- Email: [email protected]
Do trainees want e-learning in plastic surgery?
Journal of Plastic, Reconstructive & Aesthetic Surgery (2011) 64, e47ee49
CORRESPONDENCE AND COMMUNICATION Do trainees want e-learning in plastic surgery?* There are many challenges to the delivery of education and training in plastic surgery. The reduced time and opportunities available for surgical training through the introduction of the European Working Time Directive (EWTD), the constraint policies imposed by local service commissioners and the shortening of hospital speciality training have reduced exposure to valuable educational and training opportunities in plastic surgery.1,2 One solution might be to use electronic, or e-learning, which is use of the electronic technology for instruction,3 to support the plastic surgery curriculum. Before developing e-learning, trainees’ preferences should be considered. Two-hundred and forty plastic surgery trainees (181 males and 59 females) within the United Kingdom and Ireland were invited to complete a web-based survey (e-survey) about e-learning located at www.e-plasticsurgery.co.uk/survey/ plasta/that had been constructed using SurveyMonkey (Palo Alto, California, USA, www.surveymonkey.com). The e-survey enquired about trainees’ demographics, preferences for different learning methods, whether the trainees had experience of e-learning in plastic surgery, whether e-learning should be provided to support their curriculum and if so, should this be provided locally (eg by the postgraduate deanery) or nationally (eg by the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)). Trainees were invited by e-mail to complete the e-survey and were contacted by e-mail after four weeks and invited to complete the e-survey within an additional four weeks, after which the e-survey was terminated. Data were downloaded as a Microsoft Excel spreadsheet file from www.surveymonkey.com. The data were then imported into SPSS Statistics 17.0 for Windows (SPSS Inc., Chicago, Illinois, USA) for statistical analysis. The Fisher’s Exact Test was used as appropriate to compare
* Data from this paper has been presented at the 2nd International Conference on Surgical Education and Training (ICOSET) Meeting at The Royal College of Surgeons in Ireland, Dublin, 13e14 May 2010.
nominal data. A P-value of less than 0.05 was considered to be statistically significant. One-hundred and thirty-seven trainees (Table 1) replied to the survey correctly (57.1% response rate). Although only 59 (43.1%) trainees had experience of using e-learning for learning in plastic surgery (Figure 1a), 124 (90.5%) trainees believed they should have access to e-learning to support the curriculum for plastic surgery (Figure 1b). Of these, 8 (5.8%) trainees felt that their local deanery should provide e-learning and 116 (84.7%) felt that a national organisation should provide e-learning to support the plastic surgery curriculum (Figure 1c). Thirteen (9.5%) trainees felt that no organisation should provide e-learning. More male trainees had experience of e-learning than female trainees (52, or 88% versus 7, or 12% respectively and P < 0.05). This finding might reflect the different cognitive learning styles between male and female trainees, previously reported.4 Whether this might explain
Table 1
Demographics of trainees in plastic surgery n (% of total)
Gender Male Female Age group (years) 25e29 30e34 35e39 40e44 Country England Ireland (Northern Ireland & Republic of Ireland) Scotland Wales Stage of training Initial (ST1, ST2, or equivalent) Intermediate (ST3, ST4, or equivalent) Final (ST5, ST6, or equivalent) Research
109 (79.6%) 28 (20.4%) 18 69 41 9
(13.1%) (50.4%) (29.9%) (6.6%)
115 (83.9%) 5 (3.7%) 11 (8.0%) 6 (4.4%) 35 (25.5%) 68 (49.6%) 29 (21.2%) 5 (3.6%)
1748-6815/$ - see front matter ª 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2010.08.021
e48
Correspondence and communication
b
100
Proportion of trainees (%)
Proportion of trainees (%)
a
90 80 70 60 50 40 30 20 10
100 90 80 70 60 50 40 30 20 10 0
0 Yes
Yes
No
Proportion of trainees (%)
c
No
Access to e-learning
Experience of e-learning 100 90 80 70 60 50 40 30 20 10 0 Local Deanery
National Body
None
Provision of e-learning Figure 1 Proportion (%) of trainees in plastic surgery (a) with (Yes) or without (No) previous experience of e-learning in plastic surgery, (b) who would like (Yes) and would not like (No) access to e-learning in plastic surgery and (c) which organisations (Local Deanery, National Body or None) should provide e-learning in plastic surgery.
