E-learning in medical education in resource constrained low- and middle-income countries

Human Resources for Health

James Scott²  Abdel Karim Koumare³  Kristine Korhumel²  Selam Bedada²  Hannah Wohltjen²  Heather Ross²  Nadia Mikhail²  Zohray Talib²  Yianna Vovides¹  Seble Frehywot² 

[1] Georgetown University, 3700 O St NW, Washington, DC, 20057, USA;The George Washington University, 2121 K St NW, Washington, DC, 20037, USA;Université de Bamako - Colline de Badalabougou, BP E2528, Bamako, Mali, West Africa

关键词: Resource constrained;    Medical education;    Low- and middle-income countries;    E-learning;   

Others  :  822607
DOI  :  10.1186/1478-4491-11-4

 received in 2012-12-06, accepted in 2013-01-23,  发布年份 2013

【 摘 要 】

Background

In the face of severe faculty shortages in resource-constrained countries, medical schools look to e-learning for improved access to medical education. This paper summarizes the literature on e-learning in low- and middle-income countries (LMIC), and presents the spectrum of tools and strategies used.

Methods

Researchers reviewed literature using terms related to e-learning and pre-service education of health professionals in LMIC. Search terms were connected using the Boolean Operators “AND” and “OR” to capture all relevant article suggestions. Using standard decision criteria, reviewers narrowed the article suggestions to a final 124 relevant articles.

Results

Of the relevant articles found, most referred to e-learning in Brazil (14 articles), India (14), Egypt (10) and South Africa (10). While e-learning has been used by a variety of health workers in LMICs, the majority (58%) reported on physician training, while 24% focused on nursing, pharmacy and dentistry training. Although reasons for investing in e-learning varied, expanded access to education was at the core of e-learning implementation which included providing supplementary tools to support faculty in their teaching, expanding the pool of faculty by connecting to partner and/or community teaching sites, and sharing of digital resources for use by students. E-learning in medical education takes many forms. Blended learning approaches were the most common methodology presented (49 articles) of which computer-assisted learning (CAL) comprised the majority (45 articles). Other approaches included simulations and the use of multimedia software (20 articles), web-based learning (14 articles), and eTutor/eMentor programs (3 articles). Of the 69 articles that evaluated the effectiveness of e-learning tools, 35 studies compared outcomes between e-learning and other approaches, while 34 studies qualitatively analyzed student and faculty attitudes toward e-learning modalities.

Conclusions

E-learning in medical education is a means to an end, rather than the end in itself. Utilizing e-learning can result in greater educational opportunities for students while simultaneously enhancing faculty effectiveness and efficiency. However, this potential of e-learning assumes a certain level of institutional readiness in human and infrastructural resources that is not always present in LMICs. Institutional readiness for e-learning adoption ensures the alignment of new tools to the educational and economic context.

