1.1

Introduction

Medical education is constantly evolving. This field had been traditionally based on exchanges and interactions in classrooms or amphitheaters with a group of students facing one teacher. Internet and specifically Web 2.0 sociable technologies and social software helped create a new type of e-learning and training environment, which is quite challenging for the most traditional types of curricula. Some even call it education or training 2.0 . Online training or e-learning, by using Web 2.0 becomes a “technical distance learning” media tool. This “technical distance learning” nature “highlights the practices of e-learning based on educational designs and media usage not widely implemented today on campus universities” .

Thanks to Internet, nowadays students can quickly access various types of information (text, audio, video files), and are thus capable of self-training and at a distance thus limiting the constraints of attending classes. According to Karsenti, “several studies have demonstrated that students learn more and in a shorter period of time with information and communication technologies (ICT) and e-learning than face-to-face in a classroom” . The authors also unveiled other advantages for distance learning such as flexibility, possibilities for each student to study at his or her own pace, increased communication and networking options as well as different types of teaching and training methods, thus increasing students’ motivation. Furthermore, according to Dubois “Integrating educational information and communication technologies (EICT) into medical education curricula is being discussed today in our universities” . However, if the benefits of integrating ICT in the educational field have been largely studied and used in other areas , validating that this learning mode is appreciated by students , it had remained quite confidential in medical studies until the last few years .

Furthermore, regarding the National Ranking Examination (NRE) that ends the second-cycle of medical studies in France, some online learning tools have been developed these past years since now, on top of paper references used by several generations of medical students, we can add a wide array of web-based documents (e.g. specialized websites, online conference, social networks or medical students social forums).

We can in fact differentiate:

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  private websites often funded by pharmaceutical labs such as Aventis-Internat (Aventis Residency available at aventis-internat.org ), the Hippocrates conference promoted by Servier Laboratories ( laconferencehippocrate.com ). They offer educational learning tools, (notes, written up medical questions); online self-evaluations (corrected documents, medical archives, medical imaging quizzes) and social forums open to medical students;

  
  
• •
  

  these past years real online conferences have also emerged with an online live examination once a week, such as:

  
  
  
  
  • ∘
    

    Conf@Net available at Confnet.org ,

    
    
  • ∘
    

    Conference+++ ( Conf-plus.com ). Each conference is available on the web at 7 pm at the same time when the live conference is being held at the Necker Hospital for Sick Children in Paris;

  
  
  
  
• •
  

  there are also some websites managed by medical students such as the French National Association of Medical Students (ANEMF on e-carabin.net ), or another site grouping medical students, i.e. remede.org , these websites offer useful recommendations and advice to students, social forum and links to course notes or corrected documents;

  
  
• •
  

  some sites with educational contents specifically targeted for students, often have a dedicated area for medical studies with reference to the NRE, such as:

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  the UNF3S (Online French-Speaking University of Health and Sport Sciences) hosting the online French-speaking medical university ( www.umvf.org ),

  
  
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  The website from the Nice University in France, Intern@TICE ( internatice.unice.fr ) offering students and teachers relevant web links for preparing for the NRE.

There is no privileged website used by all medical students to study for the NRE. Instead of being reassuring, these profuse sources of information tend to increase their anxiety and feeling of helplessness faced with the amount of knowledge to be acquired. This is why the quality of the working document is essential, and if the accuracy of the data remains the core issue, all students have their own specific method for acquiring specific medical data that guides their preferences. Thus, in light of the increasing evolution of information communication technologies it seemed quite important to learn about the opinions and expectancies of end-users on the content and design of a medical website in order to render it the most adapted to their needs. In fact, without being completely obsolete, the initial various technical or Internet connection problems have gradually been replaced by questions related to how to properly use this e-learning, for which there are no specific recommendations yet (e.g. slides, videos). . Furthermore, students’ expectations regarding these web contents are still not completely known and could differ from the message that web designers tried to deliver .

Medical students being “addicted” to these types of web resources, we based our work on their feedback while being inspired by an original evaluation methodology for medical education websites, already used in studies regarding e-learning expectations of patients with low-back pain .

