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Journal of Audiovisual Media in Medicine 1994; 17: 77-80
Medical education - using interactive learning GWEN CHESSELL
’. . . the undergraduate curriculum should seek to promote a more self-educative approach‘. That statement by the General Medical Council in July 1990 coincided with the restructuring of the medical curriculum at the University of Aberdeen, Scotland. One of the main proposals was the introduction of self-directed learning to reduce didactic teaching in the clinical years of the course. This has led to the development of interactive learning, using learning resources appropriate to the subject being delivered, and particularly to the introduction of computer- assisted learning. This represents a major change in the way medical students are taught, which has implications for all involved in medical education. For staff, it means taking a fresh look at the way they plan and present their teaching. For students, developing the ability to take responsibility for their own learning throughout their working lives can be a challenge but is of paramount importance for effective continuing medical education.
This discussion forms part of a trilogy of presentations describing interactive learning within the medical curriculum. The applied use of interactive learning in relation to computer-assisted learning (CAL) and the human and material resource approaches will be dealt with subsequently, but I will set the scene by concentrating on these elements: the concept of interactive learning; the rationale for its use; and the implications arising from its developments.
The experience of Aberdeen Uni- versity Medical School in developing facilities to support student learning has been a key factor in current develop- ments. The movement away from didac- tic teaching towards student-driven inter- active learning is, in Aberdeen, a natural development from a simple but influen- tial initiative and can be used to illustrate this evolution in teaching and learning.
Gwen Chessell, M Ed, DipEdTech, is the Coordinator, Medical Learning Resources, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB9 2 2 0 , UK. 0 1994 Butterworth-Heinemann Ltd 01 40-51 1)(/94/020077-04
First, however, it is useful to examine the nature of interactive learning - what it is and whether it is, in fact, very much different from how students have learnt in the past.
The concept of interactive learning
What is meant by interactive learning? The word interactive means something that occurs between one thing and some- thing else. The words ‘teaching’ and ‘learning’ are interactive and represent the two sides of the ‘knowledge busi- ness’. Interactive learning in the partic- ular context of present developments, however, is the interaction between the student and what is required to be learnt - without the middleman - the teacher - being as actively involved as in more conventional forms of teaching such as lectures and teacher-led tutorials. In other words, the opposite to this model is didactic teaching with maximum teacher involvement and passive absorption on the part of the student.
In the more traditional and conven- tional modes of imparting knowledge, teachers retain control of the pace and
method of learning, and students often have much less opportunity to engage freely with what they are learning or use their own individual ways of learning. Interactive learning implies that the role of teachers - the providers - changes; it implies also that the role of students changes in that they have to develop new skills in acquiring knowledge or they have to learn how to share the interaction of the knowledge business more equally with the providers.
The importance of interactive learning
Why is interactive learning important? It is known that medical students are often unable to find time to learn and to think for themselves, and are forced into rote learning in order to pass examinations. They adopt surface approaches to learn- ing which, while enabling them to get through the course, neither engage them in deep cerebral activity nor help them to prepare themselves for a profession which demands a lifetime of continuing education. Scientific and medical knowl- edge increases and changes rapidly and there is an important need for doctors to
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be able to take responsibility for their Implications for staff and Table 1 Implications of own learning. students developing interactive learning
What makes interactive learning so valuable is that it gives students the opportunity to engage actively in their own learning by responding to stimuli in the learning content.
There is a saying which underlines the rationale for interactive learning: I hear, and I forget; I see, and I remember; I do and I understand. It is this last aphorism that lays the stress on interactive learning.
To be successful, self-directed learn- ing relies heavily on student activity within the learning experience. It is important to remember that a lecture, for example, cannot be turned into a self- learning format without being restruc- tured to include interactivity. If this is not done, self-directed learning can be as didactic as a teacher standing in front of
. Even the way interactive learning is written is important. The words used are more direct and personal allowing the student to feel an active partner in a dialogue. The inclusion of ‘tasks’ within a self-learning exercise means that lear- ners interact with the material rather than simply memorizing what is given to them. The material is structured specifi- cally with definite purposes in mind for the students to achieve. Therefore, inter- active learning requires to be planned systematically, taking note of the stu- dents* present levels of knowledge. Objectives have to be written in terms of what the students must achieve and the content and activities must allow stu- dents to achieve the objectives. In addi- tion there have to be appropriate assess- ment measures, and evaluation strategies to gain information on every aspect of the development.
