multimedia in education essay

Encyclopedia of Multimedia pp 549–554 Cite as

Multimedia in Education

• Abhaya Asthana 2  
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Multimedia combines five basic types of media into the learning environment: text, video, sound, graphics and animation, thus providing a powerful new tool for education.

Introduction

The world in which we live is changing rapidly and the field of education is experiencing these changes in particular as it applies to Media Services. The old days of an educational institution having an isolated audio-visual department are long gone! The growth in use of multimedia within the education sector has accelerated in recent years, and looks set for continued expansion in the future [ 1 – 6 ].

Teachers primarily require access to learning resources, which can support concept development by learners in a variety of ways to meet individual learning needs. The development of multimedia technologies for learning offers new ways in which learning can take place in schools and the home. Enabling teachers to have access to multimedia learning resources, which support constructive concept...

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Department of Computer Science and Engineering, Florida Atlantic University (FAU), 33431, Boca Raton, FL, USA

Borko Furht ( Department Chair ) ( Department Chair )

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Asthana, A. (2008). Multimedia in Education. In: Furht, B. (eds) Encyclopedia of Multimedia. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-78414-4_140

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Role of Multimedia in Education

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The Benefits of Multimedia Education

The field of education is changing rapidly. The old days of schools with isolated AV departments and outdated TVs are long gone -- the use of modern multimedia within the education sector has accelerated in recent years and is set for continued expansion in the future.

In general, multimedia is the combination of visual and audio representations. These representations could include elements of text, graphic arts, sound, animation, and video. However, multimedia is restricted in systems where information is digitized and processed by a computer. Interactive multimedia and hypermedia consist of multimedia applications in which the user has a more active role.

Teachers primarily require access to learning resources, which support concept development to meet the individual learning needs of their students. By using multimedia technology, educators can offer new methods of learning that can take place in schools or at home. Granting teachers access to multimedia learning resources, which support constructive concept development, allows them to focus on facilitating learning while working with individual students. And extending the use of multimedia learning resources to the home represents an opportunity to improve distance learning.

There is no doubt that the interest in technology education is rising, and has progressed fast in the past few years. Let’s explore some benefits of multimedia learning in the modern classroom.

1. Extensive understanding

According to

, information received via auditory and visual channels is processed in different parts of the brain. When students are able to learn through both of these channels simultaneously, they absorb more sensory information and are able to commit more of the lesson to memory.

2. Increased problem solving

Because a large percentage of our brain is reserved for processing visual information, we are highly stimulated when absorbing images, video, and animations alongside text. This leads to an increase in student attentiveness and information retention. In a study titled

researchers found that students exhibited high motivation, teamwork, and enhanced understanding of the project, and encouraged the use of technology-backed classrooms.

3. Surge in positive emotions

Multimedia learning tends to be much more fun for learners than gathering information through wordy textbooks, and this can actually increase their knowledge and passion for the subject being taught.

found that ‘positive emotions should be considered as important factors in instructional design”, and that “positive emotions can be generated by the instructional design that may be able to affect learners’ experience and performance”.

4. Greater access to diverse knowledge

With increased internet connection in the classroom, students and teachers are able to gather information from a diverse range of sources, and illustrate points in exciting, immersive ways. According to nonprofit organization [the Internet Society](https://www.internetsociety.org/resources/doc/2017/internet-access-and-education/), educators can obtain a wealth of information and perspectives to pass along to their students by incorporating online multimedia resources into their lessons, and innovative ways to convey their lessons.

5. Immersion and exploration

Imagine the ability to take your students to the top of Mount Everest, the NASA Space Station, or a refugee camp in Jordan. Immersive multimedia resources make this a reality, allowing educators to teach by experience without ever leaving the classroom. With a headset and a smartphone, students have all that they need to explore without limits, utilizing 360° media to interact with their environment.

Though teachers around the country are using multimedia technology in different ways, the approach is most successful when it helps students reach existing curriculum goals. As educators create effective uses for multimedia technology, imagination will be their only limit. Parents, educators, administrators, and school board members need to become familiar with multimedia, so they can begin to take advantage of its endless possibilities.

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Education: Using Multimedia for Learning Report (Assessment)

Workshop activities, animation in schools, reference list.

The website DoppelMe is a great platform for creating avatars that can be used to depict oneself or even one’s friends and relatives. The website can help students to explore their identities and share their views on themselves and others. This will make students’ interactions more informative and creative.

The website Bubbl.us is another easy-to-use tool to create graphic organisers. It can help students to learn some material through organising the most meaningful details in an orderly manner. It can also help them do various assignments. The website can help educators create efficient visual aids within short periods.

Microsoft Publisher is a great tool used to create various leaflets, flyers, and even newspapers and magazines. The tool can help students to attract their peers’ attention to various events and projects. Of course, it provides insights into some details of publishing.

The website Storybird can help develop students’ creativity and encourage them to read more. Students can write their own stories and this process can be easier as numerous pictures are provided and can be used. Students can be encouraged to read their peers’ stories and then to read more professional works.

The website Myths.e2bn is very helpful for teachers who can create visuals to tell some stories (myths, legends and so on). This tool can also be used as a teaser to introduce a novel or a short story. Students can also use this website when talking about books and stories they have read.

The website Scootle is very helpful for educators who can share their ideas, develop and share numerous resources to improve their teaching. The website can also help students to access valuable resources, especially when it comes to tests and language learning.

The website Splash.abc contains various resources that can be used by both teachers and students. There are many videos, visuals and facts that can be used to teach different topics. There are also interactive games that can help students to grasp the material better and learn more on the subject.

The website Zimmertwins can help students develop their creativity as they can make up stories and make movies. Clearly, this is a fun way to tell a story. This resource is helpful for educators as well since they can tell some stories to students especially when teachers want to stress some moral principles that will teach students to behave themselves.

The website Tagxedo is useful for teachers. They can introduce a topic with the help of word clouds. The process is very quick and easy and the teacher can attract students’ attention by using creative images. Key words used can be easily memorised and can help students to organise the material properly.

The website Makebeliefscomix can be helpful for teachers, parents and students. Teachers (and parents) can find various materials to teach different topics. There is information on teaching techniques and peculiarities of students (including some disabilities). At the same time, students can also develop their creativity through making their own comic books.

The website Bronxzoo can be used to teach students (usually young learners) about animals. It can also be used to teach English when it comes to the topic ‘animals’. Students will have fun creating their animals and they will also memorise important things about wildlife.

The website Scratch can be used as a creative assignment for students who will make their short cartoons. Educators can also create numerous videos to engage students or provide some information. Students and teachers can make games and share them with others. These games can be devoted to specific topics.

Edutopia (2015) can be very helpful for teachers who can find a lot of interesting information on teaching. Teachers can share their experience and ask for advice. Educators, researchers, students and parents upload their articles and materials. All this information can help teachers (especially novice ones) improve their teaching.

The website Pixar can be a helpful complementary resource for teachers. Teachers can use it to show the way animation films and cartoons are created. Students may learn about various processes (creating characters, writing stories, directing, producing and so on) that are often left behind the scenes.

The website ZooBurst can be used by teachers to tell stories and introduce some material. Students can also use the website to create their own books. They can also make some reports or presentations with the use of the website. Clearly, it will be very engaging for students who will do assignments and have fun.

The website Quia is very helpful for teachers. First, educators can find loads of materials for their classes (quizzes, activities, surveys and so on). These materials can be easily found as they are placed under corresponding topics. More so, teachers can create their own quizzes and activities.

This is very important, as teachers will be able to adjust to particular students or specific materials they are using. Students can also use the website for self-study, as there are many interesting quizzes on many topics. Students can check if they have grasped the material properly as answers are also provided.

The website Xtranormal can be used to make short cartoons. Teachers can introduce topics, illustrate some points or deliver important messages (concerning students’ behaviour, ethical issues, news and so on). Students can also use the website to make presentations when doing their assignments.

The website Powtoon can also be used by both teachers and students. Teachers can introduce material in a more engaging way. They can also highlight major points of the topics in their short videos. Students can also make various presentations and have fun while working on their projects.

Design Brief.

Digital Technologies for the 21 st century

This lecture focuses on the essence of education of the 21 st century. It is clear that the goal of education is to develop students’ ability to solve a variety of problems, think critically and communicate effectively. Of course, knowledge in specific disciplines and a number of skills are still a part of the curriculum. It is also mentioned that technology plays an important role in education of the 21 st century.

People as well as children are surrounded by technology and they are accustomed to using it in various settings. Of course, technology helps to make education more effective, engaging and interesting.

Importantly, globalisation is another factor that affects education and one of the most important features of the contemporary education is accessibility. At the same time, there are still many areas where young people cannot access proper education. However, technology makes it possible for many people to access high-quality educational services.

Protection of Students Online

The lecture dwells upon safety of students as well as educators when it comes to the cyber space. It has been acknowledge that the Internet is a great source of information and students are encouraged to search for data, facts and so on online. At the same time, cyber space is associated with various hazards. Thus, students and educators have to be careful when sharing their or one’s personal information or photos.

This information can be misused by some people. Thus, careless users can get a lot of spam or advertisements. Students can also be exposed to cyber bullying that is quite common. To avoid negative experiences, students (starting with young learners) should be taught how to behave safely and responsibly.

Students should share information carefully and they should make sure they do not offend anyone. One of the most effective ways for an educational establishment to promote cyber safety is to have specific codes of conduct, policies and certain staff that will focus on cyber safety.

Educational Soundness in the Digital Age

It has been acknowledged that technology can significantly improve various learning outcomes. It can help students to access a lot of different information and communicate with people from all over the world. Importantly, technology should not be used as a complete replacement of more traditional resources (hand-outs, libraries, field trips and so on). Technology should expand the boundaries.

It is necessary to add that technology provides numerous opportunities for educators who can develop curriculum that will be effective for the diverse Australian society. It is also mentioned that educators have to encourage students’ interactivity, creativity and desire to learn.

Technology can help achieve these goals. The lecture includes a number of helpful links to websites that can make teaching and learning more effective, creative and engaging.

The lecture deals with the benefits of using animation in school. It is clear that teachers can create animation films or clips to engage students and make them more involved. However, it is more important to encourage students to create their own animation. There are various positive outcomes.

Many websites provide loads of opportunities that can enable students (even those who have difficulties with creating stories) to tell their stories.

Hence, animation contributes to development of students’ creativity. Apart from that, it can help develop logical, spatial and mathematical skills as well as language skills. Of course, it can help students learn how to collaborate with peers while working on projects. The lecture contains numerous links to helpful websites.

Active Learning through Multimedia

Schank (1994) focuses on ways multimedia should be used in education. The author first makes it clear that existing programs are sometimes based on principles of conventional education that is different from the world of technology and is more restricted. The author emphasises that learning by doing should be the major principle of the contemporary education.

