Should Medical Education Be More Virtual?Leslie Fall | Associate Dean for Faculty Development at the Geisel School of Medicine, Dartmouth College
The recent announcement of the iMBA program by the University of Illinois at Urbana-Champaign, in collaboration with the online provider Coursera, highlights the rising availability of an affordable online professional education. With the cost of a private medical education now $280,000, could a virtual medical school be far behind?
Given the requirements of the medical profession, a fully online medical school is unwise. Nevertheless, medical school may provide the perfect opportunity to illustrate the power of a blended high-tech and high-touch approach.
Medical schools deliver a standardized and yet sophisticated and individualized curriculum and program of assessment. In general, they grapple with three core educational challenges: delivering a large amount of content to ensure students graduate with the biomedical knowledge required for practice; developing students’ skills in patient care, clinical reasoning, professionalism and lifelong learning; and continuously adapting the curriculum to assure that students learn today what they will need for tomorrow’s rapidly changing medical practice. This is no easy feat.
Despite their traditional reputation, medical schools often serve as early adopters of new pedagogies. Problem-based learning, team-based learning, flipped classrooms and competency-based education have found early footholds in medical education and continue to evolve rapidly within our programs. Furthermore, medical educators are well versed in the evidence behind the pedagogies we employ, and we are significant contributors to the growing scholarship in teaching and learning in higher education.
Where medical schools lag is in leveraging online pedagogies to further our common educational goals, particularly in the pre-clinical curriculum. Unlike our beloved textbooks, online learning provides flexible and adaptive content delivery methods, a self-paced and safe place to practice and fail, and data-driven assessment. Through better use of virtual learning methods, medical educators could work across institutions to create, aggregate and curate content through a consortium of recognized experts teaching from nationally derived curricular guidelines and objectives. Updating and maintaining content would become easier and more economical as well. These resources could serve, as they do in a growing number of undergraduate curricula, as the platform from which precious faculty time is re-directed towards the more personalized, student-centered and engaged teaching methods that are the hallmark of a sound medical education. Furthermore, students would be better able to access basic science content during the clinical phase of the curriculum, building and self-assessing their knowledge as they encounter real patients with real problems in the real world.
It truly takes a village to educate a medical student, with the actual cost far exceeding tuition. Unbeknownst to many, medical education operates on thin margins and is significantly underwritten by philanthropy, grants and Medicare, cost-shifting from university and clinical revenue, and many volunteer clinical faculty teaching hours. Any economy of scale that could reduce the inefficiencies, if not the cost, of a medical education would be welcome indeed.
Why is medical school late to the online learning conversation?
Despite the availability of open-source platforms, effective online content is expensive and difficult to produce, at least initially. Medical schools not affiliated with large universities that have online learning initiatives do not have the resources or infrastructure to develop effective programs of their own. When they do, I have found that most medical educators tend to design focused programs to address a specific local need and, despite relatively standard national content guidelines, success at one school is difficult to transfer to another.
Private providers face a similar uphill battle with broad adoption. Content aggregation providers offer few benefits to busy medical educators with limited time for reviewing, selecting and blending the myriad offerings into a cohesive program to meet their unique needs. Providers delivering more comprehensive courses developed on a single platform, often employing impressive features such as avatars and virtual simulations, rarely meet a broad enough need to justify their considerable cost. While some have gained a foothold at a handful of schools, national acceptance has been limited by the narrow scope of the offerings and the fact that they were developed outside the bounds of national educator organizations. Additionally, many of these programs are developed by for-profit ventures, which further limit their reception within the staunchly open culture of medical education.
In fact, what we need are more multi-institutional initiatives and non-profit ventures that provide both the education technology infrastructure and the expertise to nationally design programs that can then be modified to meet local needs. For example MedU, the nonprofit organization I co-founded in 2006, has enabled hundreds of medical educators representing ten national medical educator organizations to collaborate and deliver online learning to over 180 medical schools and 40,000 medical students annually. While MedU is often seen as a virtual patient content provider, we are, in essence, a national consortium of medical educators working together to develop both content and innovative approaches to meet local medical educational needs.[3, 4] Other ventures, such the collaboration between the Association of American Medical Colleges (AAMC) and the Khan Academy, and a new grant-funded consortium of five medical schools delivering a blended medical immunology course, show early promise as well.
These efforts not only enable broader adoption of standardized online programs, they leverage data analytics to promote individualized student learning and advance our medical education research efforts into effective online, blended and face-to-face pedagogy. Further, they provide a platform to broaden the adoption of innovations at a single institution to a national level. For example, at MedU we transitioned a successful course in radiology, developed locally by a professor and medical students at Dartmouth, into a program now in use at over 70 medical schools.
These new ventures, while ultimately saving valuable resources, are not free and cannot be sustained in the long term on philanthropy and volunteerism alone. To capitalize on the initial time and resource investments, and to maintain the quality of the programs, they must ultimately find a way to be self-sustaining.
What does the future hold?
Medical schools have the luxury of educating the best and brightest students in higher education. Medical educators often joke that our students will learn regardless of what and how we teach. Unbeknownst to most faculty, our digital native students are now privately crowdsourcing lecture notes and videos using Dropbox, GoogleDrive, Facebook, Moodle, YouTube and white board videos. In our measured approach we may soon find ourselves obsolete because our students have virtualized us already.
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 Carl Straumsheim, “All-MOOC M.B.A.” Inside Higher Ed, May 5, 2015. Accessed at https://www.insidehighered.com/news/2015/05/05/u-illinois-urbana-champaign-offer-online-mba-through-coursera
 James Youngclaus and Julie Fresne, “Physicial Education Debt and the Cost to Attend Medical School,” Association of American Medical Colleges, February 2013. Accessed at https://www.aamc.org/download/328322/data/statedebtreport.pdf
 “Medical Education Community Collaborates with Khan Academy to Help Prepare Students for New MCAT Exam,” Associate of American Medical Colleges, April 2, 2013. Accessed at https://www.aamc.org/newsroom/newsreleases/332152/040213.html
 Norm Berman, “Virtual Patients Deliver Real Learning,” Wing of Zock, June 9, 2015. Accessed at http://wingofzock.org/2015/06/09/virtual-patients-deliver-real-learning/
 Susan Dentzer, “The 21st Century Medical School and the “Flipped” Classroom,” Culture of Health, September 30, 2014. Accessed at http://www.rwjf.org/en/culture-of-health/2014/09/the_21st_centurymed.html
 “CORE: Course-Based Online Radiology Education,” MedU. Accessed at www.med-u.org/CORE