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OpenAthens Shibboleth
February 14, 2001

Medical Education and the Internet: This Changes Everything

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Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001American Medical AssociationThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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JAMA. 2001;285(6):809. doi:10.1001/jama.285.6.809-JMS0214-6-1

The ubiquitous and multimedia nature of the Web environment has already made a significant impact on medical education. In addition to facilitating the creation and distribution of innovative educational content, it creates a virtual arena for instant global communication and collaboration. Moreover, the Internet can provide tools to address some of the unique challenges posed by medical education. First, students and resident house staff need to learn, but real world mistakes that result from learning are unacceptable. Second, relevant medical knowledge, like the Internet, is evolving and expanding rapidly. Third, medical students must develop a sophisticated constellation of skills and knowledge—from communications and practical skills to pattern recognition and problem solving skills. Finally, students and residents must learn how to teach, as patient education will be one of their primary activities.

Delivering on the Promise

Our surveys indicate that most US medical students have Internet access at home, and virtually all have broadband access at school (, unpublished data, August 1999). Most students and house staff now have access to online textbooks and journals at home and school, thus reducing trips to the library. In addition, evolving wireless and personal digital assistant (PDA) applications are making it possible to deliver computer-assisted instruction (CAI) programs in a mobile format.

In addition to convenience, the Internet allows for the development of a global learning community. Communication and collaboration tools like moderated discussion forums, e-mail, chat, instant messaging, and Internet telephony facilitate discussion, debate, and learning among student peers and faculty.

The increasing availability of broadband Internet connections allows for the transmission of larger amounts of data, improving the Internet's ability to capture and transmit the drama of real patient stories. Multiple media formats like animations, video, and audio can be combined to provide an integrated learning experience that cannot be duplicated in a traditional classroom environment. This learning experience itself can be integrated with traditional teaching modalities like didactic lectures and small group learning. Any educational or reference material can be hyperlinked into the learning experience, allowing the student to explore independently as necessary.

The Internet also allows for the repackaging of education content to be used for multiple purposes. For example, a patient video about asthma can be deployed in instructional modules on topics such as ventilation/perfusion mismatch and the differential diagnosis of wheezing. Instructors can therefore "build once, use many" and even share. The future will likely give rise to a decentralized learning network where faculty and students alike can search and download learning objects and even whole coursework from the computers of other faculty and universities.1

CAI can also free up for faculty for intensive activities like small group discussion and student tutoring. For example, a school may decide to record and archive a set of core didactic lectures that would free the faculty from giving the same lecture every year.

Current Challenges

The development and integration of Web-based learning into mainstream medical school curricula has been sluggish. Most of the 124 US medical schools currently use computers for educational support.2 However, only 19 schools (15%) report offering a complete course using any form of distance learning including non-Internet methods such as teleconferencing and videotape. In contrast, two thirds of all 4-year undergraduate institutions in the United States have implemented distance learning.3

Factors that may slow adoption of the Internet as an interactive educational tool include institutional inertia, faculty unfamiliarity with the Internet, lack of funds, and poor faculty incentives to develop online learning. In addition, standards for online learning are just emerging and do not currently address the specific needs of medical education.4 Moreover, home broadband access, which is needed to deliver more sophisticated CAI, is currently limited.5 Finally, there are attribution, copyright, and intellectual property issues that must be addressed.

Looking Forward

Despite the current obstacles, the Internet has rapidly become indispensable to medical education. Current efforts are underway to develop more sophisticated CAI, including integrated medical curricula using streaming media and patient case simulators with branched decision points. For students, faculty, and medical schools committed to educational innovation and excellence, this continues to be an exciting time for experimentation and discovery.

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