The use of blended learning is not new, but in the past it consisted primarily of didactic sessions or small groups to bring students in disparate clinical environments together. Using a computer-based model incorporating adult learning principles allows more student flexibility and can present material that simulates actual clinical encounters. Students can work through the material in the way that best suits their learning styles.
Creating online materials allows for a level of creativity absent from writing syllabi or paper cases. We found that the variety of learning activities we could construct was only limited by our imaginations. Striving for the maximum interactivity allowed us to actively engage the students, and their feedback shows that they found the experience to be educationally valuable.
Based on student feedback surveys, we found that the online curriculum was well accepted, despite the extra time students spent to complete it. This likely relates to the students' ability to work on new skills and directly apply them to their work with patients. Having an interactive virtual chart allowed students to practice note and prescription writing on their own, away from the time pressures of the clinical setting. Likewise, seeing approaches to challenging patient interviews online gave students the opportunity to increase their comfort level with such patients and to reflect on their own skills outside of real clinical encounters.
More advanced students could use the curriculum to explore common primary care complaints and their differential diagnoses, tests, and treatments. Some students, however, commented that the information in Module 3 was presented at too basic a level. Reviewing the content with an eye toward its applicability to a wider range of diagnostic abilities might have improved the experience for clinically advanced students.
Although all Case medical students are issued identical laptop computers on matriculation, there were still technologic issues. Some students with slow internet connections at home had trouble viewing the streaming video and listening to the streaming audio. With the increasing availability and affordability of high-speed internet connections, this problem should become less pressing. For medical schools that don't provide or require specific computer specifications, however, care must be taken in creating content that can be used by all students.
There are strengths and limitations to all educational formats, and blended learning is no exception. We have highlighted the ability of an online curriculum to enhance clinical learning by taking advantage of interactive technology and standardizing student experiences in a way that is not place or time dependent. One obvious weakness is the distant nature of the interactions between students and teachers when communicating via discussion board or email. This is balanced, in CPCP, with the face-to-face interactions that the students have weekly with their preceptors. There is also a limited amount of flexibility in the content delivered to individual students. We addressed this by including as many links to further reading and related information as possible so each student could find content that suited his/her level of expertise.
The major limitation to this study is the difficulty in measuring behavioral outcomes. Due to the small number of control students as well as the large number of other clinical experiences during the two years of CPCP participation that could have influenced student performance on the clinical exam, sweeping conclusions are not possible. We were encouraged to see that PCT students performed well on the exam when compared with their peers and that there was a trend toward superior performance in patient counseling and a significant difference in overall performance. The strength of the blended learning model may not be reflected as clearly in performance data as it is in the feedback the students provide on their ability to use the knowledge gained to improve the actual care of patients.
In addition, when Case underwent a major curricular revision in 2006, CPCP and the online curriculum were expanded to include all second year medical students. This expansion of CPCP from an elective for primary care track students to a mandatory course further exemplifies the success of this program.