• Online Education: Where Content Meets Convenience

    Author: Garni Barkhoudarian

    Medical education has transformed significantly since the days of Vesalius and amphitheater dissections. As modern medicine has advanced through technological innovations, so have the educational tools available to medical students, residents and practicing physicians. A major component of these resources is online education content. These are now commonplace, including digital textbooks and journals, webinars, online examinations, demonstrative videos, and simulation modules.

    Access to online education has blossomed over the past decade, with increasingly more organizations and institutions providing content and resources, many with free access. As such, there has been a shift of medical education outside the classroom and into the living room. This has been received positively by students and practitioners and is quite appealing to the incoming generation of neurosurgical residents and young surgeons. Currently, many medical schools offer nearly their entire didactic curriculum as online content. Similarly, continuing medical education requirements can be easily fulfilled via online webinars and examinations.

    The question remains as to the efficacy of these online resources. Are they able to educate the student or practitioner with the same impact as traditional in-person didactic lectures and examinations? In short, does online education work? What is its role with surgical education in the neurosurgical community?

    There is little doubt that specific aspects of neurosurgical education must be taught in person-such as surgical technique, physical examination, bedside manner, and patient/family interactions. Many would argue that the only setting to learn surgery is in the operating room. However, cadaveric dissections, surgical simulation modules, virtual modules, and operative videos have augmented the education of operative techniques while simultaneously providing access to those without exposure to experienced surgeons for tutelage.

    The increased utilization of online educational resources is due to a multitude of factors including regional access, relative cost for educational value, available time for residents and physicians, preparation for examinations (written and oral boards), and continuing medical education requirements by state licensing authorities and profession-specific requirements (e.g., pain management or radiology). The quality of education provided is difficult to measure and is inferred via student comments and feedback, board examination scores, practice metrics, and content popularity (repeat or referred users). Babu et al. noted cost and time away from practice to be significant factors in surgeons' decision of CME option.1

    Much of the educational research to evaluate online or digital education impact relies on survey-based data; either from attendees or educators. A key distinction is between synchronous (real-time; e.g., live webinar) and asynchronous (post-hoc; e.g., recorded lectures or self-assessment examinations) online resources. Synchronous online resources have more impact when there is a high-quality capability of user interaction with the faculty. Asynchronous resources have increased usability given instant availability and the ability to complete the tasks in installments.

    A recent sponsored survey noted that 84% of physicians would prefer to complete their CME online, preferably using a video-on-demand system.2 An Australian meta-analysis looked at the efficacy of online CME for general practitioners and found 73% noted improvement in satisfaction, knowledge, or practice changes.3 Patient outcomes were unable to be assessed, but they noted that the value of online resources is dependent on the following: student motivation, content quality, and online medium usability.

    Not surprisingly, there is no lack of resources of online educational resources for neurosurgical education. The Congress of Neurological Surgeons offers a diverse and recently expanded array of online educational products addressing needs for medical students and residents; young attendings transitioning into practice and seasoned practitioners looking to advance their knowledge or fulfill CME requirements. These range from synchronous products such as the Live Webinar series to asynchronous products including recorded lectures, narrated Powerpoint lectures, CNS NEXUS, CNS Spotlight (comprehensive journal article review) and self-assessment examinations (SANS).

    These online resources have been consistently popular for neurosurgeons seeking to obtain CME credits and for residents and fellows preparing for their operations, rotations and board examinations. Some live webinars have been validated with pre- and post-seminar tests with generally positive benefits. Though it is difficult to verify the impact of each type of online product, it is apparent that, in the aggregate, these products have a positive impact on the students' or practitioners' preparations.

    Ultimately, there is ample evidence that online educational products are popular among practitioners and residents. Though it is challenging to measure the impact of any individual resource on education when used in the aggregate, these do have a positive effect. There is no "one-size-fits-all" online content and much of the value relies on the motivation of the student as much as the quality of the material and medium. In our current age of medicine, online resources will remain a mainstay in neurosurgical education.


    1. Maya A. Babu, Linda M. Liau, E. Sander Connolly, Fredric B. Meyer; Maintenance of Certification: Perceptions and Attitudes of Neurosurgeons, Neurosurgery, Volume 83, Issue 4, 1 October 2018, Pages 835–842, https://doi.org/10.1093/neuros/nyx498
    2. Get Educated. Online CME Survey Reveals Physicians Fussy About Online Medical Education. https://www.geteducated.com/latest-online-learning-news-and-research/488.... Accessed 11.26.18
    3. Thepwongsa, Isaraporn; Kirby, Catherine; Schattner, Peter and Piterman, Leon. Online continuing medical education (CME) for GPs: Does it work?: A systematic review [online]. Australian Family Physician, Vol. 43, No. 10, Oct 2014: 717-721. Availability: <https://search.informit.com.au/documentSummary;dn=638375411911797;res=IELHEA>ISSN:0300-8495

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