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Information and communication technologies in higher education:

Evidence-based practices in medical education

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DOI: 10.1080/01421590500441927 · Source: PubMed

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Article
Information and communication technologies in higher education: evidence-based practices in
medical education

Authors
Valcke, M. & De Wever, B.

Status
Published in Medical Teacher, 28, 40-48.

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DOI:

10.1080/01421590500441927

http://dx.doi.org/10.1080/01421590500441927

Please cite as:

Valcke, M., & De Wever, B. (2006). Information and communication technologies in higher
education: Evidence-based practices in medical education. Medical Teacher, 28, 40-48.

Homepages authors:

http://www.onderwijskunde.ugent.be/en/cv_valcke.htm

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 Medical Teacher, Vol. 28, No. 1, 2006, pp. 40–48

Information and communication technologies in higher

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education: evidence-based practices in medical

education*

MARTIN VALCKE & BRAM DE WEVER

Department of Education, Ghent University, Belgium

ABSTRACT In contrast to traditional meta-analyses of research, computer-assisted instruction based on the content analysis
an alternative overview and analysis of the research literature on of studies (MEDLINE and ERIC) set up between 1988 and
the impact of information and communication technologies (ICT) 2000. He concludes: ‘‘Few studies of good design clearly
in medical education is presented in this article. A distinction is demonstrate improvement in medical education over tradi-
made between studies that have been set up at the micro-level of tional modalities. There are no comparative studies . . . that
the teaching and learning situation and studies on meso-level demonstrate a clear-cut advantage. Future studies of
issues. At the micro-level, ICT is hypothesized to foster three basic computer-assisted instruction that include comparisons and
information processing activities: presentation, organization, and cost-assessments to gauge their effectiveness over traditional
integration of information. Next to this, ICT is expected to foster methods may better define their precise role’’ (Letterie, 2003,
collaborative learning in the medical knowledge domain. p. 849).
Empirical evidence supports the potential of ICT to introduce It is important to note that the author could identify only
students to advanced graphical representations but the studies also 210 studies that met basic research criteria to be incorporated
stress the importance of prior knowledge and the need for real-life in the analysis. An additional important critique builds on
tactile and practical experiences. The number of empirical studies the statement in the last sentence. Few studies succeed in
focusing on the impact of ICT on information organization is defining the precise role of ICT in the educational process.
restricted but the results suggest a positive impact on student Part of the research limitation is the lack of a theory that
attitudes and relevant learning gains. However, again, students drives the instructional goals of the ICT applications.
need a relevant level of prior knowledge. Empirical studies Moreover, the expected outcomes can be extremely varied,
focusing on the impact of ICT on information integration highlight which presents an additional difficulty to meta-analysis
the positive impact of ICT-based assessment and computer studies of evaluative research.
simulations; for the latter this is especially the case when novices
are involved, and when they master the prerequisite ICT skills.
Little empirical evidence is available regarding the impact
of computer games. Research results support the positive impact Alternative approach
of ICT-based collaboration but care has to be taken when skills
The present contribution revisits part of the research
development is pursued. At the meso-level, the available empirical
literature while adopting an instructional analysis approach
evidence highlights the positive impact of ICT to promote the
when considering the potential of ICT in medical education.
efficiency of learning arrangements. Research grounds the key
As to the potential of ICT, a distinction is made between
position of ICT in a state-of-the-art medical curriculum. Recent
meso-level and micro-level benefits. At the meso-level, we
developments focusing on repositories of learning materials for
focus on educational benefits that are linked to the delivery of
medical education have yet not been evaluated. The article
medical education programmes and characteristics of the
concludes by stressing the need for evaluative studies, especially in
student population. At the micro-level the focus will be on
the promising field of ICT-based collaborative learning.
specific variables and processes in the teaching and learning
Furthermore, the importance to be attached to the position and
setting. As a consequence, the analysis question is no longer
qualifications of the teaching staff is emphasized.
whether ICT results in better medical education, but rather
what type of ICT use—as it is linked to specific variables and
Introduction processes in the teaching and learning context—results in
more effective, efficient or satisfying education.
Recent reviews of research concerning the efficacy and
The empirical base gathered for this overview has been
efficiency of the integrated use of information and commu-
extracted from MEDLINE and ScienceDirect, by applying
nication technologies (ICT) in education do not always come
the search concepts medical, education and computer and with
to optimistic conclusions. The meta-analyses of Kulik (2003)
a focus on studies published in journals since 2000.
result in statements that the potential of ICT in education is
yet not clear and that the findings of evaluative studies
are conflicting. Other researchers come to comparable Correspondence: Martin Valcke, Department of Education, Henri
Dunantlaan 2, B-9000 Gent, Belgium. Tel: þ32 9 264 86 75;
conclusions (e.g. Waxman et al., 2003; Cox et al., 2003). fax: þ32 9 264 86 88; email: [email protected]
In relation to medical education, Letterie (2003) presents *This paper is based on a plenary presentation given by Martin Valcke at
a more specific analysis of research on the potential of AMEE 2005 in Amsterdam, September 2005.

