Bedside teaching, Computer Based Learning and Wiki in Medical Education
To me bedside teaching is number one in teaching anything to medical students. Nevertheless most of the teaching in med school is done in tutorial groups, lectures and computer based learning. This next four weeks I am supervising a group of 12 med students in computer based learning. In this coming weeks they have to solve patient problems on the computer and once a week they have to do some tasks under supervision. The combination of computer based learning and bedside teaching is rewarding and probably efficient. That’s why a recent study caught my eye. They compared Computer Based Learning with traditional bedside teaching (BT) and studied how the order of teaching delivery affected students’ performance.
We also used wikis in med school for the competence of professionalism in medical education, more specifically collaboration. The idea was to form groups of med students and let them make a wiki about a disease based on a case presented to them. Instead of collaboration as we hoped for they always started dividing the tasks, at best one of them had overview but the last thing they did was collaborating. We have skipped it from the curriculum. We were not alone, from a recent research we learned that others also failed to integrate wikis in medical education. They found that in an educational context, social technologies such as Wiki’s, are perceived differently compared with ordinary personal use and this discourages student adoption.
On computer based learning and bedside teaching:
The CBL package is a useful tool and is most effective if used before BT. Students prefer BT alone over CBL alone, but, if offered both, prefer to undertake CBL first.
The test or should I say competence tested in this study was the knee examination. The CBL consisted of an interactive computer-based package with a PowerPoint presentation, with written and pictorial slides, as well as video clips of performing the examination techniques with commentary. The students were able to navigate between slides at their own pace, repeating segments as they
wished. The other condition was bedside teaching of the knee examination. 28 med students participated, they were divided in two groups. Group one started with CBL followed by a test, next the BT followed by the same test. The other group the order was the opposite, first BT followed by CBL with two tests each after BT and CBL.
It was shown that CBL followed by BT was far better than the other way around in results on the tests. The students themselves preferred the bedside teaching over the computer based learning. They had no preference about the order in which they received the BT and CBL. Especially the students’ experiences of using these new technologies is scarcely tested as in this study.
Whether CBL can be used for teaching practical skills is still under debate. From this research we can conclude that CBL is as effective as BT because there was no statistically significant difference between the groups in results on the first test. However, using CBL alone would not find favour with students: 92% of them rejected it as an appropriate method of teaching.
CBL is an adjunct to BT and the optimal oder is Computer Based Learning followed by Bedside teaching Do you agree, any experience with this, let me know in the comments.
About Wikis in education:
The advantage of social software technologies such as wikis but also blogs, is that users become publishers rather than merely consumers of information. When creating a wiki students can combine, annotate and edit existing material in such a way that new content is created and used in partnership with others. Especially this last option was one of the goals of our education. Collaboration among professionals comparable to health care teams. Specialists seldom treat patients on their own anymore. It usually is team work, involves several specialisms.
How was this study done?
A freely available wiki compatible with the university’s existing virtual learning environment was found. Next the wiki was created with basic instructional scaffolding and subsequently promoted through lectures. Student engagement was informally monitored in seminar discussions and data was collected from a final year undergraduate module in information systems with a cohort size of 75 students. Logistically, qualitative questionnaires were administered in November 2007.
After 5 weeks there were zero posts on the wiki
Out of 51 responses (68% of the cohort) two thirds had visited the wiki but zero had posted anything. The reasons ranged from academic pressure from other courses (educational constraint 29%) to ease of use concerns (technical constraint 37%) to issues of self-confidence (personal constraint 14%) and a finally a total lack of interest (20%).
In our students they had to make the wiki, it was compulsory in order to make progress. Med students being practical as they usually are quickly divided the tasks. Each one participated in the task best suited to their capabilities (searchers, writers, thinkers etc). In the end the wiki was finished and mostly well done but no collaboration.
Students prioritize their time according to the greatest perceived benefit with the result that coursework deadlines for other modules and part-time work pressures are automatically awarded a higher priority.
