Bedside teaching, Computer Based Learning and Wiki in Medical Education

knee examination

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