Acad Psychiatry 30:439-441, December 2006
doi: 10.1176/appi.ap.30.6.439
© 2006 Academic Psychiatry
Pedagogy and Educational Technologies of the Future
Peter M. Yellowlees, M.B.B.S., M.D. and
Shayna Marks, B.A.
Received January 5, 2006; revised April 5, 2006; accepted May 1, 2006. Dr. Yellowlees is Professor, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California. Dr. Marks is affiliated with the Center for Health and Technology, University of California, Davis, Sacramento, California. Address correspondence to Dr. Yellowlees, 2300 Stockton Boulevard, Sacramento, CA 95817; pmyellowlees{at}ucdavis.edu (e-mail).
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INTRODUCTION
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As educational technologies continue their rapid evolution, it is all too easy to become overly enamored with particular kinds of electronic wizardry and forget that the technology is fundamentally dependent on the underlying pedagogy and learning principles employed to deliver the educational programs themselves. Even in online medical education, the course material is still more important than the technological media. With this in mind, it is useful to examine the principles of "best practices" in adult learning and determine how effectively they can be translated to the online education world.
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Educational Principles
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There are a number of basic principles of adult learning that make it very different from either traditional textbook- or classroom-based education. Adult learning emphasizes the importance of active rather than passive learning. This approach ensures that learners are interactively involved with their educational materials and resources; they are encouraged to ask questions, make comments, and contribute examples from their own experiences throughout their learning program. Often, learners are given specific sets of assessment tasks to perform during their learning activity as continuous formative assessment that is for their eyes only and is not part of the final, or summative, assessment that they undertake. Very often, active learning is problem-based or case-based. Here, a short educational trigger from an academically relevant problem is given to the student or group of students, who then work out learning objectives, and then content requirements, that are needed to solve the problem. Problem-based learning, which strongly focuses on decision-making capacities and reasoning processes, is ideal for the health care field, and this strategy is now being employed by quite a number of medical schools around the world, representing a substantial move away from traditional classroom- and laboratory-based curricula. Students typically find problem-based learning to be more relevant and more closely linked to their real world clinical learning experiences.
Equally important, in terms of adult learning approaches and principles, are what are increasingly being called "just-in-time" learning experiences. This is essentially "on the job" learning, whereby the learner is provided with educational information literally at the time it is needed. For example, a resident in a busy clinic is able to use an online decision support tool to access pharmaceutical information to guide prescribing, or can quickly find a clinical guideline on which to base the treatment plan. Such educational opportunities are increasingly being recognized as an important component of many graduate programs in particular.
The final major component of adult learning is the capacity of the learner to access and integrate multiple sources of information and to evaluate the quality of those sources so they can form a judgment as to what is useful information for them at any particular time. Traditional learners in the pre-Internet world used to depend on the reputations of textbooks and papers by learned authors published by authoritative groups; but in the Internet world it is much more difficult to be confident in the reliability and validity of much of the information that appears on easily available generic search engines, such as Google.
There has been a considerable amount of research performed on these types of adult learning approaches, with a number of studies (1–6) examining the effects of increasing levels of interactivity during the learning process, and learning outcomes, judged by the retention of information after a week or longer. If one looks at a number of different types of learning situations, it is clear that increased interaction is associated with better achievement and more retention of knowledge, and that the best ways of learning are by either "doing" or by "teaching others." Attending lectures, watching audiovisual presentations, be these animated or on PowerPoint, and attending discussion groups are all relatively less efficient.
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Technology and Pedagogy
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There are, inevitably, many problems that students and residents may not encounter in their daily practice but nonetheless should be part of their knowledge base. Making use of active, just-in-time learning is difficult in these situations and it is here that clinical simulations, sophisticated electronic mannequins, and virtual environments may be particularly helpful. The use of such simulation environments, which is increasing greatly in health care, allows learners to "learn by doing" in situations they might otherwise not encounter. Such simulations also allow learners to practice their individual and team skills by teaching and working with others in collaborative environments, as well as to demonstrate and develop simulation-based learning experiences for a whole range of adult learning-based programs. One example is our "Virtual Care Center" with electronic teaching mannequins, stent simulators, robotic instruments, and a number of Internet-based programs available for student and resident tuition.
One possible model of the use of adult learning in a paperless online environment incorporates an electronic health record, Internet access, videoconference, phone, fax, and e-mail into a comprehensive educational program. In such a program, patients are seen at rural sites along with their local health care providers, and the clinical consultation sessions are undertaken with the dual purpose of both assessing and educating the patient and educating the health care provider, offering many more educational opportunities than the traditional specialty consultation. Following each electronic consultation, an educational letter is sent to the primary care provider which, along with the usual history and diagnostic information, typically includes a number of different therapeutic options for the rural provider to undertake. In addition to consultation sessions and letters, providers are given access to interactive videoconferences and pre-recorded Web-streamed lectures, which are accredited for continuing medical education purposes. In a recently completed clinical trial, this approach to telepsychiatry consultation, which might be best called a telepsychiatry consultation/education model, has been shown to be extremely popular with primary care providers and patients. The combination of videoconferencing with the use of secure e-mail messaging and telephone access to specialists enables rural primary care providers to obtain rapid information and education about their patients "just in time." Such an educational model for psychiatry is described by Hilty et al. (7).
