education
have a curriculum with the usual four components of learning
objectives, content, learning activities, and assessment.

34
A. Residential Education (In-campus Study)

Course Curriculum
|
|
Teacher <--+--> Student
|
|
---------------------------------------------
| | | |
Objectives Content Activities Assessment

B. Distance Education (Off-campus Study)

Course Curriculum
|
|
Teacher <------------------+------------------> Student
|
|
--------------------------------------------
| | | |
Objectives Content Activities Assessment

Fig. 1. Structural and functional frameworks of residential

and distance education.

35
 Fig. 2 shows the conceptual framework of distance education.

The premises are the following:

1. The teacher and the student are at a geographic

distance from each other.

2. At this distance, teaching and learning have to take

place.

Guided by the learning objectives and content, the teacher

formulates teaching and learning strategies in consideration of
the geographic distance.

To facilitate teaching and learning in DE as well as to give

the teacher the opportunity to do formative evaluation of
student's learning, there must be interaction between the teacher
and the student. The three general ways of teacher-student
interaction in DE are the following:

1. Interactive instructional materials

(print and nonprint)

2. Teleconferencing
(telephones; broadcasts: radio and television)

3. Intermittent face-to-face interaction

At the end of the course, a summative evaluation of the

student's learning is done.

The expected outcomes of DE consist of the following:

1. At a geographic distance from the student, the

teacher should be able to:

1.1 conduct effective teaching to the student and

1.2 assess the progress of student's learning.

2. At a geographic distance from the teacher, the

student should be able to learn what he must learn.

The single most important parameter of success of DE is

whether the student learned or not. This is determined in the
summative evaluation.

36
 Geographic Distance
Situation Teacher <-----------------------------------> Student
| | |
| <----------- Interaction -----------> |
| | |
| | |
| Learning | Learning |
| Objectives ----->|<-----Content |
| | |
| | |
| | |
| ----------------------------------- |
| | Interactive | |
| | instructional materials | |
| | (print/nonprint) | |
| | | |
Input | | Teleconferencing | |
| | | |
| | Intermittent face-to-face | |
| | interactions | |
| ----------------------------------- |
| | Learning Activities and | |
| | Formative Evaluation | |
| ----------------------------------- |
| | |
| | |
| | |
| | |
|------------ Summative Evaluation -----------|
| |
v V
Output Teaching Learning
and
Assessment

Fig. 2. Conceptual framework of distance education.

37
What Distance Education Is Not

Consider whether the following teaching and learning

methods constitute DE or not:

1. Using books, journals, audiotapes, videotapes, slides,

and television outside the classroom or school.

2. Using teach yourself manuals, programmed lessons, and

computer-aided learning programs outside the classroom
or school.

3. Through correspondence study.

4. Through intermittent out-of-town postgraduate courses in

medicine.

Do all of the above teaching and learning methods constitute

distance education?

All of them may constitute DE as long as they are being

implemented under the scheme of DE. In practice, in the
Philippines, at the moment, however, they are usually not.

Correspondence study closely resembles DE. There is a

curriculum. However, the program is usually lacking in
interactiion between the teacher and the student. Interaction is
an essential feature of DE.

In intermittent out-of-town postgraduate courses in

medicine, though teaching and learning are done away from the
school, there is usually no formal curriculum and no program of
evaluation.

Other Names of Distance Education

The other names of DE are distance learning, off-campus

learning, open learning, and external study.

The universities that offer DE may carry such names as open

university, university without walls, university of the 21st
century, and university of the second chance.

All the abovementioned names and any other names for that
matter, are acceptable as long as they imply distance education
and they embody the concept of DE.

38
Residential Education vs Distance Education

Residential education is the conventional in-campus mode of

teaching and learning where the educator and the learner have the
greatest opportunities for frequent face-to-face interaction.

Distance education, on the other hand, is the off-campus

mode of teaching and learning where the educator and the learner
have less frequent and only intermittent face-to-face interaction
because of the geographic distance between them.

Table 1 shows the differences and similarities between

residential and distance education.

In DE, the geographic distance is a constraint in the

frequency of face-to-face interaction between the educator and
the learner. To make up for this loss, the educator must design
ways and means to interact with the learner as often as possible
and as necessary. Interactions can be effected through written,
audiovisual, and electronic communications. The choice of media
of communication will be dependent primarily upon how best the
learning objectives can be achieved and secondarily, on
constraints, usually cost and availability.

In DE, the learners usually work individually on their own

without the constraint of space and time. What is meant by no
constraint of space and time is that they can study and learn at
any place, at any time, and at any pace they wish. This
privilege, however, carries the responsibility that they
accomplish their assigned or expected tasks on time, as specified
by the educator or mutually agreed by the educator and the
learner.

Whether it be a residential or distance education, the basic

principles of andragogy (adult teaching and learning) utilized in
the formulation of the curriculum are the same.