【 授权许可】

   
2013 Frehywot et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]World Health Organization HIV/AIDS Programme: Task Shifting to Tackle Health Worker Shortages. 2007.
• [2]Kinfu H, Dal Poz MR, Mercer H, Evans DB: The health worker shortage in Africa: are enough physicians and nurses being trained? B World Health Organ 2009, 87:225-230.
• [3]Mars M: Building the capacity to build capacity in e-health in sub-Saharan Africa: The KwaZulu-Natal experience. Telemed J E Health 2012, 18(1):32-37.
• [4]Agrawal S, Kumar MA, ShrivastavaK KS, PantM MS: Training the trainees in radiation oncology with telemedicine as a tool in a developing country: A two-year audit. Int J Telemed Appl 2011, 2011:230670.
• [5]Oz H: Synchronous distance interactive classroom conferencing. Teach Learn Med 2005, 17(3):269-273.
• [6]Dev P, Hoffer EP, Barnett GO: Computers in medical education. In Biomedical Informatics. Edited by Shortliffe E, Cimino JJ. Springer Science and Business Media, LLC, New York; 2006:737-762.
• [7]Rajapakse S, Fernando D, Rubasinghe N, Gurusinghe S: e-Learning in medical education: guide supplement 32.6 - practical application. Medical Teacher 2009, 31(5):452-453.
• [8]McLean M: Introducing computer-aided instruction into a traditional histology course: student evaluation of the educational value. J Audiov Media Med 2000, 23(4):153-160.
• [9]Kaliyadan FF, Manoj JJ, Dharmaratnam AD, Sreekanth GG: Self-learning digital modules in Dermatology: a pilot study. J Eur Acad Dermatol Venereol 2010, 24(6):655-660.
• [10]Adanu R, Adu-Sarkodie Y, Opare-Sem O, Nkyekyer K, Donkor P, Lawson A, Engleberg N: Electronic learning and open educational resources in the health sciences in Ghana. Ghana Medical J 2010, 44(4):159-162.
• [11]Seluakumaran K, Fedelis JF, Ismail R, Husain R: Integrating an open-source course management system (Moodle) into the teaching of a first-year medical physiology course: a case study. Adv Physiol Educ 2011, 35:369-377.
• [12]Kalita J, Misra UK, Kumar G: Computer-based literature search in medical institutions in India. Ann Indian Acad Neurol 2007, 10(1):44-48.
• [13]Taie E, Mohamed KA: The role of digital libraries in Egyptian higher education. DOMES 2009, 18(2):40-56.
• [14]Clark AW, Li H: Teaching medical information retrieval and application courses in Chinese universities: a case study. Health Info Libr J 2010, 27(4):316-322.
• [15]Blankstein U, Dakurah T, Bagan M, Hodaie M: Structured online neurosurgical education as a novel method of education delivery in the developing world. World Neurosurg 2011, 76(3–4):224-230.
• [16]Vyas RR, Albright SS, Walker DD, Zachariah AA, Lee MY: Clinical training at remote sites using mobile technology: an India-USA partnership. Distance Edu 2010, 31(2):211-226.
• [17]Khoja S, Scott RE: Creating e-learning resources in preventive medicine for developing countries. J Telemed Telecare 2007, 13(2):105-106.
• [18]Missen C: Internet in a box: the eGranary digital library serves scholars lacking internet bandwidth. New Rev Info Networking 2005, 11(2):193-199.
• [19]Chang AY, Ghose S, Littman-Quinn R, Anolik RB, Kyer A, Mazhani L, Seymour AK, Kovarik CL: Use of mobile learning by resident physicians in Botswana. Telemed J E Health 2012, 18(1):11-13.
• [20]Johnson P, Ghebreyohanes G, Cunningham V, Kutenplon D, Bouey O: Distance education to prepare nursing faculty in Eritrea: diffusion of an innovative model of midwifery education. J Midwifery Women's Health 2007, 52(5):e37-41.
• [21]Silva-Lopes VW, Monteiro-Leal LH: Creating a histology-embryology free digital image database using high-end microscopy and computer techniques for on-line biomedical education. Anat Rec B New Anat 2003, 273(1):126-131.
• [22]Vichitvejpaisal P, Sitthikongsak S, Preechakoon B, Kraiprasit K, Parakkamodom S, Manon C, Petcharatana S: Does computer-assisted instruction really help to improve the learning process? Medical Education 2001, 35(10):983-989.
• [23]Nartker AJ, Stevens L, Shumays A, Kalowela M, Kisimbo D, Potter K: Increasing health worker capacity through distance learning: a comprehensive review of programmes in Tanzania. Hum Resour Health 2010, 8:30. BioMed Central Full Text
• [24]Kheng S: The challenges of upgrading from ISPO Category II level to Bachelor Degree level by distance education. Prosthet Orthot Int 2008, 32(3):299-312.
