Presenting the outline of a proposal for a 5 part program of medical education research using eLearning or Technology enhanced learning to support Learning through the continuum of Undergraduate, through Postgraduate to Lifelong learning settings

The purpose of this article is to present the outline of a proposal for a 5 part program of medical education (MedEd) research using eLearning or Technology enhanced learning (TeL) to support Learning through the continuum of Undergraduate, through Postgraduate to Lifelong learning settings.


Background
Professional training programs are faced with the constant challenge of exponentially increasing curricular content, or curricular "bloat", crowding out curricular time allocated for student interaction and content assimilation, not to mention content integration.
The paradox is that professional training programs are lengthy multiyear, if not decade long training and apprenticeship encounters ( Figure 1). As educators, we have not taken full advantage of the potential of educational technology to provide access to comprehensive, standardised, peer-reviewed, high quality content for both students, and instructors; during this lengthy training process. To revisit, and build upon fundamental principles and case-Goh P MedEdPublish https://doi.org/10. 15694/mep.2016.000141 Page | 2 based experience; utilising the best available educational theory, including mastery training and deliberate practice principles, evidence from the literature, as well as local empirical experience. We have also not taken full advantage of the potential of educational technology and eLearning to make our teaching public, scholarly, and a showcase of educational scholarship.
In the next 5 studies, as part of a "PhD level" educational proposal, the role of educational technology, eLearning or technology enhanced learning will be reviewed in the context of a longitudinal medical training program, spanning the undergraduate, through postgraduate, to continuing professional development and lifelong learning settings. A series of studies will be proposed to evaluate, assess, and measure the impact of these educational efforts in revising a training curriculum.
I have chosen in this paper, for the purpose of brevity, and readability, to focus on presenting the outline of a planned proposal for a multiyear educational research program. Sections are deliberately "incomplete" with regard to a full set of supporting references. The intention is for this paper to followed by 5 more detailed proposals where a full review of what is known will be articulated, followed by the study proposal, and discussion of where and how this might add to the existing literature. This paper can also be read as complementary to / and a follow up to the paper -Goh, P.S. The value and impact of eLearning or Technology enhanced learning from one perspective of a Digital Scholar. MedEdPublish. 2016 Oct; 5(3), Paper No:31. Epub 2016 Oct 18. http://dx.doi.org/10.15694/mep.2016.000117 (as continuation of a "scholarly conversation" arising from reviewer comments and suggestions by Ken Masters, and my response describing further work following from this).

Study 1 and 3 -eLectures vs traditional Lectures in undergraduate (study 1) and postgraduate (study 3) medical education
Lectures can (1) provide an efficient and time effective way to share complex information with large groups of students in an enthusiastic and engaging way; (2) present a framework to facilitate understanding and provide an introduction and overview of complex topics, helping integrate prior knowledge with current information for students; (3) customise the material for a specific cohort of students to address their learning needs; (4) be used to provoke thought and deepen understanding; and (5) be used to promote independent learning (Brown & Manogue, 2001;Exley & Dennick, 2004). eLectures possess many of the advantages of traditional lectures; with the added functionality and advantage of widening access to high quality standardised peer reviewed content to both students and instructors; to learn from, and build upon (see background section).
A key advantage of making eLecture content available, in both packaged, and granular form (by indexing key takehome points, key tables and graphics and important references and review papers for example); is that students can review and revisit principles, and illustrative case studies repeatedly through their longitudinal training program (with timing and sequence both guided by instructors in an adaptive curriculum; and also on demand as and when required by students). This reinforces basic principles; and improves transfer (Baldwin & Ford,1988). The provision of eLecture content which students engage with repeatedly promotes learning.
eLectures can facilitate self-directed learning in students. eLectures offer curricular planners and educators greater flexibility to deliver and customise educational content, and facilitate an adaptive curriculum. There are several ways we can evaluate and assess these assertions.
For example, for students, we can measure time to competency for undergraduates as an index for efficiency. We can measure time to proficiency, and mastery for postgraduates; as an index for efficiency. For both undergraduates, and postgraduates, we can assess understanding, knowledge retention, and ability to apply key ideas and principles as an indicator of effectiveness. For instructors, we can measure lecture preparation time as an index for efficiency. And assess the relative ease of evaluating teaching effectiveness using eLectures vs traditional lectures. Students are progressively exposed to clinical scenarios illustrated with key points in the clinical history, physical examination findings, laboratory data and clinical imaging findings.

