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A - Evaluation of an online medical teaching for

A - Evaluation of an online medical teaching for
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   7 274   © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 274–278 e-Learning & Technology  Evaluation of an online medical teaching forum Rahul Ravindran , Mavin Kashyap , Lydia Lilis , Sayinthen Vivekanantham and Gokulan Phoenix ,  Faculty of Medicine , Imperial College School of Medicine , Imperial College London , UK SUMMARY Background : Social media is increasingly being used for teaching and assessment. We describe the design and imple-mentation of a Facebook© teaching forum for medical students, and evaluate its effectiveness. Methods : A Facebook© teaching forum was set up in a London Hospital to assist with learning and assessment for undergraduate medical students. An independent online survey was used to collate their experiences. Accessibility to the forum, usefulness in stimulat-ing peer-to-peer discussion and the use of weekly formative assessments were evaluated using a Likert scale. Results : In total, 91 per cent ( n = 68/75) of students who had Facebook© joined the teaching forum. The majority of students completed the questionnaire ( n = 39/68, 57%). All students visited the teaching forum group at least once a week. A signifi-cant proportion attempted all 10 question sets ( n = 16/39, 41%). Students felt more comfortable asking questions in the forum than in ward rounds and clinics ( n = 22/39, 56%). The general consensus was that Facebook© could be used for educational purposes, with just 5 per cent of students ( n = 2/39) thinking that Facebook© should only be used socially and with 92 per cent believing that the forum helped to achieve the learning objec-tives of the curriculum ( n = 36/39). Discussion : Facebook© provides a safe environment for learning and discussion amongst medical undergraduates undergoing their clinical attachments. Furthermore, through formative assessments set by a medical educator, it provides a useful revision tool for summative assessments and reinforces knowledge learned through conventional teaching methods. Social media is increasingly being used for teaching and assessment   © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 274–278 275  INTRODUCTION F  acebook© is a social network-ing website that recently crossed the billion user mark, 1 and is increasingly used for educational purposes. American-based teachers of a pharmacology course recently reported their use of Facebook© to deliver part of the syllabus. 2 Furthermore, a survey of 759 medical students in an Australian institution showed mixed success for the use of Facebook© as an educational tool. 3 Although other fields have explored the use of Facebook© in an undergraduate educational setting, such as mathematics, 4 the use of Facebook© within medicine has been limited. 3 From our literature search we found no reports of Facebook© being used as an assessment tool in the field of medical education. We present the implementation and evaluation of a teaching forum for medical students on clinical attachments. This was established within a restricted-access Facebook© group specifically for the purposes of peer-to-peer teaching and formative assessment. METHODS Ethical approval was sought from the director of clinical studies at the hospital. Establishing the teaching forum A Facebook© group was set up by a teaching fellow (GP) under a dedicated profile, in conjunction with two medical students (MK and LL). All three were administrators. The medi-cal students were responsible for encouraging colleagues to  join, ensuring adequate group privacy settings and monitor-ing the group for offensive or non-educational activities (both of which resulted in expulsion from the group). Furthermore, students that joined the group were advised to alter their privacy settings to restrict what was accessible by the teach-ing fellow compared with their Facebook© friends. The group was private and entry was on an invitation-only basis by the administrators. The teach-ing forum was not manda-tory for students, nor was it an official part of the university curriculum. Teaching forum Ten formative assessments (not contributing to degree results and designed to aid the learning pro-cess) were posted by the teaching fellow on a weekly basis in the style of extended matching ques-tions (EMQs) and single best an-swers (SBAs) (Figure 1 ). An empty textbox was provided for justi-fication for answers, along with references. Individual students submitted answers to an e-mail address created by the teaching fellow, and the correct answers were released on the forum for discussion when 60 per cent of students had replied. The discussion board allowed students to ask questions related to topics across medicine and surgery, as well as share their experiences of their attachments. Peers were encouraged to answer each other ’ s questions, making reference to the highest-grade evidence where possible. The teaching fellow only interjected if incorrect information was provided or if higher grades of evidence were available. Students were explicitly told to anonymise details that could identify a certain patient, with failure to do so resulting in expulsion from the group. Evaluation of the teaching forum The individual experiences of students were evaluated retro-spectively using an independent online survey (SurveyMonkey©). A Likert scale with five op-tions was used to assess usage, accessibility and usefulness, in relation to revision towards Peers were encouraged to answer each other’s questions  e. Digoxin LEAD II, 25 mm/sec, 10 mm/mV c. Atropineb. Beta-blockera. Intravenous adenosineA 59-year-old male presents in syncope. The most appropriate management would be:d. Synchronised DC shock  Figure 1 .  