An e-learning experience for medical education in Mediterranean countries
C. Brancaleone1, R. Tranfaglia1, L. Mirarchi2 and M. Bracale1
1
Department of Biomedical, Electronic and Telecommunication Engineering, University “Federico II”, Naples, Italy
2
Service Marketing, Siemens Medical Solution, Milan, Italy
Abstract— Information technology tools and environments
have successfully been employed in supporting specific aspects
of medical education. Such an approach was exploited in the
IntraMEDnet project, financially supported by European
Union in the program of Interreg III B Archimed, which
involves the development of a distributed pool of specialized
educational modules in state-of-the-art scientific issues related
to medicine and biological sciences. Over-specialized scientists,
from different institutions, individually developed related
educational modules which have been combined dynamically
on a virtual classroom on the web in order to create integrated
educational units. Each such complete educational unit can be
shaped to support self-directed (or expert instructed) problem-
based learning, enhancing patient-oriented approach to
medical education. The project also considered the potential of
this virtual collection of educational modules to grow into an
integrated environment for transferring the learning process
to the e-class.
A web questionnaire have been developed in order to
evaluate the e-learning platform and the learning object,
produced in the project. The satisfaction of user and technical
aspects have been investigated.
The results of the study suggest a major employment of this
new methodology of education.
Keywords— e-Learning, medical education, virtual
classroom
I. INTRODUCTION
The expansion of clinical research in recent decades has
made the physician’s task of lifelong learning more exigent.
Yet physicians in practice do not effectively keep up-to-
date. They leave the majority of their clinical questions
unanswered [1], often consult non-evidence-based sources
of information, witness their grasp of current information
deteriorate over the years following their training [2,3], and
demonstrate wide practice variations for clinical
manoeuvres with established efficacy [4]. And traditional
didactic continuing medical education (CME) remains of
limited utility as a remedy [5].
In recent years, advances in information and
communication technology (what is often collectively
referred to as “new technologies”) have acted as catalysts
for significant developments in the sector of health care,
having a strong impact in supporting medical diagnosis,
enabling efficient and effective patient and healthcare
management and reforming medical education. There is
currently an international trend to involve computers and
the Internet in medical curricula as well in continuing
lifelong medical learning. This practice is reinforced by
active support and funding from bodies such as the
European Union and local governments. Specifically, the
European Council in its Lisbon meeting in March 2000 set
forth the European policy for an information and
knowledge-based society, stressing the need to encompass
the emerging technological revolution and change in the
exchange of knowledge affecting all institutions and various
aspects of the society [6].
II. MATERIALS AND METHODS
In the IntraMEDnet project, the partners are: University
Of Cyprus, Department Of Computer Science (Cyprus);
Paphos General Hospital (Cyprus); Democritus University
Of Thrace (DUTH) - School Of Medicine (Greece);
University Of Patras - School Of Medicine, Medical
Physics Laboratory (Greece); University of Naples
“Federico II” - Department Of Biomedical, Electronic And
Telecommunication Engineering (Italy); Aristotle
University Of Thessaloniki - School of Medicine (Grece).
They are setting out to develop a distributed pool of
specialized educational modules in state-of-the-art scientific
issues related to medicine, biomedical and biological
sciences. Over-specialized scientists from different
institutions develop individually related educational objects
which are then combined dynamically on a virtual e-
classroom on the web in order to form integrated
educational units. Each such complete educational unit can
be shaped to support either traditional expert instructed
teaching and/or self-directed problem-based learning,
enhancing the patient-oriented approach to medical
education.
Potential users of the educational services developed in
the IntraMEDnet project include:
 the traditional undergraduate medical student
 the postgraduate medical student;
 the medical professional, who is already into the working
environment and aims to further their abilities and
knowledge.
 For the needs of the IntraMEDnet project, the research
teams of the partners involved in the project have identified
general educational topics of common interest to at least
two or more partners of the project. Such topics have been
identified based on current educational needs of the
partners’ institutions as well as based on existing expertise
and excellencies within the partners. For each such general
topic, specific learning objects of interest have been
identified and described in detail. For example about the
topic “diagnostic imaging”, the learning object identified
are the following:
 radiology (Basics and the DICOM protocol)
 CT basics
 ultrasound (basics and practical examples)
 Nuclear Medicine (physiology and total body scan)
 Nuclear Magnetic Resonance (physical basics and
practical examples)
 minimal invasive surgery
The individual development of these objects emphasizes
on high quality content, delivery and service. Content needs
to be comprehensive, authentic and researched. Service
should include the provision of resources needed for
learning as well as any administrative and technical support
needed. Delivery, through the supporting technologies is
web-based and the interface of e-learning programmers both
for authoring content and for publishing is user-friendly
with communication tools to support interactivity.
The major characteristics of these individual educational
objects are the following:
 they are self contained educational units
 they have well specified educational objectives
 they are thematically targeted and overspecialized
 they have been developed by overspecialized experts in
the specific thematic area
Individual educational objects are combined to either
support traditional instructional teaching or new medical
education approaches based on problem or case based
learning.
The project has started on June 2006 and ended in
October 2008. Most of the activities of the project
concentrated on studying and analyzing educational needs
in medical education in terms of expert knowledge,
reviewing current trends in educational and related
technology, and designing and developing the educational
strategy and corresponding environment that allows for the
sharing of expert educational modules via the web.
All the partners install an e-learning environment, this
environment is Moodle.
It is noted that in general the open source Moodle e-
learning management system used as it has rather minimal
hardware requirements that are covered by all partners.
All the Learning objects created from experts in the field.
46% of the LO created to be conformant and compliant with
the Sharable Content Object Reference Model (SCORM).
3% use Problem based learning as a didactic approach, by
the use of Web 2.0 tools, such as wiki, forum and blogs.
