Medical Teacher,Vol. 24, No. 3, 2002, pp.

261267

1 2 3 4 5 6 7 8 R.M. HARDEN 1 & I.R. HART2 9 1 2 Centre for Medical Education, University of Dundee, UK; Ottawa, Canada 10111 1 SUMMARY The introduction of new learning technologies, the There may be a need for a more revolutionary approach and 2 exponential growth of Internet usage and the advent of the World for a more fundamental look at the concept of the medical 3 Wide Web have the potential of changing the face of higher educaschool as we know it today, where the emphasis is on a physi- 4 tion.There are also demands in medical education for greater globcal medical school in which students spend a signi cant part 5 alization, for the development of a common core curriculum, for of their time attending lectures and other classes (Harden, 6 improving access to training, for more exible and student-centred 2000a). Such a change could harness the unprecedented 7 training programmes including programmes with multi-professional advances that have taken place in information technology. 8 elements and for maintaining quality while increasing student numbers and working within nancial constraints.An international virWeb and internet technologies are transforming our world, 9 tual medical school (IVIMEDS) with a high-quality education argued Horton (2001, p. 1,3), presenting opportunities we 20111 programme embodying a hybrid model of a blended curriculum of could only imagine a few years ago. Nowhere are these 1 innovative e-learning approaches and the best of traditional faceopportunities greater than in training and education. . . 2 to-face teaching is one response to these challenges. Fifty leading E-technologies do not change how human beings learn.What 3 international medical schools and institutions are participating in a technology does is to remove constraints on the kinds of learn- 4 feasibility study. This is exploring: innovative thinking and ing experiences we can economically and practically create. approaches to the new learning technologies including e-learning 5 and virtual reality; new approaches to curriculum planning and Ronald Phipps and Jamie Merisotis, of the USA Institute 6 mapping and advanced instructional design based on the use of for Higher Education Policy, noted in their 1999 report 7 reusable learning objects; an international perspective on medical (p. 29) on distance education that Technology is having, and education which takes into account the trend to globalization; a 8 will continue to have, a profound impact on colleges and uniexible curriculum which meets the needs of different students and 9 versities in America and around the globe. Distance learning, has the potential of increasing access to medicine. which was once a poor and often unwelcome stepchild within 30111 the academic community is becoming increasingly more 1 The need for change visible as a part of the higher education family. Oblinger 2 (2001) has predicted a major growth in e-learning and the 3 In thinking about the future of medical education, we can emergence of global consortia leading to the creation of one 4 adopt two different approaches, suggested Harden (2000a, or more global virtual universities. E-learning will grow in 5 p. 435). We can look at the changes taking place in medical popularity, she argues, because of its convenience and exi- 6 education as a journey where the future is a continuing evobility and because of the increasing availability of computers 7 lution of what has happened in the past three decades or and students familiarity with them. It is now inevitable, 8 soan evolutionary approach. Alternatively we may visualize suggested Russell & Russell (1999, p. 8) that future cohorts 9 a more dramatic journey to a different world where there are of students will be educated in a context where a consider- 40111 fundamental changes in medical education, some of which able time is spent on-line. 1 we may have dif culty envisaging at this point at the beginKing (2001) has considered the changes now sweeping 2 ning of the twenty- rst centurya revolutionary approach. universities and affecting both campus as well as off-campus 3 The last three decades of the twentieth century have seen provision. He identi ed some of the causes of these changes 4 remarkable changes in the curricula of medical schools worldglobalization, massi cation, government intervention and 5 wide. There have been moves to more integrated and multitechnological changeand pointed to some of the manager- 6 disciplinary curricula (Harden et al., 1984; GMC, 1993; ial issues that they pose for universities. He argued that change 7 Harden, 2000b), to problem and task-based learning is inevitable and that university management must take the (Barrows & Tamblyn, 1980; Davis & Harden, 1999; Harden 8 lead in successfully steering institutions through their changet al., 1996a, 1996b), to student-centred learning (Harden, 9 ing environments. Australian-funded research on borderless 2000c; Harden, 2001), to the development of core curricula 50111 education led to two research reports (Cunningham et al., with special study modules (Harden & Davis, 1995), to com1 1998; Cunningham et al., 2000). The rst explored the munity-based education (Whitehouse et al., 1997), to multi2 mooted possibility that bricks-and-mortar institutions would professional education (Harden 1998) and to the concept of be replaced by global networks. The second looked at lessons 3 outcome-based education (Harden et al., 1999a, 1999b). to be learned from exemplary private, corporate and virtual- 4 Such changes in educational strategies, however signi cant, providers in the burgeoning post-secondary education and 5 may not be enough if medical schools are to respond to the 6 demands facing medical education as a result of changes in 7 systems of healthcare delivery, signi cant advances in mediCorrespondence: Professor R.M. Harden, Centre for Medical Education, 8 cine, increasing public expectations of the doctor, increasing University of Dundee, Tay Park House, 484 Perth Road, Dundee DD2 1LR, demands on teachers and increasing student numbers at a UK. Tel: +44 (0)1382 631972; fax: +44 (0)1382 645748; email: r.m.harden@ 9 dundee.ac.uk 60111 time of nancial constraints.

