Published online October 3, 2006, 10.1148/rg.e25
(RadioGraphics 2006;26:e25.)
A more recent version of this article appeared on November 1, 2006
© RSNA, 2006
Creating an Interactive Web-based e-Learning Course: A Practical Introduction for Radiologists1
Denis Hoa, MD,
Antoine Micheau, MD and
Gerald Gahide, MD
1 From the Department of Medical Imaging, Montpellier University Hospital, CHU Lapeyronie and Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received April 7, 2006; accepted August 15. All authors have no financial relationships to disclose.
Address correspondence to: D.H. (e-mail: denis.hoa{at}campusmedica.org).
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Abstract
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With the development of e-learning and its ability to provide rich animated content rapidly to a wide audience, new methods for teaching medical imaging have evolved. E-learning tools allow building of learner-focused structured courses. Standards such as shareable content object reference model (SCORM) or Aviation Industry Computer-based Training Committee (AICC) guidelines and recommendations provide the framework required to combine text, images, videos, animations, and quizzes for learning assessment, even if each of these elements is created with different software. The main features to consider when choosing a learning management system are content management, assessment and reporting tools, customization options, course delivery, administration, and security. The tools for building a Web-based course with pages containing text, images, videos, and Flash animations are now accessible to any radiologist. Open-source learning management systems and content authoring software are available at no cost. The authors developed e-MRI.com, a free Web-based e-learning course with interactive animations and simulations, self-tests, and clinical cases to demonstrate the potential of the latest advances in e-learning and pedagogy applied to magnetic resonance imaging physics.
Movies available at radiographics.rsnajnls.org/cgi/content/full/e25/DC1
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Introduction
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Information and communication technologies act as a catalyst for innovation in learning, providing access to contextualized high-quality content. The authors of e-learning material can use multiple media to present ideas and concepts, combining traditional educational content (text, images, graphs, and diagrams) with interactive computer-based resources (sound, video, animation, image series). Because magnetic resonance (MR) imaging physics involves complex mechanisms, it remains challenging to teach nuclear magnetic resonance, pulse sequences, spatial encoding, Fourier transform mathematics, and imaging artifacts. We developed an interactive Web-based radiologic e-learning module on the basic principles of MR imaging at www.e-mri.com. We discuss e-learning standards and the potential benefits of e-learning in teaching medical imaging, and demonstrate how to build a Web site with interactive Flash content and quizzes, structured as a learning path.
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Background
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Among all the "e" movements in computer sciences, e-learning is one of the fastest growing. The advent of digital radiology has afforded numeric archiving with the development of management systems such as picture archiving communication systems (PACS). In conjunction, the World Wide Web provides a widely accessible communication network, built on common standards, that provides easy access to information and knowledge, wherever you are and whenever you want it. Tools for collaborative remote work have become more user-friendly and more readily available. Consequently, some Web-based educational resources have arisen during the last few years. For instance, the Radiological Society of North America (RSNA) introduced the Medical Imaging Resource Center (MIRC) (1), which pools a community of libraries sharing images and data for education, research, and clinical practice. MIRC is based on a set of protocols and formats that facilitate and standardize the storage, query, and retrieval of radiologic images and related data via the Internet. Another major project is the European Association of Radiology e-learning initiative (Eurorad), a teaching database published on the Internet that displays peer-reviewed clinical cases developed by individual radiologists since 1998 (2).
Web-based e-Learning, "Connecting for Lifelong Learning" (3)
Demand for individualized services, tools, interactive experiences, and open access to knowledge is growing (4,5). Learning is no longer expected to be paced so much by the teacher as it is by the student’s capacity to grasp the material (student-focused learning). The speed at which students can progress through a course of instruction varies by factors of three to seven, even in classes of carefully selected students (6). In traditional training models, it is impossible to deliver individually customized learning solutions because of cost. The capacity of e-learning for real-time, on-demand adaptation can provide individualized learning at affordable cost. Technologies that allow collaboration, interactivity, simulation, and self-testing can help students acquire the skills being taught effectively and efficiently. It is thus possible to create a learning environment in which students become active participants, fully engaged in the learning process. Additionally, the educational topic selection can cater to a student’s particular needs. Any given student may be studying any given topic at any time, and progressing through that material at a pace appropriate to his or her learning ability.