Schank (1994) also adds that incidental learning should be widely used when developing multimedia. Thus, numerous games or projects should be designed so that students could focus on some interesting goal (winning a game, scoring and so on) but they should also simultaneously memorise facts and data without drilling (through using and being exposed to certain data).

Multimedia should also empower or provide autonomy to learners who will be encouraged to proceed.

Tus, the author articulate 10 major principles that should be used when developing educational software: learn by doing, first problems and then instruction, recall instead of recognition, tell proper stories, experience is crucial, empower students, availability of a safe place to fail, navigation to answers, the software involves evaluation of progress, fun is crucial.

Opinion of Teachers’ Towards Using Multimedia Learning Package

Sharma and Kakkar (2011) examine teachers’ attitude towards using multimedia in schools. The researchers state that teachers mainly welcome the use of multimedia as they think that it facilitates the process of teaching and learning. Educators report that multimedia enables them to make the class more engaging, interesting, informative and, hence, effective.

Notably, teachers also report about some troubles they face when using technology (these are mainly technical issues). However, they all agree that multimedia is essential and students are more active and attentive when technology is used. Thus, teachers are trying to utilise technology and learn more about effective use of multimedia in education. Educators are also willing to use multimedia more extensively in the future.

Sex and Tech

The present survey can be effectively used when considering and teaching safety in cyber space. According to the survey, a quarter of teenagers and even more young adults send or post nude pictures or videos ( Sex and tech , 2008). When it comes to sexually suggestive pictures and videos, the numbers are even higher as 40% of teenagers and 60% of young adults do that ( Sex and tech , 2008).

The report also contains valuable information that can keep people from behaving in such an irresponsible manner. It is mentioned that these pictures are often displayed to other people, they are also available for a long period and can become an obstacle for getting a good job.

The survey also includes some tips to parents who want to ensure their children’s responsible behaviour in the cyber space. Of course, talking and providing data from the survey are major instruments for parents.

Learning with Multimedia

Neo (2007) stresses that technology has become a part of the curriculum and teachers as well as students benefit from its use. The learning process has become more creative and engaging. Students have acquired more autonomy. Technology helps students to develop various skills (specific academic skills, critical thinking and communicative skills and so on).

The researcher reports about a multimedia project that involved students who had to work in pairs and develop certain multimedia. It is clear that the projects have had numerous positive effects. Students have acquired the necessary skills necessary for effective collaboration with peers and teachers. Admittedly, this is an important learning outcome.

Edutopia . (2015). Web.

Neo, M. (2007). Learning with multimedia: Engaging students in constructivist learning. International Journal of Instructional Media, 34 (2), 149-158.

Schank, R.C. (1994). Active learning through multimedia. IEEE MultiMedia, 1 (1), 69-78.

Sex and tech: Results from a survey of teens and young adults . (2008). Web.

Sharma, H.L., & Kakkar, N. (2011). Opinion of teachers’ towards using multimedia learning package. International Journal of Education and Allied Sciences, 3 (2), 27-36.

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3. problems students are facing at public k-12 schools.

We asked teachers about how students are doing at their school. Overall, many teachers hold negative views about students’ academic performance and behavior.

• 48% say the academic performance of most students at their school is fair or poor; a third say it’s good and only 17% say it’s excellent or very good.
• 49% say students’ behavior at their school is fair or poor; 35% say it’s good and 13% rate it as excellent or very good.

Teachers in elementary, middle and high schools give similar answers when asked about students’ academic performance. But when it comes to students’ behavior, elementary and middle school teachers are more likely than high school teachers to say it’s fair or poor (51% and 54%, respectively, vs. 43%).

Teachers from high-poverty schools are more likely than those in medium- and low-poverty schools to say the academic performance and behavior of most students at their school are fair or poor.

The differences between high- and low-poverty schools are particularly striking. Most teachers from high-poverty schools say the academic performance (73%) and behavior (64%) of most students at their school are fair or poor. Much smaller shares of teachers from low-poverty schools say the same (27% for academic performance and 37% for behavior).

In turn, teachers from low-poverty schools are far more likely than those from high-poverty schools to say the academic performance and behavior of most students at their school are excellent or very good.

Lasting impact of the COVID-19 pandemic

Among those who have been teaching for at least a year, about eight-in-ten teachers say the lasting impact of the pandemic on students’ behavior, academic performance and emotional well-being has been very or somewhat negative. This includes about a third or more saying that the lasting impact has been very negative in each area.

Shares ranging from 11% to 15% of teachers say the pandemic has had no lasting impact on these aspects of students’ lives, or that the impact has been neither positive nor negative. Only about 5% say that the pandemic has had a positive lasting impact on these things.

A smaller majority of teachers (55%) say the pandemic has had a negative impact on the way parents interact with teachers, with 18% saying its lasting impact has been very negative.

These results are mostly consistent across teachers of different grade levels and school poverty levels.

Major problems at school

When we asked teachers about a range of problems that may affect students who attend their school, the following issues top the list:

• Poverty (53% say this is a major problem at their school)
• Chronic absenteeism – that is, students missing a substantial number of school days (49%)
• Anxiety and depression (48%)

One-in-five say bullying is a major problem among students at their school. Smaller shares of teachers point to drug use (14%), school fights (12%), alcohol use (4%) and gangs (3%).

Differences by school level

Similar shares of teachers across grade levels say poverty is a major problem at their school, but other problems are more common in middle or high schools:

• 61% of high school teachers say chronic absenteeism is a major problem at their school, compared with 43% of elementary school teachers and 46% of middle school teachers.
• 69% of high school teachers and 57% of middle school teachers say anxiety and depression are a major problem, compared with 29% of elementary school teachers.
• 34% of middle school teachers say bullying is a major problem, compared with 13% of elementary school teachers and 21% of high school teachers.

Not surprisingly, drug use, school fights, alcohol use and gangs are more likely to be viewed as major problems by secondary school teachers than by those teaching in elementary schools.

Differences by poverty level

Teachers’ views on problems students face at their school also vary by school poverty level.

Majorities of teachers in high- and medium-poverty schools say chronic absenteeism is a major problem where they teach (66% and 58%, respectively). A much smaller share of teachers in low-poverty schools say this (34%).

Bullying, school fights and gangs are viewed as major problems by larger shares of teachers in high-poverty schools than in medium- and low-poverty schools.

When it comes to anxiety and depression, a slightly larger share of teachers in low-poverty schools (51%) than in high-poverty schools (44%) say these are a major problem among students where they teach.  

Discipline practices

About two-thirds of teachers (66%) say that the current discipline practices at their school are very or somewhat mild – including 27% who say they’re very mild. Only 2% say the discipline practices at their school are very or somewhat harsh, while 31% say they are neither harsh nor mild.

We also asked teachers about the amount of influence different groups have when it comes to determining discipline practices at their school.

• 67% say teachers themselves don’t have enough influence. Very few (2%) say teachers have too much influence, and 29% say their influence is about right.

• 31% of teachers say school administrators don’t have enough influence, 22% say they have too much, and 45% say their influence is about right.
• On balance, teachers are more likely to say parents, their state government and the local school board have too much influence rather than not enough influence in determining discipline practices at their school. Still, substantial shares say these groups have about the right amount of influence.

Teachers from low- and medium-poverty schools (46% each) are more likely than those in high-poverty schools (36%) to say parents have too much influence over discipline practices.

In turn, teachers from high-poverty schools (34%) are more likely than those from low- and medium-poverty schools (17% and 18%, respectively) to say that parents don’t have enough influence.

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• Open access
• Published: 07 October 2022

Advances in e-learning in undergraduate clinical medicine: a systematic review

• T. Delungahawatta 1 ,
• S. S. Dunne 1 ,
• S. Hyde 1 ,
• L. Halpenny 1 ,
• D. McGrath 1 , 2 ,
• A. O’Regan 1 &
• C. P. Dunne 1 , 2  

BMC Medical Education volume  22 , Article number:  711 ( 2022 ) Cite this article

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E-learning is recognised as a useful educational tool and is becoming more common in undergraduate medical education. This review aims to examine the scope and impact of e-learning interventions on medical student learning in clinical medicine, in order to aid medical educators when implementing e-learning strategies in programme curricula.

A systematic review compliant with PRISMA guidelines that appraises study design, setting and population, context and type of evaluations. Specific search terms were used to locate articles across nine databases: MEDLINE/PubMed, ScienceDirect, EMBASE, Cochrane Library, ERIC, Academic Search Complete, CINAHL, Scopus and Google Scholar. Only studies evaluating e-learning interventions in undergraduate clinical medical education between January 1990 and August 2021 were selected. Of the 4,829 papers identified by the search, 42 studies met the inclusion criteria.

The 42 studies included varied in scope, cognitive domain, subject matter, design, quality and evaluation. The most popular approaches involved multimedia platforms (33%) and case-based approaches (26%), were interactive (83%), asynchronous (71%) and accessible from home (83%). Twelve studies (29%) evaluated usability, all of which reported positive feedback. Competence in use of technology, high motivation and an open attitude were key characteristics of successful students and preceptors.

Conclusions

Medical education is evolving consistently to accommodate rapid changes in therapies and procedures. In today’s technologically adept world, e-learning is an effective and convenient pedagogical approach for the teaching of undergraduate clinical medicine.

Peer Review reports

E-learning, a pedagogical approach supported by the principles of connectivism learning theory, involves the use of technology and electronic media in knowledge transfer [ 1 , 2 ]. Connectivism views knowledge as a fluid entity circulated through technology enabled networks that foster interactions between individuals, organizations, and societies at large [ 2 ]. Based on this conceptual framework, medical curricula can potentially benefit from enhanced communication and knowledge exchange using technology.

Common e-learning instructional designs in clinical medicine include “online and offline computer-based programmes, massive open online courses, virtual reality environments, virtual patients, mobile learning, digital game-based learning and psychomotor skills trainers”[ 1 ]. To maximize the potential for e-learning, it seems rational that the roles and needs of the e-learner, e-teacher and host institution should be defined and appreciated. According to the Association for Medical Education in Europe (AMEE), an e-learner is any individual taught in an online learning environment [ 1 ]. As the role of the e-learner is central to the learning process, effective e-learning strategies should consider potential learning challenges encountered by the e-learner. Employing skilled e-teachers and providing them with sufficient supports are also important considerations. Furthermore, institutional management of the content versus process elements of educational technology use should best align with the objectives of the program [ 1 ]. For example, if the intent is to provide student access to digital content, then managing sound or video files, podcasts, and online access to research papers, clinical protocols, or reference materials, should be prioritized. On the other hand, if the focus is on student participation in digital activities, then managing processes such as discussion boards and test-taking should take precedence. Accounting for the role of the e-learner, e-teacher, and host institution in this manner, can result in successful implementation of an e-learning system. In fact, e-learning has been shown to be at least as effective as, and can serve as an adjunct to, face-to-face teaching and learning methods [ 3 , 4 , 5 ].

