Unit 4 Assignment 1 – “DLE and DME”

Photo by Dom Fou on Unsplash.

For this assignment, I thought it would be interesting to try a video blog discussing the design and impact of a digital learning environment (DLE) that I had the opportunity to contribute to at a distributed medical education (DME) campus. It is a very niche topic and I wasn’t sure if anyone would be interested in participating. Thankfully, Stephen volunteered to partner up and we recorded the following video. I truly enjoyed the dialogue with Stephen and I look forward to an opportunity for him to chat with me about a topic he is passionate about in the future.

I recommend this activity to anyone in our cohort. From our interactions so far, it’s clear that there is a wealth of experience and unique knowledge we can all share across our group.

From a critical standpoint, were I to do this again, I would develop a more detailed script to practice the points and more clearly tie them back to the source literature. This was a very high-level conversation, but any of the topics could be a standalone discourse.

Impacts of digital learning on distributed medical education

• Distributed medical education (DME) has been implemented in various models across Canadian medical schools where all sites are required to meet the accreditation standards and elements set forth by the Committee on Accreditation of Canadian Medical Schools. (CACMS, 2023; COFM, 2014; Ellaway & Bates, 2018; Bakker, 2018)

• DME was implemented to address capacity issues in Academic Health Science Centres (AHSCs), address workforce issues and increase support to underserved populations, particularly in rural and remote communities. (Ellaway & Bates, 2018; AFMC, 2010)

• The development of DME in Canada was exceedingly difficult and only possible with access to synchronous bi-directional communication tools like videoconferencing. (Ellaway & Bates, 2018; Sargeant, 2005)

• [Stephen’s notes starting here] One challenge with distributed medical education sites is demonstrating equivalence of opportunity across different sites. (Ellaway & Bates, 2018) Will someone in Okotoks, just south of Calgary, have the same learning opportunity as someone in Cressday, which is 400 kms away? Chris noted that these sites are governed by the Committee on Accreditation of Canadian Medical Schools (CACMS) to ensure equivalency and not sameness to allow for equivalent opportunities in education. (CACMS, 2023)

• Researcher Joan Sargeant, at Dalhousie University, found that when using digital deliveries for education, the temptation is often to focus more on the technology and less on the learners and instructors, often to the detriment of the educational quality (Sergeant, 2005). Chris shared that the opposite can also happen: instructors may wander out of frame, forgetting about the camera and its microphone.

• Adapting pedagogies and teaching behaviours to support success through videoconferencing was an ongoing and iterative process. (MacLeod et. al., 2019a; CFMS, 2011; Veerapen, 2010)

• McMaster developed an online curriculum management platform, Medportal, which mapped to, and facilitated compliance with, the CACMS accreditation standards and elements. Medportal provided an asynchronous platform for students to access lecture recordings, schedules, course information, grades, and evaluations. (CACMS, 2023) 

• Hardware-based lecture videoconferencing was a complicated system of analogue and digital audiovisual and network infrastructure and had many similarities to television broadcast, requiring significant support by technicians at all sites (Macleod et. al., 2017; MacLeod et. al., 2019a; MacLeod et. al., 2019b)

• COVID had a very detrimental impact on learning: hospitals had to restrict learner access, and policies were changing rapidly. At the same time, this did facilitate a transition to a heavier focus on videoconferencing, which has sustained in its use.

• Having simulation manikins is vitally important in the understanding and demonstration of concepts. Even then, it is a much different experience when your hands are on a real person who needs intervention. Modern simulation manikins have remote-administration capabilities, which can allow for trainees based in rural areas to interface with instructors in bigger centres. (Dag, et. al, 2002; Ayaz, 2022)

• McMaster developed mobile apps to digitize in-the-moment essential clinical encounters (ECE Tracker) and directly observed entrustable professional activities (MacDOT EPA). The apps allowed easier recording of in-the-moment learning activities and reduced the paperwork burden of both learners and faculty. (Levinson et. al., 2019)

• In February of this year, the Alberta provincial government cut service at hospitals in nine communities. Eight of those lost their emergency departments. This is driven primarily by a lack of physicians in the communities. In the absence of local capacity, EMS is rerouted to health facilities in surrounding communities. (Siever, 2024)

• When clinics and hospitals are closed, where does the distributed medical education happen? Can digital education backfill that experience? Chris believes that to a certain degree, it will, but these approaches are still being developed.

• Joan Sargeant’s research found that rural locations often experience decreased access to education, due to factors such as distance from a clinical teaching centre, limited availability of current medical information… and that working in isolated environments, like rural areas, where access to peers, education and information is limited, is one of the highest risk factors for physicians’ loss of medical competence. 

• Sargeant also notes that in “undergraduate and residency education, videoconferencing use is increasing and includes students and residents in rural and distributed sites”. So does the increased use of videoconferencing help to mitigate that loss of competence? Physicians and surgeons have access to libraries, databases, and source materials. They are also required to undergo a certain amount of professional development each year, to maintain their credentials. Videoconferencing is used as a part of this training, alongside other methods.