The technology allows real-time modifications, accreditation of a continuously updated tool in accordance with the research literature. Foremost, the World Wide Web can be used to dynamically transfer knowledge in real time around the globe. This will lead to higher-education opportunities for foreign students: Countries without "mass" university education can access universities in other countries through the Web. Finally, this technology is able to track use and activity, provide reports, and record information about every learner’s performance. This feedback could be included in continuing medical education courses.
Standards and Learning Management Systems
Information technology is a fast-developing, highly innovative field, creating a wide range of options for both learners and site designers. Mixing content of various media types created with different software is made possible by standards such as the shareable content object reference model (SCORM) (Advanced Distributed Learning; Alexandria, Virginia) or Aviation Industry Computer-based Training Committee (AICC) guidelines and recommendations (7,8). For building a reusable, accessible, durable, and interoperable e-learning platform, the SCORM framework is excellent. It offers a collection of standards and specifications adapted from multiple sources to provide a comprehensive suite for e-learning. SCORM helps define the technical foundations of a Web-based learning environment. At its simplest, it can be used as a model for referencing a set of interrelated technical standards, specifications, and guidelines designed to meet high-level requirements for learning content and systems. Its objective is to facilitate the process of making courseware more accessible, cost-effective, and adaptable through the creation of reusable learning content.
A learning management system (LMS) processes all the e-learning content and its structure, delivers it to the Web, and tracks content usage.
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Prerequisites
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In this article, we assume the reader is familiar with a Web browser. The reader will be asked to type text in forms, click on "OK" buttons and prepare quality documents—including images and Flash animations—and upload them to a Web site. Although no hypertext markup language (HTML) knowledge is required, familiarity with Web page design will help the reader handle the possibilities and limitations of Web publishing (9,10). Moreover, the reader should be able to retrieve images from a PACS or by digitizing them, taking file size and format into consideration, and to prepare images for Web publishing, (11–13). To create Flash animations, the Macromedia Flash software (Adobe Systems, San Jose, Calif) can be used. A trial version is available online.
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Procedure Details
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The process of creating an interactive e-learning course will be described in a six-step approach: choosing an LMS, designing a learning path, writing a basic HTML document with text and images, creating a Flash animation, building tests, and publishing the whole structured course.
Framework: The LMS
Many free open-source or commercial LMSs are available. A number of important features should be taken into consideration when choosing an LMS (Table).
We chose a Web-based course management application called Dokeos (Dokeos, Brussels, Belgium) (14). This LMS is open source and free and has been translated into 31 languages. It allows creation of pedagogic content based on rich HTML documents that can mix texts, interactive diagrams, feedback areas, video sequences, animations, simulations, and interactive image series (Fig 1).
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Figure 1. Screen capture of a Flash animation with 3D Web graphics: Spinning protons are like dreidles spinning about their axes.
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Activities are structured in learning paths. This LMS integrates many ways to interact with students and includes a reporting system to follow their progress. It is compliant with Web standards (W3C) and e-learning standards (SCORM). All the resources of this course were designed to provide an effective and user-friendly framework.
Course Conception and Learning Path
A Learning path is a sequence of learning steps included in modules. It can be content-based (like a table of contents) or activity-based (like an agenda of what you need to do to acquire knowledge or understand and practice know-how. In addition to being structured, a learning path can be sequenced. This means that some steps will be prerequisites for others ("You cannot go to step 2 before completing step 1"). A sequence can be suggestive (steps are shown in order) or imperative (prerequisites are added to force users to follow the sequence) (14).
To build a valuable learning path, the pedagogic objectives must be defined and the goals of the learning process adapted to the needs of the audience in terms of competences. To contextualize the material, pedagogic content should be designed to create learning situations that are as close as possible to real life situations. It can be useful to create a storyboard that details the different steps in every lesson (lesson objectives, content, synthesis, and assessment) (Fig 2). The user can then start building a Web-based course with HTML pages that mix texts, images and Flash animations.
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Figure 2. A learning path. The e-MRI learning path is composed of several independent modules divided into steps. Each module includes HTML pages with Flash animations, a summary of key concepts, and a quiz.