An international virtual medical school (IVIMEDS): the future for medical education?

Med Teach Downloaded from informahealthcare.com by Marc Cray on 12/20/10 For personal use only.

ISSN 0142159X (print)/ISSN 1466187X online/02/01026107 2002 Taylor & Francis Ltd DOI: 10.1080/01421590220141008

R.M. Harden & I.R. Hart 1 2 3 4 5 6 7 8 9 10111 1 2 3 411 5 6 7 8 9 20111 1 2 3 4 5 6 7 8 9 30111 1 2 3 4 5 6 7 8 9 40111 1 2 3 4 5 6 7 8 9 50111 1 2 3 4 5 6 7 8111 9 60111
Med Teach Downloaded from informahealthcare.com by Marc Cray on 12/20/10 For personal use only.

training market. The research found that while the rhetoric remains focused on globalized markets and cyberspace solutions, the reality is that virtual universities existed only in embryonic or localized form. Royal van Horn (1996, p. 796), Professor of Education at the University of North Florida, warned, however, that Universities that do not transform courses and degree programs so that they can be delivered over the Internet will not survive long into the next century. Katz & Oblinger (2000, p. 22) too have suggested that E-learning will bring about many changes in higher education. Students, who historically have come to learning sites, increasingly will participate at locations remote from the campus and the instructor. Rather than being af liated with a single institution, they will be associated concurrently with multiple providers and modes of instruction. Educational services will become unbundled, with different providers carrying out various functions: curricular development, delivery of instructional modules, provision of student services, student evaluation and awarding of credentials. Students will assume greater control over their educational experiences by designing programs that t their speci c needs with regard to program content, length, delivery mode and location. In a review of the use of web-based instruction in medical education, Michaelsen (2001) concluded that distance education methods in general, and web-based instruction in particular, can meet a growing need for change within the eld of medical education. There is, however, a seeming paradox related to the fact that medical education is a practice-based discipline that, by de nition, must be practised in order to be mastered. The answer may be to blend the huge increase in the use of the new learning technologies and webbased learning in medical education with a component of face-to-face learning. Given the scale and potential importance of a move towards e-learning in medical education and a virtual medical school, and the new ground to be broken if we are to move in that direction, a group of interested medical schools has identi ed the need for a feasibility study for such an initiative. Feasibility study An international group of 50 leading established medical schools and institutions (Appendix 1) is engaged in a feasibility study in which they will explore the concept of an international virtual medical school where the best of face-to-face learning is blended with the use of the new learning technologies. The collaborating schools were selected on the basis of the schools international reputation for excellence in medicine, their interest and expertise in medical education or their track record of innovation in the eld, including the application of the new technologies. This is in line with Jones & Pritchards (1999) argument that virtual universities should be a consortium of well-established universities as they offer an unequalled resource of knowledge and people who generate and convey it. Schools and institutions participating in the feasibility study are from North and South America, Europe, the Middle and Far East and Australasia. This international representation is important at a time of globalization in medicine and medical education (Schwarz, 2001). Postgraduate bodies are also represented among the collaborating organizations. While the primary target is undergraduate medical education, the implications for postgraduate and 262

