E-learning in cardiovascular imaging: another step towards a structured educational approach

The availability of educational resources in cardiovascular imaging varies between European countries, and access to imaging technology also differs. A survey of European cardiovascular imaging by the European Association of Cardiovascular Imaging (EACVI) provides a snapshot of imaging practice in 40 countries of the European Society of Cardiology (http://www.escardio.org/communities/EACVI/imaging-organisations/Documents/eacvi-highlight-book-v5.pdf). Consistency of education is important, but it must also take account of personal and national requirements. The European Commission definition of e-learning is ‘the use of new multimedia technologies and of the Internet to improve the quality of learning by facilitating access to resources and services, as well as remote exchanges and collaboration’. However, the relationship between e-learning and the quality of education is unproved, and an alternative definition is that of LabSET, ‘online learning focuses on the development of skills by the learner and structured by interactions with the tutor and peers’. The term ‘online’ refers to a computer attached to some form of network, either local (intranet) or global (Internet). E-learning can be used in a variety of ways, such as to introduce, extend, or complete face-to-face teaching, and it is not limited to distance learning if delivered synchronously in a virtual classroom or auditorium. It can be delivered by a variety of methods including downloads of audio or video sessions. E-learning allows techniques to be used that fit with different learning styles including the use of complex digital content and innovative methods such as meta-cognition and. Formative assessment also helps to introduce complex skills in cardiovascular imaging, and it can improve the quality of the interaction between trainer and trainee. It is more flexible in time and space, which may be particularly relevant for clinicians who often have a heavy workload, and it improves accessibility and cost. Educational tools and resources should be adapted to the target audience, and they may differ radically depending on whether the aim is for students, specialists, or researchers (Figure 1). E-learning can indeed be adapted and similar content can be presented in a variety of ways, including slides, webinars, cases, courses, and key-reference libraries (http://www.escardio.org/communities/EACVI/education/echo-box/Pages/welcome.aspx). Potential targets for e-learning in education. A common framework for structured e-learning is a fundamental step towards more homogeneous education. All the core syllabi of the EACVI family have been updated in that perspective and published1,2 or are available online (http://www.escardio.org/communities/EACVI/education/Documents/cardiac-ct-core-syllabus-2014-final.pdf). The combination of e-learning and mentoring is particularly helpful, and this increases compliance by maintaining motivation. Other forms of motivation are self-evaluations and ‘fun’ exercises and collaborative work. For example a certification process is already available for cardiac magnetic resonance (CMR) (http://www.escardio.org/communities/EACVI/accreditation/cmr/Pages/certification-processes.aspx), and remote mentoring is being considered when local support is limited. Examples of real cases are important in any clinical specialty, and these are commonly presented in courses or congresses and can be made available to share clinical experience (http://www.escardio.org/communities/EACVI/education/resources-meetings-courses/Pages/welcome.aspx) and extended to include case reports and image libraries (http://www.escardio.org/EACVI-clinical-case). The sharing of resources by social media has already been adopted by the young community (https://www.linkedin.com/groups/Welcome-to-EACVI-NEW-Club-5153456.S.5814745717431894017) and should be extended to the entire imaging community. Cardiovascular imaging can be complex and is ideally presented in modules such as a basic echocardiography course (http://www.escardio.org/communities/EACVI/education/Pages/echocardiography-elearning-course.aspx), advanced courses (transoesophageal echocardiography, stress echocardiography), and similar in nuclear cardiology, cardiac CT and CMR (http://www.escardio.org/communities/EACVI/club-35/education/Pages/tutorials.aspx). It is important to manage the pace of learning and for the process not to be too ‘linear’. Online reference tools such as glossaries, links, and online help are valuable. If e-learning is to be effective, it must encourage completion of the task and this requires high-quality material and a combination of personal and group study supported by an experienced trainer. EACVI e-learning material is peer reviewed and of high standard, such as with simultaneous online and printed paper release of recommendation papers in the European Journal of Cardiovascular Imaging.3–7 E-learning does not replace traditional teaching methods, but it compliments them. It is important that it does not engender self-confidence to the extent that traditional and clinical methods are ignored since even with sophisticated clinical simulators there is no substitute for hands on experience. Access to online facilities is still difficult for some people, and language is also a problem unless resources are made available in languages other than English. E-learning can assist education in cardiovascular imaging and can complement traditional education techniques. It has a number of advantages, and it can supplement interaction with peers and with formal trainers. It is flexible in time and space, it can be widely available, and it is relatively cheap. Resources should be adapted to each intended audience and should be supplemented by techniques for both formative and summative assessment. We plan in future to assess the impact of EACVI educational programmes in clinical practice throughout Europe. Conflict of interest: None declared.