Example of a question written by the teaching fellow  276   © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 274–278 summative assessments (where marks contribute to the degree result). RESULTS Group usage In total, 76 per cent ( n = 75/99) of clinical students based at the hospital had a Facebook© profile, of which 91 per cent ( n = 68/75)  joined the teaching forum. A to-tal of 112 posts were made. None of the students were expelled from the group. Survey results Tables 1 and 2 provide a sum-mary of the findings: 57 per cent ( n = 39/68) of students com-pleted the questionnaire; 69 per cent ( n = 27/39) of the students who responded used Facebook© more than once a day. All students visited the teaching forum group at least once a week. Most students spent more than 30 minutes studying for the questions set in the forum ( n = 29/39, 74%), with 41 per cent ( n = 16/39) at-tempting all 10 question sets. Furthermore, students agreed that they felt more comfortable asking questions on the forum than at ward rounds and clinics ( n = 22/39, 56%). The general consensus was that Facebook© can be used for educational purposes ( n = 35/39, 90%), and that the forum helped to achieve the learning objectives of the curriculum ( n = 36/39, 92%), as a supplement to the main teaching. Finally, on speaking collectively to the entire group of students, there were no strong objections to the use of Facebook© for teaching purposes. DISCUSSION We have demonstrated that Facebook© can be used as an effective peer-to-peer teach-ing and formative assessment tool in the clinical setting, as initially envisaged by the authors. Benefits include ease of access for members whilst maintaining privacy, an issue previously reported to be a limiting factor in establish-ing teacher–student commu-nication using Facebook©. 3,5 Previous studies have shown an inverse relationship between the time spent on Facebook© and academic results. 6 This is perhaps because of the addic-tive nature of Facebook©, as evidenced by the recent crea-tion of a scale for Facebook© addiction. 7 Nevertheless, we believe that Facebook© can be used for educational purposes in the medical undergradu-ate curriculum if implemented appropriately. A study at an Australian medical school has shown that out of all active Facebook© users ( n = 660), one-quarter of students had used the site for educational purposes. Of the remaining students, half were open to using it for this pur-pose. 3 This suggests that although students might be Benefits include ease of access for members whilst maintaining privacy Table 1 . Likert scale question responses Question Strongly agree n (%) Agree n (%) Neutral n (%) Disagree n (%) Strongly disagree n (%) I felt comfortable posting questions on the Facebook© page 13 (33.3) 15 (38.5) 9 (23.1) 2 (5.1) 0 (0) It was easier to ask questions on Facebook© compared with during clinical scenarios such as ward rounds or clinics 6 (15.4) 16 (41) 12 (30.8) 5 (12.8) 0 (0) I didn ’ t like the group because I think Face-book© should only be used socially 0 (0) 2 (5.1) 2 (5.1) 18 (46.2) 17 (43.6) Overall, the ‘Teaching Group’ supplemented my learning relevant to my exam 15 (39.5) 21 (55.3) 2 (5.3) 0 (0) 0 (0) Table 2 . Extent of Facebook© usage amongst students Question >7 times n (%) 3–7 times n (%) 2 times n (%) 1 time n (%) <1 time n (%)s In general, which option best describes your Face-book© usage per week? 27 (69.2) 7 (18) 2 (5.1) 1 (2.6) 2 (5.1) Roughly how often did you visit the ‘Hillingdon Teaching Group’ during the week the questions were set 0 (0) 14 (35.9) 18 (46.2) 7 (17.9) 0 (0)  © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 274–278 277 keen to use Facebook© in an educational setting, they may not have a suitable platform available for them to use it in this way. We found that 92 per cent ( n = 36/39) of students felt that the teaching group supplemented their learning relevant to exams, and  just 5 per cent ( n = 2/39) disliked the group because they thought Facebook© should only be used socially. Active participation was encouraged in order for feedback to be released (with a 60% submission rate required). We believe that this played a role in encouraging participation, as evidenced by all students accessing the group at least weekly. Learning styles Bedside teaching encompasses learning by concrete experi-ence as well as testing in new situations (active experimen-tation). 8 Our teaching forum complemented this format of learning by providing a platform for observation and reflection, and forming abstract concepts. This completes the learning cycle as described by the Lewinian experiential learning model, and cements learning for the student. 