Getting ready for the NRE remains a complex, difficult and long-term task filled with anxiety that can sometimes be quite overpowering. The NRE curriculum consists in 345 questions directly related to the objectives lined-up for the second part of their second cycle, organized around 11 transdisciplinary modules, 70 questions on “diseases and great syndromes”, and 53 questions based on clinical situations, i.e. “diagnostic orientation when faced with such and such symptoms”. Physical Medicine and Rehabilitation (PM&R) is the medical specialty from module 4, entitled “Disability, impairments, dependence” and includes five items:

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  n ^o . 49 “Clinical and functional evaluation of motor, cognitive or sensory disabilities”;

  
  
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  n ^o . 50 “Complications related to immobility and long bedridden periods”;

  
  
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  n ^o . 51 “Disabled children: orientation and care management”;

  
  
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  n ^o . 52 “Mental retardation. Legal rights, protection and assistance from a legal guardian”;

  
  
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  n ^o . 53 “Main physical medicine and rehabilitation techniques”.

Rehabilitation aspects are also covered in several other items, mainly the ones regarding debilitating chronic pathologies, especially cardiovascular disorders and cerebrovascular disease (Item n ^o . 129: “Cardiovascular risk factors and prevention”; Item n ^o . 131: “peripheral obliterating arterial disease of the aorta and the lower limbs; aneurisms”; Item n ^o . 132 “Chest pain and myocardial infarction”; Item n ^o . 133 “Cerebrovascular disease: Stroke”; Item n ^o . 250 “Cardiac insufficiency in adults”). Regarding those last two items, our department was involved in the design of a medical education website dedicated to students preparing for their Diploma of Specialized Studies (DES) in physical medicine and rehabilitation (PM&R) and Diploma of Inter-University Functional Rehabilitation (on a national level).

The aim of this study was to collect the opinions and critics of second-cycle medical students in Dijon, France on this website dedicated to cardiovascular rehabilitation, as well as asking for their suggestions for adapting the website to their expectations and meeting the national objectives of second-cycle medical studies. All this in order to evaluate the changes to be made for a further version of the website and evaluate the need or not to propose a version more-specifically designed to the expectancies of second-cycle medical students.

1.2

Material and methods

1.3

Results

1.3.3

Results of pre- and pos-test

The mean note at pretest was 5 ± 1.5 points out of 8 (Ranges: 2–7 points), improving significantly at 6.8 ± 0.8 (Ranges: 6 and 8 points) for the posttest ( p < 0.05) ( Fig. 1 ).

Mean and standard deviation of pre- and posttest scores.

1.4

Discussion

The main results of this study show that the overall quality of this website, initially designed for third-cycle medical students, was globally well noted by second-cycle medical students (65.6 ± 7.7 pts out of 100), essentially due to the quality of purely medical information. For the actual version, its relevance lays mainly in helping understanding and reviewing the medical items covered, yet for students it doesn’t seem to be a properly adapted tool to prepare for the NRE. Comments from students allowed for unveiling some points to be improved and others to be developed in order to produce a new version better suited to their expectancies. Finally, the immediate impact of this type of multimedia support tool on improving students’ knowledge seems nevertheless quite relevant and interesting.

The quality of medical information is very well noted by students, which is quite reassuring since it is of course the prime objective for this type of educational learning tool. Nevertheless, the concept does not always seems to fully meet students’ expectations, especially regarding the module on generalities of cardiovascular rehabilitation relevance, based on too many epidemiological studies “There are too many studies quoted, with globally positive results but on elements that are often quite different, not helping to clarify the general relevance, even if the duration of the presentations was quite good” (DC3 student).

The quality of extramedical information is not judged as relevant (61.1 ± 20 pts) with however some very divided opinions, as illustrated by the large standard deviation. The lower score is possibly related to the fact that these notions were covered in a very rigid format, contrarily to aspects covering strength retraining with practical photos and videos. The notion regarding the relevance of global care management seems however quite well perceived: “it interesting to see that cardiac rehabilitation is not just about riding a bike” (DC2 student). This certainly represents an added value in the framework of preparing for the NRE, were points “collected” from transversal documents are more easily obtained by having a global vision of the patient.

