A C O U R S E P A C K O N

D I S T A N C E E D U C A T I O N I N M E D I C I N E

BY

REYNALDO O. JOSON, MD, MHA, MHPEd

1995

CONTENT

FOUR SELF-STUDY PROGRAMS:

1. Distance Education in Medicine

2. How to Design a Distance Education Program in Medicine

3. How to Write a Distance Education Lesson in Medicine

*4. How to Make a Distance Education Lesson in Medicine

Using a Nonprint Medium

*With an accompanying videotape

Dear Interested Learner:

This is a course pack on Distance Education in Medicine.

The course pack consists of four (4) self-study programs,

namely:

1. Distance Education in Medicine

2. How to Design a Distance Education Program in Medicine

3. How to Write a Distance Education Lesson in Medicine

4. How to Make a Distance Education Lesson in Medicine

Using a Nonprint Medium

The first three self-study programs make use of self-

instructional materials in the print medium while the fourth
program has instructional materials both in the print and
nonprint media (videotape). Thus, when you acquire this course
pack, make sure you have a videotape together with print
materials.

The course pack is written with the medical educators in

mind.

The estimated study time for each self-study program is 1 to

2 hours.

There is a strict sequence to follow in studying the four

programs. You must start with program 1 before you can go to
program 2. You must have finished programs 1 and 2 before you
can go to program 3. Likewise, you must have finished programs
1, 2, and 3 before you can go to program 4. If you don't follow
the sequence, do not blame me if you encounter very rough sailing
and get drowned.

When you study program 4, you need a videoplayer.

Here's a very important pointer on how to maximize your

learning on the subject matter of the course pack -

Accomplish all the learning activities suggested in the

self-study programs and then communicate the results to
me. I may be able to help you further and mind you, I
am very, very much willing to do so.
 If you have any problem with any of the self-study programs,
feel free to communicate with me through the following:

Address:

Manila Doctors Hospital

U.N. Avenue, Ermita, Manila

Telephone:

524 - 30 - 11

By the way, I welcome, am actually inviting and encouraging,

comments and suggestions not only for the improvement of the
course pack but also for my improvement as a medical educator.

Lastly, I like to thank you for your interest in my course

pack.

Reynaldo O. Joson, MD, MHA, MHPEd

1995
D I S T A N C E E D U C A T I O N I N M E D I C I N E

(An Off-Campus Study)

Reynaldo O. Joson, MD, MHA, MHPEd

1995
 FOREWORD

Dear Learner,

Mabuhay!

Welcome to a learning experience in becoming a health

professional.

This program has been especially designed with you, the

learner, and the principles of effective teaching and learning in
mind.

As you go through this learning program, please bear in mind

the following:

1. I am treating you as an adult learner which

1.1 Assumes you have learning aspirations and

expectations and, therefore, are motivated;

1.2 Gives you the privilege to use other learning

strategies in achieving the objectives in this
program;

1.3 Welcomes you to go beyond the learning package

as you so desire; and

1.4 Expects discipline, honesty, and maturity in

fulfilling your learning activities.

2. We shall define learning as a positive observable

change (for the better or improvement) in human
behavior, disposition, attitude, performance, or
capability which persists over a period of time.

3. Active learning strategies and activities will be

utilized as much as possible.

4. The program will contain learning materials which I

think will be relevant to your being an effective,
efficient, and humane health professional.

5. The ultimate goal of the learning program is to

produce health professionals who will contribute to
the health development in the Philippines.
 6. When I made the program, I tried my best to
facilitate your learning. Bear in mind, however, I
am not infallible. Thus, analyze carefully
everything in this program. Don't hesitate to offer
disagreements and constructive criticisms for my own
learning and for the improvement of the program.

Best wishes for a fruitful learning with the help of this

program.

Reynaldo O. Joson, MD, MHPEd

1995
 GUIDELINES IN STUDYING THE PROGRAM

Dear Learner,

Mabuhay!

Welcome to an experience in self-instruction.

This program has been designed so that you learn on your

own. You can learn at your own pace - as fast as you can or as
slow as you wish. You can choose to study anywhere and anytime.

For effective learning, however, please follow the following

guidelines in studying the program:

1. You should diligently and chronologically go through

each part. Each part has an important role.

- The Introduction tells you the importance of the

subject matter and the benefits you can get from
studying the program.