continuing education, and for the continuum of education, will also be explored. This paper outlines the aims of the collaboration and the bene ts to be gained, and gives initial suggestions with regard to educational strategies including a blended approach to learning. The process whereby the ideas will be amended and developed further during the feasibility study is described. Aims of the collaboration The aims of the collaboration are: (1) the application to medical education of innovative thinking and approaches to the new learning technologies including e-learning and virtual reality; (2) the application of new approaches to curriculum planning and advanced instructional design incorporating approaches such as curriculum mapping, outcome-based education, the use of electronic study guides, peer-topeer learning, dynamic learning and a bank of reusable learning objects; (3) the provision of a unique international perspective on medical education which takes into account the trend to globalization and offers bene ts to society, to medical schools and to students; (4) the development of a exible curriculum which meets the needs of different students and has the potential to increase access to medicine. The IVIMEDS curriculum It is proposed that, at least in the rst instance, the IVIMEDS curriculum will cover the rst two to three years of medical school, with students completing their studies in one of the IVIMEDS collaborating medical schools and receiving the degree of that school. Students may continue, however, to have access to IVIMEDS curriculum material in their later years studies. The initial proposals with regard to the early years IVIMEDS curriculum are noted below.These will be adopted or developed further in the feasibility study. (1) Students will be accepted for entry into the IVIMEDS programme through the admission processes of individual partner schools which will guarantee that those who meet IVIMEDS exit criteria will be accepted into the clinical programme of that school. Alternatively, students may be admitted by an agreed IVIMEDS admission process. Such students who fully meet the IVIMEDS exit standards will be matched with partner schools that have agreed to take a speci ed number each year. Another approach may be one in which a collaborating medical school adopts part of the IVIMEDS curriculum to incorporate into its own educational programme. (2) Some students will be based in a partner school where they will be accepted as part of an alternative early years track, or where they are part of the standard intake.They will complete their studies in that school. Other students may be based in a hospital or community health centre that has links with one of the partner schoolsin some cases under the guidance of partner school alumni. Some may be based at home and study on-line with practical experience arranged locally or at a partner school.

1 2 3 4 5 6 7 8 9 1011 1 2 3 4 5 6 7 8 9 2011 1 2 3 4 5 6 7 8 9 3011 1 2 3 4 5 6 7 8 9 4011 1 2 3 4 5 6 7 8 9 5011 1 2 3 4 5 6 7 8 9 6011

