The e-Learning Paradigm for Health Professionals

1. Contribution to the Internet Congress Informedica 2002 “Paving the way to the global e-health”www.informedica.org/2002 The e-Learning Paradigm for Health Professionals Dr Marcelo Sosa IudicissaEuropean Parliament STOAScientific and Technological Options Assessment Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

2. Presentation, Justification 1 ¿why have I been given the priviledge of making this presentation to you? • Due to the kind invitation of Dr Nora Oliveri- who deserves all our recognition and thanks- and should be congratulated for her initiatives and projects such as Informedica 2002 • I want to express my satisfaction- for being able to contribute to such a fascinating on-line event- its format is anticipating a future that “is already here” Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

3. Presentation, Justification 2 …I have the priviledge of presenting my ideas, maybe because... • ..of my professional education (what I have learned / apprehended)in medicine, public health, informatics, telecommunication • ..of my work experiences (what I have done) family medicine, teaching, Univ of Buenos Aires, National School of Public Health, Madrid; researcher, information systems and new technologies; scientific officer, AIM-Health Telematics program, European Commission; director, National Library of Health Sciences of Spain; advisor on telemedicine, National Health Institute Carlos III, Madrid; director, electronic commerce association, consultant and entrepreneur of Internet projects; responsible, science office (STOA) of the European Parliament in Brussels Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

4. Presentation, Justification 3 As a result of all the above.. Who am I? a teacher, a researcher, an advisor, an author, an expert, a scientist? The responsibility attached to a label is very high a toll! I prefer to say no to all those labels!, but in fact, I think I am a random mixture of a little bit of all the above things This has some advantages: a multidisciplinary vision, eclecticism, few sect fidelities, indiference of dogma, humbleness, curiosity, pleasure for learning, teaching, and sharing... Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

5. Presentation, Justification 4 • aesthetic context chossenThis presentation’s background is a papyrus, deserved hommage to the ancestor of paper, the medium that has made possible the collection and transmission of knowledge, now that we enter the electronic era, masterfuly summarised by professor Ron LaPorte from Pittsburgh University, in the powerfull idea: “P-P-P, From Papyrus-To Paper-To PowerPoint”. Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

6. Educating health professionals • let’s avoid definitions- what matters: we all row in the same direction, together- a literary licence: “medicine” embraces many disciplines • it is sciencie and art- this has consequences and requisites • implies personal and socialpower - which brings along exigencies and responsabilities Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

7. Paradigms • Thomas Kuhn- The structure of scientific revolutions, 1970 • Pedro Laín: Greek teckhne- History of Medicine main phases: spontaneous – empiric - magic – technicalwe are at the culmen of an era of technical medicine that started in the Golden Century in ancient Greece • Know what and know how to in medicine- Knowledge has allways developed in the context of great schools (Isle of Kos, Salerno, Montpellier, and many others) Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

8. Traditional Paradigm • Concentration of knowledge- Isle of Kos, Ispahan, school of Salerno, etc • Personalization of knowledge- Masters: Hippocrates - Avicena – Maimonides - Sydenham • The aprenticeship of the art- Commitment, sacrifices, effort, priviledge • Knowledge as an scarce good- Transmission is necessarily personalized Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

9. Educating a professional • Transmmiting knowledge- To know - Intellectual Component • Acquire skills and habilities- To know how - Operative Component • Acquire and develope attitudes - “Hows” and “Whys”- Emotional and Moral Component Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

10. Knowledge Cycle Libraries ---> Internet Traditional printed medium: books and journals Electronic medium: discs and on-line resources Universities Hospitals Health Centers Special schools Etc Historic collection Education Generation Transmission Publications Congresses Committees Shadow colleges Etc Labs Industry Universities Hospitals Etc Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

11. Information Hierachy Discrete values; must be correct and precise; required in massive amounts; of scarce value when isolated. Data Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

12. Information Hierachy Sets of data put in relation between each other, they acquire new meanings and operative value on reality • Information • Data Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

13. Information Hierachy • Knowledge • Information • Data Experience building up from analysis and synthesis of information Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

14. Information Hierachy • Wisdom or Intelligence • Knowledge • Information • Data Zenit Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

15. “In his book on the Internet, Telematics and Health, Marcelo Sosa writes ofinformation as the cornerstone of medical sciences and pays tribute tothat information giant Dr. Hector Sosa Padilla, who was a pioneer in assistingPAHO in development of information systems. Dr. Sosa Padilla is quotedthus: Information & Knowledge Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

16. Information Sources in Health Sciences These concepts, managed by information and documentation sciences in the last decades, are strongly affected by the new realities opened up by the Internet; however, it is advisable to bear them in mind as a scheme on sources hierarchy. • Primary sourcesexample: article in BMJ- Books- Articles- Reports- Contributions to meetings- etc. Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

17. Is there an information problem in medicine? • Information explosion-15 million “facts” must a medical student learn-1990-91 = 50,000 articles in gastroenterology-250,000 art. Every 2 years, 342 / day, 4.2 /min. • “Facts” that are not factsp.e. apendicitis and pain localization • The imprecission of medical language F. T. de Dombal, 1993 Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

18. Iniciatives on telematics & health Principal Ideas: * Information Society* Employment, Growth, Competitiveness Main milestones: * 1993-"Delors white book“* 1994-"Bangemann Report“* 1994-98 -Priority to ICT and Telematics R&D Principal Iniciatives and Projects: * Action Plan* Priority in Framework Programs: IV-V-VI* Trans-European Telecom Networks* ISPO* E-Europe – e-Health Europe European Union www.cordis.lu Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

