Poster
# 4
Poster |
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6th Internet World Congress for Biomedical Sciences |
J. W. Swanson(1), D. J. Capobianco(2), D. W. Dodick(3), J. Parker(4)
(1)(2)(3)Mayo Clinic - Rochester. United States
(4)Axia Health - Calgary. Canada
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[Health Informatics] |
[Neurology] |
The exponential growth of, and access to, digital networks in health care has led to indiscriminant availability and consumption of information to the detriment of comprehensive, impartial, student-centered and timely continuing health professional education. Indeed, few medical centers have yet to assume a global leadership role in continuing medical education which exploits current Internet Protocol (IP) technology to provide individual health care professionals with inclusive learning programs that meaningfully encourage career-long learning, maintain clinical excellence and establish a global standard of clinical practice (1,2). Fewer still have demonstrated a focused information technology vision or have the capacity to allocate the extensive resources necessary to make such a vision a coherent reality (3).
In this paper, we outline our strategy of developing a globally accessible student-centric continuing medical education environment of enduring interest and value to a global community of learners in an effort to establish a community-defined and accepted standard of clinical practice. To this end, we examine current trends in global Internet usage, quality of IP-based health care information, evaluate several means of continuing health professional education and outline our IP-based learning strategies and technologies as they apply to Urology.
While accurate estimates of Internet use are difficult to uncover, all indications are that access to the Internet continues to undergo exponential growth. The number of those who routinely access the Internet has grown from under 100,000 in 1991 to over 200 million in 1999. Projected figures indicate global Internet access may approach 500 million users by 2005 (4). The table below summarizes current global Internet usage statistics:
Table 1. Global Internet Usage
| Region | Total Number of Users (M) | Percentage of Total Users |
| Africa | 1.7 | 0.8 |
| Asia/Pacific | 33.6 | 16.0 |
| Europe | 48.0 | 23.9 |
| Middle East | 1.0 | 0.5 |
| North America | 113.0 | 56.2 |
| Latin America | 5.3 | 2.6 |
| World Total | 202.6 | 100.0 |
The rate of increase of individual user Internet access is greatest outside the United States. The current ratio of United States Internet users to Internet users within other countries is approximately 2:1. By the end of 2000, this ratio is predicted to fall to 1:1.
Further, approximately 43% of global Internet users access the Internet using a language other than English with approximately 29% of such users accessing the Internet using one of many European languages while 15% of such users access the Internet using one of several Asian languages (5). The table below summarizes global Internet users by primary language of access:
Table 2. Percentage of Global Internet Users by Language of Access
| Language | Percentage of Global Internet Users |
| Japanese | 10.0 |
| German | 7.0 |
| Spanish | 6.0 |
| Chinese | 5.0 |
| French | 5.0 |
| Italian | 3.0 |
| Dutch | 2.5 |
| Portuguese | 2.0 |
| Swedish | 1.9 |
In addition to these demographic numbers, other statistics point to the exponential growth and sheer size of the Internet. For example, there are approximately 400 million web pages currently available on the Internet with the average number of new web pages that appear on the Internet on a daily basis ranging from 45,000 to 75,000.
Internet-based health information can be approximately quantified through submitting a variety of health-related search terms into one of the many ‘search engines’ prevalent on the Internet. Using one such engine, Alta Vista (http://www.altavista.com), the table below summarizes the number of web pages currently posted on the Internet for a variety of health-related terms as of December 1999:
Table 3. Web Pages Currently Available for a Sampling of Health-Related Terms
| Health-Related Term | Number of Web Pages |
| "Health" | 13,000,000 |
| "Neurology" | 175,000 |
| "Cardiology" | 175,000 |
| "Dentistry" | 300,000 |
| "Asthma" | 330,000 |
| "Urology" | 85,000 |
| "Women’s Health" | 195,000 |
| "Continuing Medical Education" | 570,000 |
Finally, information technology (IT) spending in health care has been steadily increasing since 1993. In the United States, health care IT spending has increased from 7.5 billion dollars in 1993 to 13.6 billion dollars in 1997. Estimates of health care IT spending for 2000 shows an increase to 21 billion dollars.