The essence of interactive learning is getting the students involved in activities involving the learning content. Such learning activities include assignments, exercises, tasks, group or peer activities which are contained with the learning exercise or experience. While the struc- ture of the learning exercise may still be controlled by the teacher, the details of how much and at what rate or pace or how widely the material is learnt can be controlled by the student. Interactive learning, in whatever medium, is usually
Table 1 summarizes the implications of developing interactive learning. The obvious pedagogic implications have already been mentioned but there are also important ‘human’ implications which should be considered. The resour- ces required to implement interactive learning cannot be underestimated and require time as well as financial, physical and staff resources. The type of inter- active learning being developed in Aberdeen would be impossible without staff with special skills and attributes. Interactive learning requires a different planning approach as it is likely to involve a multidisciplinary team with several areas of expertise; it also has to fit with existing conventional elements in the curriculum and requires manage- ment at each stage of development.
Support for both students and staff is important. First, students require more information and even more support than they would expect in face-to-face teach- ing. Any questions students may ask have to be anticipated and dealt with; they must be provided with guidance on how to approach and use the learning material; and given advice on where to get help. Second, and equally as impor- tant, staff need help and support to develop their teaching material in an interactive format. Both need user sup- port when interactive learning involves CAL. These implications are important and should not be underestimated.
Interactive learning at Aberdeen
Undergraduate students on the medical degree course at Aberdeen are now increasingly involved in CAL-based interactive learning as they use the first packages that have been developed as the result of a number of initiatives. These initiatives, while being separate in themselves, are in the reality of curricu- lum development closely linked and have evolved partly because the time was ripe and partly because there existed in Aberdeen a springboard that has been an important basis for these developments.
Resources Money Time Space Staff - including
administration/secretarial
Support For students For staff
Planning Multifaceted approach Integration with existing
curriculum Management
Educational structure Rationale for use Objectives Activities Tasks Assessment Evaluation
tions of the Royal College of Physicians. This innovation was reported in 1976’. The interactivity of this development was simple but pivotal to its structure - self-assessment exercises linked with 35-mm slides designed to test short- comings in existing knowledge. Its suc- cess laid the foundation for the develop- ment of other resources and facilities to aid medical education in Aberdeen.
These resources and facilities had little direct impact, however, on chang- ing or influencing teaching delivery or student learning. Their use was optional and not endorsed by departments; they did not form part of official cumculum content and they never featured in exam- inations. It quickly became clear that unless students were particularly well motivated or interested intrinsically in a subject, they would not be drawn towards optional learning which did not offer them any rewards and which car- ried no weight in itself, in other words, did not feature in examinations. Never- theless, the initiatives were noticed and
supported by text but it is important that the content and interaction is carried by
were to become influential in the Medi- Postgraduate self-study material cal Faculty,
the medium from which the students wiil The first move towards interactive learn- learn. In other words, the key learning ing in Aberdeen started almost 20 years element of a CAL-based interactive ago, with self-study material developed exercise should not be duplicated by any specifically for medical postgraduates \upporting medium. studying for the Membership examina-
Curricuium restructuring
In 1990, a Curriculum Working Group was set up in the Medical Faculty to
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'Tec hnology-based' learn ing in medicine : b e y o n d courseware
Integrat ion o f technology-based course (i.e. computers) w i th in :he medical cur r i cu lum to help students learn and teachers teach
T e n t a t i v e p l a n s f o r each c e n t r e a r e :
Dundee - S t u d e n t Gu ides A b e r d e e n - S t a f f Deve lopment Glasgow - Academic a u d i t E d i n b u r g h - ' U n s u p p o r t e d ' l e a r n i n g L i v e r p o o l - Management o f s t u d e n t l e a r n i n g Be l fas t - Logbook of s t u d e n t a c t i v i t i e s
Figure 1 Technology-based learning in medicine: beyond courseware
scrutinize the medical curriculum and decide on any changes that might be needed. Several areas of the medical course received detailed attention and one of these was the didactic nature of the medical course. This pre-dated the recommendations of the General Medi- cal Council and particularly the state- ment made in July 1990 that 'there is a strong view that the undergraduate course should seek to promote a more educative approach'. Proposals and rec- ommendations were formulated for restructuring the curriculum and started to be implemented in stages during session 1991-1992. One of the main aims of this restructuring was a reduction in the number of didactic lectures in the course by the introduction of student self-learning.