An international virtual medical school (3) The curriculum will be a hybrid model and will offer an appropriate blend of e-learning and face-to-face learning opportunities. The curriculum will be designed to maximize the rich learning opportunities associated with both approaches to ensure that the right learning is available for the student, at the right time and in the right place. It will combine proven up-to-date pedagogy with the best of evolving techniques. (4) The framework for the e-learning will be provided as a curriculum map (Harden, 2001) in the context of an outcome-based curriculum (Harden et al., 1999a). The learning opportunities will be based on a bank of reusable learning objects (Wiley, 2002). This approach is described further below. (5) A wide range of e-learning techniques will be adopted. The emphasis will be on asynchronous experiences through the Internet and CD-ROM, but some synchronous learning is likely also to be made available. One challenge facing e-learning, which will be addressed, will be the refocusing of the instruction in order to bring a new dimension to interaction which in turn will lead to more meaningful learning. This will include enhancing the links between theory and practice. The learning approaches adopted will recognize present technical limitations and future possible developments. (6) On-site face-to-face learning opportunities will be provided by the partner school at which the student will complete his/her studies or at another site or sites as arranged. This may include other hospitals, community settings or specialized centres such as clinical skills training units where a wide range of simulators are available. (7) Collaborative learning or peer-to-peer (P2P) learning will play an important part. Boud (2001) has suggested that It is likely that we will see much more innovation with regard to peer learning and new technologies in the next few years. The use of P2P learning together with other strategies will create a suitable learning climate and avoid the lonely learner syndrome. (8) The tutor has a very important role in e-learning, and can be thought of as part teacher, part party host, and part sheepdog (Duggleby, 2000). Students will have ongoing support and supervision from staff on-line or face to face from staff at their base. (9) Study guides (Harden et al., 1999c) will be customized to meet individual students needs, the requirements of the schools to which they are attached and the school at which they will complete their studies. These will guide the student through the curriculum map and indicate what they should be learning, the learning opportunities available and the assessment procedures, including how they can assess their own progress. (10) Students progress will be monitored using appropriate assessment tools. An ongoing audit and quality assurance process will be established to ensure high standards for the education programme. IVIMEDS will represent the continuum of education from undergraduate through postgraduate to continuing professional development. In the rst instance, the emphasis in the programme will be on the undergraduate phase of education. This will not, however, exclude developments in the postgraduate and continuing phases of training. Curriculum mapping and bank of reusable learning objects Two important components of IVIMEDS will be a curriculum map and a bank of reusable learning objects. A curriculum is a sophisticated blend of educational strategies, course content, learning outcomes, educational experiences, assessment, the educational environment, and the individual students learning style, personal timetable and programme of work. A curriculum map will help both students and faculty by displaying the relationships between these key elements of the curriculum (Harden, 2001). The curriculum map, based on the learning outcomes, will serve to make the curriculum more transparent to all of the stakeholders including the partner schools and the students. The map will assist teachers to exchange information about what is being taught and will help to ensure that the curriculum re ects the overall goals of the individual partner schools. IVIMEDS will use curriculum mapping to identify what, when, where and how students can learn. Staff will be clear about their different roles in the big picture. For students the scope and sequence of learning will be made explicit, and links with assessment clari ed, resulting in more effective and ef cient learning. The curriculum map will help the students learning opportunities to be enhanced by taking into account their different backgrounds and multiple levels of experience. The bene ts will be explored of individualized learning, and the value of tailoring resources such as interactive overviews for particular learning groups and allowing learners to choose the perspective from which they would like to view a topic. Students will have the opportunity to drill down and to explore an area in more depth and to call up backup or supporting material where necessary. Personal learning plans will be prepared for students, which will allow them to follow their own path through the curriculum. This will vary according to their background and prior experience, their learning style, their location and their plans for completion of their learning. Identi ed on each node in the curriculum map will be learning resource material relating to that node. This material will be contained within a bank of what has been termed reusable learning objects. These are small discrete self-contained chunks of learning. Examples in the area of stroke are: an angiogram of a patient with a vascular abnormality including a short summary highlighting the pathology and the abnormality shown; a coloured photograph with a short summary highlighting the pathology illustrated; a table comparing the clinical features and outcomes in different types of stroke; a diagram of computer animation illustrating the cerebral circulation; a patients account on videotape of his/her personal experience; an MCQ on the topic of stroke. The instructional technology called learning objects, Wiley (2002, p. 3) suggests, currently leads other candidates as the technology of choice for the next generation of instructional design, development and delivery.This is because of its potential for reusability, generativity, adaptability and scalability. Martinez (2002, p. 168) has suggested that The dream to 263

Med Teach Downloaded from informahealthcare.com by Marc Cray on 12/20/10 For personal use only.

R.M. Harden & I.R. Hart

deliver personalized learning using learning objects that t the real-time, anywhere, anytime, just-enough needs of the learner is about to become a reality. . .. The most obvious bene t of these innovations is the creation of a learning ecology that shares resources from large reservoirs of content where learning objects are shared individually, widely and more economically. A traditional lecture or instructional text can be viewed as being made up of a number of such learning objects. The objects can be identi ed and indexed with a metatagging system and a bank of objects established. The same object can be used by different teachers in different ways and may be reused a number of times in different appropriate learning contexts. Hodgins (2002), a leading innovator in the eld of e-learning, has suggested that the process is analogous to the use of Lego as a toy in that small pieces of instruction (Lego blocks) can be assembled (stacked together) into a larger instructional structure (e.g. a castle) and reused in other instructional structures (e.g. a spaceship). Any Lego block is combinable with any other Lego block and blocks can be assembled in any manner the user chooses. E-learning allows such learning objects to be easily accessible and found, and to be easily updated. They can be seamlessly tied together to make a complete learning programme delivered over the Internet as digital entities with a number of individuals able to use them simultaneously. The reusable learning object approach is poised to become the instructional technology of e-learning. It has the potential for making possible the fast and economic production of high-quality education programmes individualized to the needs of the teacher developing the course. This is achieved through the dynamic assembly of learning objects from the repository of learning objects, using a controlled language or meta-tagging. Assessment of the students The assessment process will re ect the learning outcomes to be agreed, and will be an integral and important part of the programme. The students will be expected to take a measure of responsibility for assessing their own progress. Robust summative assessments will ensure that students achieve the necessary standards in what is a relatively new learning environment. Assessment instruments are likely to include: a portfolio prepared for the student, using appropriate media and containing evidence relating to the students achievement of each of the learning outcomes; tests of core knowledge and its application, administered on computer with the necessary security precautions; an objective structured clinical examination, or other test of practical skills. The examination content, process and instruments will be developed and monitored by the partner schools, possibly in collaboration with national testing bodies. The assessment may be common to all IVIMEDS students, or, alternatively, students may take the early years examinations in the partner school to which they are attached or, where appropriate, a national test. 264 The bene ts of IVIMEDS IVIMEDS offers bene ts to society, to partner schools and to students as summarised in Figure 1.

