Journal of Medicine in the Tropics 2008: 10 (2): 3-7

Electronic Medicine and Medical Education 

J.O. Ogunranti

Department of Anatomy, Faculty of Medical Sciences, University of Jos, PMB 2084, Jos, Nigeria

Abstract

 

Electronic medicine began as a means by which modern electronic media can bring the practice of medicine close to students and practitioners alike. There are different models and they include text, image, audio (for organ sounds) videos, animations, skills and integrated procedural electronic medicine (IPEM). The IPEM model seems to capture the need of modern medical education with its problems of assessing procedural skills and eliminating learning by rote. A pluralistic electronic medium must be sought to advance this form of training in modern medical education.

Modern Medical Education

Medical education is the organized system that provides teaching and learning in the subject of Medicine which trains would be medical doctors [1]. Scientific medical education began when it was first realized that disease had morphological attribute and the barbers began to search for such in grave side dissections of the 12th century. To come nearer home, a field like psychiatry became only scientific when attributes of morphology and molecular biology were injected to it in the late 1970s which led to the development of the so called biological psychiatry [2]. Sadly medical education today has disconnected from its scientific roots and is in a total mess

          It emphasizes rote over understanding

          It selects book knowledge over procedural ones

          It has lost its holistic meaning

        It is too long

 

Examples of problem areas in modern medical education include the loss of cadaver dissections which are then replaced by models. This does not give the would-be doctor the ability to examine and interact with the cadaver in a way to stimulate his holistic approach to medical practice of the future. Embryology is a total failure; how can you learn what you can never see? Histology is dead; the dead tissues ensure that. We no longer are able to measure the skills acquired during medical practice for who will the young student perform his skills on and how can you evaluate those skills acquired? Our inability to design educational methods for assessing skill acquisition goes pari passu with the loss of pre qualification practice etc. [3]. Other examples of problems include Anatomy and Surgery which have parted ways. In the past a good surgeon was one who had mastered his anatomy and was also an anatomist. Today surgeons struggle with their anatomy and anatomists are nowhere to be found!! We are not training doctors at all but book wormers who later train themselves. The greatest problem of all is ROTE LEARNING by which the best students in learning by rote get the distinctions and awards but are lousy practitioners.

 

Finally there is a serious poverty or indeed absence of much needed subject integration in modern medical education. Those who have attempted integration in the past have had to abandon it because it is too expensive to run.

 

Procedural medicine

The skills, both diagnostic and therapeutic, acquired in medical training are the vital tools of practice by the young practitioner. In most medical curricula, far more emphasis is placed on diagnostic skills than in therapeutic ones [4,5]. A medium that captures such skills to be acquired and makes them user friendly can go a long way in solving the technology problems of modern medical education. The problems in procedural medicine include the following modest list- how to find an interactive medium that can teach clinical examination and be versatile enough to be amenable to be personalised and pluralised for individual learning styles (e.g. audio, video, interactively noisy and calm, reflective, analytical etc). It should be able to teach clinical investigations, post mortem and even cadaver dissections; in short, how to find a medium that will teach practical in all subjects of medicine with integration of clinical, paraclinical and preclinical information for in Medicine there is no such thing as ‘I HAVE FORGOTTEN’ [4, 6-7]! Such a medium can then be addressed as Integrated Procedural Electronic Medicine (IPEM) to distinguish it from the erstwhile electronic programs that favor other methods of learning. 

Many University medical schools are attempting to solve the problem of procedural acquisition in medical education by setting up Clinical skills departments [8] and /or Clinical skills websites [9]. 

Electronic Medium

Which super vehicle can provide pluralistic channels, styles and accommodation of temperaments all in one, in this modern world and still remain inexpensive to be used anywhere in the world? Which medium can be interactive in order to obviate the soporific effect often encountered in pure channels of instruction such as pure video and audio in modern DVDs and video cassettes [10]? Which super vehicle can be used to provide integration, skills acquisition in  Bloom’s taxonomy compliant way at the same time as being fast to use, communicate, duplicate and network all at the same time [11]? It is only the electronic medium that can achieve all these.

What is Electronic medicine?

