Will e-learning improve clinical judgment?
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7449.1147 (Published 13 May 2004) Cite this as: BMJ 2004;328:1147All rapid responses
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I have a problem with this article. The problem is that e-learning
here is not defined, and my concept (informed) of e-learning is completely
different from the implied definition contained in this article, as it
were, e-learning being the capacity to have access to a huge body of
information through search engines and others on Internet.
That is not e-learning. E-learning has been defined as the use of
network technologies (Internet) to design, provide, select and extend
learning processes. It's main components are contents in multiple formats,
a learning management system making it possible to track the learner's
progress, and a community of learners, teachers, developers and network
experts (see "E-learning: Current Status and International Experience,
Joanne Capper, World Bank Consultant, 2002.)
In consequence, I think that the title of this article is
missappropriate. E-learning refers to a teaching/learning experience that
is web-based but built upon an instructional design approach (maybe
constructivist, maybe cognitivist).
The wide availabilty of information on the Internet is a totally
different phenomenon to e-learning. E-learning courses, for example, when
well designed and well guided, can be an extraordinary learning
experience, for physicians as well, helping guide clinical judgement and
reinforcing appropriate clinical practices. This is so because of the high
level of interaction between learners and tutors, element which is totally
absent in the standard relationship that physicians have with the
internet.
Vivienne Bachelet, MD
Director, Medwave Ltda.
Santiago, Chile
Competing interests:
None declared
Competing interests: No competing interests
Sir:
According to my analysis, all the four integrated and interrelated
components, which include basic undergraduate/postgraduate medical
training, continuing medical education, clinical experience and medical
research have very powerful impact on clinical judgement of a physician.
The e-learning may help a clinician in several ways; possibly collecting
relevant medical information; enhancing and updating medical knowledge;
and expediting research publications. Collectively, all this may have
positive influence on physicians' clinical judgement and further help in
delivering better health care services to the consumers.
As regard e-learning improving clinical judgement of physicians, I am
afraid that the similar basic medical precepts may not be generalizable to
other groups of populations including public, patients organizations, and
patients themselves. They may get substantial information electronically
for learning purpose but it will be rather difficult for them to apply it
into clinical practice. However, the e-learning may help them prepare
solid ground to discuss with the health providers many relevant aspects of
delivered medical services.
Reference:
Daniel J Klass. Will e-learning improve clinical judgment?
BMJ 2004; 328: 1147-1148
Competing interests:
None declared
Competing interests: No competing interests
We read with great interest the article on E-learning and that
whether it shall improve clinical judgement or not. We feel that the vast
amount of information available via internet search engines, websites of
authoritative bodies, online libraries, journals and books etc should be a
supplement and not a substitute to the skills of an alert clinician.
Having a good theory knowledge is of paramount importance , but such
a knowledge is of little use if it not rehearsed by 'supervised bedside
clinical teaching'.One should be able to search effective evidence based
information and not get lost by information overload. I am personally
aware of instances where clinical performance rather deteriorated as the
student got lost in collecting internet based information and could not
apply it to clinical practice and decision making , its consequences were
demoralizing.
On the other hand , availability of clinical decision algorithms will
be welcome as they guide the clinician with a systematic framework of
patient approach.We need to stress upon the reading of 'relevant
information' and not just any information.
Henceforth we feel that E resources are a double edged sword with
potential to cause damage as well.One has to be alert in obtaining
appropriate and relevant information before applying it to clinical
practice.
Sincerely yours
Competing interests:
None declared
Competing interests: No competing interests
Learning through Internet: necessity not luxury!
We are convinced that this article will raise our awareness about a
burning issue currently medical education is facing, and hopefully will
ignite a spirited discussion among the medical education community.
Whether it is e-learning or web-based learning, on-line learning or off-
campus learning, traditional or innovative curriculum – medical students
and practitioners are needed to be adequately trained to use the vast
information available in the Internet or web. Web is “increasingly used
both as a learning tool to support formal programmes and as a means of
delivering online learning programmes”1. Many institutions have developed
“virtual campus” on the web, which are gradually replacing traditional
teaching approaches and are gaining popularity. A recent development is
the establishment of the International Virtual Medical School (IVMEDS), a
unique collaboration of 40 leading edge medical schools and institutions
of the world (http://www.ivimeds.org/). It provides a blend of high
quality student-centred e-learning and face-to-face learning with a
promise to set new standards in medical education by offering “Just-in-
time, Just-for-you, Just Anywhere” type of flexible programmes.
Exponential growth of scientific knowledge in medicine and medical
education leads to the ideas of evidence–based medicine and best evidence
medical education. Professionals need to exercise their clinical or
professional judgment to gather best evidences either present in the print
form or in the web.
Information technology has the potential to make fundamental change
in medical education. We have to divert and manage the torrent of
information and technology so that our tomorrow’s doctors and patients are
benefited to the greatest extent.
Reference:
McKimm J, Jollie C, Cantillon P. Web Based learning. BMJ 2004; 326;870-
873.
Competing interests:
None declared
Competing interests: No competing interests