Website design and concept were also differently appreciated by students with a mean score of 64.4 ± 14.9 pts. Some aspects are more technical than educational: for example one of the speakers was evaluated as “having a monotonous tone not forcing attention” (DC4 student). The global presentation, associating the video of the presenter and one slide summing up the main elements covered, does however seem to allow for a good comprehension of the relevant item (mean score for helping to understand the information 75 ± 8.7) but probably poorly adapted for a “last round” of studying for the NRE (meeting with NRE program’s curriculum was evaluated as poor, 41.2 ± 29 pts). This element is particularly underlined by DC4 students who are in the midst of preparing for the exam: “there are some missing slides for a summary of the main elements”; “it would be good to have a summary at the end of each covered theme” .

Finally, in spite of these noted imperfections, this educational learning tool did allow for a significant knowledge improvement based on the results from the pre- and posttests.

Nevertheless, this work presents several limitations.

The main bias is related to the low number of students recruited during their residency training within the department, who might have artificially over-noted some items to be “please” their teacher or in “fear” of not getting their residency training validated. The low number of students could not let us evaluate the possible specificities depending on their year of study. Furthermore, the website version evaluated was targeted at DES students when second-cycle students are essentially motivated by preparing for the NRE. Nevertheless, our objective was above all to learn about their opinions and proposals and this work brings up new pathways for discussion.

Furthermore, the impact on students’ knowledge was only evaluated on the short term only partially meeting the educational objective of any type of teaching.

Learning tools vary quite greatly from one student to the next but the reasons for these individual preferences have not been assessed in this study. Some previous studies, especially in Quebec, promote however the development of these multimedia educational tools : “the e-learning experience with courses available online conducted at the University of Quebec at Hull, brought us to the conclusion that virtual online courses had a very positive impact on students’ motivation, but there still is a huge gap between university classroom and the virtual classroom”.

Finally, one last limitation is in regards to the artificial nature of this evaluation. In fact, the students did not have to do a search using keyword to access the website. This method is nevertheless in accordance with the main objective of this study, i.e. evaluate students’ expectancies and not their research strategies, which requires a more complex methodology . It could still be relevant to make this website “stand out” from others by clearly having it referenced as following a quality chart, already clearly established for medical websites, such as labels or rules and regulations , for example “Health On the Net Foundation » (HON) ¹

1 Health On the Net Foundation. http://www.hon.ch/ .

1.5

Conclusion

Second-cycle students did appreciate this website mostly for the quality of its medical contents and how it helped their comprehension on various items from pathophysiology to clinical data. This site seems quite effective for short-term knowledge improvement. However, this type of format does only partially meet students’ expectations in the framework of preparing for the NRE. Possibilities for personalizing the website and including some quick overview module for a “cramming” type of studying for the NRE seem to be good options. These elements could be the basis for improving the future version. An important progress could be a bigger interactivity as well as the possibility to make changes to the website by inserting, for example, a tab dedicated to the most recent references of the literature to lighten the slides, or a summary for NRE last-minute studying on each of the topics. Advances in Web 2.0 should also allow students to adjust the courses to their own needs. This would then make the website more adapted to various types of end-users who would be most likely to visit it. The total duration of such an educational tool, with an “à la carte” program should be between 60 and 90 minutes. Now that telemedicine is a reality, it seems highly relevant for Teachers’ colleges and Scientific Societies to be involved in order to put online valuable quality educational teaching modules. However, we should keep in mind that if these supports seem interesting, the place of an “attractive” teacher must remain quite central, in order to give people the same opportunities for accessing medical studies and not worsening social inequalities.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

2.1

Introduction

L’enseignement est un univers en permanente mutation. Il était traditionnellement organisé sur les bases d’échanges ou d’interactions dans une salle ou un amphithéâtre regroupant étudiants et un enseignant. L’Internet, en particulier le Web 2.0 et les médias sociaux facilitent la mise en place d’un nouveau type d’enseignement et d’apprentissage, représentant un challenge pour les formes plus conventionnelles de pédagogie. Certains l’appellent même l’enseignement ou l’apprentissage 2.0 . La formation en ligne, se servant de cet outil, est une construction dite « technopédagogique ». Ce caractère technopédagogique, « met en évidence des pratiques de la formation à distance fondées sur une méthodologie de design pédagogique et sur un usage des médias peu mis en œuvre, jusqu’à aujourd’hui, pour les universités campus » .