40 ISSN 0142-159X print/ISSN 1466-187X online/06/010040–9 ß 2006 Taylor & Francis

DOI: 10.1080/01421590500441927
 Evidence-based practices in medical education

Micro-level issues A large amount of research and developmental work has been
set up in the medical field during the last decade. Current
At a conceptual level, ICT facilitates the design, develop-
developments focus in particular on developing virtual
ment, transfer, delivery and storage of information and
realities and on the validation and credibility of the models
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facilitates communication in the context of instructional

being developed.
processes. We discuss both dimensions separately.
The potential of ICT to represent information in a
variety of ways is from a practical, theoretical and empirical
ICT to foster the information-processing dimension in learning point of view important for medical education. The same
information can be presented with text, graphics, pictures,
Information and information processing are central in most video, animations and audio.
conceptions of learning. Three major phases can be From a practical point of view, advanced graphical
distinguished in information processing. These phases are representations empower medical staff with professional tools
clearly delineated in the models of Mayer (2001) and Paivio to build teaching and learning activities on complex,
(1986). Information is presented to the learner, selected by authentic and real-life learning materials.
the learner and stored in the sensory memory. Next, this From a theoretical point of view, presenting multiple
information is organized in working memory, also called representations results in the development of a richer schema
short-term memory. This results in the construction of structure in long-term memory. It also helps to take into
cognitive structures, also called schemas or mental models. account individual differences in the processing of informa-
The organization process comprises the relating, connecting, tion, which is functional, as students differ in the way they
comparing and ordering of the information. At this stage, prefer types of visual or auditory information. Moreover, both
learners continuously retrieve information from the long- visual and auditory presentation of information, in addition
term memory. This introduces the third phase in the learning to textual representation, also helps to reduce cognitive load
process: the integration of the information with the already since it helps to reduce the complexity of the information
available schemas resulting in the further elaboration and presented (Sweller, 1994).
organization of information in our memory. The three major From an empirical point of view, there is clear evidence
phases (information presentation, information processing that the presentation of graphical information (static graphics
and information integration) are depicted in Figure 1. or animations) is superior to textual information. Research by
Below, we discuss how ICT can foster these three basic Mayer (2003) and Mayer & Moreno (2002, 2003) presents
information-processing activities and what evidence is convincing evidence that the graphical representations (such
available about the efficiency, efficacy or satisfaction of ICT as the heart pump) result in stronger retention and transfer
in this respect. of the processed information. But what about research in the
medical field?
A review study by Durfee et al. (2003) on the use
ICT fosters information presentation
of graphical data in 48 ICT-based radiology courses
Information presentation is a crucial part in the field of indicated that this kind of information is underused in
medical visualization. Robb (1999) distinguishes—in the radiology courses, ‘‘although radiology is in the forefront
context of medical visualization—between real-time imaging, of incorporating information technology . . . into everyday
interactive imaging, 3D imaging and multi-model imaging. practice’’ (p. 209).

Figure 1. Information-processing activities.

