An Experiment in Web-Based Medical Education

David G. Penney, Ph.D., Professor of Physiology
Wayne State University School of Medicine
Detroit, MI

paper invited for Basic Science Educator, Spring, 1996
by Dr. Roger Koment, University of South Dakota School of Medicine, Vermillion, SD

Just a little over one year ago I began to be dimly aware of the World Wide Web, although I had used E-mail for years. With the help of a computer engineering student we decided to set up a website. Actually the site we established consisted of two web servers, one a Macintosh 8100/80 and the other a Pentium 90. The Medical School at that time had no other web presence, although there were several other web servers on "Main Campus".

To set the stage, WSU is an inner-city university of some 35K students, most of which commute to classes. WSU is said to have the largest graduate program of any U.S. university. The medical school is the largest in the U.S., located at one site, with 260 students per year. The Detroit Medical Center (DMC), in which the School of Medicine (SOM) is located is one of the largest in the country, including five large hospitals.

After writing a passable homepage for the SOM and establishing the usual links to other pages on campus and off, we asked ourselves whether this new medium might be used for medical education.

There are a number of advantages to building web-based instructional sites:

1) ease of construction,
2) capability for distance learning,
3) relatively inexpensive to set-up and maintain,
4) easy / quick to make corrections in content,
5) all the advantages of platform compatibility common to web,
6) all the advantages of linkages, save, print, etc. common to web, and
7) all the advantages of web with regard to multimedia.

Our first crude attempt in June, 1995 was to put up some Medical Physiology pages, ech of which consisted of an entire lecture, text, graphics and all. This was relatively easy to do, but made for dull reading and less than optimal flexibility and use of links.

Shortly thereafter, in discussions with the Academic Dean, I asserted that the old problem of the widely varying quality of the faculty handouts to the students could be "fixed". By placing all the text into a common application - we settled on MicroSoft Word - and redrawing the graphics in one application - here we settled on Claris MacDraw Pro - high quality notes with consistent formatting could be produced. Aside from the obvious reasons, better student evaluations which impacted my role as director of the course, etc. my ulterior motive in doing this was to have all the notes materials in a common electronic form, so that development of a web-based teaching forum, the next phase, could be easily accomplished.

We at first named our electronic forum "Virtual Medical School", but almost immediately changed it to "Virtual Classroom". While I would have preferred an unsecured site, various faculty demanded that it be closed to web users outside the DMC. Preventing the pirating of notes honed over the years was one reason stated. Another more diificult one was to prevent outsiders from seeing material "borrowed" from books and such, without permission or credit. A few faculty refused to participate for fear of discovery on this point, or because they did not want to spend the time citing their sources.

With the help of two half-time student assistants, the work of gathering, reformatting, redrawing, and printing the faculty notes for Medical Physiology began in August, 1995. HTML coding of the first part of the course (cardiovascular) began in late November. The first small version of Virtual Classroom went "up" in mid-December. We decided that Virtual Classroom should also contain the faculty notes as Word files, ie. word for word, graphic for graphic versions of the paper notes which could be downloaded to any Mac or PC running the current version of MicroSoft Word.

Because I wanted my notes pages to be maximally readable and flexible in terms of links, text pages were brief - consisting of no more than 1 to 1-1/2 screen pages per page - and graphics were placed on separate pages. I also wanted to be able to use the pages in large and small group presentations in place of slides or overheads, by simply making a web connection or drawing off a local hard-drive. While this approach accomplishes these goals nicely, developing lectures in this way routinely involves the writing of 50 - 100 separate HTML files, and thus is very time-consuming.

Another method we have explored is a compromise between this approach and the one of placing a whole lecture in a page. These pages include 2-4 screen pages of text as well as the related graphics. Although less flexible, development of these pages require less than 1/3 the time to write. Nonetheless, the time expended is still many times that necessay to simply put "up" a Word file for downloading. Of course the Word files lack the links and other advantages inherent in the HTML realm.

I was astounded to discover that the biggest challenge to development of our instructional site was not technological, but rather people and the process of change itself. Faculty gave a multitude of reasons for not joining in, e.g. too busy, not enough time; will not get research grant; little career reward; not of proven value; no better or worse than lecture format; must have animation, sound, video, interactivity, virtual reality or won't do; too far ahead; students will not use / accept; don't want to learn HTML and web stuff; just a passing fad, new medium will pop up next year; must have security so the world can't rip off one's material.

The major general hindrances to the building of web-based instructional sites are the following:

1) lack of hardware and software,
2) lack of expertise / in-service training,
3) lack of adequate "network" at site,
4) faculty entrenchment / protected turf,
5) lack of administrative encouragement / reward to faculty,
6) lack of educational theory training by faculty,
7) lack of vision and willingness for risk-taking by faculty and administration.

At WSU there have been some additional problems such as:

1) fragmentation of the offices dealing with information technology,
2) history of control of the network by the business side of the administration, and
3) an older, conservative faculty.

On the other hand, the factors encouraging the building of web-based instructional sites are many:

1) an explosive development of the web,
2) the need for inexpensive, capable distance-learning tools,
3) the high cost of paper-publishing of faculty notes,
4) need for integration with development of student computer labs,
5) a decrease in research funding,
6) the drive by the LCME to add more information technology to medical curricula, and
7) a large cadre of older faculty without research grants.

Throughout the building of Virtual Classrrom we have stressed that such sites must have certain characteristics if students are to use them:

1) Provide useful learning materials NOT FOUND ON PAPER!,
2) be readily accessible,
3) be easy to use, and
4) be enjoyable (fun?) to use.

To date we have placed a number of different kinds of materials and capabilities in Virtual Classroom:

1) complete lectures (Chapters) from class,
2) clinical correlative problem-sets,
3) problem sets of all kinds,
4) question / answer forums,
5) schedules,
6) faculty profiles,
7) course policy & procedures,
8) sample examination questions,
9) accessory graphics,
10) references / reading materials,
11) links to other sites of information,
12) review modules,
13) useful learning materials not found elsewhere,
14) instant search capability to all learning materials.

For the future, we hope to add additional materials and capabilities to Virtual Classroom such as:

1) development of full multimedia (video-sound) capability,
2) virtual reality,
3) interactivity, database manipulation,
4) wireless (radio, infrared) 'net' connections,
5) powerful palmtop (Newton-size) computers for every student / faculty, and
6) the addition of telephone, TV, etc. in one integrated system.

Presently, Virtual Classroom contains approximately 85% of the teaching materials used in the three-month long medical physiology course taught to 260 Year I medical students. Materials for other courses are being rapidly added.

If you have not already taken a look at our medical instructional site, please do so. The URL is "http://www.phypc.med.wayne.edu". Since it is password protected, you will need the code, which changes every Monday morning. Simply E-mail me at "dpenney@cmb.biosci.wayne.edu" and I will provide the current ID and Password.

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