The 52% created by the use of E-learning environments’
tools and the use of WEB 2.0 tools such as: Forum, chat,
etc..
A web questionnaire have been developed in order to
evaluate the e-learning platform and the learning object,
produced in the project. The main goal of this study was to
obtain useful data and establish criteria for the best use of
new technologies in e-learning.
It is very important to evaluate the efficacy of the e-
learning activity, particularly [7] it is very important to
distinguish:
 the evaluation of the e-learning services;
 the assessment of the student learning process.
The gathering of feedback and relevant data concerning
the practical experience [8, 9], that each partner of the
consortium has made, represent a resource for the
improvement of future e-learning activity, with the scope to
centre the aim of the IntraMEDnet project.
Before evaluating, it is important to clarify what it is
evaluated. Also, it was proposed to investigate the
perceptions of distance learning, throughout some questions
asked in a final test [10], because the distance learning
between students and instructors could produce a decrease
of efficacy of the educational process.
The educational objects have been evaluated using the
four levels of Kirkpatrick [11] model, that are:
1. Reaction: this evaluation level measures the students
reaction to the educational objects, their grade of
satisfaction, including affective response to the quality and
the relevance of the instruction.
2. Learning: in this case it is evaluated the improvements
(knowledge and skills acquired) of students after learning
the educational objects;
3. Behaviour: in this case it is evaluated if the behaviour of
students is changed after using the educational object, for
example it is evaluated if the students have improved the
use of internet, e-mail,…, or if the learners are
professionals, workers, if they have improved their way of
working.
4. Results: in this case it is evaluated the impact that the
instruction has had on broader organisational goals, if the
students that have attended the e-learning courses have
success in their work or if they get a job in brief time.
The instrument used to investigate the efficacy of the
educational objects taught, according to the Kirkpatrick
model, is questionnaire.
 The level 2 and 4 of Kirkpatrick model have been
evaluated by final test, included in the learning object, with
assesses the topic’s learning.
In our opinion the Learning level of Kirckpatrick model
is important to evaluate the e-learning activity, but at the
same level it is found the assessment of the student e-
learning process.
Web questionnaire, realized by Biomedical Unit of
University of Naples “Federico II”, was proposed to each
user, by which it was investigated the level 1 and the level 3
of Kirkpatrick model.
The questionnaire, for the evaluation of the satisfaction
level of all user, students and doctors, nurses and technician,
is composed of 15 questions, that can be divided in 5 parts:
previous experiences of e-learning, previous ICT
knowledges, technical equipments and problems,
satisfaction, potential improvements.
The first part wants to investigate how the e-learning
technology is new for the user and the familiarity of the user
with this methodologies.
The second part collects information about the user’s
level of ICT knowledges and the possible increase of it after
e-learning experience.
The third covers technical aspects that can oppose the
optimal use of educational content and platform.
The fourth part inspects the real impact of the project,
making in highlight how e-learning can be effective and
what kind of benefits the student researches in it.
The last part regards the suggestions to make more
involving and user friendly the platform.
III. RESULTS
The questionnaire have been filled by 151 users, but it’s
still on line to receive other inputs on the following URL
http://www.intramednet.unina.it/evaluation, where all the
results are reported. First of all we report a statistic about
the kinds of users that followed the courses on the platforms
of IntraMEDnet consortium. We have the divisions of users
for age, course attended, partner’s institution and
profession.
Doctors
Nurses
PhD students
Biomedical engineer
Medical s tudents
Biomedical engineering
s tudent s
Fig. 1 Distribution of the user by profession
The answers of each question have been statistically
analyzed, for example for the question number 10:
10.Does an e-learning course have advantages to a
regular course?
Fig. 2 Distribution of the answers at the question
The data have been analyzed to assess the satisfaction of
the user and how this value differs regarding the various
categories of users.
According with the level of satisfaction, the users have
been divided in 4 clusters.
The 4 clusters are composed by:
1. fully satisfied users;
2. very satisfied users;
3. sufficiently satisfied users;
4. insufficiently satisfied users.
According with the answers of the user to the questions
of the test, each user has a score, as a measurement of
satisfaction. This score identifies the cluster in which the
user is included. The maximal score is 100 points, that
indicates fully satisfaction of the platform and of the
courses by the user
The scores for the different cluster are:
 Cluster 1: from 75 to 100 points;
 Cluster 2: from 50 to 75 points;
 Cluster 3: from 25 to 50 points;
 Cluster 4: from 0 to 25 points.
We have assigned different score to the questions, in
relationship with their importance, trying to balance the five
parts of the questionnaire.
We have assigned to the answers a score between the
total of the questions and 0.
Considering all the answers of all the users and following
this approach the average score is 81,76 points on 100. It is
a very high features, from this data we could include the
average user among the users of cluster 1.
In conclusion we report also the division of the users in
clusters:
 ACKNOWLEDGMENT
This project has been financially supported by European
77,48 % fully satisfied
users Union in the project INTRAMEDNET of European
18,55% very satisfied program INTERREG IIIB ARCHIMED.
users
3,31% sufficiently
The Authors thank all the partners of the project for their
satisfied users nice and useful professional collaboration.
0,66% insufficiently
satisfied users

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Macromedia Flash plug-in and pop-up block function.
These problems are very simple to solve when the users Author: Claudia Brancaleone
often use internet to see also other web sites that require Institute: Department of Biomedical, Electronic and
Telecommunication Engineering
these plug in or protection levels of the web browser. Street: Via Claudio, 21
We must also report that 96,3 % of the users believe in City: Naples
future developments of the e-learning, through real-time Country: Italy
feedback, such as virtual classroom and videoconference Email: claudia.brancaleone@unina.it
functionality.