Yet, these figures represent only 2.0% of total health care industry revenue, a figure significantly less than that spent in other industrial sectors which ranges from 3.0% to 7.0% in manufacturing and financial services industries, respectively. However, the health care industry is expected to increase percentage of total revenue IT spending faster than any other industrial sector over the coarse of the next five years to reach a total of 7% by 2005 (6).
With the exponential growth of the Internet, critical appraisal of health-related information has proved a challenge. However, several studies and related commentaries are now appearing in the medical literature in which the quality of health-related information found on the Internet has been evaluated. In general, there is growing skepticism within the global medical community with respect to the overall credibility and utility of the ever-expanding and unregulated pool of health-related information available on the Internet.
To evaluate the accuracy, ease of access and variability of cancer information retrieval, Bierman and colleagues (7) performed a systematic study of cancer information found on the Internet, limiting the analysis to information specific to Ewing sarcoma. A number of prevalent search engines were used in the collection of such web sites and each site was evaluated in terms of its relevance to the search topic, medical information, anecdotal information and degree of peer review.
Of the 371 unique web sites dealing with Ewing sarcoma, 80 were presented in a language other than English or were otherwise inaccessible, 47 contained information not relevant to Ewing sarcoma and 30 were only peripherally related to the search term. In total, these web sites represented 50% of all sites uncovered by the search engines used in this study.
A total of 165 web sites contained medical information related to Ewing sarcoma. Of these, 35% (57 of 165) contained information that was not peer reviewed and 6% (10 of 165) of these web sites contained clearly erroneous or misleading information. These findings led the authors to conclude that erroneous or misleading information freely available on the Internet may have devastating effects on vulnerable patients and families and drive a wedge between patients and physicians. Furthermore, increasingly physicians are placed in an often compromising position of evaluating the credibility of information a patient may have encountered, either intentionally or inadvertently, on the Internet.
Henson, in his commentary of this study (8), concluded "the Internet may, in some cases, actually lead to adverse medical care by spreading misleading or even fraudulent information. Information obtained from the Internet may conflict with recommendations provided by physicians, thus leading to confusion and uncertainty in the minds of patients" (p. 373). In the arena of cancer care, Henson’s view is shared by others (9,10,11).
Given the lack of quality control and sheer volume of material available on the Internet, both credibility and utility of health-related information on the Internet should be evaluated (12,13,14). To this end, several rating instruments are now available on the Internet that review and rate web sites containing health-related information.
Jadad and Gagliardi (15) identified 47 such rating instruments and evaluated both validity and reliability criteria of each. Such instruments commonly evaluate, or rate, health-related web sites using a variety of awards, quality ratings or ‘seals of approval’. Of the rating instruments identified, only 14 provided descriptions of criteria utilized to generate ratings, 5 provided instructions for their use and none provided information concerning either interobserver reliability or construct validity.
Given the incomplete development of current rating instruments, the authors question whether such instruments should exist at all, whether they measure what they claim to measure and whether such instruments lead to more harm than good by providing misleading recommendations and ratings of health-related web sites on the Internet.
McKinley and colleagues evaluated the quality of surgery-related information available on the Internet (16). Significant variation in both accuracy and completeness of surgery information poses significant limitations on its reliability and safety for both patients and health care professionals. Such inaccuracy may have the greatest implications for patients who, through an inability to objectively evaluate surgery-related information found on the Internet, may be encouraged to practice potentially dangerous health behavior or may be mislead by false expectations regarding treatment outcomes and options.
Similar results were reported by Davison (17) who reviewed Internet web sites that provide dietary recommendations and compared these with the "Canadian Guidelines for Healthy Eating and Nutrition Recommendations for Canadians". Of the 365 such web sites found, 167 contained dietary recommendations. Of these, 76 sites (45%) provided recommendations not consistent with these established guidelines and most included commercial advertisements for dietary supplements, herbal remedies, weight loss products and promotion of specific diets. The percentage of those sites which offered inconsistent dietary information varied with the key word search term and ranged from 29% using the key word "diet" to 57% using the key word "nutrition".