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 M. Valcke & B. D. Wever

A research study by Roubidoux et al. (2002) on students such as bedside teaching. Furthermore they point to
playing ‘breast cancer detective’, a web-based breast-imaging efficiency issues, for instance in contexts where there is a
game, pointed out that the graphical nature of the shortage of neurology specialists or to expand the number of
information was preferred by the students and resulted in cases students can focus upon.
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very positive appreciation of the course and high levels of The empirical evidence put forward stresses the impor-
self-reported learning outcomes. tance of introducing advanced and professional graphical
But despite the large potential of the very advanced representations in ICT-based contexts. Most authors of the
computerized imaging approaches a balanced approach studies stress that it is important for students to learn to work
might be needed. In a large-scale study, involving over a with state-of-the-art medical imaging tools and artefacts.
thousand medical students learning anatomy, researchers But in the context of the overall development of medical
studied whether ICT-based resources could replace real-life knowledge and skills, real-life experiences, observation and
cadaver dissections. The results of this quasi-experimental practice are needed to develop in medical students a rich
study show that the proportion of students who received both information representation base.
treatments—traditional dissection and computer resources—
was significantly larger than in the other conditions (Biasutto
et al., in press). Moreover, the average mark was also larger in ICT fosters information organization
this condition. This unique quasi-experimental study builds
on a review of the research literature concerning the teaching Medical education relies heavily on the active processing
of anatomy. The authors come to the conclusion that real-life of large amounts of complex and interrelated information.
dissection remains important to develop the necessary visual From a theoretical point of view, sensory information
and tactile experience base (see also Miles, 2005). Real-life only becomes meaningful due to the active organization
experience is considered to be a catalyst to learn in an optimal of the new information. This organization implies
way from biomedical computer applications, thus resulting structuring, comparing, ordering, relating and analysis of
in superior performance. new information. In traditional teaching contexts this is
The power of ICT-supported representations is further fostered by the continuous active involvement of students in
growing due to 3D techniques and Cave Automatic Virtual interactive teaching and learning settings.
Environment (CAVE) technologies. When applying the latter The organization of new medical knowledge is also
tools, students can even walk around within the 3D pursued by developing eBooks. The system developed by
projection of the biological structure. Kral (2004) presented Lison et al. (2004) is a content free solution that supports a
applications of CAVE technologies to teach pathologies, variety of teaching and learning strategies. The technical
based on real-life patient data. Other exploratory research functionalities are linked by the authors to specific knowledge
focuses on virtual reality graphical representations that are processing activities as illustrated in Figure 2 (Lison et al.,
distributed via the Internet. Research by Lu et al. (2005) 2004, p. 168). Pilot studies with the eBook solution have
demonstrates the potential of ICT-supported representations focused especially on the feasibility of the system and testing
but also points to the critical elements, such as waiting times the delivery of a wide variety of contents.
for students that are too long and the need for extra learning ICT tools foster in a variety of ways the organization of
materials to support the viewing process. knowledge. In a 3D application, developed by the New York
A research review by Letterie (2003) focuses on the University School of Education, students can manipulate
analysis of research concerning applications of virtual reality 3D representations of the skull, orbital cavity and meninges.
(VR). Based on a review of 150 studies he projects that VR The manipulation activities include among other things
is useful for training in basic and advanced surgical skills rotation, opening up, revealing closing and positioning.
for both medical students and residents. But he immediately Each manipulation enriches the further construction of
adds that this technology has been tested to a too limited schemata. There is one condition: students have to master
extent in the medical field. Most studies are too descriptive basic prior knowledge of the anatomical structures to learn
and rather suggest future directions. This is in line with the from this tool. This is a typical tool that can serve as a base for
opinion of other authors. In the context of medical education, developing computer simulations in which students have to
and more particular in surgery education, the use of VR still manipulate simulated reality with a view to diagnosing
remains restricted (see e.g. Haluck et al., 2001). An early diseases or following procedures to treat illnesses. We discuss
study by Gallagher et al. (1999) pointed out that VR resulted this type of ICT application in the following paragraphs.
in superior performance of laparoscopic surgery skills, but Pallikarakis (2005) has designed and evaluated a web-
not of venous catheter placement when compared with based distance learning course on medical image processing.
traditional methods for training these skills. This package pursues the acquisition of the conceptual base
Next to rich graphical representations, ICT can also help of the medical image processing field. Concepts can be
to represent varied representations of information in a more studied at three levels of complexity, for example: a first level
organized way. To support neurology students in assessing with a general description, a second level with more detailed
neurological disorders, a comprehensive CD-ROM was explanation, and a third level revealing the complicated
produced covering about 100 different vignettes (audiovisual mathematical proof. Evaluation of the package revealed high
case descriptions). A study involving 401 medical students satisfaction levels, projected usefulness of the learning
resulted in clear evidence regarding the reported instructional content and efficiency in time spent on learning the content.
value of the materials (Bain & Biller, 2004). The authors In line with the remark about the need for sufficient prior
present the vignettes as adjuncts to other instructional knowledge to be able to develop organized knowledge as a
approaches and not as a way to replace other approaches result of the learning experience, the latter example reflects

