e-Learning & Technology
Teledebriefing: connecting learners to faculty members Rami Ahmed, Aimee King Gardner, S Scott Atkinson and Brad Gable, Austen BioInnovation Institute in Akron, Ohio, USA
Many simulation centres do not have access to trained debriefers
SUMMARY Background: Simulation has become widespread among medical educators. Although simulation facilities are available at most teaching institutions, the number of qualified instructors to facilitate post-simulation debriefing is inadequate, resulting in sub-par educational experiences for learners. Context: Efforts to broaden medical curricula to include simulation have been successful. An integral component of simulation-based education is the debriefing stage, in which learning and reflection are believed to be greatest. To be maximally effective, debriefing
should be performed by faculty members who have both expertise in the subject matter and a strong grasp of debriefing principles. Unfortunately, the debriefing portion of simulation exercises is often performed in a sub-par fashion because many simulation centres do not have access to trained debriefers. As a result, the overall experience of simulation training programmes is reduced, and the exercises have much less educational benefit to the learner. Innovation: This article outlines a novel use of videoconferencing technology for debriefing learners at remote locations,
which we term teledebriefing. This can be accomplished in a cost-effective and straightforward manner using basic equipment: a smartphone and a television. Implications: Teledebriefing can create a mutually beneficial faculty instructor network between institutions. By connecting clinical educators from geographically distant areas or from specialties not available locally, learners are exposed to faculty that can provide content expertise and high-quality debriefing during simulation exercises. Evaluating the effectiveness and feasibility of teledebriefing is warranted.
270 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 270–273
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6/4/2014 1:02:26 PM
INTRODUCTION
T
he ever-transforming world of medical education is producing growing challenges for clinical instructors apprehensive about the clinical and scholarly development of their students. There is pressure to provide additional training with fewer hours in the classroom and in the clinical setting. As a result, instructors are responsible for a greater number of students. One major solution to the multitude of problems faced by medical educators has been the development and assimilation of simulation technology into medical education. Simulation is steadily increasing and being employed within medical education for the training of doctors and allied health personnel all over the world.1 The use of simulation in the instruction and assessment of students is becoming viewed as an improved pedagogical approach by many medical educators. Numerous residency programmes in the USA now endorse simulation-based instruction because it provides an avenue for residents to demonstrate the attainment of curricular objectives.1,2 The risk-free environment created for novice practitioners is ideal to learn realistic and pertinent everyday clinical skills under the watchful eye of seasoned clinicians. A major component of simulation-based instruction is the debriefing process. Debriefing occurs after a simulation episode and involves faculty member-facilitated discussion in which a series of questions are asked to allow participants to reflect on the exercise and experience a deeper processing of the learned material. This structured discussion elicits important insights into trainee performance and helps connect the lessons learned from the challenging exercise to future
Concrete Experience (doing / having an experience)
Active Experimentation
Reflective Observation
(planning / trying out what you have learned)
(reviewing / reflecting on the experience)
Abstract Conceptualisation (concluding / learning from the experience)
Figure 1. The stages of Kolb’s experiential learning cycle
actions in the actual clinical arena.3,4 Experts have repeatedly identified the debriefing portion of simulation exercises as the ‘heart and soul’ of the simulation experience.4 Debriefing after simulation provides an opportunity for the learner to navigate through all of the stages of Kolb’s experiential learning cycle using a conceptual framework aimed at reflection of performance (Figure 1), with the overarching goal of improving clinical practice.5 Unfortunately, if the debriefing portion of simulation exercises is performed in a subpar fashion (e.g. the faculty member is not an expert in the subject matter or the facilitator is not trained in debriefing), the overall experience is reduced and the exercises have much less educational benefit to the learner. Thus, without a trained faculty member to facilitate the most integral part of the learning episode, the entire simulation session could be ineffective. Such situations are becoming more prevalent across institutions around the world. Many institutions fail to acquire faculty members adequately trained to conduct debriefing sessions, despite the fact that these institutions dedicate resources to obtain equipment and incorporate simulation into the curriculum. The imbalance between the demand for simulation training and the availability of faculty members who can adequately debrief learners creates missed opportunities to
perform simulation training, or provides substandard education in simulation labs. Thus, there is a need to find additional avenues by which institutions can ensure high-quality simulation-based instruction for their learners.