• [25]Syed-Mohamad SM, Pardi KW, Zainal NA, Ismail Z: Expanding nursing education through e-learning: A case study in Malaysia. Stud Health Technol Inform 2006, 122:186-189.
• [26]McLean M, Murrell K: WebCT: integrating computer-mediated communication and resource delivery into a new problem-based curriculum. J Audiov Media Med 2002, 25(1):8-15.
• [27]London International Development Center: Distance Learning for Health: What Works. London; 2011.
• [28]Erah PO, Dairo EA: Pharmacy students perception of the application of learning management system in patient-oriented pharmacy education: University of Benin experience. Inter J Health Res 2008, 1(2):63-72.
• [29]de Maio M, Ferreira MC: Experience with the first internet-based course at the Faculty of Medicine, University of São Paulo. Revista do Hospital das Clinicás 2001, 56(3):69.
• [30]Corrêa L, de Campos AC, Souza SC, Novelli MD: Teaching oral surgery to undergraduate students: a pilot study using a web-based practical course. Eur J Dental Education 2003, 7(3):111.
• [31]Obura T, Brant WE, Miller F, Parboosingh IJ: Participating in a community of learners enhances resident perceptions of learning in an e-mentoring program: Proof of concept. BMC Medical Education 2011, 11:3. BioMed Central Full Text
• [32]Vincent DS, Berg BW, Hudson DA, Chitpatima ST: International medical education between Hawaii and Thailand over Internet2. J Telemed Telecare 2003, 9(Suppl 2):S71-72.
• [33]Winthrop R, Smith MS: The New Face of Education: Bringing Technology into the Classroom in the Developed World. Brooke Shearer Working Paper Series: Brookings Institute; Smith MS: The New Face of Education: Bringing Technology into the Classroom in the Developed World: Brooke Shearer Working Paper Series: Brookings Institute.
• [34]Akkoyunlu B, Soylu M: A Study of student's perceptions in a blended learning environment based on different learning styles. J Educ Technol Soc 2008, 11(1):183-193.
• [35]Silva CS, Barreto Souza M, Silveira Silva Filho R, Medeiros L, Ricardo Criado P: E-learning program for medical students in dermatology. Clinics 2011, 66(4):619.
• [36]El Tantawi MMA, Saleh SM: Attitudes of dental students towards using computers in education–a mixed design study. East Mediterr Health J 2008, 14(3):675-685.
• [37]McLean M: Web pages: an effective method of providing CAI resource material in histology. Medical Teacher 2001, 23(3):263-269.
• [38]Barbosa SFF, Marin HF: Web-based simulation: a tool for teaching critical care nursing. Rev. Latino-Amer Enfermagem 2009, 17(1):7.
• [39]Seabra D, Srougi M, Baptista R, Nesrallah L, Ortiz V, Sigulem D: Computer aided learning versus standard lecture for undergraduate education in urology. J Urol 2004, 171(3):1220-1222.
• [40]Muñoz DC: Effective e-learning for health professional and medical students: the experience with SIAS-Intelligent Tutoring system. Stud Health Technol Inform 2010, 156:89-102.
• [41]Suebnukarn S: Intelligent tutoring system for clinical reasoning skill acquisition in dental students. J Dent Educ 2009, 73(10):1178-1186.
• [42]Rhienmora P, Haddawy P, Suebnukarn S, Dailey MN: Intelligent dental training simulator with objective skill assessment and feedback. Artif Intel Med 2011, 52(2):115-121.
• [43]Gallagher-Lepak S, Block D, Rojas YE, Birkholz L, Melgar Morán CC: Using distance technology to learn across borders: a virtual travel course in nursing. J Nurs Educ 2011, 50(8):483-486.
• [44]Botezatu M, Hult H, Tessma M, Fors U: Virtual patient simulation: Knowledge gain or knowledge loss? Medical Teacher 2010, 32(7):562-568.
• [45]Treadwell I, de Witt TW, Grobler S: The impact of a new educational strategy on acquiring neonatology skills. Med Educ 2002, 36(5):441-448.
• [46]Fors UH, Muntean V, Botezatu M, Zary N: Cross-cultural use and development of virtual patients. Medical Teacher 2009, 31(8):732-738.
• [47]Mullan F, Frehywot S, Omaswa F, Buch E, Chen C, Greysen SR, Wassermann T, Abubakr DE, Awases M, Boelen C, Diomande MJ, Dovlo D, Ferro J, Haileamlak A, Iputo J, Jacobs M, Koumaré AK, Mipando M, Monekosso GL, Olapade-Olaopa EO, Rugarabamu P, Sewankambo NK, Ross H, Ayas H, Chale SB, Cyprien S, Cohen J, Haile-Mariam T, Hamburger E, Jolley L, et al.: Medical schools in sub-Saharan Africa. Lancet 2011, 377(9771):1113-1121.