An institution may choose to employ educational technologies for the entirety of the course or provide a combination of online and in-class interactions, with the latter approach referred to as ‘blended learning’ [ 1 ]. Incorporation of e-learning into the curriculum allows for new avenues of interactive knowledge and skill transfer between teachers and students and amongst students. Interactions are not limited to face-to-face conversations but can involve text, audio, images, or video, thereby enriching the learning experience. Giving access to a greater breadth of learning resources further develops lifelong learning skills in students as they are required to independently evaluate and extract the pertinent information [ 1 ]. E-learning interventions can also be accessed at any time from almost any location, which facilitates a student-centred approach through self-directed and flexible learning [ 6 ]. As such, e-learning is an attractive instructional undergraduate health education approach [ 7 ].

To date, e-learning interventions in the sciences, particularly anatomy [ 8 ] and physiology [ 9 ], and postgraduate medical training [ 3 , 4 ] have been described. However, their use has not been reviewed systematically in the specific context of augmenting, enhancing or supporting student learning in undergraduate clinical medicine [ 10 ], or replacing face-to-face learning with online learning in the case of COVID-19 emergency remote teaching. In 2014, survey responses from senior medical students in Illinois, reported use of online collaborative authoring, multimedia, social-networking, and communication tools as point of opportunity study resources during clinical rotations [ 11 ]. Additionally, the COVID-19 pandemic has necessitated stepping away from traditional classroom and bedside teaching, and development of more flexible course delivery. A recent survey by Barton et al. collected 1,626 responses from medical students across 41 medical schools in the United Kingdom during the COVID lockdown. Results of study resources accessed daily showed that 41.6% of students used information provided by university (PowerPoint lecture slides, personal notes), 29.6% accessed free websites and question banks, and 18.4% accessed paid websites and question banks [ 12 ]. The work therefore suggests a strong tendency for students to supplement university materials with online resources [ 12 , 13 ]. The popularity of online learning platforms seems to stem from an association with achieving higher exam scores [ 14 , 15 ], ability to self-monitor knowledge gaps [ 16 ], improved knowledge retention from repeat exposure [ 17 , 18 ], and to practice exam technique [ 16 ].

Medical school educators are, therefore, called to evaluate e-learning approaches and to consider incorporation of suitable strategies into current curricula to ensure equitable access and student success. Thus, we aimed to systematically review the scope and impact of e-learning interventions published regarding undergraduate clinical medicine, and to inform medical educators of the effectiveness and character of various online learning environments.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines are used for the reporting of this systematic review [ 19 ]. The PRISMA checklist is included as Additional File 1 .

Search methods

The early 1990s marked the commercial availability of computer-based learning multimedia [ 20 ] as well as the emergence of online education programs [ 21 ]. Thus, medical subject headings (MeSH), key words and specific database headings were used to locate articles published between January 1990 and August 2021: ‘e-learning’ or ‘digital resources’ or ‘internet learning resources’ AND ‘medical education’ AND ‘undergraduate’ AND ‘techniques’ or ‘programmes’ or ‘interventions’. The search was piloted on PubMed and adapted subsequently for the databases. A total of nine databases were searched: MEDLINE/PubMed, ScienceDirect, EMBASE, Cochrane Library, ERIC, Academic Search Complete, CINAHL, Scopus, Google Scholar and grey literature. The bibliographies of each selected paper were searched manually for further studies. Websites of medical education organisations were searched for position statements and guidelines, including the Association for the Study of Medical Education, AMEE and the British Medical Journal.

Inclusion and exclusion criteria

Only studies in the English language that evaluated an e-learning intervention in subjects related to clinical medicine were selected. These included: family medicine, surgery, internal medicine, radiology, psychiatry, dermatology, paediatrics and obstetrics. Studies that did not involve undergraduate medical students, were based on pre-clinical sciences or were not focussed on an e-learning intervention were excluded. Studies that focussed on the use of internet for assessment and course administration only were not included. Additionally, studies that described interventions but not their evaluation were excluded. Of the 4,829 papers identified by the search, 42 studies were deemed eligible for inclusion in this review.

Data extraction and analysis

AMEE guidelines on e-learning interventions [ 1 ] were used to modify a previous data extraction tool that had been used in a systematic evaluation of effectiveness of medical education interventions [ 22 ]. This was subsequently piloted and refined by three of the authors until consensus was achieved to form the data extraction tool (see Additional File 2 ). With application of connectivism, individual elements of e-learning were identified to infer and appreciate their collective effects on the learning process. More specifically, data was extracted by examining two central questions: how and when to use e-learning in undergraduate clinical medical education. The primary outcomes relating to how to use e-learning were: instructional features that made the e-learning intervention effective; usability features; assessment of effectiveness and quality of the intervention. Primary outcomes relating to when were: the context, and the learner and preceptor characteristics. In addition to the outcomes measured, descriptive data was also extracted to summarise the studies including: the study design, setting and population; context and discipline; type of evaluations. All selected papers were filed in an Endnote library and the data extraction tool for each was stored in an Excel file, a summary of which is provided as Additional File 2 and Additional File 3 .

Guidelines for evaluating papers on medical education interventions from the Education Group for Guidelines on Evaluation were used as a framework to assign a global score for the strength of each paper [ 23 ]. Among these guidelines, significant value is placed on development of strong intervention rationale and intervention evaluation methods [ 23 ]. The impact of the evaluation was also measured using Kirkpatrick’s levels, a recognised system of understanding the effect of interventions [ 24 ]. The first level, reaction, is a measure of learner satisfaction with the intervention [ 24 ]. The second Kirkpatrick level, learning, is a measure of change in knowledge, skills, or experience. The third Kirkpatrick level of behaviour is a measure of behavioural change. The final level, results, is a measure of overall impact on the organization (i.e., improved quality of work, reduction in time wasted, better patient care).

Search results

A total of 4,829 papers were retrieved from database and manual searches, and this number was reduced to 42 after removal of duplicates and application of inclusion/exclusion criteria at set stages (see Fig.  1 for the PRISMA flow diagram). Two papers were retrieved from manual searches of bibliographies [ 25 , 26 ]. The main reasons for excluding studies were a lack of focus on undergraduate medical students (112 studies) or absence of an e-learning intervention (34 studies).

PRISMA flow diagram

Design of included studies

The year of publication ranged from 2003 to 2021, with most conducted within the past ten years (31 studies). Interventions were conducted in nine different countries, mainly the United States (13 studies) and Germany (9 studies). More than half of the studies were conducted in the European Union (21 studies). Several research designs were described, including 17 observational studies [ 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], 13 randomised control trials [ 26 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ], three non-randomised control trials [ 55 , 56 , 57 ], eight qualitative studies [ 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ], and one mixed methods study [ 66 ]. Thirteen of the total studies included data collection both pre- and post- intervention [ 25 , 27 , 31 , 34 , 36 , 38 , 39 , 45 , 48 , 52 , 53 , 54 , 61 ]. Six studies had follow-up data (collected weeks to months after intervention) [ 34 , 45 , 49 , 52 , 54 , 56 ] and twelve papers reported ethical approval [ 28 , 29 , 30 , 31 , 33 , 34 , 39 , 40 , 42 , 46 , 49 , 54 ]. Furthermore, eight studies described learning theories in the development or evaluation of medical curricula [ 29 , 30 , 33 , 49 , 51 , 52 , 56 , 58 ]. Of these studies, five referenced constructivism [ 29 , 49 , 51 , 52 , 58 ] three studies highlighted cognitivism [ 30 , 56 , 59 ], and one study evaluated behaviourist learning theory [ 33 ].

Study population

Students in the third year of medical school experiencing clinical exposure were the most commonly studied (sixteen studies), with fourteen studies involving multiple cohorts of students (see Additional File 3 ). Sample sizes ranged from 10 to 42,190 individuals. The most common disciplines investigated were interdisciplinary (13 studies), surgery (8 studies), radiology (7 studies), and dermatology (4 studies) (see Fig.  2 Intervention Discipline).

Intervention discipline

Intervention characteristics

Twelve types of intervention were described and the most commonly used were multimedia platforms (fourteen studies) and case-based learning (eleven studies), as per Additional File 2 and Fig.  3 . In terms of cognitive domain, 27 interventions were in the domain of knowledge [ 25 , 26 , 27 , 29 , 30 , 32 , 33 , 34 , 35 , 39 , 40 , 42 , 43 , 47 , 48 , 50 , 52 , 53 , 54 , 57 , 60 , 61 , 62 , 63 , 64 , 66 , 67 ]; eight were in the domain of skills [ 9 , 30 , 31 , 36 , 37 , 46 , 49 , 51 ] and seven in combined knowledge and skills [ 38 , 41 , 44 , 45 , 56 , 59 , 65 ]. The interventions ranged in duration from a single session to a complete academic year. Thirteen of the interventions were synchronous, where users log on at a given time [ 8 , 26 , 27 , 31 , 33 , 34 , 37 , 43 , 47 , 51 , 52 , 58 , 66 ], and the remaining 29 used an asynchronous platform (users logging on independently in their own time). Seven were accessible in a classroom setting only [ 26 , 27 , 36 , 47 , 52 , 58 , 66 ] while the others could be accessed from home (Fig. 4 ).

