Doctors tap into wireless revolution

November 23, 2001

Pat Leon discovers why the electronic classroom is the biggest thing since chalk.

Owen Epstein believes the wireless keyboards balanced precariously on his medical students' knees are the "biggest evolution in teaching since the introduction of the blackboard".

Slate and chalk might be the better analogy judging by the bowed heads of trainee doctors as they type in their responses to questions that Epstein, a consultant gastroenterologist, is posing on his PC and projecting onto a screen at the front of the class.

The students at the Royal Free Hospital in North London are demonstrating Discourse, an electronic classroom that links every student's laptop, or Studycom, with the teacher's PC workstation via infrared ceiling sensors.

"It's magic," Epstein says. "For the first time, every student can speak to the teacher at once. That radically changes the learning tradition among medics."

The Royal Free is the first medical school in the world to pilot Discourse, aided by an Astra Foundation grant. Since 1999, the school has converted nine classrooms to use Discourse and put a browser version on the campus library network.

Epstein says: "It is robust and easy to use, unlike much information technology, which is slow, costly and needs high-tech support. Technology can undermine the role of teaching. It is not 'inspirational' and can be inflexible, anti-social and lead to rapid fatigue."

The students seem to think much the same about traditional classroom lectures. When Epstein asks their views, the words - "boring", "it's easy to fall asleep", "they aren't interactive enough" - flash up on his screen. They are eager, though, to demonstrate Discourse's virtues in a session mirroring the format of a pilot seminar series on clinical reasoning.

A group of ten clinicians with no previous exposure to Discourse ran ten seminars last academic year. They posted a "problem of the week" on the Discourse website that students were expected to look at and prepare for in advance of sessions. The experiment more than fulfilled expectations. Student attendance rates consistently topped 90 per cent, and students responded to every interactive opportunity (averaging 13 per lesson). Students consistently rated the lessons as either "very good" or "good" and rated the seminars higher than all their other teaching experiences.

Epstein says the electronic classroom breaks through traditional cultural barriers. "In medical school there is a certain level of intimidation. With Discourse no one has to put their hand up. There is peer group anonymity. It engages the group one-to-one."

The clinicians also responded favourably. They were able to identify class strengths and weaknesses in an instant and target their teaching. The students evaluate each lesson electronically and this feedback provides information for in-depth audit.

The aggregated student responses were revealing. Campus dean Mike Spyer was so impressed that he supported the development of a Royal Free campus "Discourse Centre of Excellence". Over the past 18 months, there has been a progressive rollout of Discourse seminars. Some 120 undergraduates per week do them and 29 medical teachers use the classrooms.

Discourse interaction can be spontaneous or structured. In spontaneous mode, Discourse opens a two-way, free-text communication channel between teacher and class. In structured mode, a click of the mouse allows teachers to deliver multiple-choice questions (with instant automatic marking), filling in the missing word/s, and offers the class an invitation to vote. Every student's typed keystroke is digitally stored and is instantly available for review and analysis.

With gloom and low morale permeating so much of the teaching profession, Discourse offers a rare ray of sunshine.

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