The quality and accuracy of medical information shared within an electronic bulletin board for discussion of painful arm and hand conditions has been evaluated (18). Such a service, also known as a discussion group, enables ongoing discussion and contributions from patients and health care professionals alike. A total of 1658 consecutive messages were evaluated using a number of criteria including professional training of those offering medical advice, consistency of medical advice with established clinical recommendations and guidelines and the nature of evidence cited to support medical claims.
Of the messages monitored, 56% (927) addressed a medical topic. Of these, 89% (825) provided medical information by persons without medical training while 5% (37) were provided by trained health care professionals. Approximately one third of all advice provided was classified by the authors as either anecdotal or unconventional and only 9% of advice offered by patients and 18% of advice offered by health care professionals cited a published source. These findings led the authors to conclude that medical information found within such bulletin boards may be unconventional, inappropriate and based on limited medical evidence.
The relevancy of patient education resources in urology, found through two established search engines on the Internet, was evaluated by Sacchetti and colleagues (19). Relevancy rates were calculated by dividing the number relevant sites found through these search engines by the total number of sites found. Relevant sites were determined on the basis of quality and substantiation of information, comprehensiveness and objectivity. Using the search engine "HotBot", relevancy rates ranged from 10% for ".com" domains to 24% for ".edu" and ".org" domains. Overall relevancy rates when using the "Yahoo" search engine was 20%. The HotBot search engine was marginally more robust with respect to retrieving web sites relevant to the search topic. The authors conclude that, in light of the exponential growth of patient education resources available on the Internet, the number of such sites which provide complete, nonbiased information represents a small percentage of the total.
Similar results were reported in a study of health information and interactivity concerning female urinary incontinence (20). A total of 75 web sites, from academic, health care professional and commercial organizations were evaluated on the basis of several criteria including authorship, source citation, currency and balance. While there was significant variability among academic, professional and commercial sites across these criteria, 54 sites (72%) did not provide authorship of content, 50 sites (67%) did not provide source citations, 32 sites (43%) gave no indication as to currency of content and 34 sites (45%) were deemed biased in favor of commercial products or services. These results point to significant challenges with respect to overall reliability of patient education materials found on the Internet.
The author also submitted an email request for advice from a fictitious patient to each of the 75 web sites in the study. While two thirds of these sites responded to the request and, while the author suggests that information retrieved in this manner provides advice and comfort to women with urinary incontinence, there is no evidence offered which suggests that patients are able to objectively appraise such information in light of issues of reliability and credibility uncovered by the results of this study.
Reliability of information for parents on the Internet, relevant to established guidelines for managing fever in children, has been evaluated (21). A total of 41 web sites were retrieved and evaluated according to minimum temperature cited for fever, optimal sites for accurate temperature measurement, pharmacological and physical management of fever and conditions which warrant examination by a physician. Only 4 web pages (10%) adhered closely to recommended guidelines, 9 web pages (21%) provided clear direction with respect to taking a rectal temperature and 10 web pages (24%) provided accurate dose and frequency information concerning administration of antipyretics.
In addition, several web sites advocated administration of either unproven (ibuprofen) or contraindicated medications (salicylates) in the management of fever in children. Others advocated inappropriate methods to reduce body temperature, suggesting strategies of sponging (cold or alcohol) which may raise the thermoregulatory set point or, in the case of alcohol sponging, lead to alcohol inhalation induced hypoglycemia and coma in children.
These findings led the authors to conclude that that information found on the Internet must not only be complete and accurate but should be tailored to meet the specific learning needs and skills of its intended audience, in this case parents, a view shared by others (22,23).
In his commentary concerning this study, Wyatt (24) concludes "although the web makes it absurdly easy to disseminate information, by allowing anonymous authors to conceal commercial or other conflicts of interest, it does not help readers discriminate between genuine insight and deliberate invention" (p.1879). The author calls for a more systematic method of evaluating and insuring accuracy and completeness of information found on all health-related web sites for fear of "drowning in a sea of poor quality information" (p.1880).
In a recent commentary concerning issues of quality assurance for health-related information found on the Internet (25), Mcleod concludes "there is growing concern that a substantial proportion of clinical information on the Internet may be inaccurate, erroneous, misleading, or fraudulent, and thereby pose a threat to public health. It is also a concern that given the ambit of the Internet, the potential audience for misleading or dangerous information is enormous" (p. 1663). This has led to the need for quality assurance instruments that measure authorship, attribution, disclosure, scientific quality, accessibility, timeliness and readability. Yet, were such instruments to be developed, health care professionals must still assume responsibility in critically evaluating health information found on the Internet.