A major component of simulationbased instruction is the debriefing process
TELEDEBRIEFING Teledebriefing is the use of videoconferencing capabilities to debrief learners at remote locations. Trainees can be involved in hands-on simulation scenarios customised to fit their needs or discipline at their home institutions, and then connect to a seasoned debriefer through webcams or other relevant technologies. In this way, students and institutions have direct access to regional experts, the latest research findings and the same formal didactic education as their counterparts who are training at larger centres with daily exposure to a larger number of faculty members.6 This concept of instruction from afar is not new to medical education. Telementoring has been around since the 1950s, and involves the supervision of a procedure or clinical task in which a novice student or practitioner is guided by a more skilled clinician who is located at a distance from the patient.6,7 Telementoring has been shown to increase contact and involvement with ‘geographically distant experts, research, and resources to which students would not otherwise be exposed’.8 Telementoring has also been shown to support cooperative learning in terms of improved attendance, increased self-confidence and motivation, academic achievement and critical thinking skills.8,9 Additionally, pilot studies have validated telementoring to be as effective as on-site mentoring for the training of basic and advanced surgical techniques.10 Thus, adopting a
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 270–273 271
tct_12135.indd 271
6/4/2014 1:02:27 PM
Teledebriefing and telementoring share the same aim: to connect expert clinicians with novice students
similar approach for use within simulation-based training may be very fruitful, as teledebriefing and telementoring share the same aim: to connect expert clinicians with novice students or inexperienced practitioners. What follows is a brief description of how educators can implement teledebriefing systems to improve simulation-based educational programmes.
DESCRIPTION OF THE INNOVATION The simple use of a Smartphone (e.g. an iPhone® with FaceTime®, or an Android®based phone with Skype®, Yahoo Messenger® or Microsoft Messenger®), a television and an audiovisual connection from the phone to the television is all that is needed to implement teledebriefing capability within a centre (Box 1). The simulation technician, on site in a simulation lab or in a clinical setting (in situ simulation) alongside the students, holds the smartphone and uses it as a wireless camera to transmit the performance of the students (Figure 2). The recipient faculty member can watch the scenario from their computer, iPad®, iPhone®, tablet or smartphone with a camera using the same program as the host (technician). For example, the host (technician recording the scenario) could be using an iPhone® with FaceTime®, whereas the recipient faculty member could be using an Apple device with FaceTime® to watch and communicate with the students in real time. Once the scenario is over, the technician connects the phone to a large television screen using an audiovisual connection. The technician must hold the phone facing the students being debriefed so that the faculty member can see and hear the students. The phone should be held closely to the television so that the
Box 1. Instructions and set-up for implementing teledebriefing • Both participants must use the same programme on their phone or computer • To record a session you must download IMCapture to the site doing the simulation • FaceTime®, Skype®, Yahoo Messenger® or Microsoft Messenger® must be used for the recording process to take place Equipment needed (no recording) • An iPhone® with FaceTime® or an Android®-based phone with Skype®, Yahoo Messenger® or Microsoft Messenger® installed • A large-screen TV with an audiovisual connection from the phone to the TV • A computer Instructions 1. Make phone call 2. Once connected the screens can be flipped to meet the end-users needs 3. When it’s time to debrief: connect the TV at the simulation lab to an iPhone or an Android phone 4. Start the debriefing session (remember to flip the phone screen in the simulation lab so that students can see the debriefer on the TV) NOTE: The phone is the camera. Stand close to the TV so that the class is talking into the camera on the phone while looking at the debriefer on the TV. IMCapture for video recording of your debriefing sessions The same procedure is followed, except for one change: you will replace the phone in the simulation lab with a computer that has IMCapture installed (approximately $49.99). 1. Start the program IMCapture on the computer 2. Make or receive the phone call from/to the debriefer 3. The computer now becomes the recording device NOTE: This method does not allow you the ability to move around the room unless an external camera is connected to the computer.
