Medical Teacher

ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: https://www.tandfonline.com/loi/imte20

Increasing tensions in the ubiquitous use of

technology for medical education

Poh Sun Goh & John Sandars

To cite this article: Poh Sun Goh & John Sandars (2019): Increasing tensions in the ubiquitous
use of technology for medical education, Medical Teacher, DOI: 10.1080/0142159X.2018.1540773

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Published online: 16 Jan 2019.

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MEDICAL TEACHER
https://doi.org/10.1080/0142159X.2018.1540773
SHORT COMMUNICATION
Increasing tensions in the ubiquitous use of technology for medical education
Poh Sun Goha and John Sandarsb
a
Department of Diagnostic Radiology, National University of Singapore, Singapore; bFaculty of Health & Social Care, Edge Hill University
Medical School, Edge Hill University, Ormskirk, UK
ABSTRACT
The ubiquitous use of technology in medical education creates increasing tensions related to the benefits and disadvan-
tages of the ease of access to content and the opportunity to monitor online behavior. We recommend a collaborative
understanding by all stakeholders, from learners and educators to higher education institutions and professional regulatory
authorities, to inform future practice and policy.
Introduction
In this Short Communication we critically discuss two of
the major tensions that have become increasingly apparent
by the ubiquitous use of technology in medical education
over the last few years. We believe that greater under-
standing of the tensions related to the increasing ease of
access to content and the increasing opportunity to moni-
tor online behavior will inform medical educators to take
the essential steps to resolve these tensions. Effective reso-
lution of these tensions, which exist between the potential
benefits and disadvantages of the use of technology, will
require both a change in the practices of medical educa-
tors and learners, as well as the development of institu-
tional teaching and learning policies.
Increasing access to content
The widespread use of technology in medical education
offers an unrivaled opportunity to constantly access a vast
range of information. This opportunity has significant bene-
fits across both academic and clinical aspects of medical
education, with the prospect of learning at any time and
any place. Information from different resources, which
range from more traditional information websites (such as
the many specific educational websites or more general
websites identified through search engines like Google)
and multiple social media and online networking tools and
Apps (such as WhatsApp, Instagram, Facebook, Skype), can
provide a rich constructivist learning opportunity through
the integration of content.
However, there are increasing concerns that the ease of
sharing, posting, and dissemination of information can
overload cognitive capacity and this can lead to superficial
learning (Mayer and Moreno 2003; Carr 2010; Anderson
and Rainee 2018).
Technology can promote unconscious ‘short-cut’ taking,
rather than deep, slower learning approaches (Carr 2010).
Having large volumes of content at one’s fingertips can
overwhelm the learner, especially for the selection of the
CONTACT Poh Sun Goh dnrgohps@nus.edu.sg
Singapore 119074, Singapore
ß 2018 Informa UK Limited, trading as Taylor & Francis Group
right material for the specific task that has to be achieved.
This situation is concisely encapsulated in the quote attrib-
uted to Mitchell Kapor: “getting information off the
Internet is like taking a drink from a fire hydrant” (Kapor
1991). It is also only too easy to wander along endless
digital trails of information which often lead to blind cul-
de-sacs (Hollis and Was 2016).
Of particular concern is that the present generation of
learners are constantly distracted through repeated multi-
tasking and attention switching, rather than having a focus
on one task at a time (Carr 2010; Szpunar et. al. 2013).
Modern web viewing browsers allow multiple websites and
social media to be open simultaneously, and there is also
frequent use of both hyperlinking and embedding content
(still graphics, audio and video multimedia, and virtual and
mixed reality content). All of these features increase the
possibility of redirecting attention and focus, even when
there has been user experience design to improve usability
of the technology and its application.
Increasing monitoring of online behavior
Learning analytics can literally track every piece of online
activity, every digital footstep and foot print (Sclater and
Mullan 2017). The data from learning analytics can readily
highlight what content is accessed, for how long, in what
way; what is skipped and skimmed over, what is dwelled
upon; what notes are taken, and refined; what questions
are posed to peers, how-when-what is questioned
(Goh 2017).
Undoubtedly learning analytic data can provide medical
educators with potentially useful insights into the process,
efficiency and effectiveness of a learner’s online activities.
Research suggests that the length and focus of attention
during online activities has a correlation with learning
(Szpunar et al. 2013). Monitoring can track the learning