Others (12) agree with Mcleod and go on to suggest that "the time has come to discuss vigorously how a basic set of standards can be developed and applied in an electronic context. Such standards are built on a foundation of accountability - principles that amount to a framework for critical thinking, allowing professionals to reasonably judge whether what they are reading is credible, reasonable and useful and to make informed decisions about how to apply this information to the real world" (p. 1244).
Given that the number of papers published annually in the biomedical sciences is now approaching two million (26), means whereby health care professionals can best keep abreast of and integrate new knowledge into clinical practice are much studied. Indeed, the Research and Development Resource Base in Continuing Medical Education (RDRB/CME), maintained by McMaster University and University of Toronto, Canada, now contains over 8000 references to the literature of continuing health professional education (27,28).
Further, estimates of primary care practitioners who are not aware of, or do not use, new research and evidence relating to current practice range from 20% to 50% (29). Similarly, the level of current knowledge with relevance to clinical practice is known to decrease with number of years in practice (30,31,32,33). Yet, most medical professionals are highly motivated to maintain knowledge currency as personal standards of achievement and need to validate both knowledge base and practices are most often cited as the primary reasons for participating in continuing medical education programs (34).
The sheer volume of new knowledge published annually in the biomedical sciences, the growing interest in how best to maintain a professional knowledge base and practice standard and the challenges posed for health care professionals to remain current during the course of practice, all point to the need for ongoing knowledge and skill development to ensure both currency and relevance of care provided within an ever-changing health care environment (35).
Specialty certification for health care professionals and, specifically, physicians, has been documented as early as 1300 where Venetian licensed practitioners were required to attend annual refresher courses in anatomy (36). More recently, the need for systematic CME was first addressed by the American Medical Association in 1955 which, after much trial and error, led to the formation of the Accreditation Council for Continuing Medical Education (ACCME) (37,38,39,40,41,42).
Outside the United States, CME is receiving greater attention within many national and international organizations including the World Health Organization, European Union of Medical Specialists, World Federation for Medical Education, European Academy of Medical Training, the Royal Australasian College of Physicians, the Royal College of Physicians and Surgeons of Canada and others thereby making the quality and impact of CME on clinical performance and patient care issues of international interest and priority. Specifically, there appears to be growing agreement that clear accreditation guidelines, policies on ethical delivery of CME and determining and promoting competencies of CME providers are important requirements to establish professional and international standards of clinical competence and practice (43,44,45,46,47,48,49).
Yet, despite this growing attention and recognition of need to provide career-long learning opportunities to health care professionals, how best to design, implement and evaluate such programs remain incompletely understood (50,51,52,53,54,55).
Two fundamentally different approaches to continuing education, commonly utilized across a wide variety of continuing medical education programs, lie at the heart of this uncertainty: teacher-centered approach to learning and student-centered approach to learning (56). The teacher-centered approach to learning emphasizes the teacher and what is taught and involves conventional or "surface" strategies of teaching including lecturing and recall-based examinations. In contrast, student-centered learning emphasizes the learner as an active participant and what is learned by encouraging a "deep" approach to learning (57,58).
In the case of teacher-centered learning, such traditional styles of expert led teaching remain the cornerstone of continuing medical education (50,59). Yet, exclusive reliance on these methods to maintain knowledge currency and competent clinical practice has proven ineffective in achieving meaningful or permanent change in practice behaviors (60,61).
For example, Davis and colleagues (51,52,60,62) published a series of reports wherein the literature concerning effectiveness of different types of educational interventions in improving health professional performance and health outcomes was evaluated.
While the number of studies which satisfied the authors’ criteria for inclusion was relatively small, when used as the primary method of continuing medical education, "dissemination-only" strategies, such as formally planned conferences or review of education materials, including clinical guidelines, demonstrated little or no change in health professional behavior and had no discernable effects on health outcome of patients. The authors conclude that teacher-centered means of continuing medical education, involving formal conferences or review of education materials, effect little meaningful impact on professional practice, a conclusion shared by others (50,63,64,65,66,67,68,69).