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 Evidence-based practices in medical education
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Figure 2. Knowledge-processing activities. Source: Lison et al. (2004).

a very detailed and structured breakdown of the knowledge key elements that helped students to build up their knowl-
components. edge of acid and base physiology, as presented in a study by
Empirical evidence that is restricted to studying the Rawson & Quinlan (2002), in which the embedded questions
impact of information organization is hardly to be found. scaffold the learning of novices by accentuating the relevant
Most packages offer additional functionalities that go beyond features of the cases.
information organization (see following paragraphs). Assessment of complex skills present challenges to
However, the available studies suggest positive student traditional educational contexts: they require extensive staff
attitudes and report relevant learning gains. But—as stated involvement, discussions concerning objectivity and available
earlier—developers have to be aware of what they expect from training time. In this context, ICT solutions are put forward
students as a prerequisite level of prior knowledge. as ways to support this assessment. Hulsman et al. (in press)
studied the use of standardized video cases to test video
ICT fosters information integration examination of communication skills by computers. The
study involved 200 medical students and resulted in an
In the third phase of the information-processing activities, acceptable reliability of the test approach (G ¼ 0.66) and high
students organize their knowledge to a further extent and link inter-rater reliability (G ¼ 0.93). Although the researchers
the new knowledge in an active way with knowledge already indicate that more research is needed to validate the
available in long-term memory. ICT applications that approach, the study illustrated its feasibility.
particularly foster this type of activity force students to use Another study focusing on assessment and evaluation
and reuse information that has been stored earlier in their compared a face-to-face tutorial with the use of a computer-
long-term memory. Use and reuse of information is observed assisted package (CAI) in radiology education (Kim et al.,
when student solve problems, answer questions, apply their 2002). Central to both approaches was the continuous
knowledge to cases, etc. This cognitive processing activity assessment of the students. The authors found few significant
occurs in ICT-based learning environments when students differences that were pedagogically meaningful and
apply and test their knowledge. Under this umbrella we concluded that both models were effective teaching formats,
distinguish in particular (1) tutorial ICT applications but they suggest that the CAI approach might be more
that have an embedded evaluation of student learning, efficient since the students spent less time studying and no
(2) computer simulations, and (3) game-based approaches. experienced staff were involved.
Considering the importance of high-quality graphical
ICT with a focus on assessment and evaluation information as the base for teaching in medical education, the
assessment procedures are also pressurized to build on state-
In the multimedia guide to cardiopulmonary resuscitation, of-the-art technologies when representing questions and
medical students take tutorials (organizing information) and
problems. Grunewald et al. (2004) developed an Internet-
test questions in basic and advanced life support (Clark et al.,
based application to assess radiological knowledge that builds
2000). Research results comparing the web-based version
on 1650 pathology cases and 550 anatomy cases. Users can
with traditional approaches resulted in better ‘basic knowl-
select among other things the characteristics of the target
edge’ of resuscitation but not in significant differences on
population, the difficulty level and the number of questions.
practical test scores. In a comparable study by Mehrabi et al.
The available research evidence helps to confirm the
(2000), the computer-based training module, presenting new
efficiency of ICT-supported assessment approaches.
information and consequently assessing this with quizzes,
resulted in significantly higher scores as compared with
lectures. Mullins et al. (2001) set up a study to research the Computer simulations
feasibility of ICT to test medical students on radiology
clerkships. The study results support the efficiency of this The example of the CAI package in radiology education
approach in terms of time gains and low costs. Furthermore, (Kim et al., 2002) discussed earlier, is also a typical
questions and repetition of concepts were also found to be illustration of a computer simulation in which students