- The Preprogram Assessment self-assesses your

competency on the subject matter before studying
the program.

- The Objectives tells you what you are expected

to achieve after you have finished the program.

- The Text, of course, is the learning material.

- Within the text are Activities where you can be

actively involved in the learning process. Such
activities are reading illustrations and
answering questions for purposes of self-
discovery and self-assessment.

- The Summary helps you put together all that you

have learned.

- The Posttest helps you examine your

understanding of the subject matter after you
have completed the program.

- The Postprogram Assessment self-assesses your

competency on the subject matter after studying
the program.
 - The Recommended Follow-up suggests what other
learning activities you should undertake for
enhancement and mastery purposes.

- The Student's Assessment of Self-Study Program

will give me a feedback on my efforts to
facilitate your learning.

- The List of Papers to Submit provides you with

a checklist on what to submit to me for purposes
of evaluation, both formative and summative.

- The Summative Evaluation tells what you should

undertake for me, your faculty facilitator, to
be able to assess you for certifying purpose.

2. You must follow all the specific instructions to the

letter such as accomplishing duplicate or triplicate
copies of assigned activities.

3. You must complete and submit all the assigned tasks

on the specified date.

4. You need to have a ballpen and 1 to 2 sheets of

carbon papers when you accomplish the activities in
the program.

The estimated study time for the program excluding the

summative evaluation activity is 1 to 2 hours.

Best wishes.

Reynaldo O. Joson, MD, MHA, MHPEd

1995
 Table of Content

Introduction ............................................ 1

Preprogram Assessment ................................... 1

Objectives .............................................. 4

1 Concept of Distance Education ........................... 4

1.1 Definition of Distance Education

1.2 Conceptual Framework of Distance Education

1.3 What Distance Education Is Not

1.4 Other Names for Distance Education

2 Residential vs Distance Education ....................... 12

2.1 Curricular Design and Implementation

3 Benefits of Distance Education .......................... 18

3.1 For Medical Learners

3.2 For Medical Educators

3.3 For Medical Institutions and Organizations

3.4 For Public Health Administrators

Summary ................................................. 21

References .............................................. 21

Posttest ................................................ 22

Answers to Posttest ..................................... 23

Postprogram Assessment .................................. 24

Recommended Follow-up ................................... 25

Student's Assessment of Self-Study Program .............. 27

List of Papers to Submit to Faculty Facilitator ......... 28

Summative Evaluation .................................... 29

Appendix 1 .............................................. 33
 DISTANCE EDUCATION IN MEDICINE

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 DE
programs in the whole university starting 1995.

DE is, thus, a current tendency 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, like you and I,

must therefore be familiar with what DE is and can offer. It is
only after being familiar with it can we decide whether and when
to use DE in the teaching of medicine.

In this self-study program, you will learn the concept of DE

and its usefulness in medicine.

Preprogram Assessment

Before you proceed deeper into the program, will you please
fill out the Preprogram Assessment?

It is important that you accomplish the Preprogram

Assessment because it will make both of us aware of where you
stand as regards DE.

Please answer as accurately and completely as you can.

Don't be shy to divulge your inadequacies. You are here to
learn. Likewise, don't let sense of modesty inhibit you from
revealing your existing competency.

Knowing the status of your existing competency on a subject

matter should be the first step in learning. Don't you think so?

Please accomplish the Preprogram Assessment in duplicate and

furnish me a copy. Thanks.

1
 DISTANCE EDUCATION IN MEDICINE

PREPROGRAM ASSESSMENT

Name ___________________________________________ Date ___________

INSTRUCTIONS: Please accomplish in duplicate. Submit one copy to

me, your faculty facilitator.

1. Do you have experience conducting distance education before?

___ NO ___ YES

When? ______________________________________

What course(s)? ____________________________

____________________________________________

____________________________________________

2. Do you know what distance education is?

___ NO ___ YES, a lot

___ YES, somewhat
___ YES, a little

3. Do you know the usefulness of distance education in medicine?

___ NO ___ YES, a lot

___ YES, somewhat
___ YES, a little

4. With whatever amount of experience you have at this very

moment, do you want to learn more about distance education in
medicine?

___ NO ___ YES, all about it

___ YES, a little more

5. With whatever amount of experience you have at this very

moment, do you want to learn how to design a distance
education program in medicine? Check one response.

