The explosion of information technology has created new opportunities and tools to assist the trainee in the process of learning. This chapter describes how the Royal College of Obstetricians and Gynaecologists (RCOG) is embracing the opportunities provided by this technology to create interactive and engaging learning programmes designed to support trainees in achieving the knowledge, skills and attitudes required to practise. It considers how the RCOG has developed a number of online initiatives to support training, the drivers for doing so and presents some ideas for future developments.
Background
The Internet boom continues and accessing information and communicating online has become a significant part of all clinicians’ working and personal lives. In the last decade the advent of information technology has influenced how trainees think about learning in terms of the way they want to learn, the way they realise they can learn and the sophistication of learning technology which potentially allows them to enjoy a high quality, stimulating experience.
The RCOG has established that learners who are becoming accustomed to e-learning have far greater expectations for interaction with a learning resource than a traditional learner and indeed, digital natives’ attention spans work very differently. Traditional learning resources such as books and journals have always been broken down into chapters, and text, images and figures have been used for learners to visualise and digest concepts more easily. However, e-learning has taken learners’ expectations to another level and a certain amount of entertainment is expected through realistic video, animation and audio used in an e-learning format.
Learners require approaches to teaching and learning that suit their individual learning styles and that are:
- •
Accessible
- •
Intuitive
- •
Memorable
- •
Enjoyable
- •
Affordable
E-learning has the potential to meet all of these criteria. It is appropriate that an organisation such as the RCOG, in striving to meet all learners’ needs, should consider how it can best use all the tools available to enhance the learning experience for all learners, which includes those in training and continuing professional development (CPD) programmes. It is vital, however, to remember that the technology is a means to an end and not an end in its own right, and that educational content remains key with technology simply being a means to facilitate its delivery.
Time for education and training
The European Time Working Regulation (EWTR) was introduced in 2009 following the European Working Time Directive and in association with Modernising Medical Careers (MMC). The introduction of the EWTR and MMC has reduced the amount of time individual trainees now spend at work, including study time. The combined effect of this means that trainees now have to achieve clinical competencies, develop skills and confidence and continually develop knowledge to achieve the requirements of the Specialty Training and Education Programme in Obstetrics and Gynaecology in a much shorter time period than before. This means that teaching and learning opportunities must be maximised within the available workplace time. In addition, UK study budgets and the professional leave allowance for trainees to travel to national meetings, for example, those organised by the RCOG, have been reduced. Trainees are therefore now seeking alternative approaches to support their learning both to maximise workplace learning and to facilitate self-directed learning at other times.
E-learning has the potential to deliver such opportunities. It is convenient, it provides access to educational materials at any time, it allows progress at the individual learner’s own pace, it accommodates many learning styles and can enhance the learning process with the use of multimedia and interaction. Online learners also have more time to reflect on their learning and have more flexibility to join ‘chat rooms’ or threaded discussions compared with learners in a classroom-based course.
Trainees quite rightly demand teaching resources of high quality. Feedback from trainees in obstetrics and gynaecology suggests that local courses vary in terms of quality and frequency. The production of high quality teaching resources is time-consuming and represents an unrealistic expectation for the majority of practising consultants. To address these issues the RCOG has invested in distance learning programmes and subject-specific resources for trainees. The RCOG believes that by implementing pre-constructed learning modules to support clinical practice, it will not only provide accessible resources for trainees, but also enable supervisors to use these resources to deliver high quality training locally and to provide consistency in content across the different training regions.
The RCOG has therefore embraced e-learning and the next section discusses the evolution in approach adopted by the RCOG over the past decade.
Time for education and training
The European Time Working Regulation (EWTR) was introduced in 2009 following the European Working Time Directive and in association with Modernising Medical Careers (MMC). The introduction of the EWTR and MMC has reduced the amount of time individual trainees now spend at work, including study time. The combined effect of this means that trainees now have to achieve clinical competencies, develop skills and confidence and continually develop knowledge to achieve the requirements of the Specialty Training and Education Programme in Obstetrics and Gynaecology in a much shorter time period than before. This means that teaching and learning opportunities must be maximised within the available workplace time. In addition, UK study budgets and the professional leave allowance for trainees to travel to national meetings, for example, those organised by the RCOG, have been reduced. Trainees are therefore now seeking alternative approaches to support their learning both to maximise workplace learning and to facilitate self-directed learning at other times.
E-learning has the potential to deliver such opportunities. It is convenient, it provides access to educational materials at any time, it allows progress at the individual learner’s own pace, it accommodates many learning styles and can enhance the learning process with the use of multimedia and interaction. Online learners also have more time to reflect on their learning and have more flexibility to join ‘chat rooms’ or threaded discussions compared with learners in a classroom-based course.