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 M. Valcke & B. D. Wever

have to manipulate simulated reality with a view to relevant tool. Students have to interpret complex situations,
diagnosing diseases or following procedures to treat illnesses. apply their knowledge, put forward hypotheses, test them in
The developers and researchers of this CAI package carried the game settings, and receive immediate feedback. Howell
out a study in which student performance on a computer (2005) gives an overview of ICT-based interactive games
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simulation to treat cardiac dysrhythmias (Advance Cardiac and related evaluative research; some of them are relevant for
Life Support Simulator) was compared with the study of (para)medical education.
text-based materials. Initially the students in the text-based A typical example is the computer-assisted board
condition performed significantly better after the treatment game to manage patients with breast cancer. Students
period but one week later there was no longer a significant can—depending on adequate application of the work-up
difference. The decline in knowledge gain was larger in the procedure—decide to send the patient for physical examina-
text-based condition. The authors explain the initial better tion, mammography, ultrasound or office procedures (Mann
learning performance (right or wrong answer questions) in et al., 2002). Playing the game resulted in significant learning
the text-based condition by referring to the inexperience of gains in respect of the work-up procedures. It may be noted
students with learning in ICT-based learning environments. that—as compared with the earlier studies—the learning
But—and this is more important—the students were novices gains put forward are clearly related to skills development.
in this knowledge domain and were confronted with a larger
level of complexity in the ICT-based environment. Prior
ICT to foster the communication dimension in learning
knowledge is a critical asset for students when studying
complex knowledge. The researchers suggest therefore A variety of communication models can be supported with
looking for a balanced mixture of both teaching approaches. ICT. In current practices, we particularly observe ICT
Nackman et al. (2003) studied the use of simulation applications that support teleteaching and collaborative
software—with a computerized life-sized manikin—in the learning approaches.
surgical education of students during their clerkships.
They concluded that the simulation software significantly
improved skills. The researchers add in their research report Communication with teachers and experts
an important remark on their conclusions. They refer to the
In the context of medical education, real-time teaching via
fact that the approach was effective ‘‘in a clerkship that
the Internet is a recurrent approach to teleteaching. Teaching
already emphasized . . . case-based learning’’ (Nackman et al.,
activities can, for example, be enriched with viewing real-life
2003, p. 214). This remark points to the context in which
surgeons at work.
ICT-based medical training approaches might be effective.
Feasibility studies, such as the one by Filler et al. (2000),
It stresses the congruence between the variety of teaching
show how the technology is sufficiently adequate to be
models being adopted. applied in this context. Another study, focusing on the
Di Giulio et al. (2004) developed a simulator for upper distance education delivery of a postgraduate course via the
endoscopy. In their randomized controlled trial with their Internet, resulted in high satisfaction levels but also revealed
system (n ¼ 420), they put forward evidence that medical critical issues such as dropout and low participation levels
students in the experimental condition performed more (Jenkins et al., 2001). The study revealed that the computer
complete procedures, needed less assistance and obtained literacy level of the potential students is critical.
more positive remarks from the instructor. It is important to Dugas et al. (2000) studied an emergency medicine
note that the target population comprised novice trainees. online course during which students had to submit answers
Engum et al. (2003) studied a simulation package aimed to questions. This student input was displayed on a large
at developing intravenous catheter placement skills and video screen and discussed in real time by an expert. An
compared this with traditional approach. Both groups evaluation of the approach with 138 students resulted in high
developed their skills in a significant way. But student scores for acceptance and learning success.
satisfaction was lower in the computer condition. The The projected benefits of teleteaching are large and
researchers suggest a blending of the efficient computer in particular stress economic benefits. However, it is
condition and the face-to-face teaching context. striking that the medical education research literature
Meier et al. (2005) researched the impact of using particularly publishes initiatives and projects, but hardly any
a simulation-based curriculum of situations commonly evaluation results.
encountered in on-call situations during a surgical internship.
The implementation of the simulation significantly increased
the confidence of interns as compared with unsupported Communication between students: collaborative learning
transition from medical school to surgical internships.
Collaborative learning is promoted for a number of reasons in
Pulling together the results of these studies, we can
the medical domain. Ortega et al. (2003) refer to the
conclude that simulations are effective. However, this is
importance of clinical-reasoning and problem-solving skills.
especially the case when novices are involved and when they
A meta-analysis of 122 studies focusing on collaborative
master the prerequisite ICT skills.
learning with ICT as compared with individual learning
through ICT indicates that the collaborative setting results in
Computer games more effective learning (Lou et al., 2001). Research suggests
that adding a communication dimension to the information
With a view to the integration of medical knowledge, dimension in medical ICT applications results in better
interactive computer games are presented as a potentially performance. Numerous articles focus on the potential of