Figure 1. Bene ts of IVIMEDS.

Med Teach Downloaded from informahealthcare.com by Marc Cray on 12/20/10 For personal use only.

Bene ts to society The bene ts of IVIMEDS to society include: exibility in expansion and contraction of student numbers; wider access to medical education including disadvantaged and mature students; the training of doctors focused on the needs of the communities which they will serve with the potential for return of doctors to work in these communities; the training of doctors with an appropriate high level of facility in information-handling skills and an aptitude for continuing professional development; a cost-effective model of education; the possibility of using clinical learning opportunities in the community or other clinical settings which would be appropriate only with the learning opportunities offered by IVIMEDS; a stimulus to thinking about the future role of universities and medical schools in the training of doctors. Bene ts to the academic partners The bene ts of IVIMEDS to the academic partners include: collaboration with leading medical schools in the development of a vision for medical education to meet the future needs for the twenty- rst century; membership of a global network of prestigious medical schools delivering a programme of the highest quality and sharing the curriculum development; an opportunity to share with other institutions the development and application of the new learning technologies; an opportunity to utilize a medical schools resources or expertise beyond the existing boundaries of the school. This might include presentations and question-and-answer sessions by leading experts in a speci c subject area, learning resource materials developed by the school and on-site training facilities such as face-to-face clinical teaching and access to specialized facilities such as simulators; an opportunity to use, within each medical school, teachers in the roles to which they are best suited, e.g. facilitator, subject expert or resource developer (Harden & Crosby, 2000);

1 2 3 4 5 6 7 8 9 1011 1 2 3 4 5 6 7 8 9 2011 1 2 3 4 5 6 7 8 9 3011 1 2 3 4 5 6 7 8 9 4011 1 2 3 4 5 6 7 8 9 5011 1 2 3 4 5 6 7 8 9 6011

An international virtual medical school access to learning resources and opportunities provided by other schools which it may not be to the schools advantage to have available or duplicate locally; access to a more exible education programme tailored to the schools needs with the possibility of enhancing the diversity of students in training; an opportunity to plan for the continuum of medical education; the possibility of nancial gain generated from: sharing resources with other schools or students; intake of additional income-generating students without a matching increase in facilities and staff; access to a worldwide marketplace for the schools e-learning products at all levels of the continuum of medical education. Bene ts to students The bene ts of IVIMEDS to students include:
Med Teach Downloaded from informahealthcare.com by Marc Cray on 12/20/10 For personal use only.

information and the building of a consensus.The site has been designed to be user-friendly and encourage ownership of and commitment to the project. It will be of general interest and will have a number of useful features including a news section, a discussion area and a survey area. A pilot study will be conducted on the use of curriculum maps and the construction of learning programmes from a bank of reusable learning objects contributed to by the collaborating schools.Two areas in cardiology and two in neurology will be studied. Technical issues relating to the delivery of the e-learning programme, and a business model and plan will be addressed as part of the feasibility study in collaboration with EPIC Group plc, a leading e-learning company. A meeting of representatives of the partner schools will be held in St Andrews, UK on 13 and 14 June 2002 to review the work undertaken during the feasibility study. Conclusion Individual stakeholders in medical education may or may not concur with the assertion by Jarvis & Preece (2001) that education is going to be forced to introduce innovative delivery systems, which will mean fewer students attending the campuses, and with the claim by Royal van Horn (1996) that universities who do not do so will become extinct.What seems certain, however, is that the new learning technologies and e-learning will have an increasingly important role to play in medical education. Progress is unlikely to be inhibited by a small number of technosceptics and informational Luddites who believe that the Web has no place and is only a passing fad in education. The extent and the nature of developments in the area of e-learning, however, is dif cult to predict. We are only beginning to explore the possibilities offered by the Internet for teaching and learning and coming to recognize its strengths and limitations, suggested Ryan et al. (2000) in their book The Virtual University. Trying to predict the future of e-learning is like trying to guess which colours and shapes will appear at the other end of the kaleidoscope. The colour combinations and shapes are wonderful to see, yet they blend and change at the twist of the dial (Mantyla, 2001, p. 3). While distance-learning activities may appear to be magical education experiences, Fabos & Young (1999) suggest that all educators must step back, critically evaluate the inevitably enthusiastic rhetoric, and attempt to understand the complex contextual framework . . .. Emphasizing the need for a critical appraisal, Bridges (2000) warned of the profoundly disruptive potential of web-based learning. The IVIMEDS feasibility study, described in this paper, will contribute to our understanding of this key topic and will attempt to answer some of the important questions relating to e-learning. How might we bene t from a new paradigm, in which we transform not reform medical education? Do we need a new mindset that embraces the e-learning and the new technologies when thinking about medical education? Are there signi cant advantages to be gained from an international consortium of medical schools and other institutions collaborating to this end? The answers to these questions are unlikely to come from any one school on its own. Katz & Rudy (1999) have argued that The stakes in higher educations changing game are big enough to demand new levels of collaboration among those responsible for creating, managing, using, analysing and 265