Similar results were reported by Lomas and colleagues who investigated the impact of newly published guidelines on the trial of labor and frequency of vaginal delivery in women with previous cesarean section (70). When used as the sole method of education, or in combination with clinical performance audit, independent review of these newly published guidelines had no impact on either trial of labor or vaginal delivery rates. However, when used in combination with other more creative approaches to continuing education, including reinforcement provided by an opinion leader in obstetrics, rates of both labor trial and vaginal delivery were significantly higher, 46% and 85%, respectively, while duration of hospital stay was significantly lower. Similar results have been reported by several others (71,72,73).
Reasons cited as to why teacher-centered learning appears to be ineffective are varied and none has been sufficiently studied to be conclusive (56). Such teaching methods may reduce learners to passive listeners, of whom little preparation or participation is required in evaluating individual clinical competence or performance (74).
Most teacher-centered activities are designed for large groups and, as such, cannot identify or address individual learning needs and provide limited, if any, opportunity for individual engagement and feedback. Furthermore, knowledge gained through such venues is recall-based, which may not be accurately or completely remembered in patient care situations (75).
Donen (35) argues that such conventional or surface approaches to continued learning frequently mandate only attendance as evidence of participating in a continuing medical education event. Providing only evidence of attendance offers no guarantee of meaningful and permanent changes in attitude, motivation or current practice patterns. Further, such programs are not typically developed following principles of adult learning and, as such, may be interpreted as punitive by health care professionals who are, in the main, strongly motivated to engage in student-centered learning activities.
Finally, specific education strategies utilized in teacher-centered venues frequently involve heavy workloads, provide excessive amounts of course material, offer little opportunity to either choose or explore subjects in depth, involve means of evaluation which frequently provoke anxiety and reward only recall of factual information (56).
Yet, teacher-centered strategies, including formally planned conferences and reading materials, do provide effective venues for health care professionals to keep abreast of new developments in health care and should not be completely dismissed as inadequate methods of imparting up-to-date information (42). This is particularly true when the objectives of such events and venues are clearly defined and communicated to attendees and participants (76).
In contrast to teacher-centered approaches to learning, there is growing consensus that continuing medical education venues grounded in principles of both adult and student-centered learning may lead to greater and more permanent changes in clinical knowledge and performance (56,77,78,79,80).
Adult and student-centered approaches to learning are the educational strategies most likely to produce health professionals prepared for life-long learning and able to meet the ever changing needs and demands of the health care setting. Such approaches foster "deep" learning and provide a context in which students are highly motivated, actively take part in learning and explore and navigate through a well structured knowledge base. Further, adult and student-centered approaches to learning appear most effective when learning is experience-based wherein new knowledge and understanding are easily integrated into both personal and professional contexts of a learner (81).
The table below summarizes key elements of both adult and student-centered learning (Adapted from 56, 82, 83):
Table 4. Key Elements of Adult and Student-centered Learning
| Strategy | Key Elements |
| Student-centered Learning | The student initiates the following:
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| Adult Learning | The student is motivated by learning which:
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Several formats for adult and student-centered learning have been developed including both "problem-based learning" and "guided discovery learning". Problem-based learning is receiving considerable attention in the education and medical literature and is generally understood to mean a strategy whereby students identify clinical situations which require explanation and new knowledge. Understanding of underlying principles and concepts is gained through small group, collaborative, problem solving (56).
Some 10% of medical schools world-wide have adopted problem-based learning curriculums and recent evidence suggests that problem-based learning offers an effective alternative to more conventional means of learning by enhancing motivation to learn, improving knowledge recall and facilitating integration of new knowledge and learning into clinical practice (84,85,86,87,88).
Guided discovery learning combines both teacher-centered and student-centered approaches to learning which enable both discovery and exploration of knowledge, while making the learner responsible for mastery of understanding (89). Study guides are typically used to facilitate and guide student directed learning by establishing specific learning objectives, providing appropriate learning resources and enabling students to evaluate understanding of new knowledge (56).