___ NO, I don't believe in it.

___ NO, I already know how to do it.
___ YES, but I still need to learn more about distance
education in medicine.

After you are through accomplishing the Preprogram

Assessment, please turn to the next page to see my preliminary
responses to your answers.

2
 DISTANCE EDUCATION IN MEDICINE

PREPROGRAM ASSESSMENT

Name ___________________________________________ Date ___________

INSTRUCTIONS: Please accomplish in duplicate. Submit one copy to

me, your faculty facilitator.

1. Do you have experience conducting distance education before?

___ NO ___ YES

When? ______________________________________

What course(s)? ____________________________

____________________________________________

____________________________________________

2. Do you know what distance education is?

___ NO ___ YES, a lot

___ YES, somewhat
___ YES, a little

3. Do you know the usefulness of distance education in medicine?

___ NO ___ YES, a lot

___ YES, somewhat
___ YES, a little

4. With whatever amount of experience you have at this very

moment, do you want to learn more about distance education in
medicine?

___ NO ___ YES, all about it

___ YES, a little more

5. With whatever amount of experience you have at this very

moment, do you want to learn how to design a distance
education program in medicine? Check one response.

___ NO, I don't believe in it.

___ NO, I already know how to do it.
___ YES, but I still need to learn more about distance
education in medicine.

After you are through accomplishing the Preprogram

Assessment, please turn to the next page to see my preliminary
responses to your answers.

2-Duplicate
RESPONSES TO ANSWERS IN THE PREPROGRAM ASSESSMENT

As I said earlier, knowing the status of your existing

competency should be the first step in learning DE. You will
appreciate the meaning of my statement when you go through my
preliminary responses to your answers in the Preprogram
Assessment.

If your answers consisted of the following -

NO, I don't want to learn more about DE;

NO, I don't believe in DE in medicine; and/or
NO, I already know how to design a DE in medicine,

you have a choice not to go through the rest of the program.

However, if you choose to continue on just the same, you are most
welcome. Who knows, at the end of the program, you may change
your stand.

If your answers consisted of the following -

YES, I have experience conducting DE before;

YES, I know a lot about what DE is; and/or
YES, I know a lot about the usefulness of DE in
medicine,

again, you have an option not to go through the rest of the

program. However, if you choose to continue on just the same,
you are most welcome. Who knows, you may get additional
information from the program.

If, for whatever reason, you decide not to go through the

rest of the program, I like to request you to accomplish the
Summative Evaluation at the end of this program. Please follow
the instructions in the summative evaluation procedure.

If, for reason of need to learn or for whatever reason, you

decide to go through the rest of the program, I like to say
mabuhay and welcome. You can now proceed to the learning
objectives of the program.

3
Specific Learning objectives

Welcome once again to this self-study program on distance

education.

When you finish this program, you should 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.

1. Concept of Distance Education

1.1 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.

4
 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.

1.2 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).

Please take a look at Fig. 1 and compare the two frameworks

as illustrated. I will give you 2 minutes to do that. Look for
the glaring difference and similarity between the two frameworks.
After you are through, come back to this page.

Were you able to identify the glaring difference in the

frameworks of residential and distance education? Did you see
it?

Yes, you are right. The glaring difference lies in the

length of the lines between "teacher" and "student".

The said line in the residential education framework is very

much shorter than that in the distance educational framework.
Actually, these lines represent the geographic distance between
the teacher and the student. The long line in the DE framework
signifies that the teacher and the student are at a great
geographic distance from each other.

Now, what similarity did you notice between the two

frameworks?

I assume you have identified it. You are absolutely right

if you say both have a curriculum with its usual four components
parts, namely: learning objectives, content, learning activities,
and assessment.

5
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.

6
 Fig. 2 shows the conceptual framework of distance education.
Please study the figure first before you read my explanation. I
will give you 2 minutes to do that.

The premises are the following (these are contained in the

"situation"):

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 (these comprise the "input"):

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 (these

comprise the "output"):

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.

7
 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.

8
1.3 What Distance Education Is Not

Most, if not all of us, have experienced at one time or

another teaching and learning through the following ways:

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.

In-text Questions 1

Based on our definition and concept of DE and based on your

personal experience on how the abovementioned teaching and
learning methods are usually being carried out in the
Philippines, please venture an answer as to whether these methods
constitute DE or not and then support your answers.

