Online education: should we take it seriously?

KEYWORDS:

• Online education
• videoconference
• distance learning

Introduction

With science and technology both riding at a speed unknown before, it has been possible for a teacher to reach a student millions of miles away! With conferences abounding, with costs escalating and time taken to travel to meetings, it has become more and more difficult to attend such meetings or courses. Distance learning is quickly catching up, with many Courses being offered through avenues different from the traditional classroom teaching. So does this mean that this is the end of the road for traditional academics?

Traditional classroom teaching

From time immemorial, teacher – lecturing, student – listening, has been the mainstay of traditional academic education. The delivery system for education has been a classroom setting with a professor giving a lecture and students listening and writing notes. The question–answer session between the professor and student has been viewed as an essential learning session within this setting, often referred to as the 'Sage on the stage'1.

Technological improvements in communication have advanced from postal services to telephone, radio and television and, more recently, the internet, all of which have been the driving force yielding new delivery methods of teaching. These new learning methods are being used to deliver distance education and are proliferating in various graduate and postgraduate programs, leading some experts to believe that the 'traditional academic method of imparting knowledge', in the form of students attending classes at prearranged times and locations, will soon be replaced by distance education. Though an expensive option today, distance education has progressed in concept and practice from an 'anywhere' to an 'anytime' delivery method2.

Distance education through live videoconferencing

Videoconferencing is defined as a real-time, live, interactive program in which one set of participants is at one or more locations and the other set of participants is at another location. The videoconference permits interaction including audio and video between the two locations3^,4.

Videoconferencing can be made possible through four technologies:

• Satellite communication,

• Internet protocol base communication,

• Integrated services digital network (ISDN), and

• Third- and fourth-generation (3G/4G) mobile phones currently and soon the fifth-generation mobile phones in the near future.

Each of these technologies has its own advantages and disadvantages, with every new technology overcoming the disadvantages of the previous technology, as seen in Table 15–9.

Table 1. Technologies used for distance education by videoconference (VC).

Advantages	Disadvantages
VC via satellite
Portable	Expensive for equipment and for rental of satellite
Can be used anywhere where satellite coverage is available	Latency between video and audio presently 1–2 seconds
Can be used in rural areas with poor infrastructure
VC via Internet
Signal quality good	No guarantee of quality of service because depends on amount
Minimal time latency between audio and video especially in closed networks.	of traffic on Internet
VC via ISDN
	Not used today since 3G mobile telephones were introduced
VC via 3G & 4G mobile phones
Widely used in medical community in a mobile environment for  audio and video calls + broadband	Cannot communicate with traditional VC equipment Camera lenses of poorer quality
Reasonably priced	Quality of video poorer
Service accessible in many countries including developing countries	Small display on mobile phone
Dependent on special features in mobile telecom network

Distance education vs. traditional academics

The internet has helped to overcome distance globally with the ease of sitting at home, clicking a few buttons on the computer and listening live to a professor who is thousands of miles away sharing his latest research findings, along with the ability to interact with him at the same time and solving one’s queries – it’s just amazing!

But does such distance learning offer the same value as learning in a classroom? Does it help to imbibe the same knowledge as one would if one went to a class? To answer these questions, Augustead and Lindsetmo10 searched a total of 517 articles from peer-reviewed telemedicine journals and identified 51 relevant manuscripts, which included articles on videoconferencing and telementoring on surgery, education, emergency medicine, follow-up of treated patients, multidisciplinary oncology team meetings and education of health professionals. They concluded that videoconferencing is an effective clinical tool for updating surgeons on alternate surgical practices despite long distances, especially in rural areas.

A meta-analytic approach was carried out by Shachar and colleagues11 to determine the difference between traditional and distance academic performances by comparing the final course grades/scores of two groups of students between 1990 and 2002. Eighty-six studies with over 15 000 students were included in this analysis; it concluded that, in two-thirds of cases, students by direct education outperformed the students taught by traditional teaching and the mean percentile standing of the direct education group was at the 65th percentile of the traditionally taught group (mean defined as the 50th percentile).

Various countries have researched the quality of training through videoconferencing in various disciplines of medicine and surgery via the Internet to rural areas hundreds of miles away and found that surgical mentoring through videoconferencing is highly valued by graduate medical students as an educational method without having to travel long distances. It is an educational tool which has shown equally good results both in developed and developing countries. With the lack of availability of experienced specialists in rural areas, this form of training is able to reach the unreached, with extremely effective results12–21.

Student viewpoint on videoconferencing

Do students prefer this method of education? Research conducted by the United States Education Department22 found that students perform better during online courses than during traditional instructional classes. The same study also revealed that students are more likely to perform best during 'blended' courses, wherein the elements of traditional and online classes are combined to facilitate learning. Blending of online and traditional classes could be beneficial to both students and teachers as students could take learning at their own pace. For teachers, online teaching saves time and effort, yet the effectiveness still remains.

In fact, the researchers found that students are very excited and enthusiastic about online classes. They tend to pay more attention and be more participative in class activities during online or virtual sessions. This could be because students are relaxed and are able to do them in the comfort of their homes without having to travel. They also enjoy the fact that learning is not confined to the classroom.