Electronic medicine can be defined as the application of electronic means or gadget or indeed media, to medical education and/or practice of Medicine. Here electronic refers to Information and Communications technology (ICT) which includes telephony, personal computer and cybernetics. Electronic medicine is the use of electronic means or ICT to study and/or practice medicine.  When ICT is used to study medicine it is called electronic learning; when used to practice medicine it is referred to as electronic practice. A combination of the two is then called electronic medicine. .This definition is broad enough to take into account the numerous methods of electronic medicine which is presently found on internet.

Electronic medicine model of web based eMedicine
This method is adopted by the web MD website [12] in which modern and up to date information in almost all areas of medicine are kept on internet mostly in text form. It is very useful and many medical doctors and indeed postgraduate doctors use this means to update their knowledge and for continuing education.

Image oriented electronic medicine

This is a method tht relies on image identification for learning in medicine and related subjects. It is useful in radiology, pathology, anatomy as well as medicine and surgery. There are many of these methods found on the web and elsewhere. Such include the Visible man project in anatomy which contains cross sectional CT scan images of all sections of the human body for both male and female. It is found on the Visible man website [13]. Others include websites which are dedicated to imaging science such as ultrasound, CT scan, X rays etc [14].

Skill oriented electronic medicine

In view of the fact that many medical educators now realize the importance of acquisition of clinical skills during medical training, several programs and softwares, to include web-based programs are now available for skill acquisition. They include the Queens University Belfast program in clinical examination [9], University of Toronto Clinical examination program [15], University of Newcastle upon Tyne [16] Yale University Electronic dissector [17] and University of Jos programs for clinical demonstration, clinical conferences and clinicopathological conference [18]. There are some sites or programs dedicated to the acquisition of clinical audiology skills such as the identification of lung and heart sounds [19].

Clinical robots

This model uses manikin  programmed to mimic certain diseases and then used by students to learn the clinical features of such diseases. The robot when programmed can mimic clinical features of certain diseases by providing some history and then physical examination. The disadvantage of this laudable procedural medicine is that it is too expensive for common use to include use in developing countries etc. It cannot also perform clinical investigations or indeed postmortems. It is unwieldy and cannot be duplicated or networked and can have only a few students at a time

Electronic School of Medicine [20]

This happens to be in a separate class in electronic medicine for it uses a principle now called integrated procedural electronic medicine. This principle takes on board all the categories above to include image, text, procedures and finally integrates all aspects of medicine into one single whole, examining medicine as a single supersubject. Of all the above highly sophisticated gadgetry for electronic learning in medicine no one fulfills all our criteria which is that the medium most be inexpensive, test Blooms taxonomic categories and provide integration with easy duplication and use except the IPEM model.

Electronic Practice

There are various methods today for the electronic practice of medicine.

Robotic surgery-Da Vinci robot: This was first designed at Imperial College, London and is used to assist in surgery. It also uses electronic/computer skills.

Virtual screen practice. The earliest primordium of the method of clinical examination on the web is that of Boshuizen et al  [21]. The latest method is one in which diagnostic maneuvers are performed on a virtual screen patient so that diagnosis can be made for learning. The mouse becomes the interactive entity, which may be the stethoscope, percussion digits, inspector, dissector, surgical operator etc. It can also perform investigations, postmortem, image studies and make diagnosis and is useful for electronic objective structured clinical examination (eOSCE). This method is also part of the IPEM model above.

Limitations of Electronic Practice
While electronic practice as defined in this paper has many features to support and recommend it, it is essential that we spell out its limitations. It is amenable only to two out of the five senses which are visual and auditory. The third for touch is limited in its scope to tenderness. Consistency may be tested with some electronic dexterity. Hence it is to be used all the time as adjunct to the real and not just on its own!


 

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13.   Visible Human Project. http://www.nlm.nih.gov/research/visible/visible_human.html

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http://icarus.med.utotonto.ca

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http://www.ncl.ac.uk/about/facilities/list/anatomy+and+clinical+skills+centre

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18. University of Jos, Nigeria. Electronic Medicine.  http://www.unijosmedicine.org

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20.  Electronic School of Medicine.  http://www.oluwoleogunranti.com

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