There are no absolutely right or wrong answers here.

Besides, you will not be graded for your answers. So, please go
ahead and answer In-text Questions 1. Please accomplish in
duplicate. I like to have a copy. Thanks.

9
 DISTANCE EDUCATION IN MEDICINE

IN-TEXT QUESTIONS 1

Name ___________________________________________ Date ___________

INSTRUCTIONS: Please determine which teaching-learning methods

constitute a distance education (DE) based on the
concept of DE and on the usual practice in the
Philippines. Support your answers.

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

television outside the classroom or school.
___ YES ___ NO
Why?

2. Using teach yourself manuals, programmed lessons, and

computer-aided learning programs outside the classroom or school.
___ YES ___ NO
Why?

3. Through correspondence study.

___ YES ___ NO
Why?

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

medicine.
___ YES ___ NO
Why?

After you are through accomplishing In-Text Questions 1,

please turn to the next page to look at my preliminary responses
to your answers.

10
 DISTANCE EDUCATION IN MEDICINE

IN-TEXT QUESTIONS 1

Name ___________________________________________ Date ___________

INSTRUCTIONS: Please determine which teaching-learning methods

constitute a distance education (DE) based on the
concept of DE and on the usual practice in the
Philippines. Support your answers.

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

television outside the classroom or school.
___ YES ___ NO
Why?

2. Using teach yourself manuals, programmed lessons, and

computer-aided learning programs outside the classroom or school.
___ YES ___ NO
Why?

3. Through correspondence study.

___ YES ___ NO
Why?

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

medicine.
___ YES ___ NO
Why?

After you are through accomplishing In-Text Questions 1,

please turn to the next page to look at my preliminary responses
to your answers.

10-Duplicate
RESPONSES TO IN-TEXT QUESTIONS 1

As I mentioned earlier, there is no absolutely right or

wrong answer in this In-Text Questions 1. Take a look at my
responses and compare them with your answers.

All the four teaching-learning methods may constitute

distance education if 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
interaction between the teacher and the student. Interaction,
as you learned earlier, 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.

How about Fora Medica, which is being aired regularly in RPN

Channel 9? Does it constitute a distance education?

1.4 Other Names of Distance Education

When you read the literature or when you attend talks on

distance education, you will encounter the other names for DE.
Some of these other names are distance learning, off-campus
learning, open learning, and external study.

You may also encounter a variety of names for universities

that offer distance education programs. Some of these are 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 as we have defined earlier.

11
2. 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-text Questions 2

Study Table 1 and try to analyze the following statements as

to whether they are true or false. These statements will
highlight and emphasize the differences between residential and
distance education. They will also bring out other important
features of distance education.

12
 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

13
 DISTANCE EDUCATION IN MEDICINE

IN-TEXT QUESTIONS 2

Name ___________________________________________ Date ___________

INSTRUCTIONS: Please assess each statement and determine whether

it is true or false. Support your answer.

1. In distance education, there is no interaction between the

educator and the learner because of the geographic distance
between them.
___ TRUE ___ FALSE
Why do you say so?

2. In distance education, the learners have no deadlines to meet

in accomplishing their assigned tasks.
___ TRUE ___ FALSE
Why do you say so?

3. In distance education, assessment of learning is relatively

difficult compared to that in residential education.
___ TRUE ___ FALSE
Why do you say so?

After you are through answering In-Text Questions 2, please

turn to the next page for my responses. Compare your answers
with mine.

14
 DISTANCE EDUCATION IN MEDICINE

IN-TEXT QUESTIONS 2

Name ___________________________________________ Date ___________

INSTRUCTIONS: Please assess each statement and determine whether

it is true or false. Support your answer.

1. In distance education, there is no interaction between the

educator and the learner because of the geographic distance
between them.
___ TRUE ___ FALSE
Why do you say so?

2. In distance education, the learners have no deadlines to meet

in accomplishing their assigned tasks.
___ TRUE ___ FALSE
Why do you say so?

3. In distance education, assessment of learning is relatively

difficult compared to that in residential education.
___ TRUE ___ FALSE
Why do you say so?

After you are through answering In-Text Questions 2, please

turn to the next page for my responses. Compare your answers
with mine.

14-Duplicate
RESPONSES TO IN-TEXT QUESTIONS 2

1. In distance education, there is no interaction between the

educator and the learner because of the geographic distance
between them.

