What can a student-led e-learning site add to medical students’ education and professional development?

Abstract

Over the past year, a student-led project at the University of Dundee Medical School has been developing a website to allow the creation and sharing of learning resources among students. This paper describes the project and the lessons learned from it that may be applied to similar initiatives.

Key words:

• blog
• Dundee Medical School
• e-learning
• medicine
• podcast

Introduction

E-learning is now a core part of most medical curricula, and is constantly expanding in scope and depth. Dundee Medical School has been at the forefront of developing and integrating e-learning in its current undergraduate medical curriculum, with e-learning modules on various subjects created by both staff and students, and blogs created by staff to support the core curriculum. This was the environment in which a group of medical students, encouraged and supported by enthusiastic staff members, came together to create a way for students to participate in online learning in a broader way than through single projects or discussions on blogs. The aims were to:

• Address the lack of an e-forum

• Enable student-led elucidation of knowledge and understanding where there were perceived gaps (no curriculum is perfect)

• Enable sharing of the best online content found.

There have been similar student initiatives, such the general student site ‘The Student Room’ (The Student Room, 2011) and Stanford’s ‘Focus’ (Stanford, 2010), but these didn’t fully address our aims. We used a blog with some wiki elements to create the site framework. Since its inception, the site, ‘Dundee PRN’ (’pro re nata’: as and when required) (Dundee PRN, 2010), has proved a great success and has also demonstrated flexibility in adapting to user needs. The latest redesign will introduce a raft of new, innovative tools that should make it even more useful to fellow students.

As developers, we have learned a great deal in the year since its inception, through development and through resolving issues. We would encourage other students to embark on similar projects, which offer general learning benefits to the student body and a broader understanding of e-learning and online collaboration to those developing the site. These types of digital media allow for endless creative development, provide an environment for self-directed learning and encourage the development of professional skills that are eminently transferable. Students will become educators in the future and this process of encouraging autonomous responsibility in e-learning is, we feel, an essential part of this process.

Development to date

A student-led site was conceived following the success of an initiative in 2009 to introduce a blog to accompany and co-ordinate respiratory teaching called ‘Dundee Chest’. The most frequent student commentators on Dundee Chest were brought together by a respiratory consultant with an interest in digital media. An e-learning site would require students who not only had good ideas but also had the IT skills to be able to carry things forward. Our core ideas were that the site had to be accessible (and of interest) to all years in the medical school and that it should advertise learning opportunities within the hospital. The next question was what platform should be used. Tiki Wiki was settled on as the best option for building the site and, over the next two months, a test site was created consisting of four main areas: a blog, a discussion forum, revision pages and a page on hospital clinics. Two other areas — podcasts and vodcasts — were developed later.

Similar ideas have previously been put into practice by medical students from other universities — for example, medical students at the University of Wisconsin Medical School have a student website which includes forums, revision material and information on social events (University of Wisconsin Medical Student Website, 2010). Closer to home, the University of Leeds’ Medical Students Representative Council runs a site with links to interactive study resources and information on societies to get involved with (Leeds MSRC, 2010). Our envisaged site was broader in scope than these, but their success gave us ideas to work from.

Two months after its conception we launched the site to our year through announcements and emails and with the consultant from Dundee Chest making a brief presentation. We saw a surge in activity: the number of new registered users went up exponentially, with new blog posts created every day. Our experience until this point had been very positive and when we talked to other professionals they expressed an interest in applying similar models to areas such as CME teaching. The kind of exciting and interactive content developed in these first two months encourages lifelong learning and communal participation.

There are a number of facets to the site, which will be discussed below.

Blogging: The blogs allow easy and less formal communication between students of all years and members of teaching staff. Posts are usually either questions (either on course material or wider medical issues) or links to useful material elsewhere on the web. The range of users mean that questions are usually answered quickly and accurately. Staff involvement means that students can trust the answers given. There were year-specific blogs related to that year’s teaching and a general blog for topics of interest to any student.

The range and complexity of questions raised varied widely — from simple queries to complex questions on co-morbidities and differential diagnoses. Comment threads associated with the blog posts allow discussion to develop on the topic and answers to be clarified or corrected if needed.

Discussion forum: Initially the discussion forums were intended to facilitate questions about the course and general discussion; however, in practice, the blogs came to take on this function. The discussion boards came to be a place for the site moderators to discuss issues relating to site maintenance and what constituted appropriate topics for the blogs.