Other caveats are lack of computer skills, students are very often passive computer users. They can be reluctant to publish Web-based material for peer-group review. The authors suggests teachers provide students with classroom exercises in editing and publishing content. Student motivation for using social technologies appears to be linked to their perception of fun (active postings amongst friends) and consumption (individual browsing behavior). Consequently, there appears to be little appetite for engaging in altruistic behaviour with other students.
Anyone other experiences with wikis in education or medical education?
Thanks to @amcunningham for the article on wikis in education.
Peter Hull, Adnan Chaudry, Anna Prasthofer, Giles Pattison (2009). Optimal sequencing of bedside teaching and computer-based learning: a randomised trial Medical Education, 43 (2), 108-112 DOI: 10.1111/j.1365-2923.2008.03261.x
M COLE (2009). Using Wiki technology to support student engagement: Lessons from the trenches Computers & Education, 52 (1), 141-146 DOI: 10.1016/j.compedu.2008.07.003
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January 28, 2009 @ 11:51 am
It sounds very familiar. During my medical education I always made the powerpoint presentation because I was computer skilled. Others did the other work. This is also cooperation, but probably not the kind of cooperation educators are seeking. I would like to know what kind of attitudes educators would like to develop with cooperation?
Personally I think that you should do CBL first and then BT. This way as a student you already have some insides and that does make you look less stupid.
Finally I would like to add a smart thing to make the students pay attention during BT. Do a pre-BT and a post-BT test about the things they will learn during the BT. Also tell them that the test results will be announced in the group after the BT. It makes students pay more attention. Or at least I payed more attention ;-).
January 28, 2009 @ 3:57 pm
Thank you very much for this post. @wmjohn commented yesterday that he thought this was a great paper because ‘not often educational researchers report negative results’. I think if you do something and it doesn’t work you are not sure if that is because you didn’t do it well enough, or if it just don’t work. Such is the nature of complex interventions. But I think that discussing what we have or have not achieved in these spaces is a perfect use of web2.0.
January 28, 2009 @ 10:09 pm
@jan I think in medicine what we would like to achieve as collaboration is team work, usually treating a patient is a cooperation between several specialists, nurses and others, we learn from each other besides that we all have separate specialties. It’s synergy we want to achieve. But good team work needs training in certain qualities like for instance learning from each other, how to deal with negative criticism, how and when to discuss problems, respect the responsibilities of the other professionals. Could go on but this was the essence in what wikis probably won’t teach.
@ Anne Marie Cunningham. Wouldn’t it be nice to compare curricula with each other, maybe in ….wikis?;)
I agree we can learn from each other through web2.0, but even better so when meeting face to face if there is enough to discuss, what do you think?
January 29, 2009 @ 12:06 am
Hello
I also wanted to add that I agree with Ian that we nned to think about what we want out of collaboration in a wiki. @bonnycastle has mentioned before how she found that students in her university also were good at distributing tasks amongst themselves but not collaborating in learning…. which makes me think that the notion that wikis lead to a special kind of learning is hard to believe. Wikipedia is a successful wiki. Do contributors learn in the way that we hope students will? Has there been any research on the effect of contributing to wikipedia to learning?
Next, I agree that it would be wonderful to meet face to face. Are you going to AMEE? I met three fellow twitters today and it was a great experience!
January 29, 2009 @ 12:40 am
@ Anne Marie It remains to be seen what professionals can learn from wikis. Probably writing for consumers and patients, don’t think collaboration will be learned from it. Alas not going to AMEE, somewhere else in the near future I hope, kind regards Dr Shock
January 29, 2009 @ 1:21 am
http://yofl.pbwiki.com/
Have you seen this? I think it will be interesting to watch.
January 29, 2009 @ 10:56 am
@Dr Shock: I agree. Writing for a Wiki or making a presentation are not the ways to train collaboration.
If you want teamwork you should have multiplayer hospital (management) game. Someone can play the cardiologist, someone the psychiatrist etc, but you have to cooperate otherwise the patient will die. Of course students will “kill” the patient but you can learn from that as well.