Intervention type

Reported roles for e-learning within the curriculum included a revision aid for examinations [ 58 ]; the flipped classroom concept [ 44 , 57 ], whereby lectures held after an e-lecture become an interactive session; to facilitate an online community where knowledge could be discussed/ shared [ 25 ]; and, enabling just-in-time learning through timely access to facts [ 30 , 31 , 37 ]. Seven (17%) of the 42 interventions were didactic in approach [ 27 , 30 , 37 , 55 , 57 , 63 , 65 ], while the others were interactive. Twelve studies described a collaborative approach, whereby students discussed cases and problems with one another and engaged in role-plays [ 25 , 26 , 36 , 38 , 40 , 41 , 42 , 46 , 52 , 59 , 61 , 66 ]. The context of e-learning in relation to the curriculum was not stated in ten of the studies but another thirteen studies used the terms “adjunct”, “complement”, “supplement”,”hybrid” and “blended” to illustrate the common theme of integrating e-learning with traditional learning [ 25 , 29 , 30 , 32 , 44 , 45 , 46 , 47 , 50 , 56 , 57 , 58 , 62 , 63 ]. Seven studies describe temporary replacement of traditional curricula with e-learning platforms in response to COVID-19 [ 33 , 40 , 41 , 42 , 61 , 62 , 64 ]. Eight studies described a pilot phase or the inclusion of students in the development of the intervention [ 33 , 37 , 44 , 45 , 48 , 49 , 53 , 66 ]. Nineteen of the interventions had a built-in assessment, with multiple choice questions being used in most cases, to evaluate whether an improvement in learning had taken place [ 25 , 27 , 31 , 34 , 37 , 39 , 43 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 54 , 55 , 59 , 66 ]. Justification for the chosen assessment strategy or a statement on its suitability was included in two studies [ 50 , 66 ]. Kourdioukova et al. reported an improvement in knowledge and skills with computer supported collaborative case-based approach as judged by in-built multiple-choice questions (MCQ), suggesting the importance of content-specific scripting [ 66 ]. Schneider et al. used a combination of MCQ and survey, and justified their use by demonstrating that learning improved with the intervention compared to the control [ 50 ]. Five of the interventions used end of module assessments as the marker of quality [ 26 , 29 , 53 , 56 , 57 ], with one stating that this was not a suitable mechanism due to its inability to assess the students’ ability to take a patient history or perform a clinical examination [ 53 ].

Intervention evaluation

Each study was given a global rating from 1–5 based on guideline criteria from the Education Group for Guidelines on Evaluation, including whether learning outcomes and curricular context were outlined and the power and rigor of the studies [ 23 ] (Additional File 2 ). Accordingly, eleven studies scored 4/5; two scored 3.5/5; twelve studies scored 3/5; twelve studies scored 2.5/5; and five scored 2/5 (σ = 0.138).

Intervention effectiveness and acceptability

Nine studies described an impact matching a Kirkpatrick level 1, where the student reaction to e-learning intervention was evaluated using student surveys or questionnaires [ 32 , 35 , 44 , 58 , 60 , 61 , 62 , 64 , 65 ]. All these studies report that most students were satisfied with the addition of an e-learning intervention. For instance, Orton et al. note that over 91% of survey responses either ‘strongly agreed’ or ‘agreed’ that use of computer-based virtual patients enabled learning [ 35 ].

Twenty-one (50%) of the 42 studies evaluated acceptability [ 26 , 30 , 32 , 33 , 36 , 37 , 40 , 41 , 42 , 44 , 48 , 53 , 54 , 55 , 56 , 57 , 58 , 63 , 65 , 66 , 68 ]. Of these, 17 reported that the intervention was acceptable. A neutral attitude was reported to a radiology e-learning intervention that involved peer collaboration and was found to be time consuming[ 66 ]. Attitude in another study was much more favourable in junior years than in senior years, with the authors commenting on the conflict between completing assignments and preparing for high stakes examinations [ 55 ]. Another study that focussed on acceptability, with positive outcomes, found that perceived utility and ease of use were the key factors [ 30 ]. Twelve (57%) of the 21 studies further evaluated usability [ 30 , 36 , 37 , 40 , 41 , 42 , 44 , 53 , 56 , 57 , 58 , 65 ], all with positive outcomes, but only one used a formal usability assessment tool [ 58 ]. In that study, Farrimond et al. found that a usable intervention should be: simple and intuitive to use and, from a learner perspective, interactive and enjoyable [ 58 ]. In the development of virtual lectures, ease of navigation, audio-visual quality and accessibility were the key usability features [ 57 ]. Wahlgren et al. concluded that as well as navigation, interactivity is a priority for e-learning development [ 53 ]. Regarding mobile learning, the display should be adaptable to varying screen sizes, termed ‘chunking’, and it should be suitable for a number of platforms [ 30 ].

Twenty-nine (69%) of the 42 studies described an impact matching a Kirkpatrick level 2, where evaluation of whether learning took place was assessed through post intervention scores [ 25 , 27 , 31 , 36 , 38 , 39 , 47 , 48 , 50 , 52 , 53 , 54 , 56 , 57 , 61 ], final exam results [ 26 , 29 , 45 , 66 ], direct observation [ 28 , 31 , 33 , 43 , 46 , 51 , 55 ] and student survey [ 25 , 26 , 30 , 37 , 38 , 39 , 40 , 41 , 42 , 45 , 48 , 49 , 53 , 54 , 56 , 65 , 66 ]. Among these studies, two studies had included both pre- and post- intervention evaluations but neither had a control group nor longer term follow-up [ 25 , 27 ]. One randomised control trial showed a statistically significant improvement in factual knowledge acquisition after participation in an online module as judged based on performance in end of year assessments, compared to a traditional teaching control group (84.8% ± 1.3 vs. 79.5% ± 1.4, p  = 0.006, effect size 0.67) [ 26 ]. Likewise, Davis et al., found that the use of a procedural animation video on mobile device resulted in higher medical student scores on skills checklist (9.33 ± 2.65 vs. 4.52 ± 3.64, p  < 0.001, effect size 1.5) [ 30 ]. Similarly, in Sijstermans et al., mean students’ self-evaluation of their skills using five-point Likert scale questionnaire, before and after two patient stimulations showed improvement (3.91 ± 0.28 vs 3.56 ± 0.34, P  < 0.0001, effect size 1.12). Furthermore, in one study employing a problem-based e-learning approach, the number of first-class honours awarded were found to be significantly improved when compared to control group [ 29 ]. However, in another study using a problem-based e-learning intervention, no significant difference was found between control and intervention groups in subsequent examinations ( p  = 0.11) [ 53 ]. In contrast, Al Zahrani et al. found that delivery of new e-learning platforms (Blackboard Collaborate, ZOOM) in response to COVID-19 was poorly accepted by students, whereby 59.2% did not feel adequately educated on learning outcomes, 30% felt no educational difference between e-learning and traditional curriculums, and 56.1% felt e-learning is insufficient as an educational tool for the health sciences [ 40 ].

Four studies demonstrated a change in student behaviour in line with Kirkpatrick level 3 [ 50 , 52 , 59 , 63 ]. In de Villiers et al., it was found that students were using podcasts to learn course content and the classroom teaching setting to strengthen their understanding, inadvertently accepting the flipped classroom approach [ 63 ]. In Sward et al., students who were assigned to a gaming intervention were more willing to engage in answer creating and answer generating as well as independent study of subject materials prior to session time [ 52 ]. Similarly, in Schneider et al., students in the computer case-based intervention group were found to invest more time into studying course subjects (38.5 min vs 15.9 min) which resulted in significantly higher test scores [ 50 ]. Finally, in Moriates et al., following the integration of value-based modules, students have reported increased awareness of patient needs and discussions with peers regarding value-based decision-making during clerkship [ 59 ].

Learner and preceptor characteristics

Learner characteristics identified to enable successful e-learning include: good digital skills, less resistance to change [ 32 ] and a willingness to collaborate with peers [ 66 ]. Preceptor characteristics were not described in most of the studies, but the role involved guiding students through their learning [ 33 , 46 , 61 , 66 ], selection of topics of broad interest to students [ 60 ], technical support [ 54 ], student evaluation[ 28 , 31 , 37 , 40 , 42 , 45 , 46 , 49 , 51 ], content development and management [ 32 , 41 , 42 , 46 , 54 , 62 ] and providing feedback and clear instruction on what is expected of the learners [ 28 , 37 , 40 , 42 , 51 , 54 , 60 ].

The COVID-19 pandemic resulted in global university closures during periods of lockdown, necessitating educators to quickly adopt alternate pedagogical approaches. As a result, there has been a substantial increase in the use of e-learning, by which teaching and learning activities occur at a distance on online platforms [ 69 ].

In enabling a shift in the control of knowledge acquisition and distribution from the teacher to the student, e-learning facilitates the learning process. Learners filter the available information, develop new perspectives, log into networks to share their understanding, and repeat the cycle [ 2 ]. This view of learning as a fluid and dynamic process is the basis of the learning theory of connectivism and highlights the benefit of this instructional design in medical education – a field amenable to rapid changes in therapies and procedures. In fact, educational theorists have significantly influenced the development of medical curricula throughout history. Amongst the 25 higher impact studies (achieving a global score greater or equal to 3), only 7 studies (28%) were found to have described theoretical underpinnings [ 30 , 33 , 49 , 51 , 52 , 58 , 59 ]. Initially, the behaviourist perspective supported pedological practices [ 70 ]. Behaviourism described learning as largely deriving from responses to external stimuli and led to curricula aimed to influence behaviour through reward and positive and negative reinforcement. In one study reviewed, the lack of direct observation of non-verbal communication by instructors was seen as a significant learning challenge in the virtual environment [ 33 ]. A shift from behaviourism to cognitivism later ensued with the belief that the brain is much more than a ‘black box’ and learning rather involved mental processing and organization of knowledge, and memory functions [ 70 ]. With the recognition of individual differences in the learning process, online systems attempted to introduce interventions that suited multiple learning strategies. For example, learning from auditory narration with animation was found to be more effective than use of text with animation [ 71 ]. This review further highlighted the impact of repetition [ 30 ] and clinical reasoning [ 56 , 59 ] on the learning process. More recently, constructivist learning theory and the perception that learners incorporate new information into pre-existing knowledge schemas has greatly contributed to reformation of medical education [ 70 ]. Incorporating real world connections [ 29 , 49 , 58 ], building on motivations [ 52 ], application of feedback [ 51 ] and continuous reflection [ 49 ] has been noted in this review as important factors in knowledge handling and retention. Presently, e-learning interventions often utilize aspects of more than one theoretical perspective. For instance, problem-based learning interventions have emphasised the critical thinking processes of cognitivism and the self-direction of constructivism [ 29 ]. While primary studies have increased the reporting of underlying theory over time, there is still a significant lack of discussion – future work should reference theoretical principles to objectively frame and assess online education.

In addition to recognizing the needs of the e-learner, identifying required skills of e-teachers and developing content that appropriately supplement the curriculum are vital to ensuring successful implementation of an e-learning system [ 1 ]. Therefore, this study involved review of studies published between 1990 and 2021, assessing the effectiveness and character of various online learning environments in undergraduate clinical medical education. Specifically, these studies involved medical students pursuing medicine as a primary degree and those enrolled with prior degrees.