this gender difference has not been elucidated in this study of plastic surgery trainees. However, the gender difference in this study might be simply due to the greater response rate for male trainees (109/181, or 60.2%) as compared to female trainees (28/59, or 47.5%) trainees. If this difference is real, specific learning material for both genders should be considered when developing e-learning material. In rank order of preference, the different methods for learning (Tables 2) were: tutorial (61, or 44.5%), lecture (48, or 35.0%), lecture (39, or 28.5%), web site (51, or 37.2%), DVD/CD-ROM (52, or 38.0%) and other (33, or
Table 2 Rank
24.1%). The category of other consisted of consultant teaching in theatre or clinic (1, or 0.7%), discussing with colleagues (2, or 1.5%), courses or practicals (2, or 1.5%), publications (2, or 1.5%) and conferences and meetings (1, or 0.7%). More traditional methods of learning such as tutorials, lectures and textbooks were the most popular with trainees, whilst more modern teaching methods, such as web sites and DVDs or CD-ROMs, were less popular. This survey has not investigated the reasons for the preferences of trainees, but this might reflect their lack of experience of e-learning as 56.9% had no experience of e-learning in plastic surgery.
Rank order of preference of learning methods of trainees in plastic surgery DVD/CD-ROM
Lecture
Textbook
Tutorial
Web site
Other
61 33 24 13 4 0 0
5 16 15 51 42 3 0
1 1 0 0 1 33 0
n (% of total) 1st 2nd 3rd 4th 5th 6th None
12 9 23 33 52 1 0
(8.8%) (6.6%) (16.8%) (24.1%) (38.0%) (0.7%) (0.0%)
15 48 39 18 12 0 0
(10.9%) (35.0%) (28.5%) (13.1%) (8.8%) (0.0%) (0.0%)
42 30 32 13 15 2 0
(30.7%) (21.9%) (23.4%) (9.5%) (10.9%) (1.5%) (0.0%)
(44.5%) (24.1%) (17.5%) (9.5%) (2.9%) (0.0%) (0.0%)
(3.6%) (11.7%) (10.9%) (37.2%) (30.7%) (2.2%) (0.0%)
(0.7%) (0.7%) (0.0%) (0.0%) (0.7%) (24.1%) (0.0%)
Correspondence and communication An online e-learning course would allow trainees to interact in forums with their trainers, or each other. It is naturally suited to courses that require distance learning, particularly when there is geographical separation between the trainee and the academic institution. As such, an e-learning course would provide trainees with the opportunity to access the course at a time that is convenient for them. Although there is an initial cost in developing an e-learning programme, the subsequent cost of offering it to more trainees is relatively small. E-learning, therefore, might be a cost-effective strategy for the delivery of education in plastic surgery. In conclusion, although over half of trainees have not experienced e-learning in plastic surgery, most would like access to it. Most trainees believe that this e-learning should be provided nationally rather than locally. The difference between male and female trainees in their previous experience of e-learning might reflect a greater ‘perceived usefulness’ of e-learning by male trainees. These findings, together with the survey of consultants in plastic surgery,5 support the e-LPRAS (e-Learning for Plastic, Reconstructive and Aesthetic Surgery) project being developed nationally by BAPRAS.
Acknowledgements The author thanks Dr Neil Hamilton who is Director of the Medi-CAL Unit, College of Life Sciences and Medicine at the University of Aberdeen and Miss Michaela Davies who is Consultant Plastic Surgeon in the Department of Plastic and Reconstructive Surgery at the Aberdeen Royal Infirmary for their advice with the manuscript and for acting as supervisors, Miss Janice Thomas of the Department of Information Services at Barts and The London School of Medicine and Dentistry for her statistical advice and the consultants in plastic surgery who completed this survey. This research has contributed to the degree of the Doctorate of Medicine of the University of Aberdeen.
e49
Conflict of interest R.J.G.S. is a Junior Member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Funding None.
Ethical approval None required.
References 1. Paterson P, Allison K. Maintaining standards of aesthetic practice in trainees subject to NHS restrictions. J Plast Reconstr Aesthet Surg 2006;59:856e9. 2. Wong M, Jones S, Sheikh H, et al. The effect of the new deal on the operative experience of plastic surgical SHOs. J Plast Reconstr Aesthet Surg 2006;59:311e2. 3. Larvin M. E-learning in surgical education and training. ANZ J Surg 2009;79:133e7. 4. Adamczyk C, Holzer M, Putz R, et al. Student learning preferences and the impact of a multimedia learning tool in the dissection course at the University of Munich. Ann Anat 2009; 191:339e48. 5. Stevens RJG. Do consultants want e-learning in plastic surgery for continuing professional development and revalidation? J Plast Reconstr Aesthet Surg 2011;64:e50e2.
