An investigation of medical student culture and attitudes towards e-learning in Hong Kong and the implications for medicial education

Abstract

E-learning has become an increasingly important tool in medical education in the 21st century. Educators face challenges arising from a cultural shift in their students, the millennial generation, whose culture and behaviour differ markedly from previous cohorts. There has been a trend of recent studies in medical education which focus on the development and evaluation of e-learning tools, promoting their potential to transform education. There is also an emergent counter-trend which posits e-learning as hype rather than truly disruptive change. In both trends, there is a predominance for a faculty-centric approach to the understanding of e-learning. In this milieu of growing interest alongside uncertainty, there is a research gap in the understanding of the role of e-learning from the medical student perspective.

This study aimed to investigate the culture and attitudes of medical students towards e-learning. It firstly adopted a systematic review of ethnographic studies in medical education, in order to identify key methodological issues in current best practice using a quality-of-study analysis tool. It then employed a sequential exploratory mixed-methods study using a qualitative investigation to develop a further quantitative phase. This commenced with a four-month period of ethnographic fieldwork. The findings of this phase were used to develop a questionnaire survey, implemented to triangulate with the previous findings and deepen understanding of the emergent phenomena.

Following this study, a further in-situ study of medical student attitudes and learning behaviours was undertaken by constructing a game-based learning environment. Data was gathered using wearable technology to illustrate real-world medical student practice in this important element of e-learning.

There were a number of important findings arising from this thesis. First, it found that there were limited numbers of quality primary ethnographic fieldwork studies in medical education contexts and none undertaken in an Asian context. Second, that e-learning behaviour amongst students is influenced by non e-learning related factors, such as examination orientation, physical health issues and privacy concerns. Third, that hidden elements of medical student e-learning exist, and can be examples of truly peer-led learning that occurs outside of the faculty view in a digital space using sharing technologies. Fourth, students exhibit cognitive, metacognitive and collaborative learning behaviours during game-based learning.

The practical implications of the study are that faculty-centric e-learning interventions are already being supplanted by student-led initiatives in through digital means. There must be a shift in perspective from students as consumers to students as powerfully capable e-learning collaborators. The theoretical contributions are that the importance of the physical aspect of Situated Learning theory is being challenged, and that learning through observation and reflection can occur at any time and place in the digital realm. From the methodological standpoint, it underlines the case that cultural issues such as examination-orientation and privacy concerns must be addressed in order for students to benefit from novel learning practices such as e-learning. It provides support for the integration of e-learning into a balanced, rather than solely e-centric, curriculum.