Intervention design

Critical appraisal of the collected studies using EGGE criteria, identified seventeen studies (40%) meeting a global rating of less than 3. The EGGE criteria encompass a standardized framework by which quality indicators can be recognized. Lower ratings of included studies suggests that conducting and reporting of e-learning interventions is largely lacking in methodological rigour and therefore limits transferability of study results. This finding is consistent with conclusions from a review by Kim et al., describing how most of the existing literature on e-learning interventions have little quantitative data, evaluate a limited range of outcomes and have significant gaps in study designs [ 72 ]. Additionally, only 13 (31%) randomized control trials (RCTs) were included in the review [ 26 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. Amongst these studies, five reported pre and post test scores [ 45 , 48 , 52 , 53 , 54 ], three of which report long term follow up [ 45 , 52 , 54 ]. Interestingly, all the RCTs report no significant differences in knowledge mastery between control and intervention groups. However, in the immediate short term, e-learning interventions were associated with greater learner satisfaction. For example, in Lee et al., mobile learning with interactive multimedia had higher satisfaction scores compared with conventional Microsoft PowerPoint Show content, despite non-significant differences in knowledge gain [ 48 ]. Similarly, in the study by Wahlgren et al., the majority of students in the intervention group reported that the interactive computerised cases enabled better understanding of disease diagnosis and management, particularly referencing the user-friendliness and feedback [ 53 ]. Yet, knowledge gain as assessed by post-intervention examination scores did not show statistically significant differences between the two groups. Systematic reviews examining the effect of e-learning on nursing education have also demonstrated no differences between e-learning and traditional teaching modalities but report high satisfaction rates with the former [ 73 , 74 ]. While these studies suggest that e-learning is as effective as traditional educational methods, higher student satisfaction levels are indicative of more effective learning programs [ 75 ]. Therefore, the lack of longitudinal data may limit our ability to accurately evaluate the impact of e-learning technologies.

Many of the studies in this review used virtual patient and case-based pedagogical methods reflecting an educational trend towards more critical thinking [ 76 ]. Thirty-five of the interventions under review used an interactive approach, encouraging a style in which students collaborated and discussed ideas with their peers and tutors, the importance of which has been recognised [ 77 ]. Two studies of mobile learning identified wasted time for students as a concern that could be addressed by allowing immediate access to information that would soon be required [ 30 , 55 ]. This ‘just in time learning’, defined as a “brief educational experience targeting a specific need or clinical question” [ 78 ], can be facilitated through e-learning. Ten of the included studies concluded that an integrated approach works best, whereby educators do not seek to replace traditional methods but rather supplement them. This has previously been described as a ‘blended-learning’ style [ 77 ]. A recent study suggests that students thrive in blended- versus self-directed virtual reality environments due to face-to-face teacher support [ 79 ].

Despite variability in methodological design, several studies of e-learning across domains of education, politics, business, and military training have shown knowledge gains assessed by pre- versus post-intervention tests [ 80 ]. Similarly, subjects within the studies we have reviewed have reported e-learning interventions to be conducive to learning [ 32 , 35 , 36 , 44 , 58 , 60 , 61 , 62 , 64 , 65 ], have demonstrated improvements in learning [ 25 , 26 , 27 , 29 , 30 , 31 , 34 , 36 , 37 , 38 , 39 , 43 , 46 , 48 , 49 , 54 , 55 , 56 , 57 , 66 ] and modified learning strategies [ 50 , 52 , 63 ]. The specific features of e-learning strategies most likely to enhance the learning experience may include: peer-to-peer learning [ 52 ], making use of wasted time [ 30 , 40 , 41 , 42 , 81 ], feedback from clinicians and ongoing technical support [ 32 , 82 ], consolidation of information and skill through repetition [ 52 , 82 , 83 ], and convenience of online content access [ 25 , 30 , 40 , 41 , 42 ]. Usability of the intervention has specifically featured strongly in this review. Vital features of e-learning interventions facilitating its use may include: interactive software, active learning promotion (built-in quizzes following cases), asynchronous use, multimedia platforms (i.e., slideshows, videos, images), ease of use and adaptability [ 76 , 81 , 84 ]. Unsurprisingly, students are more engaged with educational material after the typical 9-to-5 work hours [ 25 , 35 ]. Whereas traditional learning opportunities may be restricted to these hours, the flexibility of being able to access online resources outside of this timeframe, may better facilitate achievement of learning objectives [ 25 , 35 ]. Additionally, the use of discussion boards [ 78 ] and games [ 77 ] may facilitate active learning and feedback to be sought and received in a timely manner. Furthermore, quality assurance is recognized as a critical factor, and if considered at the planning stage of an intervention and built into e-learning interventions, may lead to more favourable outcomes [ 23 ]. Engagement with students in this manner is in keeping with the AMEE recommended goals of e-learning [ 1 ]. Several studies also highlight how online learning might provide an encouraging environment for the development of knowledge and skills, relatively easily tailored to individual learning preferences and prior knowledge, and with the possibility of compensating for a lack of accessibility of patients or teachers [ 35 , 36 , 38 , 63 , 85 ]. Furthermore, the ability to access an extensive network of additional resources may allow students to take control of their learning and regulate the volume of information studied [ 36 ].

While our review found improved learning outcomes, other systematic reviews assessing the effectiveness of technology and electronic media in health education, report equivocal findings [ 77 , 86 ]. Proposed factors that may limit learning capacity include: hesitancy to adopt changes by students and teachers, poor technical or financial support, limited technological skills, and the lack of direct and personalized teacher communication [ 25 , 32 , 82 , 87 ]. For example, Davies et al. suggests that an open outlook on mobile device usage was required by students and clinicians, to limit non-use and acquire potential benefits [ 30 ]. In another study conducted by Alsoufi et al., online medical education programs implemented in Libya in response to COVID-19 were found to be negatively received by respondents [ 87 ]. Financial and technical barriers and the lack of hands-on bedside teaching were stated by respondents as limitations to acceptance of e-learning. The shift to online medical learning in the Philippines during the COVID-19 pandemic also identified lack of access to computers and the internet as a significant barrier [ 82 ]. Of course, with these later interventions, the rapid onset of the pandemic required development of e-learning platforms with relatively little training and preparation. As such, the logistics of e-learning curricula as it pertains to specific communities may not have been foreseen. Another reason for such discrepancies may be the underlying discipline in which the intervention is being evaluated [ 47 ]. For instance, the use of only e-learning materials when teaching new skills may not be sufficient, as the direct observation and guidance of an expert is valuable [ 88 ]. A blended-learning environment may be more appropriate in these circumstances [ 47 ]. Indeed, viewing e-learning as a complement rather than replacement of traditional approaches is already well accepted amongst students [ 80 ].

Learner, preceptor and institution characteristics

The twenty-first century learners are known to be avid consumers of various digital platforms. However, studies have shown an incongruence between their ability to use technology for entertainment and ability to use it for educational purposes [ 89 ]. Most students require guidance to synthesize information and create new understanding. In fact, students in middle school through undergraduate level studies have consistently demonstrated poor digital research skills [ 90 , 91 ]. Furthermore, students may require adjustment of learning practices to best engage with the presented e-learning platform. For example, use of PowerPoint presentations or handouts in replacement of in-class teaching can cause visual and auditory learners to require more time to comprehend the information [ 82 ]. Therefore, in addition to carrying an acceptant attitude and a willingness to collaborate with peers, the ability to engage with and extract relevant content from online resources, is a characteristic linked to success in e-learning [ 32 , 66 ].

Nevertheless, recognition of the need for continued mentoring and support in the online learning environment, requires appreciation of the role of the e-teacher. Preceptors’ roles involve development and delivery of the intervention and acting as a resource person for the duration of the module [ 68 ]. In our previous discussion of e-learning strategy effectiveness, two further roles of the e-teacher can be recognized. Firstly, the e-teacher is instrumental in providing timely feedback, one of the main features associated with improved e-learning outcomes [ 32 ]. E-teachers should actively monitor student activity and provide feedback or support where needed [ 92 ]. Secondly, success of e-learning is also strongly related to the motivation of the students and indirectly the motivation demonstrated by the e-teacher [ 30 , 92 ]. The ARCS motivational model highlights four components needed to create a highly motivational e-learning system: maintain student attention, content relevance, student confidence, student satisfaction [ 93 ]. If e-teachers can convey subject material through strategies which encompass use of interactive multimedia, humour, and inquiry for instance, they can satisfy the first component of attention [ 92 ]. Generating activities that best illustrate main ideas, tailoring to the learner knowledge level and providing positive feedback are examples of methods to instil content relevance, student confidence and student satisfaction, accordingly. In Gradl-Dietsch et al., combination of video-based learning, team-based learning and peer-teaching, along with practical skills teaching in point of care ultrasound, feedback from peer teachers, and positive instructor-learner interactions, collectively fulfil the components of the ARCS model [ 54 ]. In Sox et al., the use of a web-based module to teach oral case presentation skills satisfied student attention and content relevance [ 51 ]. However, poor adherence to module largely due to time constraints, can be suggestive of poor student satisfaction. As a result, student confidence and the quality of oral case presentations did not differ from controls (faculty-led feedback sessions). As suggested by the authors, a combination of web module with direct faculty feedback may better instil student confidence and satisfaction with module content, and thereby improve student performance [ 51 ]. Recent studies have shown that the digital literacy skills of most instructors are inadequate [ 90 , 91 ]. Therefore, institutions need to invest into the provision of training programs and supports to allow e-teachers to develop and strengthen competencies needed to sufficiently handle educational technologies [ 92 , 94 , 95 ]. For example, the use of offline tablet-based materials was shown to improve medical education in Zambia, but reported usage amongst healthcare workers was low [ 95 ]. Authors suggest that a lack of training in tablet use was the underlying reason. Taken together, while the role of the teacher has changed compared to traditional pedological approaches, their actions can still heavily influence student learning outcomes.

Limitations and future directions

In a field where technology is changing faster than studies can be completed and interventions are evolving rapidly, medical education research has become a challenging topic of debate. Research can “provide the evidence to prove—and improve—the quality and effectiveness of teaching” and therefore advise the restructuring of curricula to respond to advances in science and technology [ 96 ]. In this review, 29 studies received a global score of 3 or less out of 5, highlighting a lack of transparency and rigour in most of the studies. This justifies a need for a standardised approach for reporting medical education interventions. Pre- and post-intervention testing is informative, but follow-up months later would be an important measure of knowledge retention and therefore intervention effectiveness. Moreover, most of the studies in this review examined knowledge or skill development but few examined higher Kirkpatrick levels. The inclination towards focus on the lower levels of the Kirkpatrick model may stem from difficulty following students in the field to evaluate long-term results of the educational intervention on student behaviours (level three) and the organization at large (level four) [ 97 ]. Future work on the evaluation of associated changes in behaviour, professional practice or patient outcomes would be valuable. Other e-learning characteristics that can be evaluated in future work (Fig. 4 ) may include the capacity for adaptivity (to accommodate changing student needs and performance) and collaboration [ 98 ]. Including descriptions of curricula context can also facilitate the exploration of which e-learning strategies are best suited for specific medicine disciplines and socioeconomic settings. The use of internet resources by both students and patients alike, and the exponential growth in social media influence may also provide a platform for future e-learning interventions [ 99 ].