Revision pages: These were strong examples of ‘peer editing/reviewing’, which we hoped would prove a self-sustaining method for students to access accurate information. Templates were provided for ease of authoring and any registered user could make corrections to material.

Wards, clinics and theatres: Students have opportunities to see patients in clinics and on the wards throughout their studies. However, if they want, for example, to visit a particular clinic, the onus is on them to find out the times and locations of the clinics. Collecting this sort of information on the site allows students to access these opportunities more easily.

An example of this can be found in the musculoskeletal block, where we made contact with a surgeon and used the site to co-ordinate students observing operations. These simple acts of publicity and organisation proved very successful, significantly increasing the number of people observing operations during that block.

Podcasts: Medical podcasts are well established and have been used in various ways; for example the University of Aberdeen’s Medical Education Unit uses podcasts as short reviews of core subjects, while Stanford School of Medicine uses podcasts to interview experts on various medical subjects. With good quality general resources already existing we decided to focus on what was specifically needed at Dundee. We therefore began weekly term-time podcasts, bringing in members of staff to join discussions on anything from clinical specialties to revision tips.

The podcasts were initially led by medical school staff but we soon decided that the podcast should be more autonomous and that it should be run by students, who would act as presenters and interviewers. We tried to have guest doctors who specialised in areas relevant to what was being covered in the course at that time. We would discuss why they chose their speciality, how they would recommend others to pursue their career and other relevant issues. Following positive feedback from these podcasts more students were involved, and to appeal to a wider audience we invited guests who were not only doctors but also involved in our education. This culminated in the Dean of the Medical School appearing as a guest. However, an enduring highlight was the guest appearance of an outgoing respiratory registrar who was going back to his homeland, Iraq, to set up a respiratory service. It was wonderfully insightful and foundations were laid for possible future collaboration.

Vodcasts: ‘Vodcast’ was initially an alien term for most of us, but the idea of a video podcast was appealing, particularly to communicate more visual concepts. Anatomy was an obvious place to start. The first subject covered was neuroanatomy. We received generous assistance from the e-learning department and clinical anatomists; we secured a space to film in and models and experts to appear in the film. Our initial vodcast was about 30 minutes long, which feedback indicated was too long. We therefore reduced subsequent vodcasts to ten minutes. Vodcasts have proved to be particularly popular.

Other aspects: The site has also provided an avenue for the development of independent projects and for student input to be sought. An example of this was an e-learning tool developed by students working with the clinical anatomy department to integrate what they had learned, from anatomical dissection to examination of the musculoskeletal system. The first part of the project was on shoulder anatomy; PRN provided an avenue to ask for feedback, which informed the next parts. Aside from such projects, there is a wealth of other activity going on in the medical school which PRN has been used to advertise. The Medical Students Council (MSC) advertised its vital meetings from the very start. There are also updates on careers events and what student medical societies are doing.

What we have learned

Some potential problems were anticipated when starting the project — for example, the possibility of malicious posting on the site was a reason for not allowing anonymous posting. Concerns about accuracy of information were addressed by involving medical school staff to help ensure that the facts were correct. However, there were a number of issues that we only became aware of as the project progressed.

Professionalism

A significant issue was that of professionalism online. We have clear teaching on professional behaviour in our daily practice through the General Medical Council’s Good Medical Practice but there are no clear guidelines on what represents professional behaviour online (GMC, 2006). There have been suggestions on what exactly ‘digital professionalism’ constitutes, but no formal adoption (Ellaway, 2010). At the most basic, the statement ‘You must make sure that your conduct at all times justifies your patients’ trust in you and the public’s trust in the profession’ covers online behaviour (GMC, 2006).

This then leaves the question open as to what is appropriate. Clearly unprofessional behaviour is easy to spot but there is a vast grey area, and in online settings all behaviour is potentially visible across the globe. Those who have been part of the project have been pushed to consider these issues and, we hope, the site will serve as a model of digital professionalism within the student community.

Copyright

There was a learning curve in the matter of copyright. In an era where digital information sharing is easy, there is a simultaneous lack of knowledge of how copyright affects what can and cannot be shared. At its most extreme, this was demonstrated by a student linking to a pirated copy of a digital textbook, unaware that this was illegal (the link was swiftly removed). The increasing prevalence of digital textbook piracy means that issues like these need to be addressed in any open information-sharing environment (Mead-Robson, 2010). There are also more subtle issues — students produced a vodcast without realising that they had inadvertently included copyrighted diagrams, which meant that the video could not be shared on any open video site such as iTunesU.