While enthusiasm for student-centered strategies for continuing medical education is growing, research which clearly establishes these methods as preferential to teacher-centered means of learning is lacking and several authors suggest that, in addition to the need for further research, a combination of teacher-centered and student-centered approaches will likely prove most effective (56,90,91,92).
The ability of computers and IP-based networks to combine, control, reduce cost of distribution and incorporate communication technologies into digital media make computer aided continuing medical education appealing. Technology innovations, including CD-ROM, World Wide Web (WWW) and WWW-enhanced television, provide immediate, inexpensive access to visual, audio and text information relevant to medical education, all accessed at the convenience of individual learners. When designed following sound principles of teacher-centered and student-centered learning, these technologies make possible learning programs of relevance to communities of learners around the world who share a common and ongoing need to learn (93,94,95).
As is the case with non-digital approaches to teacher-centered and student-centered continuing medical education, comprehensive research of how best to utilize computer and IP-based technologies to create meaningful continuing medical education programs is lacking. Campbell and Johnson (96) found 258 articles within the medical literature wherein computer aided learning programs were described and, while 77% of these articles cited positive effects on teaching and learning, few referred to established education principles (24%) or education theory (7%).
They conclude that the majority of such programs, while positive, is grounded more in common sense than in sound education principles. They call for clarification and standardization of these principles which, when applied to well designed research, would lead to an evidence-based medical education system responsive to an ever changing health care environment.
Yet, consistent with the "common sense" advantages of such learning approaches, health care professionals around the world are increasingly accessing computer and IP-based learning and communication and are willing to pay for such access to high quality education programs. There is evidence to suggest that the instantaneous access to information and learning afforded by these technologies favorably impact patient care and length of hospital stay (97,98,99). Further, initial studies indicate that the impact of computer-based education on short- and long-term learning is equal to, if not greater than, more conventional means of learning including a variety of non-digital teacher-centered and student-centered approaches (100,101,102,103,104,105).
The table below contains an abbreviated list of reviews of computer and IP-based programs developed across a number of specialties:
Table 5. A Sample of Computer and IP-based Medical Education Programs
| Specialty | Technology | Purpose | Reference |
| Physiology | IP IP | Pulmonary CME Study of Membrane Potentials | 99 105 |
| Oral Health | IP IP Computer, IP IP IP IP | Problem Based Periodontology Maxillofacial Surgery Technique Dentistry Training Basic and Continuing Education Continuing Education Information Exchange | 106 107 108 109 110, 111 112 |
| Neurology | IP IP IP Computer | Information Exchange, Retrieval Email Discussion List Pediatric Neurology Resources 3 Dimensional Imaging | 113, 114 115 116 117 |
| Anesthesiology | IP Computer, IP | Quality of Internet Mailing Lists CME for Anesthesiologists | 118 119 |
| Urology | IP IP Computer IP IP | Information Sharing Medical Student Training Medical Student Training Image and Information Sharing Continuing Education | 120 121 122 123 124 |
While there are many other such programs across these and other specialties, generally speaking, these programs are developed for relatively small, localized audiences and are integrated within more complete and conventionally delivered curricula. As such, they tend to fulfill locally-defined learning objectives and do not tend to the need to establish global standards of continuing health professional education and practice.
The Global Center for Knowledge in Neurology (GCKN) is being developed to address issues addressed thus far, namely:
- Exponential growth in computer and Internet access
- Tripling of percentage of total revenue IT spending within the health care industry by 2005
- Increasing prevalence of unregulated and often inaccurate information published on the Internet
- Need for measures of authorship, attribution, disclosure, scientific quality, accessibility, timeliness and readability of electronically published materials
- Need for internationally accepted standards of continuing education for health care professionals
- Uncertainty as to how best to integrate teacher-centered and student-centered learning strategies
- Benefit of computer and IP-based learning programs in providing cost-effective and instantaneous access and potential impact on patient outcomes
Through computer and IP-based technologies, hereafter referred to as netmedia, the mandate of the GCKN is to bring together the global Neurology community to engage in career-long learning, contribute to development of an international standard of Neurology CME and preserve the integrity of netmedia-based learning.
