BMJ  2006;332:1403-1404 (17 June), doi:10.1136/bmj.332.7555.1403

Editorial

Broadband learning for doctors

Has huge potential but needs funding for high quality content

Broadband internet has finally come of age. It's changing the way we listen to music and radio, and it means we can watch television on demand. What could broadband internet do for medical education?

Early signs suggest that rapid change is underway, led by the learners. In the United States 14% of the credit hours for continuous medical education in 2004 were obtained online, double the figure for two years before.¹ In this country BMJ Learning has tapped into this demand, attracting more than 60 000 registered users in less than three years.²

Broadband could offer learners in medicine the next generation of online learning: the prospect of high quality interactive video and audio alongside traditional text and photographs. Audiovisual materials would bring many advantages: they are easy to watch, add realism, and can enable learning of procedural and interpersonal skills. Younger doctors are digital natives and will increasingly expect such materials as the norm.

But three things are necessary for this to happen—modernised curriculums, a universal broadband infrastructure, and a flourishing supply of broadband learning services from a range of suppliers. In the United Kingdom, modernised curriculums are emerging under the direction of the Postgraduate Medical Education and Training Board. The curriculum for foundation programme doctors fresh from medical school has set a high standard that others must now match. The broadband infrastructure is also in place. Connecting for Health, a Department of Health agency, has provided broadband in NHS workplaces, and learners at home have Ofcom, the telecoms regulator, to thank for making broadband available at a price they used to pay for dial-up.

The missing element is a range of thriving broadband learning services that provide engaging content, efficient administration, and a community for learners and teachers. The market for such content has yet to emerge. Potential providers of content—ranging from royal colleges of medicine to publishers—can barely afford to launch pilots.

It doesn't have to be this way. Schools in the United Kingdom have access to some of the best digital learning services in the world. Teachers' TV (www.teachers.tv) pipes over 1000 programmes to teachers, head teachers, and school governors via digital television and broadband. The Department for Education and Skills pays £20m each year to its contractor for this service. BBC Jam (https://jam.bbc.co.uk) enables children to learn after class: it was launched in January this year and will cost £150m over two years. And the e-learning credits scheme set up by the Department for Education and Skills has been quietly spending £640m over 10 years, creating an industry of providers competing to show their content on interactive whiteboards in classrooms. Overall, these services represent an investment of about £750m over 10 years. The equivalent figure for online postgraduate medical education will be perhaps £10m.

The emerging curriculums in postgraduate education now need strategic funding for commissioning high quality resources for learners and tutors. Finding the best way to achieve this requires public debate. The national workforce group for the strategic health authorities and the Department of Health recently launched this debate, proposing a £25m annual fund for developing online training materials, derived from the budgets of the postgraduate deaneries, the bodies which coordinate and pay for post-qualification training and development of medical staff in hospitals and primary care.³ Such a fund could be managed through a contract for a central commissioning organisation, using the model established by Teachers TV, or through a diversity of accredited suppliers, the model used now for the e-learning credits scheme.

We plan to continue this debate at a symposium on broadband learning in London on 22 June, jointly hosted by the BMA, the Royal College of Physicians of London, and the BMJ Publishing Group. The symposium will also showcase some pioneer projects in broadband learning—the Radiology Integrated Training Initiative, the Inter-collegiate Surgical Curriculum Project, and the work of NHS Education for Scotland. Teachers TV and Espresso Education (www.espresso.co.uk) will be there to talk about their experiences of providing online education in schools.

The time is right for leaders in medicine to match initiatives in schools that have made the United Kingdom a world leader in broadband learning. Such an investment would be good for learners, for teachers, and ultimately for patients. The chief medical officer's 2002 report Unfinished Business kick started the reform of postgraduate medical education in the UK,⁴ heralded the foundation programme,⁵ and will lead to further new and improved curriculums. Broadband learning is, in our view, the still unfinished business of Unfinished Business.

A limited number of places are available at the symposium for BMJ readers. Please apply to Helen Fogarty at helen.fogarty{at}bmjgroup.com.

BMA House, London WC1H 9JR

BMA House, London WC1H 9JR
(ebriffa{at}bmj.com)

Royal College of Physicians of London, London NW1 4LE

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Competing interests: JJ is chairman of council of the BMA, and the BMA owns the BMJ Publishing Group. SD is chief executive officer of the BMJ Publishing Group, a provider of online learning services. EB is a consultant in online learning who works for the BMJ Publishing Group. CB is president of the Royal College of Physicians of London, a provider of learning services.

References

1. Sklar B. Annotated list of online continuing medical education. www.cmelist.com/list.htm (accessed 9 Jun 2006).
2. Walsh K, Dillner L. Launching BMJ Learning. BMJ 2003;327: 1064.[Free Full Text]
3. National Workforce Group and Department of Health. Modernising healthcare training: e-learning in healthcare services. April 2006. www.nationalworkforce.nhs.uk/documents_library/attachments/national_e-learning_report_screen_version_final.pdf (accessed 9 Jun 2006)
4. Donaldson L. Unfinshed business. Proposals for reform of the senior house officer grade. Department of Health, August 2002. www.dh.gov.uk/assetRoot/04/01/88/08/04018808.pdf (accessed 9 Jun 2006).
5. Hays R. Foundation programme for newly qualified doctors. BMJ 2005;331: 465-6.[Free Full Text]

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