Trainees quite rightly demand teaching resources of high quality. Feedback from trainees in obstetrics and gynaecology suggests that local courses vary in terms of quality and frequency. The production of high quality teaching resources is time-consuming and represents an unrealistic expectation for the majority of practising consultants. To address these issues the RCOG has invested in distance learning programmes and subject-specific resources for trainees. The RCOG believes that by implementing pre-constructed learning modules to support clinical practice, it will not only provide accessible resources for trainees, but also enable supervisors to use these resources to deliver high quality training locally and to provide consistency in content across the different training regions.
The RCOG has therefore embraced e-learning and the next section discusses the evolution in approach adopted by the RCOG over the past decade.
The evolution of e-learning at the RCOG
Over the last decade distance learning opportunities provided by the RCOG have evolved and continue to do so. The first distance learning product to support trainees produced by the RCOG was StratOG (2000). Initially paper-based supported by a static website and now an interactive online educational package ( StratOG.net ), StratOG is a Structured Training Resource to Assist Trainees in Obstetrics and Gynaecology . In its original format the website held a library of archived journal articles, answers to assessments, a chat room and message board. To standardise the educational experience, provide familiarity and provide a common structure, tutorials all had the same format ( Table 1 ).
| StratOG tutorial content | Description and purpose |
|---|---|
| Aims and objectives | Clearly defined aims and objectives which related to the RCOG curriculum modules |
| Preliminary reading | Background reading for the learner to read before commencing the tutorial. The preliminary reading was designed to provide preparatory material to enhance understanding of the tutorial. The texts were available online |
| Pre-test | A set of true or false questions to assess the learner’s current knowledge of the tutorial subject |
| Educational text | Learning text to support learning |
| Images, graphs, figures | Visual presentations to further explain text and enhance understanding |
| Detailed references to guidelines and relevant recommended readings | Further texts for learners to access throughout the tutorial. Texts available online |
| True or false, multiple choice questions and short essay questions | Questions to test learner understanding and progress towards achieving the objectives of the tutorial at relevant parts. Answers would be available online but with no control as to when the learner accessed the answers |
| Case studies | Case-based learning for learners to understand the subject in context and apply the knowledge gained from the educational text |
| Peer-based exercises | Allied to the case studies, these exercises structured a discussion between the learner and their colleagues in real time or using the chat forum or discussion board |
| Post-test | Repetition of the pre-test for the learner to re-assess the knowledge gained and confirm achievement of the objectives |
At the same time, the RCOG also worked with a partner to develop a case-based learning CD resource called DIALOG (Distance Interactive Learning in Obstetrics and Gynaecology) produced principally for CPD purposes. The format is described in Table 2 .
| DIALOG content | Description and purpose |
|---|---|
| Aims and objectives | Clearly defined aims and objectives |
| Background | Based around clinical scenarios |
| Management | Question-based management options (RCOG guidelines referenced) |
| Justifications | Justifications for the management options. Enables the learner to be assessed on their decision making abilities |
| Images, graphs, figures | Colour images, video and audio clips to enhance understanding |
| True or false, multiple choice questions | Various question formats to test learner understanding and achievement of tutorial objectives |
Influences on the evolution of RCOG e-learning resources
Feedback
Feedback from trainees on the first edition of StratOG indicated that they found the resource useful in preparing for the MRCOG examination, they considered the level of content appropriate, they valued the electronic support resources and would recommend it to other trainees. However, it was clear that there were deficiencies in the topics covered and the structure did not have a clear relationship to the new curriculum format. Also, the split paper-based/online elements were not user friendly and had limited interactivity. It was very text heavy and the self-assessments were limited.
The curriculum launched in 2007
By 2007, a new RCOG specialty training curriculum had been developed to produce safe, competent clinicians who would meet the requirements detailed in The Future Role of the Consultant and Good Medical Practice . Its defined objectives related to:
- •
Knowledge
- •
Clinical competencies
- •
Professional skills and attitudes
The curriculum is modular and for each module the above criteria were clearly defined. This provided a potential structure around which to design the next version of StratOG to deliver appropriate elements of the curriculum.
Advances in technology, meeting individuals’ learning style requirements and consideration of optimising learning designs
Learning technology (LT) and internet connectivity in the workplace and at home had developed making it possible to improve elements identified as weaknesses in the feedback from the first edition of StratOG. In recognising the importance of not overwhelming trainees with “the razzmatazz of the latest technology” the RCOG was cautious about re-developing StratOG with too many multimedia components, but it also realised that improvements to certain functions would improve the learner experience.
In surveys carried out in 2006, trainees stated that they increasingly used the internet for both work and personal purposes. They could see how the internet could provide them with an opportunity to gain knowledge in ‘bite-sized’ portions when studying alongside commitments in the workplace and clinical practice. This would allow them to see theories in practice with access to e-learning (text, video or animation) close by. With these e-learning approaches, concepts can be more easily demonstrated than in textbooks and journals. If an individual can visualise a concept by seeing a graphic or animation then understanding and learning is potentially easier and the retention of information is potentially greater. The use of visual aids in learning has been demonstrated to be the most effective means of achieving effective learning, regardless of age and experience, in secondary and also postgraduate education or beyond postgraduate education.