Future intervention design recommendations

Over the past twenty years and with the recent advent of the COVID-19 pandemic, there has been a substantial increase in the use of e-learning. This review found that e-learning interventions are positively perceived by students and associated with improvements in learning. Improved learning outcomes are closely correlated with interactive, asynchronous, easily accessible and usable interventions, and those involving students and preceptors with digital skills, high motivation and receptive attitudes. While further exploration of the strengths and weaknesses of e-learning technologies is warranted, use of online platforms is a creditable educational tool for undergraduate clinical medicine.

Abbreviations

Association for Medical Education in Europe

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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Delungahawatta, T., Dunne, S.S., Hyde, S. et al. Advances in e-learning in undergraduate clinical medicine: a systematic review. BMC Med Educ 22 , 711 (2022). https://doi.org/10.1186/s12909-022-03773-1

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Top 5 most challenging requirements for 2023

The Joint Commission regularly analyzes standards compliance data to identify trends and tailor education related to challenging standards and National Patient Safety Goals (NPSGs).

Below are the Top 5 Joint Commission requirements and corresponding elements of performance (EPs) identified most frequently as “not compliant” (in the higher Survey Analysis for Evaluating Risk ® or SAFER ® categories) during surveys and reviews from Jan. 1 through Dec. 31, 2023. For more information, see the April issue of Perspectives .

Ambulatory Care

• IC.02.02.01, EP 2: The organization implements infection prevention and control activities while doing the following: Performing intermediate and high-level disinfection and sterilization of medical equipment, devices, and supplies.
• IC.02.01.01, EP 2: The organization uses standard precautions, including the use of personal protective equipment, to reduce the risk of infection.
• MM.01.01.03, EP 2: The organization follows a process for managing high-alert and hazardous medications.
• MM.01.02.01, EP 2: The organization takes action to avoid errors involving the interchange of medications on its list of look-alike/sound-alike medication.
• EC.02.05.01, EP 7: In areas designed to control airborne contaminants (such as biological agents, gases, fumes, dust), the ventilation system provides appropriate pressure relationships, air-exchange rates, filtration efficiencies, relative humidity, and temperature. For new health care facilities or altered, renovated, or modernized portions of existing ventilation systems or individual components (constructed or plans approved on or after July 5, 2016), heating, cooling, and ventilation are in accordance with NFPA 99-2012, which includes 2008 ASHRAE 170, or state design requirements if more stringent. Existing systems are in compliance with the ventilation standards that were in effect at the time the facility was constructed or last modified.

Behavioral Health Care and Human Services

• Training and competence assessment of staff who care for individuals served at risk for suicide.
• Guidelines for reassessment.
• Monitoring individuals served who are at high risk for suicide.
• NPSG.15.01.01, EP 1: The organization conducts an environmental risk assessment that identifies features in the physical environment that could be used to attempt suicide and takes necessary action to minimize the risk(s) (for example, removal of anchor points, door hinges, and hooks that can be used for hanging).
• NPSG.15.01.01, EP 2: Screen all individuals served for suicidal ideation using a validated screening tool.
• HRM.01.06.01, EP 3: The organization conducts an initial assessment of staff competence. This assessment is documented.
• NPSG.15.01.01, EP 4: Document individuals’ overall level of risk for suicide and the plan to mitigate the risk for suicide.

Critical Access Hospital

• IC.02.02.01, EP 2: The critical access hospital implements infection prevention and control activities when doing the following: Performing intermediate and high-level disinfection and sterilization of medical equipment, devices, and supplies.
• Verifies that the medication selected matches the medication order and product label.
• Visually inspects the medication for particulates, discoloration, or other loss of integrity.
• Verifies that the medication has not expired.
• Verifies that no contraindications exist.
• Verifies that the medication is being administered at the proper time, in the prescribed dose, and by the correct route.
• Discusses any unresolved concerns about the medication with the patient’s physician or other licensed practitioner, prescriber (if different from the physician or licensed practitioner), and/or staff involved with the patient’s care, treatment, and services.
• EC.02.05.01, EP 15: In critical care areas designed to control airborne contaminants (such as biological agents, gases, fumes, dust), the ventilation system provides appropriate pressure relationships, air-exchange rates, filtration efficiencies, temperature, and humidity. For new and existing health care facilities, or altered, renovated, or modernized portions of existing systems or individual components (constructed or plans approved on or after July 5, 2016), heating, cooling, and ventilation are in accordance with NFPA 99-2012, which includes 2008 ASHRAE 170, or state design requirements if more stringent.
• PC.02.01.11, EP 2: Resuscitation equipment is available for use based on the needs of the population served.
• EC.02.02.01, EP 5: The critical access hospital minimizes risks associated with selecting, handling, storing, transporting, using, and disposing of hazardous chemicals.
• Any medications administered, including dose.
• Any activity restrictions.
• Any changes in the patient’s condition.
• Any summaries of the patient’s care, treatment, or services furnished to the patient’s physician or allowed practitioner.
• The patient’s medical history.
• Any allergies to medications.
• Any adverse drug reactions.
• The patient’s functional status.
• Any diet information or any dietary restrictions.
• Diagnostic and therapeutic tests, procedures, and treatments, and their results.
• Any specific notes on care, treatment, or services.
• The patient’s response to care, treatment, or services.
• Any assessments relevant to care, treatment, or services.
• Physician or allowed practitioner orders.
• Any information required by organization policy, in accordance with law and regulation.
• A list of medications, including dose, strength, frequency, route, date and time of administration for prescription and nonprescription medications, herbal products, and home remedies that relate to the patient’s care, treatment, or services.
• The plan(s) of care.
• For DMEPOS suppliers serving Medicare beneficiaries: The DMEPOS prescription, any certificates of medical necessity (CMN), and pertinent documentation from the beneficiary’s prescribing physician or allowed practitioner.
• All pertinent diagnoses.
• Mental, psychosocial, and cognitive status.
• Types of services, supplies, and equipment required.
• The frequency and duration of visits.
• The patient’s prognosis.
• The patient’s potential for rehabilitation.
• The patient’s functional limitations.
• The patient’s permitted activities.
• The patient’s nutritional requirements.
• All medications and treatments.
• Safety measures to protect against injury.
• A description of the patient’s risk for emergency department visits and hospital readmission, and all necessary interventions to address the underlying risk factors.
• Patient-specific interventions and education.
• Measurable outcomes and goals identified by the organization and patient as a result of implementing and coordinating the plan of care.
• Patient and caregiver education and training to facilitate timely discharge.
• Information related to any advance directives.
• Identification of the disciplines involved in providing care.
• Any other relevant items, including additions, revisions, and deletions that the home health agency, physician, or allowed practitioner may choose to include.
• LD.04.01.07, EP 1: Leaders review, approve, and manage the implementation of policies and procedures that guide and support patient care, treatment, or services.
• PC.01.03.01, EP 5: The written plan of care is based on the patient’s goals and the time frames, settings, and services required to meet those goals.
• IC.02.02.01, EP 2: The hospital implements infection prevention and control activities when doing the following: Performing intermediate and high-level disinfection and sterilization of medical equipment, devices, and supplies.
• Discusses any unresolved concerns about the medication with the patient’s physician or other licensed practitioner, prescriber (if different from the physician or other licensed practitioner), and/or staff involved with the patient’s care, treatment, and services.
• NPSG.15.01.01, EP 1: For psychiatric hospitals and psychiatric units in general hospitals: The hospital conducts an environmental risk assessment that identifies features in the physical environment that could be used to attempt suicide; the hospital takes necessary action to minimize the risk(s) (for example, removal of anchor points, door hinges, and hooks that can be used for hanging). For nonpsychiatric units in general hospitals: The organization implements procedures to mitigate the risk of suicide for patients at high risk for suicide, such as one-to-one monitoring, removing objects that pose a risk for self-harm if they can be removed without adversely affecting the patient’s medical care, assessing objects brought into a room by visitors, and using safe transportation procedures when moving patients to other parts of the hospital.
• EC.02.05.01, EP 15: In critical care areas designed to control airborne contaminants (such as biological agents, gases, fumes, dust), the ventilation system provides appropriate pressure relationships, air exchange rates, filtration efficiencies, temperature, and humidity. For new and existing health care facilities, or altered, renovated, or modernized portions of existing systems or individual components (constructed or plans approved on or after July 5, 2016), heating, cooling, and ventilation are in accordance with NFPA 99-2012, which includes 2008 ASHRAE 170, or state design requirements if more stringent.
• EC.02.06.01, EP 1: Interior spaces meet the needs of the patient population and are safe and suitable to the care, treatment, and services provided.

Laboratory and Point-of-Care Testing

• QSA.02.08.01, EP 2: The laboratory performs correlations at least once every six months. The correlations are documented.
• Individual unacceptable proficiency testing results.
• Late submission of proficiency testing results (score is zero).
• Nonparticipation in the proficiency testing event (score is zero).
• Lack of consensus among all laboratories participating in the proficiency testing event (score is ungradable). These actions are documented.
• QSA.02.11.01, EP 7: The laboratory performs review of other records (for example, work records, equipment records, quality control summaries) at a frequency defined by the laboratory, but at least monthly. The review is documented.
• EC.02.04.03, EP 7: The laboratory performs preventive maintenance, periodic inspection, and performance testing of each instrument of piece of equipment. These activities are documented.
• Direct observations of routine patient test performance, including patient preparation, if applicable, and specimen collection, handling, processing, and testing.
• Monitoring, recording, and reporting of test results.
• Review of intermediate test results or worksheets, quality control, proficiency testing, and preventive maintenance performance.
• Direct observation of performance of instrument maintenance function checks and calibration.
• Test performance as defined by laboratory policy (for example, testing previously analyzed specimens, internal blind testing samples, external proficiency, or testing samples).
• Problem-solving skills as appropriate to the job.

Nursing Care Center

• EC.02.02.01, EP 5: The organization minimizes risks associated with selecting, handling, storing, transporting, using, and disposing of hazardous chemicals.
• IC.02.02.01, EP 4: The organization implements infection prevention and control activities when doing the following: Storing medical equipment, devices, and supplies.
• Documents current licensure and any disciplinary actions against the license available through the primary source.
• Verifies the identity of the individual by viewing a valid state or federal government-issued picture identification (for example, a driver’s license or passport).
• Obtains and documents information from the National Practitioner Data Bank (NPDB). The medical director evaluates this information.
• Determines and documents that the practitioner is currently privileged at a Joint Commission-accredited organization; this determination is verified through the accredited organization. If the organization cannot verify that the practitioner is currently privileged at a Joint Commission-accredited organization, the medical director oversees the monitoring of the practitioner’s performance and reviews the results of the monitoring. This monitoring continues until it is determined that the practitioner is able to provide the care, treatment, and services that they are being permitted to provide.
• Performance of a test on a blind specimen.
• Periodic observation of routine work by the supervisor or qualified designee.
• Monitoring of each user’s quality control performance.
• Use of a written test specific to the test assessed.
• PC.02.02.03, EP 11: The organization stores food and nutrition products, including those brought in by patients and residents or their families, under proper conditions of sanitation, temperature, light, moisture, ventilation, and security.

