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      Case-of-the-Week: Connected, Collaborative Clinical Chemistry

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          Introduction This project provides distance-learning tutorials for working scientists who are intending to sit for professional examinations. It utilises clinical case histories to direct learning and is delivered through the Internet using a variety of free, publicly licensed software tools. Students engage in self-directed learning through discussion forums and are supported by expert discussion to provide feedback and definitive resolution of the problems. These discussions are audio recordings (“podcasts”) of Voice Over Internet Protocol (VOIP) telephone calls. The project has now been running successfully for several months with a group of students studying for clinical biochemistry qualifications in Australia. Software Moodle1 is a learning management software package for producing internet-based courses and web sites. It is available free under the GNU (Open Source) Public License. It allows the display and editing of web page content, together with the posting of files for download. The package includes features to host discussion forums and manages student enrolment, password access, the sending of email notifications and access log maintenance. Skype2 is free software providing peer-to-peer VOIP Internet telephony. Skype is the most popular of the computer-based packages with 100M registered users of the software claimed. SkypeOut is a paid feature, which allows Skype users to call non-computer-based landline or mobile telephones anywhere in the world. This service is available at very low cost, since the charge relates only to the link between the local exchange and the landline service. Audacity3 is a free digital audio editor released under the GNU General Public License that is popular with the podcasting community. It allows cut and paste editing of sound files and includes effects tools for audio file manipulations eg normalisation. Using the LAME encoder, the exporting of MP3 files at a variety of bitrates is enabled. Hardware The recording setup utilises a small analogue sound mixer (Behringer Eurorack MX802A) and an AKG C1000S cardioid condenser microphone. The computer running the Skype software (Windows XP OS) is equipped with an M-Audio Audiophile 2496 soundcard. This setup provides high quality recording capability and sound files are saved to a second computer running Audacity. A Behringer Minicom Com800 compressor is used to limit the dynamic range and prevent sound clipping. The computer running the Skype application is connected to the Internet with an ADSL broadband internet connection at 1500/256kbps connection speed. Weekly modules Each week a diagnostic case history consisting of brief clinical notes and a set of laboratory results is submitted by one of the participating pathologists. This is uploaded into a topic module in the web-based content management system. A discussion forum is made available and a thread is started. An email to all participants is automatically generated to notify students of the updated material becoming available. Students review the case history and post comments in their own time. After an appropriate period to allow discussion, the submitting pathologist is interviewed by VOIP telephony, with a recording made of the conversation. During this discussion, student comments are reviewed and the correct diagnosis, interpretation and implications are provided. The recorded file is edited, converted to MP3 format and uploaded to the site for student access. Once again a forum posting ensures that students are emailed with notification of new content availability. Project Progress The project has been established with a group of students, many of whom are based in country areas. The relative isolation of these students in regional Victoria, along with the small size of many of the laboratories in which they work, restricts their access to educational opportunities such as workshops, seminars and peer group discussion within their own laboratories. Thus there is a particular requirement for these educational resources, which allow independent learning to take place anywhere and at any time. The project has been received with enthusiasm. Generally there are several student comments forthcoming within a few days of each case being posted. The acuity of these indicates that students have given careful thought to the problems posed and may have conducted additional research before commenting. The expert’s opinion contributes valuable insights and corrects any misconceptions from the students. Feedback has been very positive and supports the validity of this approach. Discussion E-learning is defined as, “teaching and learning that are delivered, supported, and enhanced through the use of digital technologies and media”.4 The design of effective e-learning requires the incorporation of the principles of activity, scenario, feedback, delivery, context, and influence.4 There are numerous examples of distance learning for medical education using the Internet.5-7 At this stage there is conflicting evidence as to the efficacy of e-learning compared to traditional methods,8, 9 although implementations vary making comparison difficult. The use and importance of case histories in teaching clinical biochemistry is well documented.10-12 This project ensures learner engagement through the use of the real-world context of the case history. Feedback is provided through student-to-student involvement in the forums and teacher-to-student feedback in the expert discussion. The learning mode embodies active principles in its use of forums prior to the provision of the problem solution. The discussion forums encourage cooperative learning. The equipment requirements are modest consisting of readily available computer facilities and software. A variety of approaches to the hardware and software requirements of this project are possible. Thus there are several alternative VOIP software packages or the conventional telephone network could be used with traditional recording techniques. The hardware described here has been selected to provide high quality recording, but there are many lower quality, low cost alternatives. Similarly, many of these mixer functions can be achieved using alternative software solutions eg PowerGramo13. These may result in little perceptible reduction in final audio quality since the posted files are typically heavily compressed (trading-off quality against file size). The use of VIOP telephony allows contact with a large number of professionals at extremely low cost, making available resources of expertise that are otherwise difficult to access. Together with the podcasting technique this provides an extremely efficient means of capturing and distributing information. Content creation for multimedia projects can be demanding in time and resources. As a result many projects are not sustainable after initial enthusiasm. The strength of the approach described here is due to the modest time requirement for weekly module generation. The use of publicly licensed software and low cost Internet technology ensures that project expenses other than instructor time are minimal.