Roger J.G. Stevens Department of Plastic and Reconstructive Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK Medi-CAL Unit, College of Life Sciences and Medicine, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK E-mail address: [email protected]
CORRESPONDENCE AND COMMUNICATION Do trainees want e-learning in plastic surgery?* There are many challenges to the delivery of education and training in plastic surgery. The reduced time and opportunities available for surgical training through the introduction of the European Working Time Directive (EWTD), the constraint policies imposed by local service commissioners and the shortening of hospital speciality training have reduced exposure to valuable educational and training opportunities in plastic surgery.1,2 One solution might be to use electronic, or e-learning, which is use of the electronic technology for instruction,3 to support the plastic surgery curriculum. Before developing e-learning, trainees’ preferences should be considered. Two-hundred and forty plastic surgery trainees (181 males and 59 females) within the United Kingdom and Ireland were invited to complete a web-based survey (e-survey) about e-learning located at www.e-plasticsurgery.co.uk/survey/ plasta/that had been constructed using SurveyMonkey (Palo Alto, California, USA, www.surveymonkey.com). The e-survey enquired about trainees’ demographics, preferences for different learning methods, whether the trainees had experience of e-learning in plastic surgery, whether e-learning should be provided to support their curriculum and if so, should this be provided locally (eg by the postgraduate deanery) or nationally (eg by the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)). Trainees were invited by e-mail to complete the e-survey and were contacted by e-mail after four weeks and invited to complete the e-survey within an additional four weeks, after which the e-survey was terminated. Data were downloaded as a Microsoft Excel spreadsheet file from www.surveymonkey.com. The data were then imported into SPSS Statistics 17.0 for Windows (SPSS Inc., Chicago, Illinois, USA) for statistical analysis. The Fisher’s Exact Test was used as appropriate to compare
* Data from this paper has been presented at the 2nd International Conference on Surgical Education and Training (ICOSET) Meeting at The Royal College of Surgeons in Ireland, Dublin, 13e14 May 2010.
nominal data. A P-value of less than 0.05 was considered to be statistically significant. One-hundred and thirty-seven trainees (Table 1) replied to the survey correctly (57.1% response rate). Although only 59 (43.1%) trainees had experience of using e-learning for learning in plastic surgery (Figure 1a), 124 (90.5%) trainees believed they should have access to e-learning to support the curriculum for plastic surgery (Figure 1b). Of these, 8 (5.8%) trainees felt that their local deanery should provide e-learning and 116 (84.7%) felt that a national organisation should provide e-learning to support the plastic surgery curriculum (Figure 1c). Thirteen (9.5%) trainees felt that no organisation should provide e-learning. More male trainees had experience of e-learning than female trainees (52, or 88% versus 7, or 12% respectively and P < 0.05). This finding might reflect the different cognitive learning styles between male and female trainees, previously reported.4 Whether this might explain
Table 1
Demographics of trainees in plastic surgery n (% of total)
Gender Male Female Age group (years) 25e29 30e34 35e39 40e44 Country England Ireland (Northern Ireland & Republic of Ireland) Scotland Wales Stage of training Initial (ST1, ST2, or equivalent) Intermediate (ST3, ST4, or equivalent) Final (ST5, ST6, or equivalent) Research
109 (79.6%) 28 (20.4%) 18 69 41 9
(13.1%) (50.4%) (29.9%) (6.6%)
115 (83.9%) 5 (3.7%) 11 (8.0%) 6 (4.4%) 35 (25.5%) 68 (49.6%) 29 (21.2%) 5 (3.6%)
1748-6815/$ - see front matter ª 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2010.08.021
e48
Correspondence and communication
b
100
Proportion of trainees (%)
Proportion of trainees (%)
a
90 80 70 60 50 40 30 20 10
100 90 80 70 60 50 40 30 20 10 0
0 Yes
Yes
No
Proportion of trainees (%)
c
No
Access to e-learning
Experience of e-learning 100 90 80 70 60 50 40 30 20 10 0 Local Deanery
National Body
None
Provision of e-learning Figure 1 Proportion (%) of trainees in plastic surgery (a) with (Yes) or without (No) previous experience of e-learning in plastic surgery, (b) who would like (Yes) and would not like (No) access to e-learning in plastic surgery and (c) which organisations (Local Deanery, National Body or None) should provide e-learning in plastic surgery.