For the purposes of implementing e-learning and distance learning in medicine, there is a particular need for programmes to promote critical thinking and, rather than constantly teach, to facilitate self-directed deeper learning, irrespective of different learning styles. Each learner has a different approach and response to learning and the RCOG’s learning design takes learning styles into consideration by including core knowledge, case-based discussions for the application of knowledge, self-assessments, and reflective learning exercises to review, reflect and conclude concepts from newly acquired knowledge. Honey & Mumford defined groups of learners as:
- •
Activists (Do)
- •
Reflectors (Review)
- •
Theorists (Conclude)
- •
Pragmatists (Plan)
There are several requirements underpinning the obstetrics and gynaecology curriculum, which essentially requires trainees to ‘do, review, conclude and plan’. The curriculum is diverse and some trainees will manage the theoretical components more than the practical elements; however, during a training programme, they must meet the required standards in all areas. It is essential to have the knowledge and experience to make decisions; it is essential to have the practical skills and also to have the correct professional attitude and self-awareness. It is evident that e-learning and assessment cannot directly develop or assess all these skills, but the RCOG sees e-learning as more than a tool to deliver knowledge. The RCOG has intentionally developed e-learning to support key areas of the curriculum so that learners regularly access learning content for the duration of a programme; not just to develop knowledge in a defined period leading up to an examination. Videos and case-based learning sessions, such as those in DIALOG, would ideally be accessed regularly to allow learners to continually evaluate their own practice and to keep up to date with developments to guidelines. There is a clear link between the curriculum and training support options.
Online training resources can assist with the development of practical skills, with online demonstrations of practices assisting trainees by preparing them for their first experience in clinical training: the early stages of a learning process defined as ‘knows’ and ‘knows how’ in Miller’s triangle ( Fig. 1 ).
- •
Knows
- •
Knows how
- •
Shows how (competent)
- •
Does (consistently performs competently)
Another useful classification of learning styles considered and used by the RCOG when designing e-learning is Fleming’s ‘VARK’, which emerged from neuro-linguistic programming models which explain that learning styles differ by a learner’s preferred modality of sensory intake:
- •
Visual (V) (Graphics, animations, charts)
- •
Aural/auditory (A) (Audio clips, e-lectures)
- •
Read/write (R) (Reading and reflective writing)
- •
Kinesthetic (K) (Video clips, simulation, case studies)
E-learning can provide a ‘tactile’ learning environment when designed and built using different media objects and tools as it is multi-faceted and has an ability to provide excellent provision for the majority of learning styles within any single e-learning session.
Current RCOG approaches to e-learning and future plans
STRATOG.NET
In 2005, based on the above drivers and considerations, the RCOG embarked upon a project to enhance the first edition of StratOG and to produce a fully online e-learning programme to support the new curriculum: StratOG.net . The RCOG is an international organisation and by publishing completely online, the College could better serve its Fellows, Members and trainees due to the increased accessibility of e-products. A fully online programme would also be easier to keep up to date, and the tutorials could be quickly updated to reflect changes to the curriculum and new developments and guidelines.
Successful components of the learning design of StratOG and DIALOG were to remain but, with more sophisticated learning technology features and functionality, the overall educational experience was to be improved.
The team required to develop 12 modules of StratOG.net included a team of Fellows and Members of the RCOG. An Editor-in-Chief, 12 module leaders and over 100 authors have been engaged in the authorship process and the continued success of StratOG.net is dependent on authors remaining dedicated to updating content based on changes to guidelines, changes to the curriculum and the feedback received by the StratOG.net Editorial Board by users and expert reviewers. Two internal editors with biomedical qualifications, instructional design expertise and experience of the e-learning publication process are dedicated to ensure the standard of StratOG.net is maintained in the long term and that, as technology and learning media evolves, StratOG.net e-learning content remains suitably modern.
StratOG.net aims
The principal function of StratOG.net is to facilitate trainees’ learning in preparation for the Membership of the Royal College MRCOG Part 2 examination and the content is set at this level. It can, however, be used by trainees in other countries and other professions as a learning resource and also for CPD purposes.
StratOG.net is a modular, self-directed e-learning resource. It consists of 12 modules ( Table 3 ), which mirror in terms of content the 19 RCOG curriculum modules. Each StratOG.net module includes a variable number of e-tutorials written to address the knowledge and, where possible, skills and attitudinal elements of the curriculum. Table 4 gives examples of the e-tutorial content for three of the StratOG.net modules. The e-tutorials were written by Fellows and Members of the RCOG and peer-reviewed.