Figure 2. Technician using a smartphone to broadcast a live simulation session to off-site faculty
Figure 3. Smartphone connected to a television to allow interactive live debriefing with an offsite teledebriefer
students will appear to be talking directly to faculty members on the large television, and can interact with them as if they are seeing each other on the television screen (Figure 3).
be able to view the patient simulator and the team participating in the simulation exercise. Meanwhile, the on-site simulation technologists can provide the initial orientation and instructions to the learners. This technology will allow the faculty mentor to direct the student’s attention to specific normal or abnormal physical findings, images or
As described here, the implementation of a teledebriefing system can be very straightforward. The faculty mentor will
272 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 270–273
tct_12135.indd 272
6/4/2014 1:02:27 PM
sounds. This is of vital importance to the fidelity of the sessions and to the debriefing portion of the simulated tutorial session.
participating scholars and allow for the execution of cutting edge training at their respective institutions.
TELEDEBRIEFING APPLICATION
Future programmes and research should examine the utility of this novel concept. Conditions regarding its utility, efficiency and educational success should be investigated.
Teledebriefing will allow students to experience the vast array of educational communities throughout the world. The incorporation of these technologies into medical simulation will further extend the reach of sound educational strategies and curricular design. It is important to keep in mind that medical simulation itself is not a technology: rather, it is a sound pedagogical strategy. This strategy, coupled with technology that facilitates teledebriefing, will play a critical role in the future of medical education. This approach can eliminate obstacles such as distance, cost, and time away from practice that once impeded scholars and simulation specialists from disseminating their expertise and unique skill set. This ability to pair expert clinical faculty members with expert debriefers could lead to a simulation faculty network that provides an unparalleled training environment to learners who would otherwise never have access to such specialists. This network would potentially allow institutions to identify a training need, pinpoint the appropriate specialist(s) from a network of
CONCLUSION In summary, teledebriefing offers a dynamic and effective way to address the shortage of clinical educators with content expertise and training in postsimulation debriefing. By making available clinical educators from geographically distant areas, or from specialties not available locally, learners are exposed to faculty members that can provide content expertise and high-quality debriefing during simulation exercises. The simple use of a smartphone, very basic equipment and a television is all that is needed to bridge the gap between these experts and the students that require training in simulation labs. REFERENCES 1. Mclaughlin S, Fitch M, Goyal DG, Hayden E, Kauh CY, Laack TA, Nowicki T, Okuda Y, Palm K, Pozner CN, Vozenilek J, Wang E, Gordon JA. Simulation in Graduate Medical Education 2008: A Review for Emergency Medicine. Acad Emerg Med 2008;15:1117–1129.
2. Fernandez GL, Page DW, Coe NP, Lee PC, Patterson LA, Skylizard L, St Louis M, Amaral MH, Wait RB, Seymour NE. Boot cAMP: educational outcomes after 4 successive years of preparatory simulation-based training at onset of internship. J Surg Educ 2012;69:242–248. 3. Husebo SM, Dieckmann P, Rystedt H, Søreide E, Friberg F. The Relationship Between Facilitators’ Questions and the Level of Reflection in Postsimulation Debriefing. Simul Healthc 2013;3:135–142.
Learners are exposed to faculty members that can provide content expertise and high-quality debriefing
4. Rall M, Manser T, Howard S. Abstract No. 2: Key Elements of debriefing for simulator training. EJA 2000;17:516–517. 5. Kolb D. Experiential Learning. Experience as the source of learning and development. New Jersey: Prentice-Hall; 1984. 6. Lewis Y, Bredfeldt R, Strode SW, D’Arezzo KW. Changes in Residents’ Attitudes and Achievement After Distance Learning Via Two-Way Interactive Video. Fam Med 1998;30:497–500. 7. Rosser JCJr, Gabriel N, Herman B, Murayama M. Telementoring and Teleproctoring. World J Surg 2001;25:1438–1448. 8. Perez S, Dorman S. Enhancing Youth Achievement Through Telementoring. J Sch Health 2001;71:122–123. 9. Gokhade A. Collaborative Learning Enhances Critical Thinking. Journal of Technology Education 1995;7:22–30. 10. Rosser J, Young S, Klonsky J. Telementoring: an application whose time has come. Surg Endosc 2007;21:1458–1463.