Grâce à Internet les étudiants ont aujourd’hui la possibilité d’accéder rapidement aux sources d’informations, accessibles sous diverses formes (texte, audio, vidéo), et pourraient ainsi s’autoformer et limiter ainsi les contraintes de formations présentielles. D’après Karsenti, « de nombreuses études montrent qu’un étudiant peut apprendre plus, et plus vite, avec les technologies d’information et de communication (TIC) et les cours en ligne qu’en face à face dans une salle de classe » . Il pointe également d’autres avantages de la formation à distance comme la flexibilité, la possibilité pour chacun d’adopter un rythme qui lui est propre, les possibilités de communication et d’interactions accrues, et la variété des modes d’enseignement et d’apprentissage, augmentant la motivation des étudiants. Par ailleurs, selon Dubois « L’intégration des technologies de l’information et de la communication pour l’enseignement (TICE) dans la formation médicale est un thème d’actualité dans la majorité de nos facultés » . Cependant, si les bénéfices d’intégrer les TIC dans l’enseignement ont été largement étudiés et utilisés dans d’autres domaines , et que cette modalités est appréciée des étudiants , leur utilisation est resté limité jusqu’à ces dernières années dans les études médicales .

Dans le domaine en particulier de la préparation de l’Examen Classant National (ECN), qui clôture le second cycle des études médicales, des outils d’aide en ligne se sont largement développés ces dernières années puisque, aux collections de références papier utilisées par plusieurs générations d’étudiants, s’ajoutent désormais toute une panoplie de documents disponible sur Internet (sites spécialisés, conférences en ligne, blogs ou forum carabins, etc.).

On peut ainsi distinguer :

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  les sites dépendants d’organismes privés, souvent financés par des laboratoires pharmaceutiques comme par exemple Aventis-Internat ( aventis-internat.org ), la conférence Hippocrate soutenue par les Laboratoires Servier ( laconferencehippocrate.com ). Ils proposent des outils de travail (fiches, questions rédigées), des évaluations en ligne (dossiers corrigés, annales, quiz iconographiques) et des forums ouverts aux étudiants en médecine ;

  
  
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  depuis quelques années de véritables conférences en ligne sont apparues avec examen en direct une fois par semaine, comme par exemple :

  
  
  
  
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    Conf@Net accessible sur Confnet.org ,

    
    
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    Conférence+++ ( Conf-plus.com ) Chaque conférence est accessible par Internet à partir de 19 heures en même temps que la conférence ayant lieu à l’hôpital Necker à Paris ;

  
  
  
  
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  des sites sous la responsabilité d’étudiants en médecine comme l’Association nationale des étudiants en médecine de France (ANEMF) sur e-carabin.net ), un autre regroupement d’étudiants en Médecine sur remede.org , qui proposent des nombreux conseils aux étudiants, des forums et des liens vers des cours en ligne ou des dossiers corrigés ;

  
  
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  des sites de contenu pédagogique destinés spécifiquement aux étudiants, comportant un espace concernant les études médicales avec une partie réservée à l’ECN, tels que :

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  l’université numérique francophone des sciences de la santé et du sport (UNF3S) qui héberge l’université médicale virtuelle francophone ( www.umvf.org ).

  
  
• ∘
  

  le portail de la faculté de nice Intern@TICE ( internatice.unice.fr ) qui propose aux étudiants et aux enseignants une sélection de liens pertinents pour la préparation aux ECN.