this gender difference has not been elucidated in this study of plastic surgery trainees. However, the gender difference in this study might be simply due to the greater response rate for male trainees (109/181, or 60.2%) as compared to female trainees (28/59, or 47.5%) trainees. If this difference is real, specific learning material for both genders should be considered when developing e-learning material. In rank order of preference, the different methods for learning (Tables 2) were: tutorial (61, or 44.5%), lecture (48, or 35.0%), lecture (39, or 28.5%), web site (51, or 37.2%), DVD/CD-ROM (52, or 38.0%) and other (33, or
Table 2 Rank
24.1%). The category of other consisted of consultant teaching in theatre or clinic (1, or 0.7%), discussing with colleagues (2, or 1.5%), courses or practicals (2, or 1.5%), publications (2, or 1.5%) and conferences and meetings (1, or 0.7%). More traditional methods of learning such as tutorials, lectures and textbooks were the most popular with trainees, whilst more modern teaching methods, such as web sites and DVDs or CD-ROMs, were less popular. This survey has not investigated the reasons for the preferences of trainees, but this might reflect their lack of experience of e-learning as 56.9% had no experience of e-learning in plastic surgery.
Rank order of preference of learning methods of trainees in plastic surgery DVD/CD-ROM
Lecture
Textbook
Tutorial
Web site
Other
61 33 24 13 4 0 0
5 16 15 51 42 3 0
1 1 0 0 1 33 0
n (% of total) 1st 2nd 3rd 4th 5th 6th None
12 9 23 33 52 1 0
(8.8%) (6.6%) (16.8%) (24.1%) (38.0%) (0.7%) (0.0%)
15 48 39 18 12 0 0
(10.9%) (35.0%) (28.5%) (13.1%) (8.8%) (0.0%) (0.0%)
42 30 32 13 15 2 0
(30.7%) (21.9%) (23.4%) (9.5%) (10.9%) (1.5%) (0.0%)
(44.5%) (24.1%) (17.5%) (9.5%) (2.9%) (0.0%) (0.0%)
(3.6%) (11.7%) (10.9%) (37.2%) (30.7%) (2.2%) (0.0%)
(0.7%) (0.7%) (0.0%) (0.0%) (0.7%) (24.1%) (0.0%)
Correspondence and communication An online e-learning course would allow trainees to interact in forums with their trainers, or each other. It is naturally suited to courses that require distance learning, particularly when there is geographical separation between the trainee and the academic institution. As such, an e-learning course would provide trainees with the opportunity to access the course at a time that is convenient for them. Although there is an initial cost in developing an e-learning programme, the subsequent cost of offering it to more trainees is relatively small. E-learning, therefore, might be a cost-effective strategy for the delivery of education in plastic surgery. In conclusion, although over half of trainees have not experienced e-learning in plastic surgery, most would like access to it. Most trainees believe that this e-learning should be provided nationally rather than locally. The difference between male and female trainees in their previous experience of e-learning might reflect a greater ‘perceived usefulness’ of e-learning by male trainees. These findings, together with the survey of consultants in plastic surgery,5 support the e-LPRAS (e-Learning for Plastic, Reconstructive and Aesthetic Surgery) project being developed nationally by BAPRAS.
Acknowledgements The author thanks Dr Neil Hamilton who is Director of the Medi-CAL Unit, College of Life Sciences and Medicine at the University of Aberdeen and Miss Michaela Davies who is Consultant Plastic Surgeon in the Department of Plastic and Reconstructive Surgery at the Aberdeen Royal Infirmary for their advice with the manuscript and for acting as supervisors, Miss Janice Thomas of the Department of Information Services at Barts and The London School of Medicine and Dentistry for her statistical advice and the consultants in plastic surgery who completed this survey. This research has contributed to the degree of the Doctorate of Medicine of the University of Aberdeen.
e49
Conflict of interest R.J.G.S. is a Junior Member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Funding None.
Ethical approval None required.
References 1. Paterson P, Allison K. Maintaining standards of aesthetic practice in trainees subject to NHS restrictions. J Plast Reconstr Aesthet Surg 2006;59:856e9. 2. Wong M, Jones S, Sheikh H, et al. The effect of the new deal on the operative experience of plastic surgical SHOs. J Plast Reconstr Aesthet Surg 2006;59:311e2. 3. Larvin M. E-learning in surgical education and training. ANZ J Surg 2009;79:133e7. 4. Adamczyk C, Holzer M, Putz R, et al. Student learning preferences and the impact of a multimedia learning tool in the dissection course at the University of Munich. Ann Anat 2009; 191:339e48. 5. Stevens RJG. Do consultants want e-learning in plastic surgery for continuing professional development and revalidation? J Plast Reconstr Aesthet Surg 2011;64:e50e2.
Roger J.G. Stevens Department of Plastic and Reconstructive Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK Medi-CAL Unit, College of Life Sciences and Medicine, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK E-mail address: [email protected]