44
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 Evidence-based practices in medical education

collaborative learning in medical education (see e.g. Wiecha of fourth-year medical students playing an interactive web-
& Barrie, 2002). But few evaluation studies have actually based breast-imaging game (Roubidoux et al., 2002).
been published. Greenberg et al. (2003) discuss a study in which they
In the study by Romanov & Nevgi (in press) two ICT provide in-service medical trainees with online research
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conditions were compared: a simple web-based course and articles to update their knowledge and skills in respect of
an alternative design that was enriched by general discussion diagnostic radiology, in accordance with the residency
groups and special discussions on lectures. Learning perfor- review committee requirements. Results from a pre-test–
mance increased significantly when third-year medical post-test design study underpin the significant learning
students could work together. gains.
De Wever et al. (2005) analysed the use of asynchronous A very specific implementation of ICT in a teleteaching
discussion groups involving students during a semester of context is found in developing countries. Mukundan et al.
clinical rotation in paediatrics (n ¼ 49). In the electronic (2003) describe a telemedicine system that was introduced
discussions, students worked with real-life cases in order to in the Solomon Islands. A small-scale evaluative study
enhance professional reflection and critical thinking on underpinned the flexibility and efficiency of the teaching
patient management and as an exercise in evidence-based model. The authors stress the low-cost and sustainable
medical practice. Student input in the discussions was nature of the teaching approach.
analysed to determine the level of knowledge construction. Medical education is often hindered by the combination
In a quasi-experimental study, some of the students were of clerkships and continuous face-to-face training. The
expected to adopt specific roles (e.g. moderator). Significant distributed nature of the clerkships makes it difficult for
differences in the levels of knowledge construction were students to attend lectures. In a rare evaluation study of the
observed between groups that were moderated by a student use of videoconferencing to cope with these difficulties,
and groups moderated by the instructor (z ¼ 3.96, p < 0.01). researchers indicated that the videoconference-based lectures
Student-moderated groups resulted in higher cognitive were as effective to deliver the didactic lectures in a surgical
involvement as reflected in the quality of the student input; clerkship as the conventional teaching approach. However,
students’ messages are 1.75 times more likely to reflect higher the videoconferencing approach was significantly more
levels of knowledge construction. The results do not question efficient due to time gains and reduction in travel costs
the importance of the instructor being available and being (Stain et al., 2005). In the study by De Wever et al. (2005),
involved. They point in particular at the significant value of discussed above, the ICT-based collaborative learning
ICT to foster discussions between students in a distributed environment was also implemented in a context where
setting. medical students could not attend the university for
Although the research literature on collaborative learn- face-to-face meetings. The efficiency of the approach was
ing in ICT-based environments presents convincing results appreciated by the students.
regarding the efficacy of this kind of ICT application (see also Johnson et al. (2004) studied student satisfaction with a
Valcke & Martens, 2006), few research studies have been web-based courseware system that was meant to foster just-
reported in medical education. Nevertheless, the limited in-time education and expected to be an efficient solution to
number of available studies presents overall a positive picture. promote flexible delivery of medical education. Overall, the
There may be limitations when it comes to the actual system was considered to be efficient and effective. End-users
development of skills; for example, in surgical training. raised some concerns about the quality of technical
A study by Rogers et al. (2000) indicated that skills instruction and feedback.
acquisition was superior in an individualized computer- The study by Masiello et al. (2005) focused on the
assisted (CAI) environment as compared with a peer- readiness and attitudes of students to take online microbiol-
teaching-supported CAI setting. It is important to stress ogy courses. On average, the students mastered the pre-
that this study was set up with novices. requisite ICT competences and expressed positive attitudes
towards the system to use it in a flexible way. But—and this is
ICT at the meso-level crucial—the actual learning experience with the system
resulted in a more negative attitude towards the learning
ICT and flexibility in medical education management system. The critiques centred on functionalities
such as reading from screen and replacing lectures with the
Flexibility is a central concept when ICT is put forward to
computer system.
deliver medical education in environments in which course
delivery is constrained due to time, place and pacing
limitations of the target audience. Grunewald et al. (2003) ICT in the medical education curriculum
present their radiology website explicitly as a solution to solve
problems in relation to flexibility in access to and use of ICT is also put forward in medical education because it can
educational materials. Students can choose time, place and provide students with opportunities to get acquainted with
pace of learning. technologies they need in their professional lives (Stromso
In the study by Durfee et al. (2003), it was clear that et al., 2004; De Wever et al., 2005), which are necessary
due to the use of the Internet, the radiology courses could to keep up with the rapid growth in medical knowledge
be delivered in a very flexible way with a variation in student (Hagdrup et al., 1999). Nattestad et al. (2002, pp. 127–128)
numbers, number of times of offering the course and a emphasize the importance of ICT skills in order to avoid
required versus an elective nature of the course. becoming ‘‘a clinician who is unable to access or handle
Accessibility was also a major advantage quoted by 96% new electronic technology [and] therefore [is] left with the