The basic components of the Global Center for Knowledge model are depicted in the diagram below:
Figure 1. Global Center for Knowledge Model
The Global Center for Knowledge (GCK) is surrounded by those with vested interests in a given domain of learning, each serving an important function to guarantee success and longevity of the center: Knowledge Experts, Global Benefactors, Learners and Commercial Interests.
Knowledge Experts are affiliated with a world recognized health care institution and are known for their contributions and expertise in a given health care discipline. Learners comprise a global community of specialists who share a common and ongoing need to learn. Learners access a GCK through annual subscription fees that help defray development costs and enable ongoing improvement and refinement of modules. Further, Learners are motivated to learn and, in a growing number of instances, must provide ongoing evidence of continuing health care education to their organizing bodies and professional associations.
Global Benefactors consist of noncommercial professional associations, state and federal level ministries and departments of health and global organizations, all of which have a vested interest in making the knowledge within a GCK available to their respective health care professionals. Such benefactors provide a GCK to their health care professionals free of charge through licensing arrangements.
Finally, Commercial Interests represent the commercial health care industry which provide products and services to the group of Learners within the GCK. Commercial Interests do not fund development of the GCK but do play an important role is globally distributing the program once complete.
The GCK itself is comprised of a number of netmedia modules, each comprised of teacher-centered and student-centered learning technologies and strategies and each focusing on a given subspecialty within a domain of learning. Knowledge Experts provide "raw content" to the center on an ongoing basis as their contribution to knowledge development.
This raw content is then modified by "expert translators", experts in netmedia-based curriculum design and distance education, who carefully construct content structures for each module and then apply optimal learning strategies to the content. In doing so, each module is comprised of integrated print, CD-ROM and Internet technologies with the identical content structure applied to each of these three components. In addition, each module is developed free of third party influence and, as such, offer authoritative, timely and unbiased knowledge and learning.
Both print and CD-ROM components of an integrated module represent the fundamental standards of knowledgeable and competent clinical practice. The print component is comprised of high resolution images and concise text while the CD-ROM component is comprised of high bandwidth content including video, audio, high resolution images and text. Once this standard is created, the Internet component is used to expand upon fundamental understanding through scheduled publishing of content that follows the content structure of the module.
This process of "dynamic publishing" is facilitated by three basic IP-based technologies that enable posting, discussion and rigorous testing of understanding of new content. Further, given that dynamic publishing follows the content structure of a module thereby enabling a predetermined publication schedule, knowledge experts know their publishing obligations for a GCK well in advance and, similarly, learners can schedule focused learning up to one year in advance.
Development and distribution of digital content and web server hosting, maintenance and upgrading are undertaken by our development partner that shares our mandate of providing global communities of learners with authoritative, timely and unbiased knowledge and learning. These ongoing duties require extensive resources which go beyond our capacity and include expert translators, application programming, computer and IP systems management, creative design, business management, legal, marketing and sales.
Accreditation for continuing medical education is sought during development of each module through national and international accrediting bodies including the Royal College of Physicians and Surgeons of Canada and the European Union of Medical Specialists. The standards these accrediting bodies apply to the modules of a GCK insure that each module reflects learner input, is developed by a knowledgeable planning committee, has clearly defined learning objectives, incorporates teacher-centered and student-centered learning activities, enables learner-to-learner and learner-to-expert interaction and provides learners with opportunities to evaluate understanding through testing and feedback.
When applied to Neurology the GCK model takes the current configuration as depicted in the diagram below:
Figure 2. The Global Center for Knowledge in Neurology - GCKN
At the present time, we are focusing our efforts on development of Migraine, the first of many Neurology modules within the GCKN. Other modules to be developed for the GCKN include Seizure Disorders, Cerebrovascular Disease, Neuro-oncology, Trauma, Neuromuscular Disease and Behavioral Neurology. Other institutions, known for their expertise in one or more of these areas of Neurology, have opportunity to participate in development of these future modules.
Accreditation for Migraine is currently being sought through Mayo Clinic’s Office of Continuing Medical Education and well as the European Federation of Neurological Societies, the Neurology arm of the European Union of Medical Specialists. Work is now well underway on development of the module with an anticipated global release date of September 2000.
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[Health Informatics] |
[Neurology] |
