Evolving Models Formedical Physics Education And Training .
View metadata, citation and similar papers at core.ac.ukbrought to you byCOREprovided by PubMed CentralAvailable online at http://www.biij.org/2008/1/e16doi: 10.2349/biij.4.1.e16Biomedical Imaging and Intervention JournalREVIEW ARTICLEEvolving models for medical physics education and training:a global perspectiveP Sprawls, PhDSprawls Educational Foundation, Montreat, North Carolina, United StatesReceived 21 December 2007; accepted 5 February 2008ABSTRACTThere is a significant need for high-quality medical physics education and training in all countries to supporteffective and safe use of modern medical technology for both diagnostic and treatment purposes. This is, and willcontinue to be, achieved using appropriate technology to increase both the effectiveness and efficiency of educationalactivities everywhere in the world. While the applications of technology to education and training are relatively new, thesuccessful applications are based on theories and principles of the learning process developed by two pioneers in thefield, Robert Gagné and Edgar Dale.The work of Gagné defines the different levels of learning that can occur and is used to show the types and levels oflearning that are required for the application of physics and engineering principles to achieve appropriate diagnostic andtherapeutic results from modern technology. The learning outcomes are determined by the effectiveness of the learningactivity or experience. The extensive work of Dale as formulated in his Cone of Experience relates the effectiveness tothe efficiency of educational activities. A major challenge in education is the development and conduction of learningactivities (classroom discussions, laboratory and applied experiences, individual study, etc.) that provide an optimumbalance between effectiveness and efficiency. New and evolving models of the educational process use technology asthe infrastructure to support education that is both more effective and efficient.The goal is to use technology to enhance human performance for both learners (students) and learning facilitators(teachers). A major contribution to global education is the trend in the development of shared educational resources.Two models of programs to support this effort with open and free shared resources are Physical Principles of apm.org/international). 2008 Biomedical Imaging and Intervention Journal. All rights reserved.Keywords: Effective education, efficient learning activities, technology enhanced education, shared resourcesINTRODUCTIONPresent address: Director, Sprawls Educational Foundation, PO Box1208, Montreat, NC 28757, United States. E-mail: sprawls@emory.edu(Perry Sprawls).Medical practice and healthcare facilities in mostcountries are becoming increasingly effective indiagnosing and treating many diseases, thanks toadvances in science and technology for both diagnosticand therapeutic applications. In order for these advances
2P Sprawls. Biomed Imaging Interv J 2008; 4(1):e16This page number is notfor citation purposesto benefit citizens anywhere in the world, the medicaltechnology has to be available and accessible, andhighly-educated and trained medical professionals haveto be able to utilise the technology for maximumeffectiveness.Medical physicists have the knowledge to ensureoptimum and safe utilisation of modern medicalequipment for the benefit of all patients. This is achievedthrough applied clinical activities such as treatmentplanning and imaging procedure optimisation, educationand training of other medical professionals such asphysicians and technologists, evaluation of equipmentperformance, risk analysis, and management of qualityand safety activities.There are two specific dynamics that have an impacton the effectiveness of education and training activitiesin a specific geographic region. One is the many rapidadvances in the science and technology that requirealmost constant updating of knowledge, experience, andeducational materials on a local basis. The other is theneed to transfer knowledge from the few centres ofexperience with new technologies and methods to themany worldwide locations for clinical application. Theseneeds will only be met by transiting to new models of theeducation and training process where state-of-the-arttechnology is used to enhance human performance ofboth learners (students) and learning facilitators(teachers). The goal is to produce enriched learningenvironments on a global basis to support highlyeffective learning activities.We will now review the characteristics of learningenvironments, especially with respect to theireffectiveness and efficiency, as described by two of themajor pioneers in the educational process and thenanalyse two models that are making major contributionson a global basis.EFFECTIVE LEARNINGIn order to contribute to improved healthcare, theknowledge of medical physics must be applied in theclinical environment to plan and optimise procedures,analyse performance, solve problems, and other creativeactivities. This requires a higher level of learning thanmight be required for adequate performance on manywritten examinations.Robert Gagné, introduced in Figure 1, provides ananalysis of the learning process which defines thedifferent types of learning.Gagné's Principles Applied to Medical PhysicsEducationA major contribution of Gagné that applies tomedical physics education is the formulation of thehierarchy and levels of learning as illustrated in Figure 2.Not all learning activities result in achieving thesame abilities to perform specific functions. Theapplication of medical physics in the clinicalenvironment generally requires the higher levels oflearning as illustrated above.The level of learning achieved and the ability toperform specific functions depends on the effectivenessof the learning activity. While it is desirable for alearning activity, such as a classroom discussion, to behighly effective there is a major compromise that mustbe considered. That is the efficiency of the learningactivity in terms of required resources such as personneltime and effort, institutional facilities, and financial costsas illustrated below.RELATIONSHIP OF EFFECTIVENESS AND EFFICIENCY OFLEARNING ACTIVITIESThis significant relationship between effectivenessand efficiency of learning activities was formulated byEdgar Dale and described with the Cone of Experiencewhich has been published in different forms as illustratedin Figure 3.Dale's Cone of ExperienceDale's cone of experience is shown in more detail inFigure 4.As one can see, the cone of experience organiseslearning experiences and activities in terms of theireffectiveness in producing learning outcomes.The learning outcomes that are crucial to clinicalmedical physics (analyse, create, evaluate, problem-solve,etc.) are best developed by experiences and learningoutcomes at the base of the cone.The Cone of Experience Applied to Medical PhysicsEducationThe concept of the cone of experience applied morespecifically to medical physics education is shown inFigure 5.Relationship of the Cone of Experience to Effectivenessand EfficiencyA major question is why a specific type of learningactivity is selected and used. The answer is found whenthe characteristic of efficiency is added to the cone asshown in Figure 6.EFFICIENCY OF EDUCATIONAL ACTIVITIESMany factors that have an effect on efficiency areillustrated in Figure 7.Any learning activity requires resources and it is thisoverall requirement that determines the efficiency of theactivity. As has been observed above, learning activitiesthat can be highly effective with outcomes to supportapplied clinical medical physics (the lower section of theCone of Experience) require significant resources, andare therefore not the most efficient when compared tosome other educational methods.