journey of a learner, and provide essential insights to
inform detailed and specific feedback on both what con-
tent they access, as well as how learners access the range
of different sources.
Department of Diagnostic Radiology, National University of Singapore, 5 Lower Kent Ridge Rd,
2 P. S. GOH AND J. SANDARS
The creation of big data sets and the judicious use of
artificial intelligence (AI) can increasingly allow medical
educators and administrators to visualize online behaviors
across a whole cohort, selective group or an individual
learner. Text analysis of written output using AI algorithms
can now allow comparison between the performance of an
individual learner with a trained practitioner (Chan
et al. 2018).
However, an important tension that needs to be recog-
nized in the use of learning analytics is the major risk to
the privacy for learners, especially when the monitoring
extends beyond online activities related to a specific learn-
ing event to the collection of data related to all online
behavior. Just because it is possible to constantly monitor
online behavior does not mean that it has to be done.
These concerns, and the extent to which Universities rou-
tinely monitor the use of student social media, was
recently highlighted (Bauer-Wolf 2017).
Responding to the tensions
Effective learning requires the learner to have content of
sufficient quality, depth, suitability and relevance. However,
this has major implications for novice learners who prefer
less choice, less content, and more guidance (Donnelly
2015). An essential competence for all learners is the devel-
opment of digital literacy for finding and evaluating the
relevance, accuracy and potential usefulness of the vast
range of information sources and content (Lynch 2017).
More information and content do not necessarily lead to
deeper insight and improved learning. It is increasingly
important that all medical educators can also develop their
own digital literacy, especially in the creation, curation and
recommendation of content (Sherwood 2017). Curation
brings together different sources of information to provide
a prepackaged coherent store of content for learners but
recommendation of the most appropriate sources of con-
tent is also important, especially when combined with a
collaborative user-rating system that involves learners and
other medical educators.
To protect, and mitigate privacy risks and concerns, it is
important to consider that it is not necessary for medical
educators to know specific personal details of an individual
student. It is easy to separate the verification process for
online access from the tracking of online behavior and
learning outcomes (Marinova 2018).
The recognition of identifying individual online behavior
has important implications for all learners, with the need to
develop ’digital professionalism’ (Ellaway et al. 2015;
Janczukowicz and Rees 2017). Learners need to develop
critical awareness of the potential consequences of their
actions when they post and share comments. It is too easy
to post irrelevant and frivolous comments but this can be
easily rectified by providing time for the author to edit, or
delete, their post before this becomes accessible to others
(Hui 2018).
The increasing and ubiquitous use of technology across
the spectrum of medical education, from undergraduate to
continuing, will create increasing and new tensions that
have to be resolved if the potential benefits are to be fully
realized. We consider that the creation and implementation
of external control, through guidelines, standard operating
procedures, professional regulatory frameworks and statu-
tory laws, will not be sufficient for resolving these tensions.
We recommend that a collaborative approach for all stake-
holders in medical education, from learners and educators
to higher education institutions and professional regulatory
authorities, is developed. This collaborative process should
allow the critical discussion of the different and divergent
perspectives so that a shared understanding of the ten-
sions can inform an appropriate way forward.
Conclusion
We have highlighted two increasing tensions associated
with the ubiquitous use of technology in medical educa-
tion. A shared critical awareness and understanding of
these tensions by all stakeholders is essential to ensure
that the future exciting use of technology across the spec-
trum of medical education can achieve its full potential for
learners, educators and institutions.
Disclosure statement
The authors report no conflicts of interest. The authors
alone are responsible for the content and writing of
this article.
Notes on contributors
Poh Sun Goh, MBBS, FRCR, FAMS, MHPE, FAMEE, is an
Associate Professor and Senior Consultant Radiologist at
the Yong Loo Lin School of Medicine, National University
of Singapore, and National University Hospital, Singapore.
He is a graduate of the Maastricht MHPE program, a mem-
ber of the AMEE TEL committee, and a Fellow of AMEE.
John Sandars is Professor of Medical Education at Edge
Hill University Medical School, Ormskirk UK, and is Co-Chair
of the AMEE Technology Enhanced Learning Committee.
ORCID
Poh Sun Goh http://orcid.org/0000-0002-1531-2053
John Sandars http://orcid.org/0000-0003-3930-387X
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