What have we learnt about using digital technologies in health professional education?

Informed use of digital learning technologies can contribute to effective learning experiences

The growing use of digital educational technologies in health professional education has mirrored the changes wrought by the digital revolution as a whole. However, while some activities in contemporary health professions education are almost exclusively mediated online (such as providing learning materials), others are still largely conducted face-to-face (such as supervision and assessment). Indeed, as the heat of the e-learning revolution has cooled,1 it has been replaced by a growing focus on integrating and sustaining the many technologies that learners, teachers and administrators now use. Despite this, the use of technology in health professions education is often ad hoc and reactive, rather than being purposive and strategic. In this article, we highlight some of the prevailing misconceptions surrounding the use of technology and recommend that educators and health professionals recognise that compromises are needed when designing technology-mediated educational experiences.

Technology is a medium

Education has always been dependent on technology, it is only the forms of technology we use and their affordances that have changed. Contemporary digital technologies in health professions education include e-learning, mobile devices, social media, learning management systems, virtual patients, massive open online courses, podcasts, game-based learning, open educational resources, virtual and augmented reality and more. Despite their differences, these technologies share many common affordances — including expanding connectivity of people and resources, accelerating users’ speed of action, and allowing people to interact and collaborate across great distances, both synchronously and asynchronously — while supporting unprecedented levels of observation and user tracking.2 For instance, the use of technology has enabled the creation of distributed medical education programs aiding rural and remote communities’ access to medical training. Technology is also key to competency-based medical education as systems and tools facilitate the much expanded tracking and reporting activities that this approach requires. The Box provides further examples of digital technologies and their affordances, uses and limitations.

Despite the variety of available digital technologies, instruction delivered online is not intrinsically any better or worse than traditional face-to-face didactic lectures or tutorials.3,4 This is not surprising given that educational outcomes depend on much more than the medium used, including the design of learning activities and the teaching approaches used. Even though digital technologies offer opportunities for learning in new ways, teachers often use them merely to substitute or augment existing teaching techniques, rather than modifying or redefining their teaching practices. Medical educators therefore need to be more aware of the ways in which education technologies can transform both teaching and learning.

The myth of the digital native

A common assumption is that younger people are innately competent and keen online learners. This notion has been shown to be overly simplistic5 as there is often, in any given class, wide variation in learners’ digital competence and experience. Although learners may show apparent interest in using technology (such as social media), this may not translate to competency in the use of specific learning technologies.6 There are implications that flow from this. First, learner competence and confidence in using technology should not be assumed.7 Second, given the many ways in which technology can intersect with medical education, more attention should be given to raising learners’ awareness about digital professionalism, such as attitudes towards ethics, privacy and the skills needed to responsibly maintain professional boundaries.8

It’s not about content

There is inherent attractiveness in the notion of creating freely available, online, reusable learning resources such as lecture recordings, self-paced tutorials and use of images (collectively referred to as open educational resources) to a wide audience. However, these resources often need a multidisciplinary team of content experts, educational designers and multimedia experts to create and maintain them, and they are often difficult to blend with other educational materials. Although development costs can be balanced by economies of scale with lower incremental costs per learner,9 despite worldwide investment in open educational resources and repositories, they often fall short of expectations and quickly become outdated.10 Effective online education involves far more than merely providing access to content and resources. Contemporary views about online education emphasise the importance of designing learning activities that encourage interactions between teachers, learners and content.2,7,11 This is reflected in the growing use of tools such as massive open online courses that support collaborative participation in a community of learners. Technology does not provide all of the answers; online learners still need guidance in locating and appraising appropriate content and synthesising their online learning experiences in ways that meet their learning needs.6 Clearly, there is still a central role for teachers in online education.

Staying human

Facilitating connections between individuals using digital technologies is possible but by no means inevitable; achieving these kinds of outcomes requires careful planning and management. Central to an effective online education experience is enabling online teachers to orchestrate two-way interactions between learners, teachers and the material being studied, and encouraging learners to produce rather than merely consume knowledge.11,12 Unlike face-to-face teaching environments with their dependence on physical spaces, in online environments both teachers and learners have greater autonomy over how and when they engage in educational activities. However, the speed of interaction afforded by digital technologies can also lead to inflated expectations from learners, in particular that their teachers are online and available 24/7 to respond to their queries. This loss of direct personal connection and potential perceived loss of learner trust and direction (the “lost at sea” feeling)13 can be overcome by online teachers clearly articulating their expectations and designing flexible learning pathways.14

Teaching and learning in the panopticon

Digital technology has been compared with a panopticon as it allows teachers to monitor their learners, and organisations to monitor both teachers and learners without them being aware of being observed. Students’ and teachers’ online learning behaviours create massive amounts of digital data which are stored in the digital systems we use. How these data are accessed and by whom raises important ethical questions, not least because most of us are unaware that we are being tracked in these ways. These data can be used to monitor and guide individual learning pathways using learning analytics techniques to track trainees’ progression towards competency, or the data can be used to support adaptive learning where content, activities and assessment tasks are dynamically selected to meet learners’ needs.15 However, tracking data may also be used for commercial purposes or to selectively monitor groups of learners such as those at risk of failure. Data capture and analytics should therefore be conducted in a transparent and accountable way that reinforces professional standards and ethics.

Compromise as an organising principle

There are many different technologies that can be used in health professional education and the list continues to grow.2,16,17 The effort required to appraise and implement these technologies can be high, and learning environments can quickly become chaotic and unstable if too many different technologies are used simultaneously. Consequently, most institutions focus on a small number of supported tools to maintain coherence and reduce costs. Most educators have to work with the tools that their institution supports, needing to work around their limitations rather than using tools that are optimised to their specific needs. We can therefore say, in practice, that compromise is the organising principle for using technology in education.

Of course, all medical education involves some level of compromise; technology is just one dimension to consider. Sometimes front-end compromises need to be made. For instance, technology should not be seen as exchanging one medium (single teacher giving a lecture) for another (video recording the same lecture) unless there is no practical alternative. Even then, the technological replacement should reflect the desired learning experience, not just the content. If information transmission is the goal then opportunities for checking learners’ understanding need to be embedded into the lecture recording through the use of automated key concept quizzes or other asynchronous opportunities such as online discussions to allow opportunities for learners to clarify any misconceptions.

Teachers need to take a holistic approach towards the use of digital technologies, appraising the whole learning situation and how it relates to core principles of effective teaching and learning.17 Design decisions are ultimately shaped by a consideration of the learners, the desired outcomes and the learning context, as well as the mediating role of technology in the learning activity.2,7,9,17 Readers can refer to the Box and also follow emerging trends in digital technologies by reviewing the yearly report provided by the New Media Consortium.18

Conclusion

Educators in the health professions need to look past the hype associated with the ever-expanding range of technologies available to them. Although the use of digital technologies can help in the education of tomorrow’s health professionals, their use is not central or essential to this process. Health professionals will gain maximum benefit from learning in the digital age if they focus on what they need to know and be able to do rather than chasing the latest technological wave.