a high-quality unique education programme with access to leading experts locally, nationally or internationallythe best in the world; a global perspective with students being part of an international student community, participating in an international school with cultural diversity and a curriculum with a global avour. This will include student contact with teachers in other countries and the possibility of clinical experiences and attachments in other countries; a exible and adaptive curriculum catering for the needs of individual students.This will include fast-track and parttime options, and the choice from a wide range of learning opportunities and approaches; the choice of a home base with the possibility of saving money; experience gained with the new technologies and approaches to information technology; preparation for lifelong learning. Study details The implications of the proposed initiative are far reaching. The issues relating to the form it might take and how it might be implemented and operationalized will be developed as part of the feasibility study. During the feasibility study, the role and remit of IVIMEDS will be clari ed. The potential contribution of e-learning to medical education, the synergies between e-learning and current trends in medical education and the most appropriate form for a blended curriculum of e-learning and face-to-face learning will be explored. The nature and approach to collaboration between schools will be developed, building on unbundling approaches to curriculum development where each school can make a different contribution to the curriculum.The degree of exibility in the education programme and issues relating to widening access to medical education, to multi-professional education, and to the continuum between undergraduate, postgraduate and continuing education will also be explored. International standards, student assessment and accreditation for the early years of training will be studied. The potential problems and barriers to the implementation of IVIMEDS will be addressed. An IVIMEDS website with access restricted to the 50 collaborating schools and institutions will facilitate the sharing of