Il n’existe pas de source privilégiée par l’ensemble des étudiants pour préparer l’ECN. À défaut de les rassurer, cette abondance de sources d’information aurait plutôt tendance à accroître l’anxiété et le sentiment d’impuissance devant la somme de connaissances à assimiler. La qualité du document de travail est donc capitale, et si l’exactitude des données reste évidemment le prérequis essentiel, les méthodes d’acquisition propres à chaque étudiant vont orienter leurs préférences. Ainsi, au vu de l’évolution galopante des TIC il apparaît important de connaître les avis et les attentes des utilisateurs sur le contenu et la forme du site pédagogique médical le plus adapté. En effet, sans disparaître complètement, les divers problèmes techniques ou reliés à l’accès à Internet ont ainsi graduellement fait place à des questionnements liés aux modalités d’utilisation de ce support, pour lequel il n’existe pas de recommandations spécifiques à l’heure actuelle (diaporamas, vidéos…) . De plus, les attentes des étudiants concernant ces supports sont imparfaitement connues et pourraient différer du message que les concepteurs du site ont pu vouloir délivrer .

Les étudiants du second cycle étant de gros « consommateurs » de ce type de ressources, nous nous sommes tourné vers eux pour ce travail, inspiré d’une méthodologie originale d’évaluation des sites Internet médicaux, déjà utilisée dans des travaux concernant les attentes de patients lombalgiques dans ce domaine .

La préparation de l’ECN demeure en effet pour les étudiants un travail de longue haleine, source d’anxiété parfois importante. Le programme de l’ECN est basé sur 345 questions directement en relation avec les objectifs de la seconde partie du second cycle, qui s’articulent sous la forme de 11 modules transdisciplinaires, 70 questions portant sur « maladies et grands syndromes », et 53 questions type « orientation diagnostic devant… ». La médecine physique et réadaptation (MPR) constitue la discipline médicale de support du module 4, intitulé « Handicap, incapacité, dépendance », et comporte cinq items :

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  n ^o 49 « Évaluation clinique et fonctionnelle d’un handicap moteur, cognitif ou sensoriel » ;

  
  
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  n ^o 50 « Complications de l’immobilité et du décubitus » ;

  
  
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  n ^o 51 « L’enfant handicapé : orientation et prise en charge » ;

  
  
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  n ^o 52 « Le handicap mental. Tutelle, curatelle, sauvegarde justice » ;

  
  
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  n ^o 53 « Principales techniques de rééducation et de réadaptation ».

Les aspects rééducatifs sont également envisagés dans de nombreux autres items, principalement ceux concernant les pathologies chroniques incapacitantes, et en particulier les pathologies cardio- et cérébrovasculaires (Item 129 : « Facteurs de risque cardiovasculaire et prévention » ; item n ^o 131 : « Artériopathie oblitérante de l’aorte et des membres inférieurs ; anévrysmes » ; item n ^o 132 « Angine de poitrine et infarctus myocardique » ; item n ^o 133 « Accidents vasculaires cérébraux » ; « Item n ^o 250 « Insuffisance cardiaque de l’adulte ». Concernant ces derniers items, notre service a participé à la conception d’un site d’enseignement destiné aux étudiants du diplôme d’étude spécialisé (DES) en MPR et du diplôme interuniversitaire de rééducation fonctionnelle (enseignement national).

L’objectif de ce travail était de recueillir le jugement d’étudiants en médecine Dijonnais du deuxième cycle sur ce site Internet concernant la réadaptation cardiovasculaire, et leurs suggestions d’adaptations à leurs attentes et au objectifs du second cycle. Cela dans le but d’évaluer les adaptations à apporter à une version ultérieure de ce site, et de juger de la nécessité ou non de proposer une version répondant plus spécifiquement aux attentes des étudiants du second cycle des études médicales.

2.2

Matériel et méthodes

2.3

Résultats

2.3.2

Évaluation du support d’enseignement

La note moyenne de qualité globale était supérieure à 50/100 points (65,6 ± 7,7 pts) ( Tableau 1 ). La note moyenne concernant les informations médicales était élevée (84,8 ± 8,1 pts), largement supérieure à celles de l’information extra-médicale (61,1 ± 20 pts) et de la conception (64,4 ± 14,9 pts).

Tableau 1

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