This statement is FALSE.

Inspite of the geographic distance, there is and must be

interaction between the educator and the learner. The educator
must design ways to promote and maintain constant interaction
with the learner. The interaction may be through written,
audiovisual, or electronic communications.

It is true that the frequency of face-to-face interaction

between the educator and the learner is expectedly less than that
in residential education because of the geographic distance. 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.

2. In distance education, the learners have no deadlines to meet

in accomplishing their assigned tasks.

This statement is FALSE.

Learners in distance education usually work on their own

without the constraint of space and time. What is meant by no
constraint of space and time is that they can learn at any
place, at any time, and at any pace they wish but they must
accomplish their assigned tasks at a specified time reasonably
set by the educator or mutually agreed upon by both the educator
and the learner.

3. In distance education, assessment of learning is relatively

difficult compared to that in residential education.

This statement is TRUE.

When it comes to assessment of learning, nothing can beat

the situation in which the educator is constantly and directly
observing how the learner performs. This situation is offered by
the residential mode of education. In distance education,
although assessment of learning is relatively difficult, it can
still be done effectively and efficiently. We just have to be
patient and diligent in finding and implementing the right method
of student's assessment.

15
 How do your answers compare with mine?

If we have the same answers and ideas, then good. That

means we are in the same wavelength and that you have discovered
some more essential features of distance education.

If we don't have the same answers and ideas, don't feel bad.
The In-Text Questions were just made to stimulate you to discover
things. If you didn't discover anything or everything when you
were answering the questions, at least, you got them when you
read my responses. Am I correct in saying so?

2.1 Curricular Design and Implementation

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

or off-campus study. Will there be differences in the curricular
design and implementation in the two modes of study?

Yes, there will be and the differences are mainly due to the
factor of geographic distance between the teacher and the
student. However, whether it be a residential or distance
education, the basic principles of andragogy (adult teaching and
learning) utilized in the formulation of the curriculum remain
the same.

2.1.1 The Learning Objectives

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.

2.1.2 The Learning Content

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

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

2.1.3 The Learning Strategies and Assessment

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.

16
 To facilitate the student's learning in DE, as earlier
mentioned, instructional 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.

What you have been reading up to this time is an

instructional material which I prepared for DE use. Compared
to the usual teaching and learning hand-outs that we used to have
and to prepare in medicine, do you notice the differences? Take
a look at Appendix 1. Here you will see a write-up on the same
topic "Distance Education in Medicine" but using a different
format, the traditional format. I suppose you notice the
differences between the manuscript in Appendix 1 and this
instructional material given to you for DE use.

Just to mention a few, the distinguishing features of DE

instructional materials consist of the following:

1. Interactive
2. Informal
3. Structured and programmed
4. Contains active learning activities
5. Contains assessment exercises

Have you ever seen a teleconference before? I think you

have when you saw and heard radio and television newscasters and
commentators in Metro Manila talking to and discussing issues
with another group of people in areas such as Cebu and Davao.
Remember? Such a teleconference can be applied in the teaching
of medicine. A commonly used term for such a situation is
"telemedicine".

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.

So, in which among the four components of the DE curriculum

(objectives, content, activities, and assessment) will planning
and implementation offer the greatest challenge to the medical
educators who are not used to DE?

Answers:
1. ________________________________________

2. ________________________________________

17
 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.
We will now try to identify the benefits of DE in medicine.

3. 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.

3.1 For the Medical Learners

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.

3.2 For the Medical Educators

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.

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).

3.3 For the Medical Institutions and Organizations

For the medical educational institutions and organizations,

DE can achieve the following:

1. Widening access to medical education.

18
 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.

3.4 For the Public Health Administrators

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.

In-Text Questions 3

Can you identify other benefits and usefulness of DE in

medicine?

Please list them down and share them with me. Turn to the
next page and accomplish the form provided. Contribute at least
one more for each category.

Please accomplish in duplicate and give me one copy. Thanks.

19
 DISTANCE EDUCATION IN MEDICINE

IN-TEXT QUESTIONS 3

BENEFITS AND USEFULNESS OF DISTANCE EDUCATION IN MEDICINE

Name ___________________________________________ Date ___________

INSTRUCTIONS: Please list down other benefits and usefulness of

distance education that I have not mentioned in my
list. Contribute at least one more.

