Why Online Medical Education Is Here To Stay: Part II

Part II of the series on online medical education focuses on the future structure of digital instruction in healthcare, and what we can learn from the successes of Khan Academy and MOOCs.

In 2004, Salman Khan was living in Boston while remotely tutoring his cousin in New Orleans via telephone and Yahoo Doodle. Once her grade drastically improved thanks to Khan’s help, her brothers asked to be tutored as well. Eventually, news of Khan’s assistance began to spread and he suddenly found himself tutoring several cousins and family members. While Khan was happy to help, finding time to personally tutor this many people proved to be difficult. To solve this problem, Khan began recording instructional videos and posting them on YouTube for his “students” to watch on their own time. What transpired next is a concept that is turning the traditional vision of online education upside-down and is radically altering how we will teach individuals, including medical professionals in the future. What I’m referring to, of course, is Khan Academy.

Part I of this series took a broad approach in discussing the future of online medical education by exploring three key components behind its success – convenience, price, and flexibility. Part II narrows the spectrum of support by analyzing what we can learn from two proven digital learning tools – Khan Academy and MOOCs (Massive Open Online Courses). Before digging deeper into the effect that Khan Academy and MOOCs will have on the future of online medical education, it’s important to know some background information on both of these tools.

What is Khan Academy?

The following is a direct transcript from KhanAcademy’s FAQ page

“Khan Academy is a not-for-profit educational organization started by Salman Khan in 2008. Our mission is to provide a free, world-class education to anyone, anywhere. Our online materials cover subjects ranging from math and finance to history and art. With thousands of bite-sized videos, step-by-step problems and instant data, Khan Academy provides a rich and engaging learning experience.”

- Kahn Academy

The format for each of the videos typically stays consistent regardless of the subject it concerns. All you hear is the instructor’s voice, and all you see are the instructor’s colorful sketches on a digital blackboard. This digital blackboard serves as a traditional classroom overhead projector and allows the instructor to write on images, diagrams, or a blank screen. Some videos feature more than one person, as the instructor will invite a guest who specializes in a specific area to help teach. Here are three separate Khan Academy videos that show you how this format works:

Posting free educational videos online for anyone to see began as an idea for efficiently tutoring a few friends and family members. That idea has now turned into a revolutionary reality. According to MindShift, the Khan Academy website now offers over 5,500 instructional videos and 100,000 practice problems. In this 60 Minutes report, Sanjay Gupta refers to Sal Khan as “the most-watched teacher in the world.” Even Bill Gates, one of the wealthiest and smartest humans alive, uses Khan Academy to help his kids learn.

"Khan, this teacher to the world, is giving us all a glimpse of the future of education.”

- Bill Gates

What are MOOCs?

Massive Open Online Courses, better known as MOOCs, are electronically delivered educational courses made available to “massive” audiences via the Internet. MOOCs are the newest trend to gain significant traction in the world of digital learning. As David Harlow of The Health Care Blog puts it, MOOCs are “the new darling of the online educational community.” Even The New York Times declared 2012 as “The Year of the MOOC.” To gain a better understanding of what exactly a MOOC is, let’s consider the meaning behind each word.

Massive. Exactly how big of an audience does a MOOC draw? Naturally, that answer varies. MOOCs are capable of operating with any number of enrollees, but it is not uncommon for a particular MOOC to have anywhere between a few hundred, to tens of thousands of participants. The largest MOOC to date was Udacity’s CS101 class, which had over 300,000 students enrolled.

Open. The word “open” serves several different purposes when it comes to MOOCs. It mainly portrays the price and enrollment requirements – or lack thereof – for most MOOCs. According to this infographic from OnlineColleges.net, Most MOOCs are free, unless a form of accreditation is involved, and open to anyone interested.” Essentially, the vast majority of MOOCs are available to anyone and everyone who wants to sign up and complete the course. Additionally, most MOOCs are entirely free of charge. You may have to pay to get credit towards an institution upon completing a course, but rarely do you need to pay for partaking in the actual course. MOOCs are also “open” in the sense that they are designed to rely heavily on participants networking with one another to collaborate and share their thoughts. The course material and ideas of those enrolled are openly shared and discussed among all enrollees and instructors participating in that course.

