Monday, February 17, 2003

Education

just-in-time learning just in time

By Rosalie R. Phillips

Doing more in less time - a hallmark of our age - has caught up with medical education. And online learning systems are providing a solution that is gaining strength across the country.

Resident training programs, where physicians go after completing medical school, got a jolt in September 1999 when the Accreditation Council for Graduate Medical Education (ACGME) changed the rules.

In addition to learning about their area of specialty, residents must now develop competence in six broad areas, including those of practice-based learning and improvement and systems-based practice. That means that in addition to becoming good diagnosticians, residents must demonstrate competencies aimed at improving their patient care practices and advocating knowledgeably to optimize care within a complex delivery system.

To continue to receive accreditation, residency training programs must show that residents have acquired these mandated competencies. That means that faculty must teach more - and residents must learn more - in the same amount of time. And program directors must show they are meeting the new teaching mandates.

"Our faculty, all of whom are busy, practicing doctors, are being asked to teach new, often unfamiliar material. Resident physicians, who commonly have long weeks, now have to master new areas in addition to learning their clinical specialties," explained Francis X. Campion, vice president for clinical integration at Boston's Caritas Christi Health Care System. "Online learning is making a very positive difference to our faculty and students, and it's coming just at the right time."

Residents are using this "just-in-time learning" to access online modules, related applied learning exercises, and self-assessments at their convenience, often juggling the new educational mandates around their 80-hour-a-week schedules.

Online learning has been around for several years. What's new is the adoption of this technology by a teaching community that traditionally has followed an apprenticeship model of "See one, do one, teach one."

Successful adoption of supplemental online learning in medical education circles takes the field's teaching tradition into account by linking highly focused, content-rich learning modules to exercises that require young physicians to actively apply new knowledge in their area of specialization within clinical settings.

"Online learning is valuable because it provides high-quality supplemental teaching resources that are helping prepare our residents to succeed in an often turbulent health system," said Karen Bradley, associate director of managed care, continuing medical education and faculty development at the University of Florida College of Medicine in Gainesville.

In 2002, approximately 8,000 residency programs at 1,655 sites trained more than 100,000 resident physicians in the United States. In addition, more than 100,000 faculty members are employed by or are affiliated with these training programs.

This represents a lot of opportunity. But to be embraced by the medical world, online teaching programs, according to Campion and his colleagues across the country, must meet three stringent requirements:

• The content must be authoritative, accurate and easily accessible

• Students must be able to apply that content in clinical settings to comprehend and make use of the new knowledge

• Online learning programs must provide assessment measures that enable faculty to determine whether competency is being achieved, as well as to build their case for continued accreditation.

Tufts Health Care Institute (THCI) teaches about the systems-based and practice-improvement competencies. It works closely with medical content and education experts. Affiliated with Tufts University School of Medicine and Tufts Health Plan, THCI recently received funding from the U.S. Department of Education to use its Web-based resources to train physicians throughout the country in these two competency areas.

"Since a number of the competencies we are now required to teach are new areas, many resident training programs are grappling with how to acquire and teach them," Bradley said.

For that reason, she adds, a good online learning resource provider in the medical arena is one who understands the evolving teaching mission, supplies the right content and provides a user-friendly learning experience.

"A traditional, if somewhat idealized, view of doctors pictures them as strong, competent people who solve problems on their own," Campion said. "We teach our residents that being strong and competent today means knowing how to work with a team and within a complex delivery system. The online learning experience leads them to new information tools not traditionally in their grasp. We are introducing a way of learning and accessing information which will stay with them throughout their careers in medicine."

Rosalie R. Phillips has been the executive director of Tufts Health Care Institute since its founding in 1995. She can be reached at Rosalie_Phillips@tufts-health.com.