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Five Questions ... for David A. Cook

By Lisa Gualtieri / July 2009

TYPE: INTERVIEW
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Lisa Gualtieri: How did you become interested in e-learning?

David Cook: While doing my residency training after medical school, I developed a Web-based learning site for our internal medicine residency program. This evolved into a series of e-learning programs which we continue to update each year and form a core part of our internal medicine residency training program formal curriculum. We have also used these modules as a "laboratory" to study several interesting research questions in e-learning.

LG: I saw you recently gave a talk on "The Efficacy of E-learning in the Health Professions." What was the focus of this presentation?

DC:The talk focused on the results of three systematic reviews my colleagues and I have recently completed on Internet-based instruction, virtual patients, and computer animations, all in the field of health professions education.

In these reviews we found that educators have published a lot of comparisons of e-learning against no intervention (such as single-group pre-post studies or comparisons with no-intervention arms) or against non-computer interventions (such as "traditional" lecture, small group sessions, or textbook). Unfortunately, studies of this sort have two serious problems.

First, the results are fairly predictable. No-intervention-comparison studies invariably show a difference, usually quite large, while non-computer comparisons predictably show on average no significant difference.

Second, the concepts behind these studies are flawed. We shouldn't be surprised that no-intervention-controlled studies show a difference. This just shows that if we teach people something they will learn. No big shock! On the other hand, we shouldn't be surprised that e-learning and "traditional" methods are similar. After all, it's the instructional methods—not the medium—that makes a difference in instruction.

Computers can definitely enable or facilitate instructional methods that might be otherwise difficult to implement in traditional ways, but when learning improves (or becomes more efficient) we should chalk it up to the superior instructional methods, not the computer itself. Thus, research studies showing that e-learning is better than or worse than traditional are only true for that particular pair of courses; they don't apply to anyone else's course! The bottom line message is that computers are powerful tools, but most of the research to-date is either irrelevant or cannot be generalized to new settings.

However, we also noted some wide variation in the effect of specific e-learning interventions. This suggests that some e-learning applications are more effective than others. Again, that's not a big surprise. What's surprising is how little research has been done to look at how to make e-learning more effective (that is, comparisons of two or more e-learning interventions), at least in health professions education.

The bottom line of this presentation is that we don't need any more no-intervention-controlled studies, and we don't need any more media-comparative studies. We need more research of this type, the stuff that Richard Mayer and his collaborators and protégés have published over the past 25 years, to advance the science.

LG: Is there a video of the presentation available?

DC: Yes, the video is available on MedBiquitous.

LG: How is e-learning in the health professions different than in other fields? Are there particular challenges?

DC: With very rare exceptions, such as learning disabilities, people appear to learn the same way. In that sense, the same fundamental principles of learning and e-learning that have been validated in other educational settings should hold true in health professions education as well.

However, there are some challenges. First, health professionals must learn and stay on top of a huge amount of constantly-changing information. Second, the specific things to be learned—how to interview a patient, how to perform procedures on living and usually sick human beings, how to obtain and interpret information needed to make the right diagnosis—are somewhat unique to medicine, although there is overlap with other fields. Third, health professionals are experienced learners. By the time the residents in our program begin using our e-learning software, they have been going to school for more than 20 years, which can be both good and bad. Finally, health professionals tend to be extremely busy and often sleep deprived, so motivating them to learn can be a problem.

LG: What have been your best experiences with innovative technologies for teaching and for social networking?

DC: I took several online courses for my Master's degree in Health Professions Education, and that was a wonderful opportunity. The technology was relatively rudimentary (a basic threaded discussion board) but that was all we needed to have a marvelous learning experience.

I tend to be a bit of a "back to basics" person. While I try to stay abreast of new technologies, I also try to avoid fads—especially fads with a high price tag!—until it's clear that there's an advantage to the new way of doing things. In my experience, it doesn't take a lot of bells and whistles to facilitate highly effective learning.

I've used social networking for personal use and to collaborate with colleagues at other institutions on research projects, but have used it only sparingly in my teaching activities.

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