– There is evidence that learners educated in DME communities stay and practice in 

the region of training. (Utzschneider & Landry, 2018; Lovato et. al., 2019). However, resolving the gap in rural and community family medicine is complex requiring further incentives and research. (Bakker et. al., 2020; Lovato et. al., 2019)

References/Sources

Ayaz, O., & Ismail, F. W. (2022). Healthcare simulation: A key to the future of medical education – A review. Advances in Medical Education and Practice, 13, 301–308. https://doi.org/10.2147/AMEP.S353777 

Bakker, D., Russell, C., Schmuck, M.L., Bell, A, Mountjoy, M., Whyte, R., Grierson, L. (2020). The relationship between regional medical campus enrollment and rates of matching to family medicine residency. Canadian Medical Education Journal,11(3): e73-e81. https://doi.org/10.36834/cmej.69328 

Committee on Accreditation of Canadian Medical Schools (CACMS). (2023) CACMS standards and elements: Standards for accreditation of medical education programs leading to the M.D. degree. CACMS. https://cacms-cafmc.ca/for-schools-with-visits-in-2023-2024/ 

Council of Ontario Faculties of Medicine (COFM). (2014) Distributed medical education in Ontario: Program compendium 2014. COFM. https://cou.ca/reports/distributed-medical-education-program-compendium/ 

von Lubitz, D. K., Carrasco, B., Levine, H., Pletcher, T., Gabbrielli, F., & Patricelli, F. (2002). Simulation-based medical education: Advanced distributed learning as a tool for the future. MedSMART Inc.

DeRosa, K. (2022, June 2). Telus Health’s services under review after allegations of two-tiered medical care. Vancouver Sun. https://vancouversun.com/news/local-news/telus-health-services-review-two-tiered-medical-care 

Ellaway, R., & Bates, J. (2018). Distributed medical education in Canada. Canadian Medical Education Journal, 9(1), e1-e5. https://doi.org/10.36834/cmej.43348 

Hassan, N. & Rogers, E. (2011). Distributed medical education: A student-centred review and best practice recommendations. Canadian Federation of Medical Students (CFMS). https://www.cfms.org/files/position-papers/cfms_dme_paper_-final_for_distribution2.pdf 

Levinson, A.J., Rudkowski, J., Menezes, N., Baird, J., Whyte, R. (2019). Use of mobile apps for logging patient encounters and facilitating and tracking direct observation and feedback of medical student skills in the clinical setting. In: Auer, M., Tsiatsos, T. (eds) Mobile Technologies and Applications for the Internet of Things. IMCL 2018. Advances in Intelligent Systems and Computing, vol 909. Springer, Cham. https://doi.org/10.1007/978-3-030-11434-3_14 

Lovato, C.Y., Hsu, H.C.H, Bates, J., Casiro, O., Towle, A., Snadden, D. (2019). The regional medical campus model and rural family medicine practice in British Columbia: a retrospective longitudinal cohort study. CMAJ Open. 7(2): e415-e420. https://doi.org/10.9778/cmajo.20180205 

MacLeod, A., Kits, O., Mann, K., Tummons, J., Wilson, K.W. (2017). The invisible work of distributed medical education: exploring the contributions of audiovisual professionals, administrative professionals and faculty teachers. Advances in Health Science Education, 22(3): 623-638. https://doi.org/10.1007/s10459-016-9695-4 

MacLeod, A., Cameron, P., Kits, O., & Tummons, J. (2019b). Technologies of exposure: videoconferenced distributed medical education as a sociomaterial practice. Academic Medicine, 94(3): 412-418. https://doi.org/10.1097/acm.0000000000002536 

MacLeod, A., Cameron, P., Kits, O., Power, G., & Tummons, J., (2019a). Teaching and learning with videoconferencing at regional medical campuses: Lessons from an Ethnographic study. Journal of Regional Medical Campuses, 1(6). https://doi.org/10.24926/jrmc.v2i1.1559 

Sargeant, J. M. Medical education for rural areas: Opportunities and challenges for information and communications technologies. Journal of Postgraduate Medicine 51(4): 301-307, Oct–Dec 2005. https://hdl.handle.net/1807/6886 

Siever, K. (2024, May 14). 8 rural Alberta hospitals lost ER service last month. The Alberta Worker. https://albertaworker.ca/news/8-rural-alberta-hospitals-lost-er-service-last-month/ 

Utzschneider, A., & Landry, M. (2018). Impacts of studying in regional medical campus on practice location. Canadian Medical Education Journal, 9(1), e44-e50. https://doi.org/10.36834/cmej.42015 

Veerapen, K., & McAleer, S. (2010). Students’ perception of the learning environment in a distributed medical programme. Medical Education Online, 15(1). https://doi.org/10.3402/meo.v15i0.5168 
The Association of Faculties of Medicine of Canada (AFMC). (2010). The future of medical education in Canada (FMEC): A collective vision for MD education. AFMC. https://www.afmc.ca/resources-data/social-accountability/future-of-medical-education-in-canada/