E-learning: Is it the end of medical schools?

The internet will radically change medical education The next decade may see the emergence of a new type of medical school. It will not be made of bricks and mortar, but based mostly in the hard drives of computers, accessible by thousands of students all over the world. New investment trends are driving this efficient, cheap, and convenient way of delivering information. While patient contact will remain integral to learning medicine, perhaps what will emerge is a way to personalise education, reduce costs for students, and prepare them more thoroughly for contact with patients.

In November 2000 Sir Brian Fender, head of the Higher Education Funding Council for England, called on private sector investors to take a stake in his £200m venture to set up an e­university. His venture was one of several. Universitas 21 is a network of United Kingdom and overseas universities linked with an electronic publishing group in a multimillion pound agreement to deliver e­degrees. Alan Gilbert, chairman of U21, estimates that e­student numbers will reach 160 million by 2025, and that "education will become the biggest industry in the world."¹

E­learning potentially offers huge benefits for users (see box). International recognition of training will also be assured since companies will demand international collaborations. This is because national systems will always be perceived as being of variable quality. U21 includes universities in Europe, China, North America, Australia, and New Zealand. Other universities, such as Oxford, are setting up their own international consortiums. It is a convenient medium for ongoing education, a necessity in the medical field.²

Dissemination of information and education via the internet will also allow for equality in medical knowledge and training across the globe. But many obstacles exist before this ideal can become a reality. For example, in poorer nations, access to the internet will have to improve in the developing world to make potential equality a reality.3 Access in Africa is slow, intermittent, and very expensive compared with the often free access in the United States.

There are other obstacles. Some estimates suggest that it takes 200 hours to produce one hour of online tuition, invoking the need for huge investment.¹ Despite the current investor frenzy, online learning has not yet produced commercial success. The University College of Los Angeles school of dentistry spent $750 000 (£535 000) over five years developing an online course to train periodontists. It has been a commercial failure.4 So it seems that the correct business model has yet to be found. But with such large potential revenues from electronic education, it is only a matter of time before the right solution makes e­learning a reality.

Clearly e­learning will not wholly replace teacher led or hands on training. We still need patients. But patients should not be our guinea pigs. Online scenarios can allow us to gain confidence and appropriate background knowledge before the hands on portion of learning, replacing time spent learning theory, with more time mastering the skill.² For instance, a simple program can test competence on applying leads when performing diagnostic electrocardiography. Crucial supervised practice can then follow to gain essential clinical experience. Furthermore, certain areas lend themselves more easily to online teaching. Multimedia instruction is particularly well suited to help students learn physical diagnosis, with visual and audio aids enhancing recognition of heart and lung sounds, physical examinations, and pathology.⁵

New models of medical education will continue to emerge as the qualities and knowledge required by juniors is constantly reviewed. But there seems little doubt that electronic learning will be right at the centre of its future.

Jason O'Neale Roach, fourth year medical student, Guy's, King's, St Thomas's Hospitals Medical School, London
Email: jasononeale@yahoo.com


studentBMJ 2001;09:171-216 June ISSN 0966-6494

1. MacLeod D. Clever business. Guardian November 28 2000.
2. Goettner P. Effective e­learning for healthcare. Health Management Technology 2000;21:64,63.
3. Godlee F, Horton R, Smith R. Global information flow. BMJ 2000; 321:776­7.
4. Lessons of a virtual timetable. Economist February 15 2001:101­3.
5. Grundman JA, Wigton RS, Nickol D. A controlled trial of an interactive, web­based virtual reality program for teaching physical diagnosis skills to medical students. Acad Med 2000;75:547­9.