Corresponding author’s contact details: Rami A. Ahmed, Department of Medical Education, Summa Health System, 41 Arch Street, Room 506, Akron, OH 44304, USA. E-mail: [email protected]
Funding: None. Conflict of interest: None to declare. Ethical approval: Not required. doi: 10.1111/tct.12135
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 270–273 273
tct_12135.indd 273
6/4/2014 1:02:28 PM
Teledebriefing: connecting learners to faculty members Rami Ahmed, Aimee King Gardner, S Scott Atkinson and Brad Gable, Austen BioInnovation Institute in Akron, Ohio, USA
Many simulation centres do not have access to trained debriefers
SUMMARY Background: Simulation has become widespread among medical educators. Although simulation facilities are available at most teaching institutions, the number of qualified instructors to facilitate post-simulation debriefing is inadequate, resulting in sub-par educational experiences for learners. Context: Efforts to broaden medical curricula to include simulation have been successful. An integral component of simulation-based education is the debriefing stage, in which learning and reflection are believed to be greatest. To be maximally effective, debriefing
should be performed by faculty members who have both expertise in the subject matter and a strong grasp of debriefing principles. Unfortunately, the debriefing portion of simulation exercises is often performed in a sub-par fashion because many simulation centres do not have access to trained debriefers. As a result, the overall experience of simulation training programmes is reduced, and the exercises have much less educational benefit to the learner. Innovation: This article outlines a novel use of videoconferencing technology for debriefing learners at remote locations,
which we term teledebriefing. This can be accomplished in a cost-effective and straightforward manner using basic equipment: a smartphone and a television. Implications: Teledebriefing can create a mutually beneficial faculty instructor network between institutions. By connecting clinical educators from geographically distant areas or from specialties not available locally, learners are exposed to faculty that can provide content expertise and high-quality debriefing during simulation exercises. Evaluating the effectiveness and feasibility of teledebriefing is warranted.
270 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 270–273
tct_12135.indd 270
6/4/2014 1:02:26 PM
INTRODUCTION
T
he ever-transforming world of medical education is producing growing challenges for clinical instructors apprehensive about the clinical and scholarly development of their students. There is pressure to provide additional training with fewer hours in the classroom and in the clinical setting. As a result, instructors are responsible for a greater number of students. One major solution to the multitude of problems faced by medical educators has been the development and assimilation of simulation technology into medical education. Simulation is steadily increasing and being employed within medical education for the training of doctors and allied health personnel all over the world.1 The use of simulation in the instruction and assessment of students is becoming viewed as an improved pedagogical approach by many medical educators. Numerous residency programmes in the USA now endorse simulation-based instruction because it provides an avenue for residents to demonstrate the attainment of curricular objectives.1,2 The risk-free environment created for novice practitioners is ideal to learn realistic and pertinent everyday clinical skills under the watchful eye of seasoned clinicians. A major component of simulation-based instruction is the debriefing process. Debriefing occurs after a simulation episode and involves faculty member-facilitated discussion in which a series of questions are asked to allow participants to reflect on the exercise and experience a deeper processing of the learned material. This structured discussion elicits important insights into trainee performance and helps connect the lessons learned from the challenging exercise to future
Concrete Experience (doing / having an experience)
Active Experimentation
Reflective Observation
(planning / trying out what you have learned)
(reviewing / reflecting on the experience)
Abstract Conceptualisation (concluding / learning from the experience)
Figure 1. The stages of Kolb’s experiential learning cycle
actions in the actual clinical arena.3,4 Experts have repeatedly identified the debriefing portion of simulation exercises as the ‘heart and soul’ of the simulation experience.4 Debriefing after simulation provides an opportunity for the learner to navigate through all of the stages of Kolb’s experiential learning cycle using a conceptual framework aimed at reflection of performance (Figure 1), with the overarching goal of improving clinical practice.5 Unfortunately, if the debriefing portion of simulation exercises is performed in a subpar fashion (e.g. the faculty member is not an expert in the subject matter or the facilitator is not trained in debriefing), the overall experience is reduced and the exercises have much less educational benefit to the learner. Thus, without a trained faculty member to facilitate the most integral part of the learning episode, the entire simulation session could be ineffective. Such situations are becoming more prevalent across institutions around the world. Many institutions fail to acquire faculty members adequately trained to conduct debriefing sessions, despite the fact that these institutions dedicate resources to obtain equipment and incorporate simulation into the curriculum. The imbalance between the demand for simulation training and the availability of faculty members who can adequately debrief learners creates missed opportunities to
perform simulation training, or provides substandard education in simulation labs. Thus, there is a need to find additional avenues by which institutions can ensure high-quality simulation-based instruction for their learners.