R.M. Harden & I.R. Hart

reporting an institutions priorities, behaviours and investments. On the international front, Jones & Pritchard (1999, p. 56) have referred to the need to foster the development of truly international learners and make that learning universally available. That 50 leading schools and institutions have agreed to participate in the IVIMEDS feasibility study recognizes the bene ts of seeking a consensus view on the issues described and of international collaboration in medical education. Acknowledgements The authors are obliged to the Scottish Higher Education Funding Council, Scottish Enterprise, Scottish Knowledge and the Scottish Council for Postgraduate Medical and Dental Education for support for the feasibility study. Notes on contributors
Med Teach Downloaded from informahealthcare.com by Marc Cray on 12/20/10 For personal use only.
R.M. HARDEN is Director of the Centre for Medical Education, University of Dundee, and Director of the Scottish Council for Postgraduate Medical and Dental Educations Education Development Unit. I.R. HART is Professor Emeritus at the University of Ottawa and an independent consultant in medical education. HARDEN, R.M. (2000c) Independent learning, in: J.A. Dent & R.M. Harden (Eds) A Practical Guide for Medical Teachers, pp. 147157 (Edinburgh, Churchill Livingstone). HARDEN, R.M. (2001) AMEE Guide No 21: Curriculum mapping: a tool for transparent and authentic teaching and learning, Medical Teacher, 23(2), pp. 123137. HARDEN, R.M. & CROSBY, J.R. (2000) AMEE Education Guide No 20: The good teacher is more than a lecturerthe twelve roles of the teacher, Medical Teacher, 22(4), pp. 334347. HARDEN, R.M. & DAVIS, M.H. (1995) AMEE Medical Education Guide No. 5: The core curriculum with options or special study modules, Medical Teacher, 17(2), pp. 125148. HARDEN, R.M., CROSBY, J.R. & DAVIS, M.H. (1999a) AMEE Guide No 14: Outcome-based education: Part 1an introduction to outcome-based education, Medical Teacher, 21(1), pp. 714. HARDEN, R.M., CROSBY, J.R., DAVIS, M.H. & FRIEDMAN, M. (1999b) AMEE Guide No 14: Outcome-based education: Part 5From competency to meta-competency: a model for the speci cation of learning outcomes, Medical Teacher, 21(6), pp. 546552. HARDEN, R.M., LAIDLAW, J.M. & HESKETH, E.A. (1999c) AMEE Medical Guide No 16: Study guidestheir use and preparation, Medical Teacher, 21(3), pp. 248265. HARDEN, R.M., LAIDLAW, J.M., KER, J.S. & MITCHELL, H.E. (1996a) AMEE Medical Education Booklet No 7, Part 1: Taskbased learning: an educational strategy for undergraduate, postgraduate and continuing medical education, Medical Teacher, 18, pp. 713. HARDEN, R.M., LAIDLAW, J.M., KER, J.S. & MITCHELL, H.E. (1996b) AMEE Medical Education Booklet No 7, Part 2: Taskbased learning: an educational strategy for undergraduate, postgraduate and continuing medical education, Medical Teacher, 18, pp. 9198. HARDEN, R.M., SOWDEN, S. & DUNN, W.R. (1984) ASME Medical Education Booklet No. 18: Some educational strategies in curriculum development: the SPICES model, Medical Education, 18, pp. 284297. HODGINS, H.W. (2002) The future of learning objects, in: D.A.Wiley (Ed.) The Instructional Use of Learning Objects (Agency for Instructional Technology, Association for Educational Communications and Technology). Bloomington, Indiana. HORTON, W. (2001) Leading e-learning (Alexandria, VA, ASTD, pp. 1, 3. JARVIS, P. & PREECE, J. (2001) Future directions for the learning society, in: P. Jarvis (Ed.) The Age of Learning: Education and the Knowledge Society (London, Kogan Page). JONES, D.R. & PRITCHARD, A.L. (1999) Realising the virtual university, Educational Technology, September-October, pp. 5660. KATZ, R.N. & RUDY, J.A. (1999) Information Technology in Higher Education: Assessing its Impact and Planning for the Future (San Francisco, Jossey Bass). KATZ, R.N. & OBLINGER, D. (2000) The E is for Everything. Educause Leadership Strategies (San Francisco, Jossey-Bass), p. 22. KING, B. (2001) Managing the changing nature of distance and open education at institutional level, Open Learning, 16(1), pp. 4760. MANTYLA, K. (2001) Blending E-learning: The Power is in the Mix (Alexandria, VA, ASTD), p. 3. MARTINEZ, M. (2002) Designing learning objects to personalise learning, in: D.A. Wiley (Ed.) The Instructional Use of Learning Objects (Agency for Instructional Technology, Association for Educational Communications and Technology). Bloomington, Indiana. MICHAELSON, V.E. (2001) The use of web-based instruction in medical education, DEOS News, 11(5), pp. 211. OBLINGER, D. (2001) Will e-business shape the future of open and distance learning?, Open Learning, 16(1), pp. 925. PHIPPS, R. & MERISOTIS, J. (1999) Whats the Difference? (Washington, DC, Institute for Higher Education Policy), p. 29. RUSSELL, G. & RUSSELL, N. (1999) Cyberspace and school education, Westminster Studies in Education, 22, pp. 717). RYAN, S., SCOTT, B., FREEMAN, H. & PATEL, D. (2000) The Virtual University. The Internet and Resource-based Learning (London: Kogan Page).