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Creating a Web-based Course
In this section, we demonstrate how to create a course on a Dokeos platform and how to modify the main page (Movie 1). Content is managed with the Documents tool. This tool allows the user to create, import, edit, and export sophisticated multimedia Web pages. The embedded multimedia editor enables the user to create HTML pages that integrate images, audio, video, Flash animation, and mathematics. The user can also upload files of any type (HTML pages, word processor files, slide shows, Flash, Quicktime movies, etc) (Fig 3, Movie 2).
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Figure 3. The embedded multimedia editor in Dokeos. This editor allows what-you-see-is-what-you-get (WYSIWYG) editing of rich Web pages without requiring any HTML knowledge.
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Interactive and Multimedia Content: Creating a Flash Animation that Allows Cine Function with a Full Image Series
Our interactive multimedia content is authored with Macromedia Flash software. All major browsers are now including Flash player as part of their default installation. Macromedia Flash provides optimal support for animation, scripting, video, and audio. Moreover, it produces small files that download quickly. For example, with such Flash animations the student is able to view image series with cine function or change MR imaging parameters (repetition time, echo time, inversion time, flip angle, etc) with automatic feedback on the MR image, thanks to scripting abilities provided by the Actionscript language included in Flash. (see STIR sequence from www.e-mri.com, for example). We used Macromedia Flash to create an animation that shows a full MR image series with cine function (Fig 4; Movies 3, 4).
Learning Assessment
Practice and evaluation are key factors for successful learning. Self-tests with automated feedback are created with quiz-generating software. The test tool embedded in Dokeos allows many test interaction types: drag-and-drop, fill-in-the-blank, true/false, multiple choice, and identification. For instance, we can include the Flash animation we created previously into a clinical case quiz (Fig 5, Movie 5).
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Figure 5. Learning assessment. Screen capture of an e-MRI clinical case with a multiple-choice question and a Flash animation displaying a full MR image series.
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Structuring Learning Objects in a Learning Path and Delivering the Course
E-learning courses can be delivered online (Web-based LMS) or offline (CD-ROM). Web-based courses can be easily updated, are available world wide, and allow more interactivity with students (media streaming, videoconferencing, forums, etc) and recording of results. Knowledge content is structured in a learning path (Movie 6).
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Conclusion
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With the tutorial presented here and a free open-source LMS, any radiologist can build a structured e-learning Web site with interactive animations and learning assessment at little cost. Based on high-quality SCORM-compliant material, www.e-mri.com is a free student-focused e-learning course. It includes Flash animations, self-tests, and clinical cases that help in understanding the complex mechanisms of MR imaging physics. The site demonstrates the potential of the latest advamces in e-learning and pedagogy, applied to the teaching of medical imaging.
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Footnotes
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Abbreviations: AICC = Aviation Industry Computer-based Training Committee, HTML = hypertext markup language, LMS = learning management system, PACS = picture archiving communication systems, SCORM = shareable content object reference model
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References
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- MIRC: Medical Imaging Resource Center. Available at http://www.rsna.org/mirc/. Accessed April 3, 2006.
- European Association of Radiology e-Learning Initiative. Available at http://www.eurorad.org/. Accessed April 3, 2006.
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- Shaffer K, Small JE. Blended learning in medical education: use of an integrated approach with web-based small group modules and didactic instruction for teaching radiologic anatomy. Acad Radiol 2004;11:1059–1070.[CrossRef][Medline]
- Gettinger M. Individual differences in time needed for learning: a review of the literature. Educational Psychologist 1984; 19:15–29.
- SCORM: advanced distributed learning. Available at http://www.adlnet.gov/scorm/index.cfm. Accessed April 3, 2006.
- AICC/CMI guidelines for interoperability. Available at http://www.aicc.org/pages/down-docs-index.htm. Accessed April 3, 2006.
- Ryan AG, Louis LJ, Yee WC. Informatics in radiology (infoRAD): HTML and Web site design for the radiologist: a primer. RadioGraphics 2005; 25:1101–1118.[Abstract/Free Full Text]
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- Caruso RD, Postel GC. Image editing with Adobe Photoshop 6.0. RadioGraphics 2002;22:993–1002.[Abstract/Free Full Text]
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- Dokeos open source e-learning documentation. Available at http://www.dokeos.com/documentation.php. Accessed April 3, 2006.
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Abstract
Introduction