Office-Based Surgery

• IC.02.02.01, EP 2: The practice implements infection prevention and control activities when doing the following: Performing intermediate and high-level disinfection and sterilization of medical equipment, devices, and supplies.
• IC.02.01.01, EP 2: The practice uses standard precautions, including the use of personal protective equipment, to reduce the risk of infection.
• EC.02.04.03, EP 4: The practice conducts performance testing of and maintains all sterilizers. These activities are documented.
• HR.01.06.01, EP 5: Staff competence is initially assessed and documented as part of orientation.

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Nicholas Kristof

The Case for Saying ‘I Do’

By Nicholas Kristof

Opinion Columnist

With little notice, the United States may be crossing a historic milestone in family structure, one that may shape our health, wealth and happiness.

Historically, most American adults were married — more than two-thirds as recently as 1970. But the married share has crept downward , and today only about half of adults are married. Depending on the data source, we may already have entered an epoch in which a majority are not married.

“Our civilization is in the midst of an epochal shift, a shift away from marriage,” Brad Wilcox, a sociologist who directs the National Marriage Project at the University of Virginia, writes in his new book, “ Get Married .” “In place of marriage, many Americans are remaining single or simply living together without wedding rings. And to be clear, it’s more of the former than the latter.”

Wilcox believes that perhaps a third of today’s young Americans will never marry. As a long-married romantic myself, I find that troubling, but it’s not just soggy sentimentality. Survey data indicates that married couples on average report more happiness, build more wealth, live longer and raise more successful children than single parents or cohabiting couples, though there are plenty of exceptions.

“Fixing what ails America starts with renewing marriage and family life, especially in poor and working-class communities where the fabric of family life is weakest,” Wilcox argues.

He’s up against a counter view that one should dodge family responsibilities, relish freedom and play hard. Many boys and men flock to the online rantings of Andrew Tate , the misogynistic influencer facing human trafficking charges, who has argued, “There is zero advantage to marriage in the Western world for a man.”

Some women have likewise celebrated freeing themselves from an institution that often shackled them to cooking, laundry and second-class status at a cost to their careers. As women have enjoyed more economic opportunities, they’re less often forced to marry some oaf who gets violent after a few drinks — and, anyway, what self-respecting woman with independent means would want to marry, say, a fan of Andrew Tate?

Yet even as marriage has receded, the evidence has grown that while it isn’t for everyone, in many cases it can improve our lives more than we may appreciate.

“Marriage predicts happiness better than education, work and money,” Wilcox writes. For example, survey data indicates that getting a college degree increases the odds of describing oneself as “very happy” by 64 percent. Earning a solid income lifts the odds by 88 percent. Being “very satisfied” with one’s job raises them by 145 percent. And marriage increases the odds of being very happy by 151 percent — while a “very happy” marriage boosts the odds by 545 percent.

I’ve long been interested in family structure for two reasons. First, I believe the left made a historic mistake by demonizing the Moynihan Report, which 59 years ago this month warned about the consequences of family breakdown. Daniel Patrick Moynihan was prescient, for we now know that households headed by single mothers are five times as likely to live in poverty as those with married couples.

Second, loneliness and social isolation are growing problems. One poignant example: Perhaps 100,000 or more dead bodies in America go unclaimed each year, often because there are no loved ones to say farewell. It’s a topic explored in another recent book, “The Unclaimed,” by sociologists Pamela Prickett and Stefan Timmermans.

Marriage doesn’t solve loneliness and social isolation, but it helps. And there is good news on the family front: The divorce rate has dropped to a 50-year low , and the share of children raised in an intact family with married parents has increased slightly in recent years. Today about 51 percent of American kids reach adulthood with the same two parents they started out with.

But it’s also true that the marriage rate has collapsed, particularly for working-class Americans. Of those without a high school diploma, more than two-thirds are unmarried.

Wilcox writes that “the American heart is closing,” but I wouldn’t put it that way. I think many Americans want to marry but don’t feel sufficiently financially stable, or they can’t find the right person.

I’m staggered by the interest in virtual boyfriends and virtual girlfriends. One virtual boyfriend app offers an assortment of possibilities such as “polite and intelligent Edward” or “romantic and cute Daniel.”

“Don’t be shy, he’ll definitely like you,” the app advises. “He knows how to cheer you up, so you won’t feel sad or lonely.”

Just reading that makes me achingly sad. Virtual mates feel like an elegy for civilization.

One reason for the decline in marriage in working-class communities may be a lack of economic opportunity, particularly for men, and another may be culture and changing norms. That’s worth pondering. In polls, majorities of college-educated liberals seem diffident about marriage, unwilling to criticize infidelity and disagreeing with the idea that children do better with two married parents. Perhaps this liberal lack of enthusiasm for marriage also accounts for the marriage penalties built into benefit programs like Medicaid, in turn disincentivizing marriage for low-income Americans.

Wilcox scolds elites for clinging to traditional values themselves — in the sense that they get married and have kids for the most part — even as they are reluctant to endorse marriage for fear of seeming judgmental or intolerant. Elites “talk left but walk right,” he says.

We are social animals, Aristotle noted more than two millenniums ago, and it’s still true. Spouses can be exasperating (as my wife can attest), but they also can cuddle, fill us with love and connect us to a purpose beyond ourselves. They are infinitely better, for us and for society, than virtual lovers on an app, and that seems worth celebrating openly.

Update: I have the final figures for my 2023 holiday giving guide , so I owe readers a follow-up and a “thank you.” More than 5,400 readers contributed a total of $7.2 million to the three nonprofits I recommended , and here’s what the donations will mean in practical terms: 12,150 girls in rural Africa will be supported for a year of high school through Camfed ; 1,645 young people in the United States will be supported for a year of instruction and mentoring to succeed in college or technical school through OneGoal ; and 4,218 low-income Americans will get free training in information technology through Per Scholas so that they can start better-paying careers in the tech world. All three organizations do excellent work. In addition, 671 readers volunteered to help refugees settle in the United States through my recommended volunteer opportunity, Welcome.US . Thanks so much to all who donated and volunteered: People are benefiting here and abroad from your generosity.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow the New York Times Opinion section on Facebook , Instagram , TikTok , WhatsApp , X and Threads .

Nicholas Kristof became a columnist for The Times Opinion desk in 2001. He has won two Pulitzer Prizes, for his coverage of China and of the genocide in Darfur. @ NickKristof

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Essay: Application Of Multimedia In Education

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Application Of Multimedia In Education

This paper present how we can applied multimedia elements in a way which it can be used for educational purpose. The traditional approach of learning system that had been used for the last generation had proved to be helpful. However, with the help of multimedia, it can help enhancing our educational system and make learning to be more interesting and fun. The problem with the traditional approach of learning is that it is lack in creativity and often hard to understand. This tend to make learning a bit difficult and boring. Traditional learning also lack in resource. This will make learning harder as students tend to be confuse and unable to understand the topic that they learn. With the help of multimedia which provide a lot of resource, learning could be fun and exciting experience. It will also help students to fully grasp an understanding of the subject that they learn. With the help of multimedia element, the educational system could evolved into that is much better that the traditional system.

Keywords: multimedia, education , traditional

I. INTRODUCTION

Multimedia is defined as any combination of text, graphic, sound, video and animation. Multimedia can be delivered to user via electronic or digital manipulated means. In order to create a good multimedia project, you need to be creative, technical, organizational and business skills. When the user is allowed to control what and when these elements are delivered, it become an interactive multimedia. Interactive multimedia can be called hypermedia. This happened when a user is provided with a structure of linked elements for the use of navigation.

With the advancement of technology in this world, we can see that the world that we live in is changing rapidly and the field of education are one of the field that are growing to be much better. The old day education where the learning environment are passive is long gone. We can see that the use of multimedia in education has grown a lot in this recent year and is looking to expend ever further in the future.

Teacher primarily required resources in order to help students to understand better about the topic that they are learning. By enabling teacher to have access in multimedia learning resource, which help to support constructive concept development, allowing the teacher to be more focus to teaching the subject while working to help the students to understand the topic individually. The development of multimedia also help to ease learning by enabling students not to just learn in just school but also at home. This will potentially help students to improve their learning skills. With the help of multimedia elements, which is text, graphic, video, sound and animation, it can create an interactive learning environment that can help teacher and students teaching and learning.

II. THE TRADITIONAL APPROACH IN LEARNING

The traditional education also know as conventional education is a long-established customs found in school that society has traditionally deemed appropriate. This type f education is more to teacher-centered that focused on rote learning and memorization. In the traditional learning, students are a passive absorbers of information and authority. They are less active in class and lack in problem solving skills. Furthermore, the traditional ways of learning are much more linear with factual accumulation and skill mastery while the new approach with the help of multimedia are non-linear, with one idea linked to another, allowing the learner to choose the path that they want to learn.

The traditional approach of learning also lack in resource. Knowledge can only be absorbed through lecture and textbook. By using multimedia, they will be much more resource that can be attain especially through the use of the internet. The traditional approach of learning is also less creative. The students are more passive as they lack in material resource needed in order to express their creativity. Such loop hole can make children to be less passionate and unmotivated to learn. This is why multimedia use in education is vital in education.

III. THE MULTIMEDIA APPROACH IN LEARNING

Multimedia is vital in our life. This is because it is pack with various elements such as text, graphic, sound, video and animation. All of this element can be seen in our surrounding. It is also used in various fields such as in education, training, business, games and science and technology. This is a proof that multimedia is important. In fact, multimedia is changing the ways of learning itself. Instead of just limiting you with a linear presentation such as reading text from a book, multimedia makes many improvement in learning by bringing various elements in order to make it more dynamic.

"Multimedia is a synthesis: a hybrid offering the advantages of the user-driven book with the wonders of electronic technology" -Robert Winter; UCLA Roundtable in Multimedia

Education courses, skills and knowledge are often taught in a context. To overcome this, the use of multimedia as education aids help to provide a real world example using a computer with high quality content. The various type of software available on the market can also help to provide a friendly interactive method of learning. Multimedia and tool such as the internet can provide teacher an instant excess to millions of resource available. These material can help the teacher to provide the students with cooperative learning, critical thinking, discussion, and problem solving. So, multimedia approach in education provide many advantage over the traditional method.