There are tools available to help avoid these problems (for example the Online open educational resources toolkit, produced by the Higher Education Academy) but use of these tools requires awareness that there is a problem in the first place (HEA, 2010). Learners need to be aware of these issues, especially if they are expected to be teachers in the future, and we hope that we can increase knowledge among students in this area.

Publicity

In terms of marketing, word of mouth seems to have been the most effective publicity. Even though there were presentations on the site, and a Facebook group, the greatest usage of the site (using data on registered users collected by the site) is by those who are in the same year as those who created the site.

Software

We believed that our initial choice of software would be suitable for all future needs so would not need to undergo any changes but this has not been the case. The site is being migrated from a Tiki Wiki platform to a WordPress platform, in line with the other teaching blogs at Dundee. Usability is a very important factor in encouraging interaction with the site, and this was another motivator to shift to another platform. The most difficult aspect of this has been changing to different servers or software platforms; changes within the platform have been relatively easy. Dependable predictions of the direction of multiuser needs may not truly be possible, rendering the decision on the most suitable platform problematic.

Benefits to learners and teachers

Functionality

The first thing to note is the huge amount of functionality packed into an e-learning network such as Dundee PRN: digital bulletin board, an interactive safe space, home for basic local information, podcasts, vodcasts — and the potential for much more. Some would argue that these benefits could be achieved without the use of a website like Dundee PRN, but we think that application of this technology brings a whole new dimension to both professional learning and teaching. There simply is no equivalent streamlined all-in-one solution to providing such a range of options in a format that both teachers and learners find palatable. From a course administrator or institutional point of view, technology such as our site can run with little financial input while managing to provide incredible functionality and streamline student interaction and additional resource provision.

Student input

With a large user base, interactions such as a question/answer forum and discussion around a topic have the potential to receive unprecedented input. Didactic lectures, text and audiovisual content comprise the most basic and probably least effective forms of learning, while applying knowledge and teaching others have been demonstrated as the most effective ways to learn. With the inclusion of podcasts and vodcasts, students have become the teachers, often presenting information for other students in a more relatable fashion. In this sense, we hope that the site will encourage students to teach each other in a learning community online, benefiting themselves by helping each other.

Perhaps one of the greatest advantages of the website is the elimination of barriers between learners and teachers, possibly one of the more important aspects of a web 2.0 approach to online learning (Sandars and Haythornthwaite, 2007). In the medical profession, as is probably the case in most professions, there may be barriers between students and teachers. Students may feel nervous about approaching a professor to ask a question, and teachers may feel that they are under the spotlight when presenting to a lecture theatre full of students. The website removes those barriers and allows free communication between students and teachers. Seemingly naive questions (that many students may have but are afraid to ask) can be answered in a public sphere. In this way, the teacher effectively has a massive audience, but without the intensity or individual load created when trying to deal with numerous students at a one-on-one level.

Broadening learning

The other unique aspect of the site is that it broadens learning from an activity that just takes place in formal settings such as lectures, tutorials and other timetabled sessions. A website is always there and always accessible so students can learn when and where they want. With the advent of devices such as the iPhone, netbooks and other portable computing devices, interaction with highly sophisticated and informative resources such as Dundee PRN is easier and more flexible than ever. There can be resistance to this as an assault on ‘tried and tested’ didactic teaching methods, but slowly, more learner-centred and collaborative methods, such as peer tutoring and Interactive Teaching Area sessions, have been implemented in curricula internationally, adapting to contemporary changes in learning styles. The next big push in education is to facilitate and expand this through the use of technological assets such as blogs and social networking sites. The average student is already well versed in using these tools — albeit in a social context; it is just a matter of providing an academic context to which these skills can be transferred. Ultimately, it has to be remembered that these technological innovations are not intended to replace traditional teaching entirely. Lectures and other formal teaching sessions are sometimes the most efficient and effective way to impart certain types of information, but there are other situations where interactive, collaborative or learner-centred learning will lead to far better outcomes, and it is here that sites like ours have great potential.

