Different compartments of medical education can be distinguished either in relationship to the already collected competence of the students (undergraduate, postgraduate, specialist), or to the subject of teaching (anatomy, physiology, disease – oriented), to the presentation of the information (passive, interactive, closed, open), to the presentation of the disease (bedside teaching, basic symptoms), to practical performance (dummies, action under supervision), or to online interaction (expert consultation, virtual slide (remote control) performance). The general properties of a teaching–learning process have been described by several authors; however, specific conditions in performing an optimized arrangement are not in agreement [1–4]. The accreditation of teaching institutes such as universities or medical schools in Europe has been standardized by the Bologna process , which regulates the standards of teaching and education at the high school and university level . An international comparison of the students’ competences in relation to the taught courses should be obtained by the introduction of credits, i.e., scores that a student receives once he has successfully passed certain classes. The formal conditions have been fixed and internationally agreed to; however, the actual implementation, i.e., the actual quality of teaching and learning still remains uncertain. Independently from the Bologna process several universities introduced teaching and learning modules that take advantage of the internet, i.e., its open and standardized access [6–8].
Which conditions e-education systems have to be met in order to provide standardized and acknowledged services that are in agreement with the Bologna process? What are their specific conditions, and how can they be derived from conventional systems designed for both medical undergraduate and postgraduate education?
Basic conditions and principles of e- educational program:
Education is,in general,a transfer of information from a teacher or institution to students or humans who want to receive and practice this information [2, 9–11].
Adequate teaching and learning can be analyzed in terms of
performance (methods and program)
outcome of learning (knowledge and competence)
quality evaluation and assurance (accreditation)
Adequate performance or information transfer requires that the level of submitted information is adjusted to the pre-existing knowledge of the students, otherwise the students will not benefit from the education either by not understanding the issue, or not adding new information to their knowledge . Adequate performance is usually assured by sequential arrangement of classes, lectures, etc. with corresponding tests of students at the beginning and end of the classes. Classic education usually includes both, acoustic and visual information transfer. Acoustic information transfer is the backbone of classic education, which is summarized in the well-known sentence of “hearing his teacher’s voice” . Acoustics allow a dynamic information transfer that is difficult to perform with movies or images (if viewed without acoustics). The differences of acoustic and visual communication are discussed in detail in [11, 12]. These difference play an important role in e-education, as it is commonly based primarily on visual, and less on acoustic communication (see figure 1).
Aspects of human perception which are of importance in understanding the teaching– associated increase of competence are also related to the presentation of information, because perception is time or speed associated. It allows the student to eventually reach a level of competence which is higher compared to that of his teacher . E-education should keep in mind that learning by still images remarkably differs from that of learning by speech or movies [11, 13–15]. Electronic presentation of information for teaching purposes can be of passive (television, radio station, internet, etc.), of primarily passive (multiple choice tests, internet forums, electronic shopping, etc.) or of mainly active (games, chats, programming) nature. Independently from its formal nature, electronic presentation of information can be quantitatively measured at its source. At the side of its receiver it can, in addition, be classified into different distinct levels, which might be of more complex and higher stage compared to those at the side of the sender. In this case, the acquired knowledge possesses higher information content than presented, and is a quality measure for the teaching procedure.
Resources of e–education include image archives (microscopy, radiology, ultra sound, etc.), collections of drawings and schemes (anatomy, physiology), movies (animal experiments, patient’s behaviour, etc.), animations (simulation of functions in physiology, tissue growth, interactions of macromolecules, etc.), remote control performance (robotic microscopy, robotic surgery, etc.), and electronic simulation. They are subject related, and can be divided into constant information (such as the knowledge of anatomy, physiology, cellular interactions, etc.), and into those that can change by time (recognition and classification of diseases, diagnostic procedures, therapeutic regimes, etc.).
Outcome of learning is graded by tests that should assure that the student possesses the knowledge and competence either to enter the next class, or to practice the acquired information. In medicine both knowledge of diagnostics and therapy, and competence which is the correct and secure application of the taught methods are important. The quality of the applied tests can be judged by formal and content related parameters. The quality evaluation should focus on potential bias (exclusion of preference of certain students), individuality of the performed tests (not known to the students), and the level of requested knowledge (credit related).
Final accreditation of the university or medical school depends again on formal and content related items, which can be formal described by a tuning process . In Europe, the analysis of the resources, performance, and obtained students’ knowledge and competence is handled by specific accreditation institutions which are commercially oriented . We leave it to the opinion of the reader whether it is scientifically justified to transfer duties of significant social and human impact to commercially oriented institutions. Obviously, the arrangement is compatible to the trend of our society to strengthen the impact of an individual on the costs of the society.