References
BARROWS, H.S. & TAMBLYN, R.M. (1980) Problem-based Learning: An Approach to Medical Education (New York, Springer). BOUD, D. (2001) Conclusion: challenges and new directions, in: D. Boud, R. Cohen & J. Simpson (Eds) Peer Learning in Higher Education: Learning From and With Each Other, p. 10 (London, Kogan Page). BRIDGES, D. (2000) Back to the future: the higher education curriculum in the 21st century, Cambridge Journal of Education, 30(1), pp. 3755. CUNNINGHAM, S., RYAN,Y., STEDMAN, L.,TAPSALL, S., BAGDON, K., FLEW, T. & COALDRAKE, P. (2000) The Business of Borderless Education (Commonwealth of Australia, Dept of Education, Training and Youth Affairs Evaluation and Investigations Program). CUNNINGHAM, S.,TAPSALL, S., STEDMAN, L., RYAN,Y., BAGDON, K. & FLEW, T. (1998) New Media and Borderless Education: A Review of the Convergence between Global Media Networks and Higher Education Provision (Commonwealth of Australia, Dept of Education, Training and Youth Affairs Evaluation and Investigations Program). DAVIS, M.H. & HARDEN, R.M. (1999) AMEE Medical Education Guide No 15: Problem-based learning: a practical guide, Medical Teacher, 21(2), pp. 130140. DUGGLEBY, J. (2000) How to be an Online Tutor (Aldershot, UK, Gower). FABOS, B. & YOUNG, M.D. (1999) Telecommunication in the classroom: rhetoric versus reality, Review of Educational Research, 69(3), pp. 217259. GENERAL MEDICAL COUNCIL (1993) Tomorrows Doctors: Recommendations on Undergraduate Medical Education (London, General Medical Council). HARDEN, R.M. (1998) AMEE Guide No 12: Multi-professional education: Part 1effective multi-professional education: a three dimensional perspective, Medical Teacher, 20(5), pp. 402408. HARDEN, R.M. (2000a) Evolution or revolution and the future of medical education: replacing the oak tree, Medical Teacher, 22(5), pp. 435442. HARDEN, R.M. (2000b) The integration ladder: a tool for curriculum planning and evaluation, Medical Education, 34, pp. 551557.

1 2 3 4 5 6 7 8 9 1011 1 2 3 4 5 6 7 8 9 2011 1 2 3 4 5 6 7 8 9 3011 1 2 3 4 5 6 7 8 9 4011 1 2 3 4 5 6 7 8 9 5011 1 2 3 4 5 6 7 8 9 6011

266

An international virtual medical school

SCHWARZ, M.R. (2001) Globalization and medical education, Medical Teacher, 23(6), pp. 533534. VAN HORN, R. (1996) Technology Phi Delta Kappan, February, p. 796. WHITEHOUSE, C., ROLAND, M. & CAMPION, P. (1997) Teaching Medicine in the Community: A Guide for Undergraduate Education (Oxford, Oxford University Press). WILEY, D.A. (2002) The Instructional Use of Learning Objects (Agency for Instructional Technology, Association for Educational Communications and Technology, Bloomington, Indiana).

Appendix 1

IVIMEDS Partner Schools and Institutions

Accreditation Council for Graduate Medical Education (ACGME), USA Arabian Gulf University, Bahrain Brown University, USA China Medical Board, USA and China Emory Medical School, USA Flinders University, Australia Foundation for Advancement of International Medical Education and Research (FAIMERSM), USA German Association for Medical Education (GMA), Germany Harvard Medical International, USA IVIMEDS Catalan Group, Spain Eberhard-Karls-University Tbingen, Germany Leicester/Warwick Medical School, England Mayo Clinic Medical School, USA National Board of Medical Examiners, USA National University of Mexico, Mexico National University of Singapore, Singapore NHS Education for Scotland, Scotland Pan American Federation of Associations of Medical Schools (PAFEM), South America Queens University Belfast, Ireland Robert Wood Johnston Medical School, USA Royal College of Surgeons of Ireland, Ireland Sherbrooke University, Canada Uniformed Services University of Health Sciences, USA Universidad Austral-Medicina, Argentina University of Aberdeen, Scotland University of Auckland, New Zealand University of Birmingham, England University of Bristol, England University of Dresden, Germany University of Dundee, Scotland University of Durham, England University of East Anglia, England University of Edinburgh, Scotland University of Florida, USA University of Glasgow, Scotland University of Heidelberg, Germany University of Hong Kong, China University of Insubria, Italy University of Manchester, England University of Miami, USA University of Michigan, USA University of New Mexico, USA University of Newcastle, Australia University of Newcastle, England University of Queensland, Australia University of St Andrews, Scotland University of Wales College of Medicine, Wales University of West Virginia, USA University of Western Australia, Australia Wake Forest University, USA

Med Teach Downloaded from informahealthcare.com by Marc Cray on 12/20/10 For personal use only.

267