Reflection

Finally, the site provides the best platform for reflection — an integral, yet undervalued aspect of professionalism. Reflection on performance and collecting feedback is often an arduous and frustrating process for teachers to facilitate — and for students to complete. Students can instantly comment on blog posts or learning materials on the site, reflecting on their learning or providing feedback to the content creators. With a large user base, polls can be set up and huge amounts of data collected. Even informally, traffic to different pages can be tracked and trends in topics of interest can be observed. The whole system can speed up feedback on teaching, aid learners by providing them with prompt replies to their questions, and facilitate group reflection through forums. This aspect of the site is perhaps more useful for teachers as it provides a highly accurate, up-to-date picture of their students’ competencies, needs, questions and suggestions.

The future

The concept of the blog caught on but, after the initial heavy traffic, use plateaued at the beginning of the summer as students finished for the year. The residual activity during the first part of the summer was maintained by the administrators and a few others. Then, to our surprise, just before re-sits, traffic picked up again. Keen to develop the site to its fullest potential, we then asked ourselves how we could develop the site to be a constant feature of learning in Dundee.

In order to bring together the medical school blogs, migration of Dundee PRN to the same format as the other blogs is being implemented to allow all to be held under this umbrella. This migration will result in the loss of the wiki functionality of Tiki Wiki but it is hoped that the most useful resources can become part of the new site and the rest will remain archived.

The new magazine format will improve the appearance and navigability of the site, and we hope to see another surge in activity when it is relaunched. However, we want to build on our successes to create a sustainable site. As such, the new site will have two blogs: one for more informal discussion and one for questions. One of the aims is to try to integrate and share knowledge throughout the five years of the course and beyond.

We aim to expand the horizons of the podcasts to encompass academic medicine, tapping into the strong research environment that exists at Dundee. We also want to hear from as many allied health professionals as possible — from nurses to nurse assistants, speech therapists and physiotherapists. As future members of multidisciplinary teams, the perspectives of other professionals are a key part of our learning. Ultimately, as future professionals committed to patient-centred medicine, we hope to have more patients interviewed in podcasts. We have initiated this by contacting patient support groups and we hope to have our first patient podcast very soon. The vodcast programme will run in parallel to the podcasts, focusing on aspects where visuals are beneficial and where students feel it will benefit their learning.

The status of e-learning in the medical school has been raised and many students are now getting involved in exciting new projects. The forum for discussion of these projects has been PRN. We can only see this being enhanced as the site is improved and we hope to host and publicise new student-led projects.

Careers advice is an important issue for students and, in order to offer a coherent platform, Dundee PRN has started a collaboration with other student bodies in the medical school to enhance careers advice through collective advertising. This includes becoming involved in non-online projects initiated by the Medical School Council and the Medical Education Society such as an evening symposium series. These involve the advancement of general educational aims, as well as opportunities to present work in a real-world environment — all positive for future career aims.

Conclusions

The group involved in the creation of PRN has gained a greater understanding of the challenges that teachers face in trying to create content that is useful and useable for students, while being delivered in a fashion that is contemporary and accessible. Issues of professionalism, responsibility for content, interprofessional working and effective collaboration have all come to the fore for the group. Overall, we firmly believe that developing student-led e-learning and online professionalism can provide an avenue through which young professionals can develop lifelong learning skills, experience continuing professional development and learn and work in a professional community.

We hope that we have demonstrated the benefits of our e-learning project so that professionals working with students might encourage similar student-led collaborative projects. This is the epitome of self-directed learning. Dundee Medical School has demonstrated confidence in the ability of its students to create tools to aid learning for themselves and others. With the ease of authoring allowed by web 2.0 and the variety of systems/platforms available, it is awareness, enthusiasm and effective leadership which are required to take forward a project like this, rather than in-depth technical knowledge. Initial guidance from teachers makes way for progression to autonomous management and content generation by students. Interaction with other students enhances this process and allows for the development of content in unison.

Ideally, our goal would be a network where joining and contribution is not mandatory but where every student feels motivated to learn and to help others learn. This is a situation where one size does not fit all — the needs of students at different institutions will be different and will change — but a broad base of users will help contribute to developing appropriate resources and evolving the site appropriately. A core group of keen students acting as moderators is essential for practical reasons and they should strive to communicate their enthusiasm to other students. Students are the cornerstone of innovation through education and giving them the ability to influence how they are taught is key to encouraging this future generation. Running or starting a project like this will not change things overnight but we believe that it encourages diverse skill development profile — learning not just medical facts but ways of working and learning that will serve continuing education in years to come.