FOR THE MEDICAL LEARNERS

FOR THE MEDICAL EDUCATORS

FOR THE MEDICAL INSTITUTIONS AND ORGANIZATIONS

FOR THE PUBLIC HEALTH ADMINISTRATORS

20
 DISTANCE EDUCATION IN MEDICINE

IN-TEXT QUESTIONS 3

BENEFITS AND USEFULNESS OF DISTANCE EDUCATION IN MEDICINE

Name ___________________________________________ Date ___________

INSTRUCTIONS: Please list down other benefits and usefulness of

distance education that I have not mentioned in my
list. Contribute at least one more.

FOR THE MEDICAL LEARNERS

FOR THE MEDICAL EDUCATORS

FOR THE MEDICAL INSTITUTIONS AND ORGANIZATIONS

FOR THE PUBLIC HEALTH ADMINISTRATORS

20-Duplicate
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.

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, Croom 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.

21
 DISTANCE EDUCATION IN MEDICINE

POSTTEST

Name ___________________________________________ Date ___________

INSTRUCTIONS: Indicate which of the following statements are TRUE

(T) or FALSE (F) by encircling the appropriate
letter. Without looking at the answer key,
accomplish in duplicate. Submit one copy to me.

T F 1. A take-home reading assignment and then to report to

the teacher the next day is an example of distance
education.

T F 2. In distance education, all the teaching and learning

must take place at a geographic distance between the
teacher and the student.

T F 3. In distance education, there is no face-to-face

interaction between the teacher and the student.

T F 4. In distance education, the formulation of learning

strategies is one of the most challenging tasks of the
educator.

T F 5. In distance education, assessment of student's

learning can be omitted because of the distance
constraint.

T F 6. The principles of andragogy utilized in the

formulation of a distance education curriculum are
different from those utilized in the residential
education curriculum.

T F 7. Distance education has the tendency to be more

relevant to the community needs.

T F 8. In the long run, distance education is more cost-

effective than residential education.

T F 9. Distance education has the tendency to promote adult

learning than residential education.

T F 10. Distance education has the tendency to improve the

residential education in a university that offers both
modes of teaching and learning.

Turn to the next page to check your answers.

22
 DISTANCE EDUCATION IN MEDICINE

POSTTEST

Name ___________________________________________ Date ___________

INSTRUCTIONS: Indicate which of the following statements are TRUE

(T) or FALSE (F) by encircling the appropriate
letter. Without looking at the answer key,
accomplish in duplicate. Submit one copy to me.

T F 1. A take-home reading assignment and then to report to

the teacher the next day is an example of distance
education.

T F 2. In distance education, all the teaching and learning

must take place at a geographic distance between the
teacher and the student.

T F 3. In distance education, there is no face-to-face

interaction between the teacher and the student.

T F 4. In distance education, the formulation of learning

strategies is one of the most challenging tasks of the
educator.

T F 5. In distance education, assessment of student's

learning can be omitted because of the distance
constraint.

T F 6. The principles of andragogy utilized in the

formulation of a distance education curriculum are
different from those utilized in the residential
education curriculum.

T F 7. Distance education has the tendency to be more

relevant to the community needs.

T F 8. In the long run, distance education is more cost-

effective than residential education.

T F 9. Distance education has the tendency to promote adult

learning than residential education.

T F 10. Distance education has the tendency to improve the

residential education in a university that offers both
modes of teaching and learning.

Turn to the next page to check your answers.

22-Duplicate
ANSWERS TO POSTTEST

1. F 6. F

2. F 7. T

3. F 8. T

4. T 9. T

5. F 10. T

23
 DISTANCE EDUCATION IN MEDICINE

POSTPROGRAM ASSESSMENT

Name ___________________________________________ Date ___________

INSTRUCTIONS: Please accomplish in duplicate. Submit one copy to

me, your faculty facilitator.

1. Do you know what distance education is?

___ NO ___ YES, a lot

___ YES, somewhat
___ YES, a little

2. Do you know the usefulness of distance education in medicine?

___ NO ___ YES, a lot

___ YES, somewhat
___ YES, a little

3. With whatever amount of experience you have at this very

moment, do you want to learn more about distance education in
medicine?

___ NO ___ YES, all about it

___ YES, a little more

4. With whatever amount of experience you have at this very

moment, do you want to learn how to design a distance
education program in medicine? Check one response.