A major component of simulationbased instruction is the debriefing process
TELEDEBRIEFING Teledebriefing is the use of videoconferencing capabilities to debrief learners at remote locations. Trainees can be involved in hands-on simulation scenarios customised to fit their needs or discipline at their home institutions, and then connect to a seasoned debriefer through webcams or other relevant technologies. In this way, students and institutions have direct access to regional experts, the latest research findings and the same formal didactic education as their counterparts who are training at larger centres with daily exposure to a larger number of faculty members.6 This concept of instruction from afar is not new to medical education. Telementoring has been around since the 1950s, and involves the supervision of a procedure or clinical task in which a novice student or practitioner is guided by a more skilled clinician who is located at a distance from the patient.6,7 Telementoring has been shown to increase contact and involvement with ‘geographically distant experts, research, and resources to which students would not otherwise be exposed’.8 Telementoring has also been shown to support cooperative learning in terms of improved attendance, increased self-confidence and motivation, academic achievement and critical thinking skills.8,9 Additionally, pilot studies have validated telementoring to be as effective as on-site mentoring for the training of basic and advanced surgical techniques.10 Thus, adopting a
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 270–273 271
tct_12135.indd 271
6/4/2014 1:02:27 PM
Teledebriefing and telementoring share the same aim: to connect expert clinicians with novice students
similar approach for use within simulation-based training may be very fruitful, as teledebriefing and telementoring share the same aim: to connect expert clinicians with novice students or inexperienced practitioners. What follows is a brief description of how educators can implement teledebriefing systems to improve simulation-based educational programmes.
DESCRIPTION OF THE INNOVATION The simple use of a Smartphone (e.g. an iPhone® with FaceTime®, or an Android®based phone with Skype®, Yahoo Messenger® or Microsoft Messenger®), a television and an audiovisual connection from the phone to the television is all that is needed to implement teledebriefing capability within a centre (Box 1). The simulation technician, on site in a simulation lab or in a clinical setting (in situ simulation) alongside the students, holds the smartphone and uses it as a wireless camera to transmit the performance of the students (Figure 2). The recipient faculty member can watch the scenario from their computer, iPad®, iPhone®, tablet or smartphone with a camera using the same program as the host (technician). For example, the host (technician recording the scenario) could be using an iPhone® with FaceTime®, whereas the recipient faculty member could be using an Apple device with FaceTime® to watch and communicate with the students in real time. Once the scenario is over, the technician connects the phone to a large television screen using an audiovisual connection. The technician must hold the phone facing the students being debriefed so that the faculty member can see and hear the students. The phone should be held closely to the television so that the
Box 1. Instructions and set-up for implementing teledebriefing • Both participants must use the same programme on their phone or computer • To record a session you must download IMCapture to the site doing the simulation • FaceTime®, Skype®, Yahoo Messenger® or Microsoft Messenger® must be used for the recording process to take place Equipment needed (no recording) • An iPhone® with FaceTime® or an Android®-based phone with Skype®, Yahoo Messenger® or Microsoft Messenger® installed • A large-screen TV with an audiovisual connection from the phone to the TV • A computer Instructions 1. Make phone call 2. Once connected the screens can be flipped to meet the end-users needs 3. When it’s time to debrief: connect the TV at the simulation lab to an iPhone or an Android phone 4. Start the debriefing session (remember to flip the phone screen in the simulation lab so that students can see the debriefer on the TV) NOTE: The phone is the camera. Stand close to the TV so that the class is talking into the camera on the phone while looking at the debriefer on the TV. IMCapture for video recording of your debriefing sessions The same procedure is followed, except for one change: you will replace the phone in the simulation lab with a computer that has IMCapture installed (approximately $49.99). 1. Start the program IMCapture on the computer 2. Make or receive the phone call from/to the debriefer 3. The computer now becomes the recording device NOTE: This method does not allow you the ability to move around the room unless an external camera is connected to the computer.