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 M. Valcke & B. D. Wever

significant risk of being unable to provide optimal evidence- A large number of studies focus on the information
based care’’. component of ICT, while less light is shed on the commu-
What is the evidence to support the need for ICT skills nication component. Moreover, in addition to descriptive
in the medical education curriculum? Logan & Price (2004) studies, more evaluative studies of ICT tools are required,
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validated the curriculum of medical informaticians, revealing focusing on the efficiency and the impact on students’
some neglected areas in the current curriculum. But is ICT learning. In this respect, ICT-based communication is
also considered essential in a curriculum for general a promising field, as networked technology can serve as a
practitioners and clinicians? A national study in the UK powerful environment to support collaborative learning.
revealed that the IT skills of medical students are not well A final element in the context of this discussion is that
developed as regards their professional qualifications ICT is but one component in the context of medical
(Murphy et al., 2004). Respondents were clearly in favour education. ICT cannot be alienated from the broader
of a national IT curriculum for the medical field (with a teaching and learning context. A key factor in this context
strong focus on health informatics). Researchers also tried is the teaching staff. Ward et al. (2001, p. 795) point out some
to look for explanations for this current state of affairs. implications and dangers of the integrated use of ICT in
They point at the critical IT training level of teaching staff. education. They conclude that ‘‘all of these aspects relate to
the skills and attitudes of the teaching staff themsel-
ves . . . investment in staff training in these novel educational
Learning repositories methods is needed’’.
A particular innovative area in the application of ICT in
medical education is related to the implementation of
learning repositories. Geueke & Stausberg (2003) describe Notes on contributors
a large repository that consists of a large set of reusable MARTIN VALCKE is currently Professor of ‘Instructional Sciences’ at
learning objects (see for example, http://mmedia.medizi- Ghent University and head of the Department of Education. Building on
n.uni-essen.de/portal/). These learning objects can be used his PhD work in the field of educational information sciences, his current
in other educational contexts and are described by adding field of research focuses now on the innovation of higher education and
metadata to them. In this way, teaching staff can easily trace the integrated use of information and communication technologies.

relevant learning materials to be used in the context BRAM DE WEVER is a PhD student in the Department of Education of
concerned. Thus far, no evaluative information is available Ghent University. His research deals with the impact of adding scripting
approaches (role-assignment, self-assessment, peer-tutoring) to
in respect of this new development.
computer-supported collaborative learning environments on students’
levels of knowledge construction in both educational and medical
settings (e-mail: [email protected]).
Conclusions
Current ICT-related research has shifted its focus from a
media-oriented research paradigm to a stronger focus on References
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