3P Sprawls. Biomed Imaging Interv J 2008; 4(1):e16This page number is notfor citation purposesFigure 1 Robert Gagné.Figure 2 Gagné's Levels of Learning as illustrated by the author.
4P Sprawls. Biomed Imaging Interv J 2008; 4(1):e16This page number is notfor citation purposesFigure 3 Edgar Dale's Cone of Experience has been interpreted and published in many different forms asillustrated here.Figure 4 Dale's Cone of Experience illustrating different types of learning.
5P Sprawls. Biomed Imaging Interv J 2008; 4(1):e16This page number is notfor citation purposesFigure 5 Medical physics learning activities range from listening to verbal lectures at the top of the cone to directcontact, interaction, and experience with the physical items and conditions that form the base.Figure 6 The real significance of the cone of learning activities, especially for applied medical physics, is thateffectiveness of the learning experience to produce the higher levels of learning and necessary outcomesis generally the least efficient and most costly to produce.
P Sprawls. Biomed Imaging Interv J 2008; 4(1):e166This page number is notfor citation purposesFigure 7 Factors that determine the efficiency of educational activities.8Figure 8 Technology, especially through the global availability of high-quality visuals and images, iscontributing to more effective learning.
7P Sprawls. Biomed Imaging Interv J 2008; 4(1):e16This page number is notfor citation purposesThe Role of Digital TechnologyThe long-standing challenge between the efficiencyand effectiveness of education activities is now beingreduced through the availability of state-of-the-art digitaltechnology. One of its contributions that relates to thecone of experience and the levels of learning isillustrated in Figure 8.Technology is now making a major contribution tomore effective medical physics education by providinghigh-quality visual representations to enrich the learningenvironments and move the learners closer to thephysical reality that they are studying.High-quality visuals have the capability of ‘makingthe invisible now visible’ (radiation, atomic structures,etc.), showing relationships and interactions, andillustrating virtually all aspects of medical imaging.The increased efficiency comes from the sharing ofthe digitised resources so that local learning facilitators(teachers) and learners (students) can devote their timeand effort to a more productive learning process.The Traditional Classroom Learning Environment ModelFor centuries, the usual learning environment hasbeen the classroom as illustrated in Figure 9.While the traditional classroom process continues tobe useful for many topics, especially those that areconveyed through audio media (music, languages, etc.),it presents a major challenge for effective medicalphysics education for both the learners and the learningfacilitators as illustrated in Figure 10.The production of high-quality visuals that canconnect the learner to the physical world (medicalphysics) about which they are learning requires extensivetime, talent, knowledge, experience, and technicalresources that are not generally available to thetraditional classroom teacher.Because of the rapid advances in medical physicsand the associated technology for both imaging andtherapy, and the migration of these around the world, thelocal learning facilitator is challenged with having tokeep ‘up-to-date’ through continuing education andlifelong learning.The Learner in the Traditional Classroom ModelThe learner in the traditional classroom model isfirst challenged with the necessity of recording, inwritten form, both the visuals and spoken words and thenusing the materials later for effective learning asillustrated in Figure 11.Technology Enhanced EducationMany of the challenges and short-comings oftraditional education methods, especially in medicalphysics, are being reduced by innovative applications oftechnology.The desired role of technology is not to replace thelearning facilitator/teacher but to enhance humanperformance, through increased effectiveness andefficiency, of both the learner/student and the learningfacilitator/teacher.This is, and will continue to be, achieved throughevolving models of the educational process that combinethe advantages and values of both technology andhumans. Figure 12 shows how this is achieved in avariety of medical physics academic courses and forcontinuing education.When high-quality visuals are available from anonline resource, the local learning facilitators can devotetime to guiding and leading the learning process withtheir personal knowledge and experience. This can be ahighly effective learning activity producing the desiredoutcomes for clinical medical physics applicationsbecause it combines high-quality visuals to enrich thelearning environment with the experience of the locallearning facilitators. It is also very efficient for thelearning facilitators because their effort can be directedto engaging the learner and guiding the learning processrather than having to produce visuals and other relatedmaterials.The learner is now "seeing" much of the physicaluniverse rather than hearing it described in words, whichresults in a much more effective learning experience andhigher levels of learning. When the visuals and relateddescriptive materials are also available to the learner forlater study and review, the