Online courses that doctors take to learn and maintain their skills have a reputation for being tedious: They are often just videotaped lectures or PowerPoint presentations with voiceovers and not much in the way of graphic design, animation or video.
The Stanford Center for Continuing Medical Education, in the School of Medicine, aims to help upend that legacy: It has debuted new online continuing medical education courses that show how information freed from words-only presentation can be an effective medical education tool. It's show, not tell, with animation and video, and a minimum of talking heads.
Based on the knowledge that more than half of us are visual learners whose attention may drift during a video of a podium-bound lecture, online-course designers in all fields increasingly incorporate animation, infographics and videos to illustrate information. The medical school's new CME courses reflect this trend.
The new courses also include teaching topics that have become more important in recent years, such as antibiotic and opioid overuse — two national health issues now near the top of the priority list of the Centers for Disease Control and Prevention. Other courses are meant to engage primary care physicians as partners in prevention health care for conditions with serious consequences.
“These new courses are designed to be more engaging for learners," said Griff Harsh, MD, associate dean for postgraduate medical education. “We believe they are also unique in quality and content. Their development also reflects the innovation possible at Stanford when faculty, medical educators and our IT experts collaborate."
The new courses don't resemble video games, as do Septris and Sicko — two CME offerings recently developed at Stanford. They do, however, share the use of a teaching environment that is more image-driven than word-dependent, including some dramatic recreations based on what doctors have experienced in practice. “We wanted to break free of the passive culture of lecture and find ways to visualize what's being taught," said Kimberly Walker, PhD, the instructional designer with Stanford Medicine Information Resources & Technology, who worked with Stanford Health Care doctors to design the courses.
The new CME course on prescription drug misuse is a good example of what Walker means. The course uses actors to portray patients in a series of videos that dramatize what actually happens in doctors' offices. Anna Lembke, MD, assistant professor of psychiatry and behavioral sciences, wrote the scripts based on her knowledge of the kinds of conversations doctors experience when patients are pressing for medications.
“The video, far more interesting than a deck of slides, really pulls you into the situation," Walker said.
That's the kind of reaction Lembke wants for a topic she has usually seen addressed only with depictions of cases with perfect endings. Lembke wanted those cases to reflect the imperfections of typical conversations between doctors and patients. She designed the course's videos “to show exactly what a doctor shouldn't do," she said. “I've found that in medicine we learn the most from our mistakes."
Another new course, one that will feature an introduction by Arjun Srinivasan, MD, the CDC's associate director for health-care-associated prevention programs, was developed because of the worldwide value of its content: the antibiotic timeout. “Studies show that up to half of all antibiotic use in the hospital is inappropriate, and we know that antibiotic overuse leads to medication-resistant superbugs and can harm patients," said course co-creator Marisa Holubar, MD, clinical assistant professor of infectious diseases. “We also know that clinicians don't necessarily have the right training to make these decisions. That's why we developed the course."
The antibiotic timeout, a term promoted by the CDC, asks doctors to take some time 48-72 hours after a patient has started a first course of antibiotics to re-evaluate the prescription, using clinical information and laboratory data. The timeout allows doctors to think about the value of that medication, its dosage, delivery method and duration, Holubar said. It's a question of teaching the kind of approach that will become second nature to physicians in all fields.
There's no lecture in this online course, either. Holubar and her collaborators created five case studies, supported with illustrations that include the molecular structure of certain medications, photographic images of organisms and, instead of a talking head, a narrator's voice. Each case study presents a clinical condition — sepsis is included — followed by clinical treatment options that could be applied in that case. “We wanted to make it case-based and real-world and appropriate for learners with some experience," Holubar said.
The antibiotic timeout is a priority for the CDC, and this course will be featured on its website and that of the California Department of Public Health.
Treating congenital hypothyroidism
An online course designed by Laura Bachrach, MD, professor of pediatric endocrinology and diabetes, aims to teach pediatricians about the testing and treatment of congenital hypothyroidism. It's a common disorder but can be easily detected with a blood test in newborns, Bachrach said. Without screening and proper treatment within the two to three months of life, followed by continuing appropriate care, infants with the condition will suffer intellectual disabilities. By the time clinical symptoms appear, Bachrach said, it can be too late to reverse the damage. That's why the mandatory screening of all infants is so important.
“We have many more babies with congenital hypothyroidism than we have pediatric endocrinologists, so we need the help of pediatricians to care for them," Bachrach said. Those doctors may also need help teaching parents about the condition, so the course includes a special video in which Bachrach plays a primary care doctor working with parents upset by the news of their newborn's condition. “Teaching pediatricians and family physicians through this online resource allows us to reach many more providers on the frontline," she said.
“I am so grateful to Stanford," Bachrach added. “This is the first time I've ever done anything like this." She's also happy that Stanford will offer the course for free and that the American Academy of Pediatrics will link to it from its website.
Linda Baer, director of the Center for Continuing Medical Education, said a second round of new courses will become available next year.
“The online learning space is evolving," said Mark Rosenberg, the online program manager for Stanford's CME center. “Each context has its own set of best practices: There are differences between online academic learning and professional development training. CME falls somewhere in the middle. What we're doing now is very different from what's typically out there. We think of ourselves as innovators, and we'll continue to explore and experiment."