Study 2 -role of interactive eCases in undergraduate medical education
This process of building a firm foundation of clinical case based scenario recognition ("think fast", pattern recognition, or "what") supported by a firm foundation of increasing deeper understanding of basic science principles ("think slow" or "why") is fundamental to developing both forms of clinical reasoning, giving future clinicians the ability to quickly recognise common and important clinical scenarios, as well as the capacity and ability to reason from first principles with atypical clinical presentations, with less defined, multiple and conflicting clinical features (Kahneman, 2011).

Study 4 -role of interactive eCases in postgraduate medical education
Re-imagining a postgraduate training curriculum A combination of eLectures (e=online; e=edited, 0.5 time traditional lectures), daily deliberate practice sessions with theme based interactive online sets of clinical cases for compare and contrast practice coupled with online and regular face to face feedback and discussion with clinical tutors; together with supervised daily clinical sessions with clinical teachers in a coaching role; augmented by individual resident ePortfolios for formative assessment and self reflection; can potentially dramatically reduce the training time required in postgraduate training programs, delivering a more personalised educational experience, focused on identifying an individual trainee's strengths and augmenting these, as well as strengthening areas of weakness in performance (Figures 2 and 3).

Study 5 -role of a hyperlinked indexed eRepository in continuing medical education
An eRepository, particularly one that is comprehensive, and representative of current, and actual teaching and training material, has a similar utility to that of a well stocked, well laid out, and clearly signposted and labelled Goh P MedEdPublish https://doi.org/10.15694/mep.2016.000141 Page | 4 grocery store or market, with a well stocked frozen food/prepared meal section. To take this food and cooking analogy further, this resource would allow a chef, or cooking instructor/demonstrator, to devote his or her time more efficiently, and potentially more effectively, by focusing effort on actual cooking and demonstrating, rather than sourcing for ingredients.
Translating this analogy to an education and training setting, the instructor can focus on customising a teaching and training program, and refining an educational offering; rather than spending time sourcing for material, creating content from scratch, or looking through past presentations and training resources to attempt to update or customise these for a particular audience.
This paradigm also facilitates personalised content review by learners, who now can not only review previously presented packaged presentations, but also go back to the original source material and "raw ingredients", for example clinical scenarios, take home points, key references, key points made in these references, key illustrations (including graphics, radiology images, anatomy and pathology digital photographs), charts and tables.
This promotes a modular, potentially more standardised, systematic and programatic; customised and personalised review of educational material; particularly with the aid of prepared curricular plans, and the assistance of teachers and trainers in a coaching role. Digital access and accessibility promotes and widens access to this educational and training material; facilitates formal, informal and just in time learning and performance support; anytime and anywhere. This resource supports content review before class. Valuable face to face time and live class time is now available for more interactive discussion with peers and instructors, with a focus on deepening understanding, translating theory to practice, using group interactions and other active learning strategies ("blended" eLearning with face to face interaction; and the "Flipped Classroom" model).
For example, the potential of "collections of potential training situations for a wide range of professional tasks" is discussed by (Anders Ericsson, 2009), where he suggests "using collections of representative tasks with verifiably correct answers", which can "not only be used to measure objective performance of experts", but can "be used for training new recruits as well as maintenance testing and continued training of experienced professionals" (Chapter 18, page 422-423).
Ericsson concludes with this suggestion, that "with an increased interest in the lifelong development of professional performance, there should be an increase in the studies examining deliberate practice in many different types of professional activities, as well as designing training environments with challenging relevant situations that require immediate action and that can provide feedback and opportunities for repeated encounters of the same and similar tasks" (Chapter 18, page 425).