total learning activitybecomes much more efficient.ENRICHING THE LEARNING ENVIRONMENT WITHSHARED RESOURCESOne of the greatest needs in medical physicseducation and training is to enrich the local learningenvironments everywhere in the world with the up-todate experience associated with the developments inscience and technology. A model of how this can beachieved is illustrated below.The requirement is that physicists, other scientists,and medical professionals who have the experience withthe various technologies and applications transfer theirknowledge into digital resources that are shared withboth learners and learning facilitators on a global basis asillustrated in Figure 13.We will now consider a model for each of theseapplications.The Physical Principles of Medical Imaging OnlineThe Physical Principles of Medical Imaging Online(PPMI) is a multifaceted shared resource as illustrated inFigure 14.The purpose of PPMI Online is to support andenrich each step in the integrated learning process of thephysics of medical imaging for medical physicists,radiologists, and other medical imaging professionals. Inmost applications it is integrated into, and used as aresource for, courses provided by institutions under thedirection of the local medical physics faculty.
P Sprawls. Biomed Imaging Interv J 2008; 4(1):e16This page number is notfor citation purposesFigure 9 The traditional classroom has been the best available learning environment from the standpoint ofefficiency. Large groups of learners can be brought together and "taught" by the highly efficient (but notso effective) lecture process.Figure 10 For the learning facilitator/teacher there is the need to produce visuals (windows to the physical world)and to have an up-to-date knowledge of applied medical physics.9
P Sprawls. Biomed Imaging Interv J 2008; 4(1):e16This page number is notfor citation purposesFigure 11 Factors that limit both the efficiency and effectiveness of classroom learning and individual study beforethe availability of technology.Figure 12 The foundation of most technology enhanced learning is the availability of a comprehensive collectionof digital resources to support the different activities with the goal of making them both more effectiveand efficient. This is best achieved by shared resources made available on a global basis by distributionover the Internet or through the physical distribution of recorded digital media like CD-ROMs.10
P Sprawls. Biomed Imaging Interv J 2008; 4(1):e16This page number is notfor citation purposesFigure 13 Shared resources developed in this process enrich the learning environments both for courses providedby academic institutions and by organisations for continuing education and lifetime learning.Figure 14 The types of resources and the learning activities supported by the Physical Principles of MedicalImaging Online at http://www.sprawls.org/resources.12
P Sprawls. Biomed Imaging Interv J 2008; 4(1):e1611This page number is notfor citation purposesOpen Resources for Medical Physics ContinuingEducationThe American Association of Medical Physicists(AAPM) provides many continuing education activitieseach year. These include approximately 50 coursespresented during each AAPM Annual Meeting and alsothe Summer School devoted to a specific topic of interesteach year. These courses and the proceedings of theSummer School are now available through the onlineVirtual Library as illustrated in Figure 15.In addition to being available to AAPM members,the courses are now available at no cost to all medicalphysicists in developing countries who register to be anAAPM Developing Country Educational Associate(DCEA) through the international portal web site(http://www.aapm.org/international/).SUMMARY AND CONCLUSIONSThere is a significant need for high-quality medicalphysics education and training in all countries to supporteffective and safe use of modern medical technology forboth diagnostic and treatment purposes.This is, and will continue to be, achieved usingappropriate technology to increase both the effectivenessand efficiency of educational activities everywhere in theworld. While the applications of technology to educationand training are relatively new, the successfulapplications are based on theories and principles of thelearning process developed by two pioneers in the field,Robert Gagné and Edgar Dale.The appropriate goal is to use technology to enhancehuman performance for both learners (students) andlearning facilitators (teachers).Two models of programs to support this effort withopen and free shared resources are: Physical Principles of Medical Imaging Onlineat: http://www.sprawls.org/resources AAPM Continuing Education Courses availablethrough:http://www.aapm.org/international
P Sprawls. Biomed Imaging Interv J 2008; 4(1):e16This page number is notfor citation purposesFigure 15 The AAPM Virtual Library provides continuing medical physics education that is available anywhere inthe world through http://www.aapm.org/international.
Edgar Dale and described with the Cone of Experience which has been published in different forms as illustrated in Figure 3. Dale's Cone of Experience Dale's cone of experience is shown in more detail in Figure 4. As one can see, the cone of experience organises learning experiences and activities in terms of their
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