Online. Alex Cusack, a contributing writer at Moocs.com, defines a MOOC in this infographic as being “facilitated wholly online.” Fundamentally speaking, it is this ‘wholly online’ element that is most responsible for MOOCs' growing popularity. Cusack goes on to show a variety of MOOC forms, of which each model is built around the power of the Internet. And in a world where an Internet connection gives you direct access to an unfathomable supply of information, it’s easy to understand why MOOCs are quickly gaining popularity.

Course. A MOOC is classified as a “course” due to several components that mirror the blueprint of a traditional education course. For example, a MOOC takes place over a specific time period that begins and ends on set dates. Also, participants include both instructors and learners who review the prearranged course material together. That having been said, don’t mistake a MOOC for a traditional course – or even an ordinary online class for that matter. The overriding disparity between the two, other than the digital format, is the general strategy used for knowledge acquirement. The large number of individuals enrolled in a MOOC considerably hinders the instructor’s ability to provide one-on-one support. Instead, MOOCs look to other methods to assist learning. David Kernohan, program manager for eLearning Innovation at JISC, elaborates in this article from The Guardian by saying that a student in a MOOC, “tends to not get any individual attention (from the instructor). This is instead approximated by peer support such as online discussion forums.” With MOOCs, learning the material is not driven by homework assignments and grades, but rather through digital networking and collaboration. MOOCs are also entirely optional, thus eliminating potential distractions caused by uninterested individuals involved only for requirement purposes. Perhaps a more accurate description of MOOCs would be an elective gathering, rather than a course. They are digital communities where like-minded individuals can voluntarily convene to learn and share ideas on a particular subject. MOOCs simply provide the location< – albeit remote – and structure needed.

Why Online Medical Education Is Here ...I should note that despite several identical components, Khan Academy’s videos and MOOCs are not the same things. While Khan Academy’s videos provide quick 10-minute lessons, MOOCs go a step further by including additional components to provide a more interactive, course-like experience. Despite being separate entities, there is an unmistakable link between the two. Although his videos technically are not MOOCs, many leaders in education technology refer to Khan as “the most influential person to the MOOC landscape,” as Peter High writes in Forbes. High’s article goes on to quote Stanford professor Sebastian Thurn regarding the role Khan played in inspiring him to pursue technology in education. Thurn describes Khan’s impact by saying, “I stumbled into this after listening to a gentleman named Sal Khan of Khan Academy. In his speech, he noted that he had tens of millions of students in his classes. I was teaching at Stanford at the time and had tens of dozens of students in my classes, and I felt I should try something different and see if we could do what I do and scale it to many people.” Thurn is now the co-founder and CEO of Udacity, one of the three largest MOOC providers on the Internet today. Sal Khan and Khan Academy laid the foundation for educational technology that made additional resources possible.

The future of online medical education will be substantially affected both directly and indirectly by Khan Academy and MOOCs. Educators can indirectly learn from their short history of strengths and weaknesses to mold future resources into more efficient products that will enhance the capabilities of online medical education. The direct impact, on the other hand, is already beginning to take form. Various medical education facilities have partnered with Khan Academy and MOOCs to integrate the technological advantages each provides into their curriculum.

One educational facility at the forefront of exploring education technology in their curriculum is Stanford’s School of Medicine. For the last two years, Stanford has been experiencing with what they refer to as a “ flipped classroom” approach. The school’s official website defines a flipped classroom as, “replacing a lecture with some sort of interactive session (e.g. discussion, Q&A, team learning), and delivering the lecture material before class using tools like online video, audio, or interactive content.” This futuristic process was stimulated by the Khan Academy’s success with short instructional videos. The driving force behind the movement is Dr. Charles G. Prober, Senior Associate Dean of Medical Education at the Stanford School of Medicine. In an article from The Stanford Daily, Dr. Prober claims that two main changes in the classroom have come from this: how content is delivered and how students’ time in the classroom is spent. A major issue in medical education today, especially in regards to students in medical school, is the remarkably low attendance rate for class lectures. Stanford professors themselves estimated that around 70% of medical students do not attend lectures. This alone is a major reason that the number of medical professors who believe online learning needs to be a focal point for future medical education is beginning to multiply. As Sal Khan says in the video below, “If human beings are in a room together they should be interacting with each other. If you have 300 people in the room, at least in my mind, one of the worst things you could do is one person lecture to the other 299 people.” The flipped classroom technique of providing the lectures through online videos, rather than traditional in-person lectures, helps on multiple levels. Not only does the increased accessibility to the lecture result in more students hearing it, but it also frees up class time to be spent on more beneficial activities involving interaction and critical thinking skills. Stanford refers to this movement as SMILI, an acronym for Stanford Medicine Interactive Learning Initiatives.

