To me online learning of clinical skills almost sounds like an abomination or contradiction in terms. You learn them knee deep in blood, saliva, urine you name it but not behind a computer screen.
Recently an article was published about the experience of developing an online learning resource that supplements the learning of basic clinical skills for undergraduate medical students. Supplements, so it doesn’t replace the learning of clinical skills completely. This got me interested about their experience with this kind of online learning resource. Mind you, this is not a randomized controlled trial but just some wise advice and clear instructions on how to make a video to be put online for e-learning.
But first the wise advice, The bottom line from the Belfast Experience:
Online learning (Clinical skills) is best placed in conjunction with other traditional forms of clinical teaching, in a blended approach. Educators must be sure that online learning augments the students learning experience. It must not inadvertently promote learner isolation or a reduction of patient-centred teaching.
Especially this last warning is very important. Ah, we have a beautiful comprehensive online learning program so we can sit back and wait for skillful clinicians to be delivered.
Concerns that the uptake of such educational mediums may be influenced more by novelty than by pedagogical evidence, has driven the need for educationalists to share their experiences of e-learning
Sequence of events when producing an online clinical skills video from the discussed article:
- Preparation and planning
- Identify the clinical skill
- Establish any funding requirements (for example, simulated patients and audio-visual fees)
- Ensure that there is a clear understanding of the learning outcomes and relevance to the curriculum
- Produce a storyboard
- Hold a meeting with audio-visual specialists, clinicians and educationalists to approve the story board
- Co-ordinate a date and book a location for filming (ideally at a quiet time)
- Book the audio-visual and relevant clinical equipment
- Book a simulated patient
- Practice the skill to be filmed
- Day of filming
- Brief team on filming sequence
- Gain written consent from simulated patient(s) and participating clinician(s)
- Set up scene, including lighting and sound checks
- Perform a dry rehearsal of the skill
- Film the complete skill
- Film any further specific takes (for example, close-up shots, etc.)
- Debrief on video, and consider re-filming any sequences (difficult to undo after the film has been edited!)
- Post filming:
- Record audio narration, if required
- Edit film, with the addition of text and ? or graphics, if required
- Project team and clinical experts approve final version
- Place on website for streaming
Learning clinical skills is a two phase process in this curriculum. First students learn basic clinical skills such as history taking, clinical examination and simple procedural skills, with the use of mannequins, simulated patients and peer examination. In this first phase they have a website at their proposal. From the home page, students can select a number of options: for example, information and contact details, an updated news section, a ‘Frequently asked questions’ page and a general student support area.
However, the main focus of the website is on the pages and videos of the basic clinical skills taught. The students can review a step-by-step online guide of how to perform this skill by means of text, relevant images and videos. Built into the learning material are links and connections that help to vertically and horizontally integrate this new knowledge.
Advantages of this online learning of clinical skills:
- Students can access learning material whenever and wherever they choose
- Access to online videos are particularly useful for visually intensive clinical skills
- Allows for greater transparency of learning outcomes for both students and teachers
- Facilitates improved communication between teachers and students over a large geographical ‘clinical campus’
- Allows both students and teachers to make wider connections with other aspects of the curriculum
- Promotes greater standardisation of teaching
- Complements traditional methods of clinical skills learning in a blended fashion
- Promotes interprofessional education and sharing of reusable learning objects
They arrive better prepared to the next phase of the teaching of clinical skills: attend in small groups clinical ‘bedside’ attachments, where they have the opportunity to progress these clinical skills on
real patients. They can also rehearse their instructions online on PC or PDA.
What do you think, or do you have experience with this kind of online teaching?
Gerry Gormley, Ian Bickle, Clare Thomson, Kate Collins (2009). Online learning in clinical skills: the Belfast experience The Clinical Teacher, 6 (1), 46-50 DOI: 10.1111/j.1743-498X.2008.00253.x
