Technology in medical education remains a trending topic, as was recently evidenced at the AMA’s spring meeting. Professors and administrators from the 32 schools in the AMA’s consortium praised the virtues of new tools to enhance online learning while also discussing the glitches that still needed to be ironed out to make such learning go more smoothly.

Irsk Anderson, MD, assistant professor of medicine at the University of Chicago Pritzker School of Medicine, talked of his and his students’ experiences with a pilot program using Yammer, an enterprise-based social media platform. Between the summers of 2014 and 2016, the students were required to make four posts in the style of morning reports and to join four additional conversations each month to discuss other students’ posts.

One part of Yammer’s appeal, said Dr. Anderson, is its Facebook-like user interface, which makes it easy for both students and faculty to navigate. Participants could make posts, comment and reply, attach links and files, and organize conversations by various tags.

But Yammer’s main draw was its security options, said Dr. Anderson. Since students would be sharing patient information, privacy was a top concern. “Even though any kind of documentation used was always deidentified, we wanted to have another level of security within the private user groups,” said Dr. Anderson.

Yammer requires multiple levels of invitations to allow access to discussions, ensuring patient privacy and minimizing the likelihood that patients would be identified through their symptoms.  

Dr. Anderson and other participating staff considered the program a success. Feedback evaluations showed that 83 percent of students felt that it enhanced their learning experience and allowed them to communicate valuable information to their peers, while  77 percent said it improved faculty interactions and about half felt that it improved their critical thinking skills.

Nevertheless, challenges do remain, said Dr. Anderson. For starters, a certain level of oversight is necessary to ensure that students discussing complicated cases are conveying accurate medical information. While the two-year study involved only fourth-year medical students on their internal medicine subinternship, his group is interested in moving Yammer into all of the third-year clerkship rotations. This would require involvement from the various specialty clerkship faculty who can make sure the students stay on track.

“We’re trying to see where there’s a need and how we can tailor it to each of the different specialty curricula,” he said.

Dr. Anderson also wants to ensure Yammer adds value. “We’re looking at how this is going to help students—is it adding to or taking the place of existing curriculum?”

Though some students said Yammer participation was difficult due to existing obligations, and others declined to contribute at all, Dr. Anderson remains optimistic. “Whether we decide to use Yammer or another platform, this is a new space where we can continue the conversation and learning. It’s hard enough to get everyone together for a one-hour case discussion,” he said. “This way, we’re able to extend the learning in a student-led fashion.”

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Lisa Watts, DO, assistant dean of clinical services at A.T. Still University School of Osteopathic Medicine in Arizona, in Mesa, focused on overcoming obstacles inherent to online learning. Because A.T. Still University’s program has clinical locations across the country, “we use distance learning technology quite a lot,” said Dr. Watts. “We’re using video conferencing technology [in our residency programs] for their joint didactic sessions to connect [residents] for morning reports and journal clubs.”

Video conferences seemed like an obvious way to get the most out of their program, she said. “I thought we’d have the best didactic program in the country because we were going to be able to pull the best experts from each of these locations and use them in our program,” said Dr. Watts.

Unfortunately, this was not the case at first. “As I looked at our evaluations, they were terrible,” she said. “Our speakers didn’t want to come back for a second round.”

Speakers had difficulty gauging and matching the interest level of their audience. Typical technological malfunctions compounded this problem. To try and save some of the sessions, Dr. Watts said, “I started throwing out questions verbally, and I was met with dead silence.”

She found out the disconnect between the speakers and their audiences was only part of the issue. On the residents’ end, many participants would mute or shut off their webcams.

Still, Dr. Watts recognized the potential of online technology and pushed ahead to improve the shortcomings, soon realizing there were more complications involved in the video conferences than anticipated.

“Students said there was an audio time delay, and it was causing people to start to speak over one another and they got used to keeping quiet to avoid the awkwardness,” said Dr. Watts.

To address some of the issues, Dr. Watts and her team set a few ground rules: Residents were required to view the sessions in groups, with at least one person always operating the computer and serving as a spokesperson for the group.

Providing assistance to presenters helped to ensure the presentations went smoothly from start to finish. “For our presenters, some of whom never presented over video conferences, we went through dry-runs of the sessions and we provided moderators for the sessions and … on-the-fly IT support and assist with slides,” said Dr. Watts.

Dr. Watts and her team also took steps to keep the audience engaged with interactive elements. “We asked [presenters] to embed active learning technology within their presentations instead of just giving a lecture.” Element such as “audience response systems [and] Jeopardy-style games” were included.

After implementing these steps, the evaluations improved significantly and many more speakers expressed interest in giving additional presentations. Dr. Watts also began having residents give their own presentations. “Not only did they help to problem-solve some of the issues we encountered,” said Dr. Watts, “but they became much more sympathetic with the speakers and more active audience members.”

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