19. R&D on health telematics - AIM (Advanced Informatics in Medicine): II Framework Program (FP) / 1989-1990, 42 projects, 22 MEcus - Healthcare Telematics: III FP / 1991-1993, 50 projects, 105 MEcus - Telematics Applications - Health: IV FP / 1994-1998, +120 projects R+D+Validation,140 MEcus - IST-Information Society Technologies - Systems and services for the citizen - Health V FP / 1999-2003+250 MEuros- Continuation in VI FP / 2002-2005 European Union Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

20. The long march of EU R&D(*) Barcelona Conference AIM Euroforum Seville Lisbon Conference Services for Citizens TELEMATICSAPPLICATIONS V FP TELEMATICSAPPLICATIONS IVPM AIM Bangeman Report III PM II FP INFORMATION SOCIETY BICEPS 1984 1986 1988 1990 1992 1994 1996 1998 2000 (*): R&D, research and development Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

21. Examples of Projects • CHIC (Health information regional models) • HECTOR (emergencies-Telemedicine) • PROREC (Electronic Health Records) • CoCo ( Regional Networks) • IT-EDUCTRA (Health Professionals Education and Training) • WIDENET Creation of the European Health Records Institute EUROREC • MOBIDEV Mobile Comunications in healthcare Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

22. Education and Training for Health Informatics in EuropeState of the Art - Guidelines - ApplicationsEdited by:A. Hasman , A. Albert , P. Wainwright , R. Klar and M. Sosa1995, 286 pp., hardcoverISBN: 90 5199 234 3 Eductra Concerted action,started in 1992 with 12 countries of the then European Community Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

23. Eductra “...general guidelines for European curricula in health informatics as they were developed and elaborated by the members of the EDUCTRA Concerned Action (1992-1994). The third part of this volume entails the detailed descriptions and applications of curricula in health informatics in European states” Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

24. Information Society • Informatics Revolution: transistor, printed circuits, microprocessor, PCs, Moor’s law, CD-ROM, DVD, operating systems and software • Telecom Revolution: transmission via satellites, digitalization of basic telephony, local networks, ISDN, broadband technologies, fiber optics, mobile telephony, GSM (European success story), cable TV, videoconference, residential DSL • Internet Revolution: open standard, data packets commutation, collaborative efforts, servers, electronic mail and WWW, platform for convergence, e-commerce Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

25. Information Society: Trends • Liberalization of telecommunications, universal access and tariff reductions • From data processing to knowledge access through multimedia information • Development of workgroup, distant learning, teleworking and telemedicine • Massive creation of new products, services and electronic businesses of Internet-based companies • Emergence of a new model of a digital economy Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

26. New Paradigms Internet Health Electronic Health eHealth Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

27. Citizens Trends • Higher economic possibilities and prospects of individual and family achievements • Welfare state culture • Better levels of information and more critical attitudes • Desire of more personal, family and social autonomy • Higher level of exigence of public services (infraestructures, transport, media, health care...) “Empowerment” Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

28. Health: Trends • Influence of the media and the Internet • Sociological changes in the health professions • Changes in the physician-patient relation, braking away from authoritarian and paternalistis schemes • Changes in the relation between users and health care services, as a consequence of social changes • Appearance of a tax-payer concience and an informed consumer attitude Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

29. New Paradigms Education Internet Electronic Learning e-Learning Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

30. Learners Trends • Posibilities of better vocational achievements • Broad educational supply with great ramifications of thematic areas • Better possibilities of geographic mobility for all. In Europe: 1 million university students have beneffited from the Erasmus program (one year in a foreing university) “Learning Empowerment” Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

31. Education: Trends • Influencie of the media and the Internet • Sociologic changes in the education professions • Changes in the learner-teacher relations, braking away from authoritarian and paternalistic models • Changes in the relation between users and educational establishments, as a consequence of social changes • Emergence of a conscience of tax-payer and informed consumer Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

32. Pioneers Dr Francis Timothy de Dombal England, 1937-1995 Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

33. Internet, Telematics and HealthMarcelo Sosa-Iudicissa, Nora Oliveri, Carlos Gamboa, Jean Roberts1997, 556 pp., hardcover plus CD-ROMISBN: 90 5199 289 0 Pioneers Contributions from Tim de Dombal, Ron LaPorte and other distinguished professionals totaling up to 80 authors from 22 countries. Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

34. Pioneers F.T. De Dombal, J.R. Hartley, D.H. Sleeman:A Computer-assisted system for Learning Clinical Diagnosis. The Lancet. Medical Education 18 January 1969 Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

35. Pioneers Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

36. New developments • Massive utilization of basic information repositories. Example: Pittsburgh University Supercourse • Use of simulation environments, virtual reality and immersion environments • Videoconference from any where to any where, from one-to-one, from one-to-many, or from many-to-many • Development of tools based on artificiall intelligence engines and knowledge databases Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

37. Emerging Paradigm • Education and training along the whole life • Without barriers of time or place • Access to best knowledge whereever it is located • Possibility for all to be readers and writers, students and teachers • Utilization of all technologies available, at present or in the future, for accessing contents and learning experiences Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

38. The Knowledge Society • We build it up together • For the benefit of all Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals

39. Many thanks for your interest to all participants of Informedica 2002 and the Supercourse who have read this presentation. Your opinions or comments are welcomed. Dr Marcelo Sosa-IudicissaMSosa@EuroParl.EU.int Nov 2002 – Dr Marcelo SosaE-Learning Paradigm for Health Professionals