8 Furthermore, together, clini-cal teaching and the teaching forum accommodate all learning styles. Clinical education is often criticised by students for not being standardised. The Facebook© group is a focused way of supplementing key concepts of the curriculum to all students at the same stage of their medical education, and at the same pace. This highlights areas that students need to work on and lets them gauge the level of detail required for that topic. Our solution not only reduces the variability of the experiences of different medical students, but also provides an area for sharing these experiences for others to learn from. The majority of students agreed that it was easier to ask questions on Facebook© com-pared with ward rounds or clinics. The teaching forum provided a safe group to post queries, without feeling intimidated or embarrassed by seniors. Furthermore, as students were online whilst using the group, simple questions could be easily answered through web searches, prior to posting on the group. This encouraged students to research their questions, which is not always possible in a clinical setting, and reduced the number of trivial questions posted to the group. Currently used online resources at our institution Blackboard© is an established re-source used at our institution, as well as many others, to manage online learning. Facilities include banks of assessments, handouts and lecture slides, in addition to other resources. The Facebook© group may be perceived to be equivalent to Blackboard©, or other such online resources; how-ever, the significant difference is that most students already use Facebook© for social purposes and are likely to visit this site more frequently. 9 We believe this unique aspect of our delivery of teaching is what sparks conver-sation and allows it to flour-ish, which is a critical process in students engaging with the questions that are set. If educa-tors adapted to what students regularly use, rather than try to unnecessarily implement a new system, it is more likely to be well received. Limitations Joining the Facebook© teaching forum was on a voluntary basis, and required a Facebook© profile, which some students did not want; however, we see Facebook© as a supplement to learning as opposed to a replacement, and all students had the option to join if they wanted to. This may also explain the lower than expected questionnaire response rate, as the teaching forum was not part of the core curricu-lum and there was no specific incentive to complete it. We at-tempted to increase the response rate by contacting students on their college e-mails as well as messaging through Facebook©; however, with the timing of the questionnaire being during the student holiday period, it was difficult to improve the response rate. Facebook© usage may lead to an increased chance of unprofes-sional behaviour being seen by the public. 10 Maintenance of the forum required continuous monitoring to ensure confidenti-ality and to prevent deviation of the group from educational purposes. We accept that confidentiality may be inadvert-ently broken whilst using Facebook©, but the private group set-up greatly limited this. Additional teaching fellows would be required to establish the group at other hospital sites; however, if more teaching fellows were involved, the workload of creating new questions could be shared. Concluding remarks The Facebook© teaching forum is an effective way of supple-menting the medical curriculum. From our experience, we found Facebook© to be a safe environ-ment for students and educa-tors to post questions for each other. In future it would be of interest to investigate correla-tions between forum use and summative assessment perfor-mance, as well as harnessing the constantly updated functional-ity of Facebook©, for example Facebook© Docs. We propose that medical educators look into the use of Facebook© as both a teaching and assessment tool at their institutions. Clinical teaching and the teaching forum accommodate all learning styles   278   © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 274–278  REFERENCES 1 . Facebook . Facebook – key facts . Available at . Accessed on 16 April 2013. 2 . Estus EL . Using facebook within a geriatric pharmacotherapy course .  Am J Pharm Educ 2010 ; 74 : 145 . 3 . Gray K , Annabell L , Kennedy G . Medical students’ use of Facebook to support learning: insights from four case studies . Med Teach 2010 ; 32 : 971 – 976 . 4 . Goodband JH , Solomon Y , Samuels PC , Lawson D , Bhakta R . Limits and potentials of social networking in academia: case study of the evolu-tion of a mathematics Facebook community . Learning, Media and Technology 2012 ; 37 : 236 – 252 . 5 . Hew KF . Students’ and teachers’ use of Facebook . Computers in Human Behavior 2011 ; 27 : 662 – 676 . 6 . Kirschner PA , Karpinski AC . Facebook© and academic per-formance . Computers in Human Behavior 2010 ; 26 : 1237 – 1245 . 7 . Koc M , Gulyagci S . Facebook Addiction Among Turkish College Students: The Role of Psychological Health, Demographic, and Usage Characteristics . Cyberpsychology, Behavior, and Social Networking 2013 ; 16 : 279 – 284 . 8 . Kolb DA . Experiential Learning: Experience as the Source of Learning and Development . Englewood Cliffs, NJ: Prentice-Hall , 1984 . 9 . DiVall MV , Kirwin JL . Using Facebook to facilitate course-related discussion between students and faculty members .  Am J Pharm Educ 2012 ; 76 : 32 . 10 . Garner J , O ’ Sullivan H . Facebook and the professional behaviours of undergraduate medical students . Clin Teach 2010 ; 7 : 112 – 115 . Corresponding author ’ s contact details: Rahul Ravindran, Imperial College School of Medicine, Imperial College London, South Kensington, London, SW7 2AZ, UK. E-mail: Funding: None. Conflict of interest: None. Ethical approval: Ethical approval was sought from the Director of Clinical Studies at the hospital, and standards of the Declaration of Helsinki were maintained. doi: 10.1111/tct.12139 The Facebook© teaching forumis an effective way of supplementingthe medical curriculum
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