Videoconferencing for developing regions of the world

Medical education in developing regions of the world typically suffers from two problems. First, medical universities and residency programs rarely have enough qualified instructors and sometimes lack access to modern curricula and equipment. Second, poor or non-existent continuing medical education (CME) programs prevent practicing clinicians from keeping their skills sharp. The global health-care expertise is particularly low in the world’s poorest countries23. Green, in his article 'Emerging market medical educations goes digital', dated March 10, 2015 in Global Tech Learning, quotes the World Health Organization estimates that the world needs more than 7 million additional skilled health professionals, with shortages in many parts of South Asia, Southeast Asia, and Africa22. The University of Washington’s Department of Global Health is a leader in the use of distance learning technologies for low-resource settings. Through an initiative called 'eDGH', it runs e-learning programs in more than 30 countries. Since 2007, it has opened two small program sites in Kenya and Haiti and delivered online education to students in many parts of the globe. Its flagship course on 'Clinical Management of HIV' now reaches over 1000 students globally each year.

Personal experience in India

My own experience has been extremely satisfying. India is a vast country with pockets of expertise matching international standards of health care, whilst large areas offer only basic health care. Advances in the field of medicine rarely reach these areas, mainly because physicians in rural areas are so far and few that, if they leave the areas in which they work, there is nobody else to take over from them. Neither can the people who live there afford the luxury of going into a city to avail themselves of better health care.

So Science stands still for decades together in remote areas which either cannot be accessed due to connectivity or due to socioeconomic reasons. The questions constantly nagged me 'How do we reach out to these health practitioners and medical students, who are so distant and cannot afford the high costs of attending medical conferences, nor the cost of purchasing reputed medical journals nor the latest text books? How can we update their knowledge so that they can offer better care to their patients?'

It was a decade ago that the changed concept of videoconferencing became popular in India and offered the best of professors to be heard by the remotest of medical students and clinicians. This was possible through the use of the telemedicine facility 'Edusat' of the Indian Space Research Organization (ISRO)24, the same organization which landed the Indian satellite on the moon! After conducting a couple of medical events and understanding its reach, we initiated the 'Satellite School' in 2006 under the aegis of the Federation of Obstetric & Gynecological Societies of India (FOGSI)25. ISRO was magnanimous in lending its facilities for one Sunday every month for a period of 36 months. Our academic teams would travel to the ISRO Headquarters and conduct two sessions of 4 hours each from ISRO’s studios. The programs were down-linked live through satellite dishes installed in about 70 medical colleges all over the country, especially in the remote areas, through an unrestricted educational grant from a magnanimous corporate.

The response was tremendous! We were able to impart the latest advances in medicine to the remotest of areas through telemedicine. Everyone was excited and was happy to participate, both professors and students. Live surgeries and newer techniques were demonstrated through excellent satellite transmission, which is actually very expensive, but was free to all of us for 3 years! Then came the era of the Internet, which is cheaper and has now replaced the satellite technology for the purpose of education, through live webinars for students and clinicians all over India.

Online programs from the International Menopause Society

The International Menopause Society (IMS) has taken its first step towards online education through a global program entitled 'IMS Webinars'. The IMS Webinars, meant for physicians, are conducted as a discussion with members of the IMS or other global experts on a predetermined subject for a period of 2 hours, with the first 1 hour 15 minutes dedicated to a discussion between the Moderator and panelists from anywhere in the world, and the next 45 minutes dedicated to questions received from delegates sitting in the comfort of their homes, which are answered by the experts immediately online.

The first Webinar was held in May 2015 on the subject of 'Osteoporosis', with experts from South Africa and India. Rod Baber, President of IMS, launched the Webinar Series through a Welcome Video online. The Webinars are currently being conducted quarterly and are being publicized to all IMS members through the IMS website. The website is being completely revamped, and all the Webinars will be archived on it, so that delegates who have missed them live can watch them later at a more convenient day and time.

Another online program of the IMS is the 'IMS YouTube Videos', meant for online education of perimenopausal women. Currently there are six beautiful videos loaded on YouTube offering information on various issues which affect this group of women. They are truly a treat to watch, as they feature some of our Board members talking directly to women, offering expert advice from the IMS26.

Videoconferencing – advantages to different sectors

The advantages of this technology can be seen in various sectors such as telecommunications, health care, education, etc. Online diagnosis has become possible in the health-care sector and experts can be consulted online, so that emergency situations can be handled very efficiently even in remote locations, both for medical and surgical difficulties. New e-learning tools will increase the number of health workers globally by training them through experts and provide them in places which desperately need them. This would also assist in task-shifting certain responsibilities from the experts to the next level of health workers such as the primary-care physicians or nurses.

Conclusion

Educational institutions (mostly in the higher levels of academia) have adopted these new direct education methods as the educational delivery systems of the future. The insertion of direct education delivery methods into learning programs has been seen in a variety of formats: optional, complementary, interchangeable, or full and completely online programs. It is doubtful, however, that the traditional academic model will disappear in the near future. Students, when offered the option of direct education as a means of pursuing their academic quest, now choose learning programs mainly on the merits and quality of the programs offered, without fear that direct education may hinder their academic performance outcomes.