Consider a course which can be conducted either as in-campus

or off-campus study.

The learning objectives of the course will usually be the

same, whether conducted as in-campus or off-campus study.
Adjustments, however, can be made in the DE mode to make the
learning objectives more relevant to the particular needs of
students and their community where they are studying and will
work after graduation.

The content of the course will also usually be the same,

unless adjustments in the learning objectives have been made for
reason of relevance.

39
 Table 1. Differences and similarities between residential and
distance education.

Residential Distance

In-campus Off-campus

Frequent face-to-face Intermittent face-to-face

interactions interactions

Interactions usually
through written,
audiovisual, and
electronic
communications

Usually, learners Usually, learners

working in a group working on their own
with constraint in with no constraint in
space and time space and time

-----------------------------------------------------------------

Curriculum

Usually same learning objectives

Usually same learning content

Formulated within | Learning strategies | Formulated within

the context of | | the context of
in-campus | Assessment of learning | off-campus
situation | | situation

40
 There are two areas in the DE curriculum where planning
and implementation will be very challenging to the medical
educators who are not used to DE. These areas are the learning
strategies and evaluation of student's learning. Careful and
meticulous planning and implementation are required to ensure
that learning is being facilitated and is taking place as the
student does the study on his own.

To facilitate the student's learning in DE, as earlier

mentioned, intructional materials and teleconferencing are used,
especially the former. These two methods are not easy to develop
and to accomplish. Extensive programming and skills in
developing interactive instructional materials are needed.

Aside from facilitating learning, the educator in DE will

have to find effective and efficient way of assessing student's
learning. Because of the geographic distance which makes close
and direct observation of the student's performance difficult,
if not impossible, the educator will have to exert more efforts
in coming out with a valid, reliable, and realistic way of
assessing student's learning.

Designing and implementing teaching and learning strategies

and evaluation methods of student's learning in DE may be
difficult but they can be learned and mastered by the willing
medical educators who realize the usefulness of DE in medicine.

Benefits of Distance Education in Medicine

For DE to be a trend in education, medical education

included, there must be benefits or usefulness that can be
derived from its use. In fact, DE in medicine can benefit the
learners, the educators, the teaching institutions, and public
health administrators.

For the medical learners (physicians-to-be, specialists-to-

be, and medical practitioners), the main benefit of DE consists
of the opportunity to obtain an education (both undergraduate and
postgraduate) which otherwise they will not be able to have in
the presence of constraints, such as time, geography, family, and
work responsibilities.

For the medical educators, the following are some advantages

of DE:

1. Efficiency in teaching, in the sense that more medical

learners can be reached within a set period of time.

41
 2. Avoidance of burnt-out syndrome that usually results from
repetitive teaching because of different batches of
medical learners.

3. Release from the time pressure/load of frequent face-to-

face meeting with medical learners as seen in the
residential mode.

4. Improvement in teaching skills because of additional

training (in distance education).

For the medical educational institutions, DE can achieve the

following:

1. Widening access to medical education.

2. Offer opportunities for alternative access to quality

medical education for disadvantaged population groups.

3. Establish a systematic need-based approach for continuing

medical education to sustain professional growth and
improve technical skills among those who cannot leave
their jobs or home for full time studies.

4. Improve the residential program through the instructional

materials and faculty developed for distance
education. Because of its more rigid requirements, DE
tends to be more structured than the residential program.

For the public health administrators, DE can contribute to

health development of the community by improving the health
delivery system through improved health personnel resulting from
an effective, relevant, affordable, and accessible distance
education medical program.

Summary

The essential features of distance education consist of the

following:

1. Teacher and student are at a geographic distance

from each other.

2. Teaching and learning have to take place at a

geographic distance.

3. For effective teaching and learning to take place at

a geographic distance, teacher must plan carefully
and student must cooperate.

42
 4. The roles of the teacher in distance education are:

4.1 manager of student's learning

4.2 producer of learning resource materials

4.3 producer of assessment exercises

5. Majority and not all of the teaching and learning

activities take place at a distance.

6. Interaction between the teacher and learner is

present despite the geographic distance. It can be
through interactive instructional materials (either
print or nonprint media); teleconferencing
(telephones; broadcasts: radio or television); and
intermittent face-to-face interactions.

Medical educators who appreciate the usefulness of distance

education and who would like to use it in the teaching of
medicine will have to acquire skills in developing interactive
instructional materials and assessing DE students.

References

1. Harden RM: What is ... distance learning? Medical

Teacher 10: 139-145, 1988.

2. Holmberg B: The Concept of Distance Education:

International Perspectives. In Stewart D, Keegan D, and
Holmberg B (eds). London, Croo Helm, 1983.

3. Dodds, T: Administration of Distance-Teaching

Institutions: A Manual. Cambridge, NEC Print, 1983.

4. Propper R, Beard N: Distance learning: The role of

telemedicine. Medical Education 28: 124 - 125, 1994.

43