___ NO, I don't believe in it.

___ NO, I already know how to do it.
___ YES, but I still need to learn more about distance
education in medicine.

After you are through accomplishing the Postprogram

Assessment, please turn to the next page to see my preliminary
responses to your answers.

24
 DISTANCE EDUCATION IN MEDICINE

POSTPROGRAM ASSESSMENT

Name ___________________________________________ Date ___________

INSTRUCTIONS: Please accomplish in duplicate. Submit one copy to

me, your faculty facilitator.

1. Do you know what distance education is?

___ NO ___ YES, a lot

___ YES, somewhat
___ YES, a little

2. Do you know the usefulness of distance education in medicine?

___ NO ___ YES, a lot

___ YES, somewhat
___ YES, a little

3. With whatever amount of experience you have at this very

moment, do you want to learn more about distance education in
medicine?

___ NO ___ YES, all about it

___ YES, a little more

4. With whatever amount of experience you have at this very

moment, do you want to learn how to design a distance
education program in medicine? Check one response.

___ NO, I don't believe in it.

___ NO, I already know how to do it.
___ YES, but I still need to learn more about distance
education in medicine.

After you are through accomplishing the Postprogram

Assessment, please turn to the next page to see my preliminary
responses to your answers.

24-Duplicate
RESPONSES TO ANSWERS IN POSTPROGRAM ASSESSMENT

If your answers consisted of the following -

NO, I do not know what distance education is and

NO, I do not know the usefulness of distance education;

or, if your answers showed no improvement when your

Pre- and Postprogram Assessments are compared,

then no learning has taken place. Something must have gone

wrong. We must see each other to seriously analyze the problem.

If your answers showed improvement when your Pre- and

Postprogram Assessments are compared,

then congratulations! You have learned.

If your answers showed the following -

YES, I want to learn more about DE and

YES, I want to learn how to design a DE program in medicine

then I have succeeded in convincing you of the importance of

DE in medicine.

Proceed to Recommended Follow-up.

RECOMMENDED FOLLOW-UP

Try to get hold of print and nonprint instructional

materials used for distance education and evaluate them.

Try to get hold of videotapes showing teleconference or

telemedicine and evaluate them.

If you know the concept of distance education and if you are

convinced of the usefulness of DE in medicine, you can go to the
next phase of learning DE.

The next phase is to learn how to design a distance

education program in medicine.

25
 To obtain proficiency in distance education in medicine, you
should accomplish at least the following modules:

1. Distance Education in Medicine

(which you have just accomplished)

2. How to Design a Distance Education Program in

Medicine

3. How to Write a Distance Education Lesson in

Medicine

4. How to Make a Distance Education Lesson Using a

Nonprint Medium

26
 STUDENT'S ASSESSMENT OF THE SELF-STUDY PROGRAM

Name ___________________________________________ Date ___________

PROGRAM: ________________________________________________________

AUTHOR: _________________________________________________________

INSTRUCTIONS: Please assess the program through the following

statements. Use the key below:

KEY : 5 = Strongly Agree

4 = Agree
3 = Uncertain
2 = Disagree
1 = Strongly disagree

1. The objectives were clear. 5 4 3 2 1

2. The objectives were "must knows." 5 4 3 2 1

3. The objectives were too heavy. 5 4 3 2 1

4. The content was appropriate based on 5 4 3 2 1

the stated objectives.
5. The content was adequate based on 5 4 3 2 1
the stated objectives.
6. The content was clear. 5 4 3 2 1

7. The content was presented in logical 5 4 3 2 1

sequence.
8. The learning activities were 5 4 3 2 1
appropriate based on the objectives.
9. The learning activities were 5 4 3 2 1
effective in facilitating learning.
10. The summative evaluation was appropriate. 5 4 3 2 1

INSTRUCTIONS: Please answer seriously. Use back page if needed.

Were there any parts, concepts, or words that you found

particularly difficult or not well explained? If there were,
please give details.

Any suggestions on what might have helped you in this instruction?

Any suggestions to improve the self-study program?