Figure 2. Technician using a smartphone to broadcast a live simulation session to off-site faculty
Figure 3. Smartphone connected to a television to allow interactive live debriefing with an offsite teledebriefer
students will appear to be talking directly to faculty members on the large television, and can interact with them as if they are seeing each other on the television screen (Figure 3).
be able to view the patient simulator and the team participating in the simulation exercise. Meanwhile, the on-site simulation technologists can provide the initial orientation and instructions to the learners. This technology will allow the faculty mentor to direct the student’s attention to specific normal or abnormal physical findings, images or
As described here, the implementation of a teledebriefing system can be very straightforward. The faculty mentor will
272 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 270–273
tct_12135.indd 272
6/4/2014 1:02:27 PM
sounds. This is of vital importance to the fidelity of the sessions and to the debriefing portion of the simulated tutorial session.
participating scholars and allow for the execution of cutting edge training at their respective institutions.
TELEDEBRIEFING APPLICATION
Future programmes and research should examine the utility of this novel concept. Conditions regarding its utility, efficiency and educational success should be investigated.
Teledebriefing will allow students to experience the vast array of educational communities throughout the world. The incorporation of these technologies into medical simulation will further extend the reach of sound educational strategies and curricular design. It is important to keep in mind that medical simulation itself is not a technology: rather, it is a sound pedagogical strategy. This strategy, coupled with technology that facilitates teledebriefing, will play a critical role in the future of medical education. This approach can eliminate obstacles such as distance, cost, and time away from practice that once impeded scholars and simulation specialists from disseminating their expertise and unique skill set. This ability to pair expert clinical faculty members with expert debriefers could lead to a simulation faculty network that provides an unparalleled training environment to learners who would otherwise never have access to such specialists. This network would potentially allow institutions to identify a training need, pinpoint the appropriate specialist(s) from a network of
CONCLUSION In summary, teledebriefing offers a dynamic and effective way to address the shortage of clinical educators with content expertise and training in postsimulation debriefing. By making available clinical educators from geographically distant areas, or from specialties not available locally, learners are exposed to faculty members that can provide content expertise and high-quality debriefing during simulation exercises. The simple use of a smartphone, very basic equipment and a television is all that is needed to bridge the gap between these experts and the students that require training in simulation labs. REFERENCES 1. Mclaughlin S, Fitch M, Goyal DG, Hayden E, Kauh CY, Laack TA, Nowicki T, Okuda Y, Palm K, Pozner CN, Vozenilek J, Wang E, Gordon JA. Simulation in Graduate Medical Education 2008: A Review for Emergency Medicine. Acad Emerg Med 2008;15:1117–1129.
2. Fernandez GL, Page DW, Coe NP, Lee PC, Patterson LA, Skylizard L, St Louis M, Amaral MH, Wait RB, Seymour NE. Boot cAMP: educational outcomes after 4 successive years of preparatory simulation-based training at onset of internship. J Surg Educ 2012;69:242–248. 3. Husebo SM, Dieckmann P, Rystedt H, Søreide E, Friberg F. The Relationship Between Facilitators’ Questions and the Level of Reflection in Postsimulation Debriefing. Simul Healthc 2013;3:135–142.
Learners are exposed to faculty members that can provide content expertise and high-quality debriefing
4. Rall M, Manser T, Howard S. Abstract No. 2: Key Elements of debriefing for simulator training. EJA 2000;17:516–517. 5. Kolb D. Experiential Learning. Experience as the source of learning and development. New Jersey: Prentice-Hall; 1984. 6. Lewis Y, Bredfeldt R, Strode SW, D’Arezzo KW. Changes in Residents’ Attitudes and Achievement After Distance Learning Via Two-Way Interactive Video. Fam Med 1998;30:497–500. 7. Rosser JCJr, Gabriel N, Herman B, Murayama M. Telementoring and Teleproctoring. World J Surg 2001;25:1438–1448. 8. Perez S, Dorman S. Enhancing Youth Achievement Through Telementoring. J Sch Health 2001;71:122–123. 9. Gokhade A. Collaborative Learning Enhances Critical Thinking. Journal of Technology Education 1995;7:22–30. 10. Rosser J, Young S, Klonsky J. Telementoring: an application whose time has come. Surg Endosc 2007;21:1458–1463.
Corresponding author’s contact details: Rami A. Ahmed, Department of Medical Education, Summa Health System, 41 Arch Street, Room 506, Akron, OH 44304, USA. E-mail: [email protected]
Funding: None. Conflict of interest: None to declare. Ethical approval: Not required. doi: 10.1111/tct.12135
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 270–273 273
tct_12135.indd 273
6/4/2014 1:02:28 PM
