Medical education has many long-established academic approaches to learning including face to face lectures in classrooms - via a teacher-centered model. This particular approach to educational practices can manifest within a teaching culture, becoming universal within an organization or discipline, leading to an unwillingness to adopt new and emerging practices and technologies. Over the last number of decades, there has been a shift in medical education practice from traditional forms of teaching to other media that employ online, distance, or electronic learning. As described by Howlett et al., “Electronic (e) or online learning can be defined as the use of electronic technology and media to deliver, support and enhance both learning and teaching and involves communication between learners and teachers utilizing online content”.
Online learning can provide students with “easier and more effective access to a wider variety and greater quantity of information”. However, the transition from traditional to online learning is not without challenges. Increasing time constraints and demands are continually placed on students and educators alike, driving departments to find new ways of providing a more personalized, self-directed learning experience.
Medical graduates of this time are expected to ‘hit the ground running’, requiring not only a traditional clinical education but also one that is up-to-date with the latest technologies in order to ensure flexibility in a dynamic workplace. There has never been a greater need for educators, students, and clinicians to continuously update their skills, to remain well-informed of the changing healthcare environment and to remain ‘digitally literate’.
Digital literacy has been defined as:
(a) The ability to use digital technology, communication tools or networks to locate, evaluate, use and create information,
(b) The ability to understand and use information in multiple formats from a wide range of sources when it is presented via computers.
(c) Literacy includes the ability to read and interpret media, to reproduce data and images through digital manipulation, and to evaluate and apply new knowledge gained from digital environments’. The advent of mobile devices, Web 2.0, Web 3.0, and more recently Web 4.0 and the explosion of social media technology provides opportunities for learners to create their own personalized learning experiences. Academic faculty and tutors, therefore, have a crucial role in guiding and supporting the effective use of technology for such learning.
Many factors can influence whether or not an online learning program will succeed or fail, ranging from student-led factors to staff-led factors. For example, “cultural resistances” amongst staff have previously been identified as a barrier to student engagement with technology-based education; therefore, staff focused initiatives may be key to the introduction of successful e-learning programs. It has also been recognized that changes and developments in medical education are putting extra pressure on already overworked faculty. When considering the implementation of e-learning within a medical school or program robust evidence-based research may strengthen one’s position when encouraging faculty to remain up-to-date on technological developments.
It will aid in addressing primary concerns amongst medical faculty who may be resistant to integrating e-learning into teaching practices. In order to ensure a robust evidence base for, or against, e-learning in medical education, it is crucial that account is taken of all perspectives (student, educator, training body/school/university).
To date, there has been no review of the evidence on barriers and solutions from a medical educator’s perspective but there has been work completed in regards to the barriers which students face and the solutions to improve engagement with online learning.
The below categories are inclusive of barriers to the development and implementation of online learning and also offer solutions to those barriers
Barrier – Skill deficit
Lack of skills, in particular technical skills, was found to be one of the barriers met by educators when engaging with the development and implementation of online learning. Insufficient computer and typing skills together with poor infrastructure can prevent educator’s willingness or ability to engage with the development or delivery of online learning.
Solution – Engagement
In order to gain the necessary skills, it was acknowledged that engaging with e-learning, including the development of such programs, was important for gaining skills for teaching practice.
Barrier - time
Medical educators are already under pressure to find sufficient time to manage teaching, research, and maintain a work-life balance personal life commitments. In this context, inadequate time to devote to the mastery, development, and implementation of online learning tools can be seen as a significant barrier. This expectation of time to be invested can be seen as detrimental in an educator’s own academic system in conjunction with predetermined notions that computer-based tools “always take longer than expected”. Interestingly, lack of time appears to be linked with a lack of incentives to engage with online or e-learning.
Solution - time
The adoption of digital tools can, in fact, free up time allowing medical educators to learn concepts and to reflect on practices. Furthermore, where educators are asked to spend time engaging with the development or implementation of online learning it is proposed that there be a ‘formal mechanism for faculty reward and acknowledgment for efforts.
Barrier –poor communication
Where there was a lack of institutional support and limited direction as to how tools or programs would be implemented, implementation was rarely successful.
Implementing e-learning is often reported as a process that is adopted in polarization; while the adoption of e-learning tools may be taking place across a number of departments in an institution, there may be a lack of interdepartmental communication which is seen as a barrier.
The asynchronous environment generated is perceived as one which does not support the active exchange of ideas and shared knowledge.
Solution - collaboration
One of the most important ways in which implementation of online / e-learning programs can be completed successfully is to include all relevant stakeholders and departments within a faculty and for new approaches to be adopted to facilitate collaboration. They specifically outlined the need for e-learning managers to put appropriate mechanisms in place in order to
i) have qualified and dedicated human resources,
ii) allocate financial resources and
iii) Support of all stakeholders according to their needs.
An institutional strategy is therefore required which facilitates the implementation of key skills and the adoption of methodologies by faculty when implementing online learning.
Barrier – Attitude
The negative attitude amongst educators in engaging with new technologies and tools can be seen as a barrier to the development and implementation of online learning. Educators noted feeling overwhelmed with the entire process of engaging with new tools and having little patience for navigating minor technical issues.
Such feelings of inadequacy, stemming from limited knowledge of, or proper training with, a particular tool may be influencing the attitude of some educators when asked to commit to implementing and developing online learning practices.
Solution - culture
Maintaining a positive attitude in the face of seemingly difficult to use and time-consuming e-learning tools and technologies can be quite problematic. Educators must maintain a positive attitude.
Adopting these new tools may, in fact, produce a positive experience overall and even break down preconceived notions;
Fostering a change of norms and attitudes, therefore, is an important solution in the development and implementation of online learning in medical education.
Overall, online learning in medical education is a relatively new concept and one which is rapidly expanding. It is important therefore that postgraduate training bodies, medical schools and their educators are aware of the barriers and solutions to the development and implementation of the type of learning and of the need for a culture to be in place which strives to promote and support the use of online learning amongst staff. In doing so, medical educators and students will be better prepared for the challenges faced in this digital age.