Pediatr Radiol (2014) 44:697699
DOI 10.1007/s00247-014-2913-4
MINISYMPOSIUM
Digital media for distance education
Mogamat Musaed Abrahams
Received: 18 November 2013 / Accepted: 30 January 2014
# Springer-Verlag Berlin Heidelberg 2014
Distance medical education via e-learning media have come
to the forefront with the recognition that academic expertise
and knowledge has to be made accessible to those clinicians
most underserved because of geographical constraints, travel
costs or lack of available expertise and time. Although cen-
tralized face-to-face courses maintain their value, they are
conducted at a high financial cost, for a limited number of
participants. As noted by Carruth and Carruth [1], e-learning
provides one potential route by which to overturn the twin
barriers of lack of time and geographical isolation encountered
by many learners. The challenges that outreach e-learning
address are thus accessibility to quality instruction, asynchro-
nous training (applicable especially to settings with high staff
turnover) and ongoing learning via regular updates.
The revolution in distance education is largely caused by:
(1) the rapid march and ubiquity of technology, i.e. accessi-
bility to computers, Internet connectivity and especially
mobile technology and networks, which serve to lever-
age the reach and impact of academic and training de-
partments, and
(2) the low cost and ease of use of new software and plat-
forms that give lay instructors the tools to create and
distribute quality educational material to target audi-
ences. Many of the presentation tools such as Prezi
(www.prezi.com), ScreenFlow/Camtasia (www.
telestream.net/screenflow; www.techsmith.com/
Camtasia), YouTube (www.youtube.com) and Vimeo
(https://vimeo.com) are free or have a very low cost.
M. M. Abrahams (*)
Southern Africa Medical Unit (SAMU), Medecins Sans Frontieres
(MSF), 15 Cheltenham Rd, Rosebank, 7700 Cape Town,
South Africa
e-mail: musaed.abrahams@gmail.com
The production of high-quality educational resources can
be linked to a good game. A game has the following:
(1) an engaging narrative,
(2) instructive components,
(3) interactive components (quizzes, Q&A, live interaction),
(4) levels of progress,
(5) assessment, and
(6) community involvement.
Inclusion of all these elements often requires a large invest-
ment in an established learning management system and a
professional instructional designer. Moodle (www.moodle.com)
is a popular open-source, educator-centric platform. Moodle
implements NeuroRad, a digital library and learning community
of online neuroradiology courses, lectures and educational re-
sources [2]. For low-resource options or pilot programs, it is
possible to get good results using a few of the free tools for
creation and distribution.
Creating
Any educational resource, from a PowerPoint presentation to
a sophisticated video, needs to begin with clear definition of
the learning outcomes. Listing the learning outcomes of the
target audience gives direction and focus to the material. What
is the aim? Is it to inform or to persuade? What are the target
audiences specific needs and limitations regarding back-
ground knowledge and experience and how can these be
leveraged to improve the material? Style of delivery is impor-
tant because engaging e-learning material benefits from a
conversational rather than a formal style of delivery [3].
Well-designed PowerPoint or Prezi presentations can enhance
the learning experience, and the addition of audio or video, via
USB microphones, is a simple way to make material more
698 Pediatr Radiol (2014) 44:697699

engaging. Although these tools can enhance the final product,

care must be taken that they do not overshadow the learning
outcomes. Camtasia and ScreenFlow are software programs that
simplify audiovisual screen capture and editing for distribution.
Webinars are a more interactive form of learning and
provide real-time question and answer periods. Platforms like
WebEx (Cisco Systems, San Jose, CA) and Adobe (Microsoft,
Redmond, WA) are the premier solutions but are quite costly.
Cheaper alternatives include FuzeBox (https://www.fuzebox.
com/), GoToMeeting (www.gotomeeting.com) and Skype,
but low-bandwidth settings remain a challenge. Sessions
can, however, be recorded for later access.
All these forms of e-learning are further enhanced when
interactive sessions, assessments and face-to-face discussion Fig. 1 A training video posted on YouTube demonstrates sputum induction
are added. Mdecins Sans Frontires (Doctors without Bor- technique for diagnosing pediatric tuberculosis. The video has been viewed
by 1,700 people, 25% of whom accessed this material via mobile phone
ders) received very good feedback after presenting radiology
training videos in Malawi and Zimbabwe at Mdecins Sans
media. These technologies empower educators to create and
Frontires field project trainings.
distribute good e-learning materials to the places it is needed.
Radiology teaching is ideally suited to these e-learning tools,
Distribution

Distribution of resources can be achieved via USB storage or via

online cloud storage services, such as Dropbox (www.dropbox.
com). A Web site that houses the links for the training material is
best, because usage can be monitored through stored analytics.
Videos can be uploaded to YouTube (large audience, medium
quality, large presence of advertising) or Vimeo (smaller
audience, high-quality high definition, cleaner interface).
Comment sections are useful for learner feedback. Advantages
of these services include analytics, which tabulate the number of
views, countries viewed, devices accessed, and downloads
performed. An example of these analytics: of the 1,700 people
who viewed a video on YouTube demonstrating pediatric
sputum induction technique for diagnosing tuberculosis (http://
www.youtube.com/watch?v=sbGITrNP8j8), 25% accessed this
material via mobile phone (Fig. 1).

Marketing

The marketing of the material is stronger via word-of-mouth and

direct e-mail to related institutions (academic and non-
governmental organizations) to disseminate to interested groups.
Social media such as Facebook (Fig. 2), Twitter and LinkedIn
are useful for promoting the material, sourcing feedback and,
more important, for providing community engagement.

Conclusion
Fig. 2 Cover page of a Vimeo training video for the interpretation of
The digital revolution is here and the learning playing fields chest radiographs in suspected pediatric tuberculosis cases, marketed
can be leveled with optimal use of free and cheap digital through Facebook
Pediatr Radiol (2014) 44:697699
and for people in developing countries the use of mobile
networks and telephones helps to solve geographic obstacles.
It is important to note that care must be taken to analyze the
audience, focus on learning outcomes and, where possible,
use these tools together with personal interaction to provide
the best learning experiences.
Conflicts of interest None
699
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