IV. MULTIMEDIA ELEMENTS IN EDUCATION

Multimedia elements can be use for many thing. With the help of a computer software such as Adobe Photoshop, Adobe Illustrator and Adobe Flash you can create and combine various multimedia elements to create a great project. But, you must know each and every function of those multimedia elements so that you can applied it in your learning.

Text are the most basic element in multimedia and it is very easy to use. But, you must not underestimate it because text can give the most impact on the quality of the multimedia interaction compared to the other elements. This is because text contain a lot of font. A font is a collection of characters of a single size and style belonging to a particular typeface family as shown in Figure 1.In general, text are used in order to provide important information. This is because text are more direct and easy to understand rather than the other multimedia elements. In learning, text are the most commonly used element. But, by using multimedia text, the word can be much more interesting rather that plain text thus increasing the learning effectiveness.

Figure 1. Different type of font.

Graphic are two-dimensional figure or illustration. It is the most creative ways of learning approach. It can be either a photograph, drawing or picture. There are many types of picture format such as GIF, JPEG and PNG. Using graphic in education will increase the students understanding. It will also enhance their memory skill because picture are easy to remember. This is because image use a massive amount of cortical skills such as color, form, line, dimension and imagination. This will help the students to get a clear picture of what they are learning. Figure 2 shows the use of graphic in education.

Figure 2. The use of graphic for storytelling in education.

Audio has been use in education for many decade. Because everything that we learn can be recorded, it is an effective tool for the students because they use it to interact with the course content provided by their teacher at any times and any location that they want. Audio also ease the students by conducting live online discussion via audio tools and platform. There are a few widely use software that can be use for this such as Wechat, Whatapps, Line and Skype. This will not only save some time rather than meeting face-to-face it also frequently used for long distance learning. Sound can also be use by teacher to present a lot of information at once. This will help teacher to explain the content of the topic in a much interesting ways which will help the students to understand the topic. Learning by using audio also can help disable people such as blind people to learn as shown in Figure 3. This is one of the few ways for them to learn because they cannot see and read. This shows that the use of sound in education can benefit a lot of people if used in the correct way.

Figure 3. Shows An app for the Android tablet helps blind students learn math through touch and sound.

Video is widely used multimedia element. It also has the highest performance on your computer or device among the five elements. There are a few standard video format for educational use such as MPEG2 that is used for Digital Versatile Disc (DVD) playback or MPEG4 for home video. Sometimes, using text or other multimedia elements to convey information are hard and complex This type of multimedia element are used because it can provide visual stimulation for students so that they can have a better understanding in learning. This prove to be helpful in surgical training where students cannot just understand the producer for surgery just by reading. So, a video of a surgery in action is needed so that the students can understand. Teacher can also ask their students to make a video project. This is because it can help them getting in touch with the real element of what they are learning and show it to their other classmate. It also can help to enhance their practical skill. This is because, by doing a video they are expose to the outside element rather than just sitting in the classroom. So, they can gain more experience and improve their skills. This shows that video can help to improve our educational system. Figure 4 shows the use of video in classroom.

Figure 4. Shows the application of video in classroom

E. Animation

Animation are created using continuous motion and shape change combined together to produce an animation. This happened because of a biological phenomenon called persistent of vision and psychological phenomenon called phi. This enable us to see animation the way it is. Animation are different than video. This is because video is taken from real life event while animation are usually taken from drawing. There are a few animation software that are used in educational field such as Adobe Flash, Authoware and Director. By using this software, students can use their own creativity and idea to present a project that they like. this help to improve their creativity while bringing fun in learning. Animation also can help students to learn faster and easier. This is because they can help teacher to explain a difficult topic. For example, the flow of blood throughout the body cannot be seen. The flow of blood in and out of the heart are difficult for students to understand in the beginning. By providing a structural animation of our blood circulatory system and the heart, students can see clearly how it work. This can help provide a better understanding about the topic to students. With the help of computer animation, learning and teaching can be much more easier faster and amusing.

V. ADVANTAGE OF MULTIMEDIA APPROACH IN EDUCATION

There are many advantages in applying multimedia elements in education. One of it is that multimedia enable students to represent information using several different media. This prove to be helpful when students need to do their project. By using multimedia elements, they can present their project in a much more creative ways. Moreover, multimedia approach also provide flexibility of where and when can they learn. This is because by using multimedia approach such as audio and video, student can record or make connection with one another for discussion or listening to the previous topic that they have recorded. Multimedia approach also helps the students to develop a higher order thinking skills. By using the multimedia elements, students use their own idea and creativity to combine the elements of multimedia to produce something fresh and new. Furthermore, multimedia approach are also much more engaging compare to the traditional one. With multimedia, interactive learning can be done with live-action video, feedback, questions and answers to keep the students interested and help enhancing their skills. Next, with multimedia simulation technique can be effectively applied. By using simulation, student can grasp a better understanding about the step and producer to make or do a certain project. This can improve their understanding and also help improving their skills.

VI. CONCLUSION

In conclusion, multimedia possessed a lot of advantages to make learning interesting. With the help of its elements, it can invoke creativity in both teacher and students so that they can apply it in order to teach or learn. Learning also become much more easier with the help of multimedia. multimedia can help improve our educational system. This is a must because we need to keep up our pace with the evolvement of our technology.

Tay Vaughan(2010), Multimedia: Making It Work Eight Edition, Appleton , McGraw-Hill.

JICS Digital Media(2014), Using audio in teaching and learning,Retrived from http://www.jiscdigitalmedia.ac.uk/guide/using-audio-in-teaching-and-learning

Masozi Nyirenda(2013), Using multimedia approach in multimedia, Retrieved from http://www.ippmedia.com/frontend/?l=57601

Abhaya Asthana, Multimedia in Education-Introduction, The Elements of, Educational Requirement. Classroom Architecture and Resource, Concerns, Retrieved from http://encyclopedia.jrank.org/articles/pages/6821/Multimedia-in-Education.html

Satheesh Kalanilayam(2009), Multimedia Approach to Teaching Learning Process, Retrieve from http://sathitech.blogspot.com/2009/03/multimedia-approach-toteaching-learning.html

Steven Hick Ph.D(1997), BENEFITS OF INTERACTIVE MULTIMEDIA COURSEWARE, TRICAN MULTIMEDIA SOLUTION INC. Retrieved from http://http-server.carleton.ca/~shick/mypage/benifit.html

John Blackwell(1997), SEED : Multimedia Applicationsin Education, Retrieved from http://web.viu.ca/seeds/mm/#Introduction

Wingra School(2012), Different Between Traditional and Progressive Education, Retrieved from http://www.wingraschool.org/who/progressive.htm

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I reviewed my Yale admissions file to see what the Ivy League school really thought about my application. What I learned surprised me.

• I reviewed my Yale admissions file to see what the Ivy League school thought about my application. 
• Most of my scores weren't that impressive, but they really liked my genuine attitude and excitement.
• Reviewing my application reminded me how far I have come as a student. 

"Brian spoke so fast it was electrifying."

This was the first quote from my Yale interviewer. She wrote those words in my admissions file, a document I finally got my hands on three years after being accepted into Yale University .

I remember that interview like it was yesterday. It was a Zoom call — my application cycle happened at the crux of pandemic remote learning — and I was wearing my father's old, oversize dress shirt. The interviewer was lovely. Some of my answers to her questions probably didn't make sense, and she was right. I definitely forgot to breathe in between my sentences.

But viewing my admissions file years later gave me a peek into what my interviewer was actually thinking that day, and I learned what really got me into Yale.

I reviewed my application as a junior with the registrar

Every student in the US can review their college admissions file under the Family Educational Rights and Privacy Act. I emailed my university registrar, and within 45 days, a member of their support staff reached back out to schedule a virtual meeting. Picture-taking and recording were not allowed, so I jotted notes by hand.

There was very little verbal interaction between me and the staff member. She screen-shared my admissions file and let me read in silence. Something told me she understood the emotional weight of this moment for students, and I appreciated that. It is intimidating for any teenager to package their identity into a 650-word common application essay and a questionnaire — but it is arguably even more so to witness retrospectively how everything was judged.

I got a behind-the-scenes look into Yale admissions when they read my application

Each aspect of my application was rated out of nine points. My readers gave me a six for my extracurriculars and for my first teacher recommendation. They gave me a seven for my second teacher recommendation and my counselor's recommendation. I received an "outstanding" for my interview and a 2++ for my overall rating. The overall rating is given on a scale from 1 to 4, with 1 being the highest, and pluses were a good sign.

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In all, my ratings weren't exactly bad, but they weren't extraordinary either. The numbers on the pages stared back at me — cold, formulaic, and transactional. It felt strange to be reduced to a system of numbers, knowing that something as qualitative as extracurricular activities could still be broken down and scored.

Beyond the ratings, however, what truly stood out were the comments left by the admissions officers . Many of the comments were on my character, my essays, and the possible contributions I would make as a student.

"I teared up reading Essay 1," one reader wrote of my common application essay. Another said of the same essay: "His Chinese New Years are untraditional in that they remind him of his family's financial struggles."

I got emotional. All the memories of writing that essay came flooding back. I remembered how difficult it was to start it. I knew there was no easy way for someone to understand me without first knowing my background. I wanted to prove that I deserved a seat at the table where legacy students and the wealthy continue to outnumber their first-generation, low-income peers like myself.

I kept reading and found more comments from admissions officers that moved me: "He treats his mom well;" "He seems to have a truly good heart;" "One of the most intelligent, sincere, jovial students ever met;" "I have no doubt that Brian would push his peers at Yale to stand up for what's right;" and "I come away with compelling impressions that the student would contribute significantly to the undergrad community."

I searched for a negative comment. There were none.

I didn't deserve this, I muttered under my breath. Here I was, a junior in college, no longer a 4.0 student , my post-grad plans murky, balancing two part-time jobs and hoping to make it out of midterms alive. It felt good knowing that someone had rooted for me to be here.

The process reminded me how far I have come

Coming from an underserved household where no one had gone to college, I had always looked at the Ivy League application process skeptically.

Without the resources to enroll in SAT test prep and the financial safety net to pursue unpaid leadership positions and resume-boosting activities at school, I had doubted the "holistic" admissions process many colleges boast. My critiques about Yale remain numerous.

But at least in their comments, the admissions committee gave me grace in that they reviewed my application in light of my circumstances. I might never know exactly what happened in that reading room. Still, a couple of lessons ring true, based on my own viewing experience and my conversations with others who had done the same: Good character and potential are the key; I didn't need to be perfect.

And finally, I — not anyone else — needed to give me the fighting chance of applying in the first place.

"GPA is outstanding, especially in context," an admissions officer said. "This is a home run."

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