The recommendations of the 1990 Curriculum Working Group specially highlighted the use of computers and interactive videodisc to capitalize on student learning involvement. It was recognized that a key step forward would be the recruitment of a CAL research fellow to push through developments in this area. This has been accomplished
successfully through a grant from the university and, as a consequence, the movement towards computer-based interactive learning has been exception- ally speedy.
TL TP project
A further development is Aberdeen's involvement in a Teaching and Learning Technology Programme (TLTP) con- sortium of six medical schools (Figure I ) . The mission of the consortium is to create the infrastructure that will enable students to use computers whenever relevant and appropriate during the med- ical curriculum. This will allow com- puter-based learning to be fully inte- grated within medical curricula, using technology to raise standards of teaching and learning. Each member of the con- sortium has a development officer who follows a particular remit. The develop- ment officer in Aberdeen has a particular responsibility for staff development - one of the important implications already mentioned as arising from the introduc- tion of interactive learning, and also for producing study guides in specific areas such as paediatrics and pathology.
Enterprise in higher education initiative
The Faculty of Clinical Medicine is also involved in the university's Enterprise Initiative. This initiative is about devel- oping capabilities in students and the one relevant to this discussion concerns information-seeking skills and knowl- edge of new technologies.
'Core plus options'
The last initiative is the one which perhaps presents the greatest challenge
Subcommittee on I Subcommittee on
Curriculum development steering group
Subcommittee on curriculum development
I I
Figure 2 New curriculum committee structure
The Journal of Audiovisual Media in Medicine (1994) Vol. I7/1vo. 2 79
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and the biggest change in the medical curriculum in Aberdeen. It is one that again comes from the recommendations of the General Medical Council. This is the move towards a curriculum based on a core of essential knowledge which will represent about 70% of the cumculum, plus options or choices which are now called special study modules that will make up the remaining 30%. ‘Core’ courses in the urinary tract and repro- ductive systems will be implemented during 1993-1994. This initiative gives enormws scope for the development of interactive projects.
Finally, the management of these ini- tiatives has necessitated a change in the educational committee structure of the faculty. Figure 2 summarizes how the initiatives are being organized.
The Subcommittee on Curriculum Development comprises individuals who work out and implement what should happen. Within that committee is a small group of six individuals who make up the ‘core plus options’ group. The curric- ulum development steering group is composed of senior members of staff (e.g. the Dean and heads of departments) who give sanction and authority to the proposals of the subcommittee on cumc- ulum development. All committees report to the Cumculum Committee of the Board of Studies in Medicine. The Subcommittee on Teaching Technology deals specifically with CAL innovations within the wider plans for curriculum development and consists of a number of individuals, academics, medical illus- trators, computer experts, staff develop-
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GALLERY
ment officers and educationists, all of whom contribute and work together to achieve results. This melange of expert- ise and experience is one of the strengths of the Faculty of Clinical Medicine at Aberdeen .
At the end of the day, however, no matter how complex, demanding, chal- lenging, stimulating and, indeed, seduc- tive, the lure of new educational technol- ogy is, it relies for its success on an awareness of human needs and qualities.
Reference
1. Morton RA, Hedley AJ. The clinical slide library: a valuable learning resource in continuing medical educa- tion. Med Biol lllust 1976; 26: 203-7.
Philip Wilson FMAA AIM1 Freelance Medical Artist, London, UK
Arthrodesis of the shoulder I Line and stipple technique
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