The electronic health record, which is gradually being introduced in many major health care institutions across America, also offers tremendous educational opportunities, particularly if it can be combined with video communication environments, secure e-mail and chat facilities, and scheduling programs. The combining of these types of programs will allow distant providers to access both clinical and educational information much more easily than is now possible and will undoubtedly become more widely available within a few years. If these types of electronic facilities can be combined with an "electronic education record," such as that presently being given to all UC Davis medical students, then the educational opportunities will be even greater.
The ePortfolio, one version of an "electronic education record," is essentially an electronic space given to medical and health care students which allows them to store all of their favorite educational resources, including lectures, papers, or PowerPoint, video, and audio files. The space allows them to communicate with each other and with their teachers, to submit their work online, to see their schedules and the curriculum, and to receive "educational learning support" packages. These packages are potentially very exciting and include templates and guidelines for particular academic activities, such as critiquing a paper, writing an article, describing a clinical scenario, or composing some clinical notes. The incorporation of these "electronic learning records" into the increasingly sophisticated educational "Collaborative Learning Environments," such as the open source Sakai project (www.sakaiproject.org), has great potential, especially if they can eventually be combined with electronic records in a single clinical, educational, and research portal.
"Just-in-time" learning can, however, be taken considerably farther than this. It is well known, for instance, that most students now own two core electronic appliances, the cellular telephone and iPod or equivalent instrument. Our present generation of students is used to multitasking, receiving music downloads, instant messaging, and using phones as ubiquitous instruments for Internet access and photography in addition to communication. Increasingly, education will be aimed at these mobile environments. We, among other schools, have recently begun experimenting with podcasting for distributing audio files of lectures. Podcasting allows students to download files directly to their iPods or computers, and then to listen to the files at their leisure, and is a sure forerunner to Vodcasting, the streaming of video to iPod instruments.
A number of other, more technically high-powered environments will also be increasingly used for adult learning-based education approaches in the future, the most obvious of which is the use of virtual reality programs, either on the Internet, via headsets, or through specialized three-dimensional rooms, often called "caves." We have been using a multiuser commercial platform (www.secondlife.com) to develop three-dimensional environments on the Internet where learners navigate digital representations of themselves, called "avatars," through a three-dimensional virtual psychiatric ward (8). This system is designed to help students learn more about the subjective experience of psychosis and, ultimately, to improve care to their patients. In this environment, users can literally see and hear hallucinations as a patient might, as they "walk" through the halls of the virtual "hospital." We have evaluated this environment with over 800 Internet users, and the vast majority reported that they found the experience both useful and educational. The auditory and visual hallucinations themselves are based on the real, lived experiences of a number of patients, which have then been recreated using multimedia techniques, and validated by the patients as being reasonable representations of the abnormal phenomena that they experienced. There are clearly a number of areas in mental health to which virtual reality technologies can be applied (9). These include the potential for virtual therapy, with patients logging in as avatars from any number of different sites to meet their therapists online, the development of therapeutic environments for the cognitive behavior "virtual in vivo" treatment of addictions, obesity, anxiety, and pain, and the development of some specific programs for obsessions, phobias, and related fears. This whole area, recently termed "serious games," is full of exciting innovations that increasingly make sense from a pedagogical perspective.
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Conclusions
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It is clear that online environments offer exciting educational opportunities and are particularly congruent with the principles of adult learning. It appears likely that a number of educational and technological innovations will change the way we teach courses and programs over the next decade or so and, although the actual technologies themselves are not predictable, what is important is that educational processes are continuously developed, monitored, and evaluated so that learning drives the technological innovations, rather than the other way around. Over the next several years, it is critical that all educators think broadly about educational principles and practices and how they can be improved and modified to take advantage of the marvels of our changing technological world.
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REFERENCES
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- Inwood MJ, Ahmad J: Development of instructional, interactive, multimedia anatomy dissection software: a student-led initiative. Clin Anat 2005; 18:613–617[CrossRef][Medline]
- Issenberg SB, Gordon MS, Greber A: A bedside cardiology skills training for the osteopathic internist using simulation technology. J Am Osteopath Assoc 2003; 103:603–607[Abstract]
- Najjar LJ: Principles of educational multimedia user interface design. Hum Factors 1998; 40:311–324[CrossRef]
- Seabra D, Srougi M, Baptista R, et al: Computer aided learning versus standard lecture for undergraduate education in urology. J Urol 2004; 171:1220–1222[CrossRef][Medline]
- Vichitvejpaisal P, Sitthikongsak S, Preechakoon B, et al: Does computer-assisted instruction really help to improve the learning process? Med Educ 2001; 35:983–989[CrossRef][Medline]
- Williams C, Aubin S, Harkin P, et al: A randomized, controlled, single-blind trial of teaching provided by a computer-based multimedia package versus lecture. Med Educ 2001; 35:847–854[CrossRef][Medline]
- Hilty DM, Yellowlees PM, Cobb HC, et al: Models of telepsychiatric consultation-liaison service to rural primary care. Psychosomatics 2006; 47:152–157[Abstract/Free Full Text]
- Yellowlees PM, Cook JN: Education about hallucinations using an Internet virtual reality system: a qualitative survey. Acad Psychiatry 2006; 30:534–539[Abstract/Free Full Text]
- Wiederhold BK: Virtual Healing. San Diego, Calif, Interactive Media Institute, 2004>
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INTRODUCTION
Educational Principles