27
 LIST OF PAPERS TO SUBMIT

Preprogram Assessment

In-Text Questions 1

In-Text Questions 2

In-Text Questions 3
(Benefits and Usefulness of DE in Medicine)

Posttest

Postprogram Assessment

Student's Assessment of Self-Study Program

Summative Evaluation

Deadline for Submission: ________________________________________

Note: You can only proceed to the next self-study program after
you have submitted all of the above and have satisfactorily
passed the summative evaluation. Remedials may be given if
you don't pass the summative evaluation.

Reynaldo O. Joson, MD, MHA, MHPEd

28
 DISTANCE EDUCATION IN MEDICINE

SUMMATIVE EVALUATION

Dear Learner,

I shall be doing a summative evaluation on how much you have

learned from the module entitled "Distance Education in
Medicine."

Let's review the learning objectives of the module.

At the end of the self-study program, you must be able to:

1. Explain the concept of distance education.

2. Identify in which of the four components of distance

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

3. Identify the usefulness of distance education in medicine

for the students, the teachers, the teaching
institutions, and the public health administrators.

To do the summative evaluation, I have decided on the

following procedure:

Imagine yourself being invited to contribute an article to

the journal of the Association of Philippine Medical Colleges.
You are asked to write an article with the title "Distance
Education in Medicine."

The aims are to inform and then to convince medical

educators to go into distance education in teaching medicine.

The content of your article should include at least the

following:

1. Explanation of the concept of distance education

2. Identification of which of the four components of

curriculum will planning and implementation be
very challenging to the medical educators not used
to distance education

29
 3. Identification of the usefulness of distance
education in medicine for the students, teachers,
teaching institutions, and public health
administrators. (at least two for each category)

Avoid plagiarism. Do not copy the content of the module

verbatim. You can use the module as a reference. You can use
other references as you wish.

The length of the article should be at least 5 and at most

8 pages of short bond papers, typewritten, double-spaced,
inclusive of illustrations you may want to use.

Your article will be evaluated primarily as to whether it is

complete, clear, and convincing. Please take a look at the
evaluation form at the next page and use it as a guide when you
write your article.

Please prepare 3 copies. Submit 2 copies to me. If I find

your article worth publishing, I shall submit it to a journal.

Deadline for submission: ___________________________________

Best wishes.

Reynaldo O. Joson, MD, MHA, MHPEd

30
 DISTANCE EDUCATION IN MEDICINE
SUMMATIVE EVALUATION FORM

Manuscript Code ____________ Evaluator __________________________

Instructions: Please use the attached answer guide to help you in

the evaluation. (Note this is purposely omitted in
this program. Don't look for it.)
For all SOMEWHAT or NEEDS IMPROVEMENT answers,
please elaborate.

The student was able to:

1. Explain the concept of distance education -
ADEQUATELY? YES SOMEWHAT NO

ACCURATELY? YES SOMEWHAT NO

CLEARLY? YES SOMEWHAT NO

2. Identify in which of the four components of distance

education curriculum (objectives, content, activities,
and assessment) will planning and implementation be most
challenging to the medical educators who are not used to
DE -
ADEQUATELY? YES SOMEWHAT NO

ACCURATELY? YES SOMEWHAT NO

CLEARLY? YES SOMEWHAT NO

3. Identify the usefulness of distance education in medicine for

the students, the teachers, the teaching institutions, and
the public health administrators -
ADEQUATELY? YES SOMEWHAT NO

ACCURATELY? YES SOMEWHAT NO

CLEARLY? YES SOMEWHAT NO

4. Express his thoughts CLEARLY? YES SOMEWHAT NO

5. Use effective strategy in trying to

convince reader to go into DE? YES SOMEWHAT NO

Pls. encircle an overall grade you will give to the student based
on above criteria:
1 - Excellent (all yes answers plus other factors)
2 - Satisfactory (all yes answers)
3 - Needs improvement (with somewhat and no answers)

31
 DISTANCE EDUCATION IN MEDICINE
SUMMATIVE EVALUATION

Manuscript Code ____________ Evaluator __________________________

Is the manuscript worth publishing? YES NO

If yes, any suggestions where?

Is the manuscript worth compiling as a

reference for future students? YES NO

Does the manuscript need rewriting? YES NO

Judging from the manuscript, the student seems to

Be resourceful in additional learning? YES NO

Be creative and innovative YES NO

Other comments and suggestions for student:

Evaluator's Signature: ________________________

Evaluator's Name: ________________________ Date: ___________

32
 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.

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 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.

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 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.

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