Stanford has now teamed up with Khan Academy to ensure their transition towards online medical education runs as smoothly as possible. “I’m very attracted to what they’re doing, very impressed by Sal Khan. Their mission really resonates, the mission to educate anyone, everywhere, at no cost. When we create medical education, I want to share it as broadly as possible, at no profit. If it helps raise the level of education, that’s great. That’s our mission,” Prober told The Stanford Daily in the link above. Prober and Khan presented their three-step plan in this edition of AAMC’s Academic Medicine. The first and most essential step is to build a framework for the “core preclinical curriculum,” constructed of the most essential medical information. The second step is to create a “library of short (~10 minutes) videos that learners can use to access the content in an order consistent with the organization of their school’s curriculum.” The third step in their proposal involves students digging deeper into specific knowledge by encouraging them to pursue, “in-depth experiences fueled by students’ specific learning objectives and passions, linked to the areas of expertise represented in their medical schools.” In other words, Stanford’s School of Medicine meets with Khan Academy representatives regularly. That representative is often the head of Khan Academy’s medical and science initiatives, and the head of its partnership with Stanford, Rishi Desai. The two sides meet to discuss the content, which is then created and openly shared on Khan Academy’s platform.

For more on Stanford’s partnership with Khan Academy, check out this video on their shared initiative towards interactive learning with education technology, provided by Stanford’s School of Medicine:

Khan Academy has also partnered with the Association of American Medical Colleges (AAMC) and Robert Wood Johnson Foundation for online medical education purposes. Together, they have combined forces to provide free, online resources aimed to help students prepare for the revised Medical College Admission Test (MCAT) that will be first administered in the spring of 2015. When the AAMC broke the news in May of 2013, President and CEO Dr. Darrell G. Kirch spoke of the partnership by saying, “We view this effort as an important addition to the work the nation’s medical schools and teaching hospitals are doing to encourage and attract future physicians from diverse backgrounds, including students from economically and educationally disadvantaged communities.” To develop the content, the three institutions sponsored a competition that allowed medical students and residents to create their own material and submit it. Once the deadline hit, Khan Academy reviewed and selected the winners for the competition – who were then given the opportunity to work with their staff to convert the winning material into the prototypical Khan Academy format.

A second competition is currently underway, thanks in large part to the great response they received for the initial competition. The deadline for submissions is June 13 th, 2014. Khan Academy released this video to promote the competition. The growing collection of videos designed for MCAT2015 preparation can be found here.

Below is another excellent resource to help you understand the potential of MOOCs in medical education. The video features Daphene Koller, yet another Stanford professor. Koller co-founded Coursera, another of the three dominant MOOC providers.

With all the particulars that can be learned from Khan Academy and MOOCs, it’s important not to overlook one rather subsidiary aspect that Dr. Prober addresses in the first video: fun. Incorporating technology into learning makes it more fun. In Dr. Prober’s words:

“The biggest challenge that I see, but one of the greatest advantages of the interactive classroom, is that it provides an opportunity to make classroom learning fun. FUN. And it should be fun. We’re bringing together all these talented people, both students and teachers. Everyone loves to learn. Teachers like to teach. But I think what’s happened is that the classroom no longer is fun. And so the biggest revolution we can create is to make the classroom fun… There’s no reason, given the talent pool, and the fact that we all want to become excellent doctors and have the best knowledge base we can, that the classroom should not be fun. And I think that’s the greatest advantage and that’s what we can offer with the interactive classroom.”

- Charles G. Prober, M.D.

It’s hard to refute the overwhelming evidence supporting an imminent shift in medical education towards online learning. I know we are excited to see where things go in the future – are you? We’d love to hear your thoughts on these recent changes, and the role online learning will play in medical education today, and in the future. For more information about online medical certification for ACLS, PALS, or BLS, visit eMedCert.com or send us a message