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          Most cited references 8

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          A new vision for distance learning and continuing medical education.

           R Harden (2004)
          Increasing demands on continuing medical education (CME) are taking place at a time of significant developments in educational thinking and new learning technologies. Such developments allow today's CME providers to better meet the CRISIS criteria for effective continuing education: convenience, relevance, individualization, self-assessment, independent learning, and a systematic approach. The International Virtual Medical School (IVIMEDS) provides a case study that illustrates how rapid growth of the Internet and e-learning can alter undergraduate education and has the potential to alter the nature of CME. Key components are a bank of reusable learning objects, a virtual practice with virtual patients, a learning-outcomes framework, and self-assessment instruments. Learning is facilitated by a curriculum map, guided-learning resources, "ask-the-expert" opportunities, and collaborative or peer-to-peer learning. The educational philosophy is "just-for-you" learning (learning customized to the content, educational strategy, and distribution needs of the individual physician) and "just-in-time" learning (learning resources available to physicians when they are required). Implications of the new learning technologies are profound. E-learning provides a bridge between the cutting edge of education and training and outdated procedures embedded in institutions and professional organizations. There are important implications, too, for globalization in medical education, for multiprofessional education, and for the continuum of education from undergraduate to postgraduate and continuing education.
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            A review of e-learning practices for undergraduate medical education.

            This paper describes the findings of a literature review conducted on the current usage, lessons, and limitations of e-learning for undergraduate medical education with an emphasis on synchronous delivery in the first 2 years. The review was conducted as part of an initiative to expand the UBC undergraduate medical program in British Columbia, Canada. The 50 e-learning articles included in the review described the deployment of various types of e-learning technology and content in different settings. The seven videoconferencing articles provided product information, health education examples, and innovative approaches. The six review articles provided general guidelines and trends on e-learning in undergraduate medical education in United States and Europe. Overall, while the literature is informative, there are few reported studies that address distributed synchronous learning in these undergraduate programs.
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              How to successfully implement E-learning for both students and teachers.

              Electronic learning (e-learning) may provide a means to enhance learning efficacy. However, introduction of e-learning often fails. We describe a strategy of how an e-learning curriculum was successfully implemented. The curriculum was designed based on published evidence. It consists of self-directed learning, an online discussion forum, and discussion rounds. The e-content in nuclear medicine and radiotherapy was produced by the k-MED team of medical authors, web designers, and psychologists. The online courses were delivered via a dedicated learning management system. The e-content for diagnostic radiology and physics was provided as PDF/HTML script by the respective teachers who objected to participate in the k-MED project. The exam was taken online. Online evaluation of the curriculum by the students was taken at the end of the course. The new curriculum proved very effective. The time for the preparation for the clinical part of the radiology course could be reduced from 4 to 2 weeks. The students particularly enjoyed the self-directed learning. Although the material provided by k-MED received 90%-99% positive scores, the HTML and PDF scripts scored worse (13%-67% positive ratings). The positive results of the evaluation convinced the teachers responsible for physics and diagnostic radiology to participate in k-MED. As our example shows, new e-learning curricula can successfully be introduced. The strategy of implementation should be based on the existing evidence from the literature. The new curriculum helped to increase the efficacy of teaching and save time as the duration of the respective part of the course could be reduced by half.

                Author and article information

                The Communications and Publications Division (CPD) of the IFCC
                01 July 2006
                July 2006
                : 17
                : 2
                : 28-31
                [* ]Laboratory Medicine, School of Medical Sciences, RMIT University . Bundoora Victoria 3083 Australia
                [# ] Birmingham Heartlands Hospital, Birmingham Heartlands and Solihull NHS Trust , Bordesley Green East, Birmingham, B95ST UK
                Copyright © 2006 International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). All rights reserved.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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