Wiecha John M, Vanderschmidt Hannelore, Schilling Kathy
Department of Family Medicine, Boston University School of Medicine, MA 02118, USA.
Acad Med. 2002 Sep;77(9):925-6.
The potential of distance learning technology to deliver educational programs in which instruction and evaluation are of a consistent and high standard across multiple settings is hampered by a lack of instructional design models. In response, we developed the HEAL (Heuristic for Electronic Asynchronous Learning) model for designing online curricula.
HEAL is based on the theories that learning is facilitated by independent problem solving, investigation, and discovery (heuristics); collaboration between students fosters learning; and the proven educational cycle of practice, feedback, and reflection is integral to the interrelated domains of skill development and personal awareness.(1) The HEAL model is defined by synergistic online learning activities integrated with real patient care. It is applicable to all medical education levels. We applied this innovative design template to an online curriculum that augments our conventional six-week third-year clerkship. Our students, who were placed in distant family physician offices, needed more interaction and learning from peers and faculty. The three elements of HEAL, and implementation in the "online clerkship," are: (1) Didactic modules teach and illustrate concepts. Students study modules (HTML pages) on management of diabetes (DM), and complete five modules on evidence-based medicine (EBM). They do EBM literature searches reviewed online by peers, faculty, and librarians, who provide feedback. (2) A problem-based case discussion promotes application of concepts from modules (horizontal curricular integration). Students view streamed video of a patient with a history suggestive of diabetes, review her medical chart online, and suggest evidence-based management in an asynchronous discussion group. The case progresses weekly to mimic 12 months of continuity of care. (3) A collaborative journal activity explores the results of applying elements one and two to real patients (vertical integration). Additional elements advance reflection, professionalism, and medical humanism. Participation in the journal discussion group, stimulated by online readings, enhances self-awareness, informs psychosocial aspects of element 2, and promotes generalization of learning objectives to real patients. We use BlackBoard software. Students log in two to three times per week. Faculty who are trained in online moderation facilitate the threaded discussion groups and provide feedback.
Students in alternating clerkship blocks complete the online clerkship. Their performance is compared with that of students who complete a face-to-face diabetes curriculum, but no curriculum on EBM or medical humanism. After nearly a year (105 students), compared with the non-online group, students completing the online clerkship demonstrated greater gains in reported EBM skills from preto post-clerkship, larger increases in mean score (from pre to post) on a medical-humanism aptitude scale, and higher scores on a post-clerkship diabetes management assessment (all comparisons p <.05). The online clerkship will become a permanent part of our clerkship and we have begun to use HEAL to design other online courses, including continuing education courses.
由于缺乏教学设计模型，远程学习技术在提供教育项目方面的潜力受到了阻碍，这些项目要求在多种环境下的教学和评估都具有一致且高标准。作为回应，我们开发了用于设计在线课程的HEAL（电子异步学习启发法）模型。
HEAL基于以下理论：通过独立解决问题、调查和发现（启发法）可促进学习；学生之间的协作能促进学习；实践、反馈和反思这一经过验证的教育循环对于技能发展和个人意识的相互关联领域至关重要。（1）HEAL模型由与实际患者护理相结合的协同在线学习活动定义。它适用于所有医学教育水平。我们将这个创新的设计模板应用于一个在线课程，该课程是对我们传统的为期六周的三年级临床实习的补充。我们的学生被安排在偏远的家庭医生办公室，他们需要更多与同龄人及教师的互动和学习。HEAL的三个要素及其在“在线临床实习”中的实施情况如下：（1）理论教学模块传授并阐释概念。学生学习关于糖尿病（DM）管理的模块（HTML页面），并完成五个关于循证医学（EBM）的模块。他们进行循证医学文献检索，由同龄人、教师和图书馆员在线审核并提供反馈。（2）基于问题的病例讨论促进对模块中概念的应用（横向课程整合）。学生观看一位有糖尿病病史患者的流式视频，在线查看她的病历，并在一个异步讨论组中提出循证管理建议。病例每周推进，以模拟12个月的连续护理。（3）协作式日志活动探索将要素一和要素二应用于实际患者的结果（纵向整合）。其他要素促进反思、专业精神和医学人文主义。受在线阅读启发，参与日志讨论组可增强自我意识，为要素二的心理社会方面提供信息，并促进将学习目标推广到实际患者。我们使用BlackBoard软件。学生每周登录两到三次。经过在线主持培训的教师促进线程讨论组并提供反馈。
交替进行临床实习的学生完成在线临床实习。将他们的表现与完成面对面糖尿病课程但没有循证医学或医学人文主义课程的学生进行比较。经过近一年（105名学生），与非在线组相比，完成在线临床实习的学生在临床实习前后报告的循证医学技能有更大提升，医学人文主义能力量表的平均分（从实习前到实习后）有更大提高，并且在临床实习后糖尿病管理评估中的得分更高（所有比较p <.05）。在线临床实习将成为我们临床实习的永久组成部分，并且我们已开始使用HEAL来设计其他在线课程，包括继续教育课程。
