Evolution in Congenital Cardiology Education: The Rise of Digital-Learning Tools

Abstract

Technology-enhanced learning is now an established part of medical education due to its ready availability and on-demand nature. This offers new opportunities but also challenges to both learners and teachers. This review outlines the current use of social media tools and online resources in medical education with a particular emphasis on congenital cardiology. It provides strategies to the reader on how to optimize learning in the digital environment and offers guidance on how such tools can be incorporated into routine educational practice. Suggestions for developing and assessing educational material online are discussed. Lastly, the concepts of digital professionalism and digital scholarship are explored to aid medical teachers and educators employ these technologies effectively into their teaching and career development.

The methods used by medical students and physicians to learn and acquire knowledge have changed over the last decade driven by the millennial generation’s comfort with and preference for educational material online.1, 2, 3 A shift from traditional means of self-directed learning such as reading textbooks to digital media has been observed.1, 2, 3 Although the adoption of digital technologies in medical education had already been steadily increasing, the COVID pandemic significantly accelerated this process as there was an immediate widespread need for remote learning.^4,5 These developments provide opportunities and challenges for learners and medical teachers.^5,6 Although teaching within the digital environment cannot replace that afforded within the clinical environment, it can assist learning.⁷ This review will explore the current role of technology-enhanced learning (TEL) in medical education, emphasizing congenital cardiology. It will describe the more popular digital tools currently adopted by learners and teachers and how these tools are being used and incorporated into educational practice. Their application in teaching, self-directed learning, and assessment will be described with attention paid to the potential advantages and disadvantages of using such tools. Suggestions for developing and assessing educational material online will be discussed. Lastly, digital professionalism and digital scholarship will also be explored to aid medical teachers and educators in effectively employing these technologies in their teaching and career development.

Defining Learning Within the Digital Environment

When defining learning within the digital environment, many overlapping terms are used within the literature, which can be confusing to the reader. E-learning, digital learning, mobile learning, and TEL are all used; however, e-learning remains the most common term in the literature.⁸ Clark and Mayer⁹ broadly define e-learning as “instruction delivered on a digital device that is intended to support learning.” Defining e-learning has been problematic, however, with a number of definitions arising from differing authors’ professional approaches or perspectives.⁸ In an attempt to create an inclusive definition, Sangrà et al.⁸ reviewed the literature and elicited opinions from recognized experts in the fields of education and technology. They subsequently defined e-learning as “an approach to teaching and learning representing all or part of the educational model applied, that is based on electronic media and devices as tools for improving access to training, communication and interaction and that facilitates the adoption of new ways of understanding and developing learning.”⁸ The term TEL has been advocated by others.¹⁰ Central to the concept of TEL is a focus on examining how the use of technology alters how teachers teach and learners learn.11, 12, 13 This review will use the term TEL rather than e-learning.

The increasing popularity of TEL derives primarily from its ability to bypass several barriers to learning.¹¹ The variety of digital-learning tools cater well to the different learning preferences of individual learners.^2,3 TEL is flexible in time and space allowing for both synchronous and asynchronous learning.¹⁴ Asynchronous learning is desirable to busy clinicians with heavy work and time commitments.¹⁵ TEL also improves accessibility reducing travel costs and enabling participants to attend remotely.¹⁶

Concepts to Guide the Medical Teacher and Educator in the Digital Environment

To optimize teaching in the digital environment, the medical teacher should be cognizant of several important functional concepts to optimize the learning experience. Three foundational concepts to consider in TEL are transactional distance, presence (cognitive, social, and teaching), and the role of the independent learner.¹⁷ Moore’s¹⁸ theory of transactional distance refers to the challenges in overcoming the gap that exists between the knowledge held by the teacher and that of the learner within the digital realm. The degree of this distance is dependent on the communication between the learner and teacher, the design of the course structure, and the autonomy of the student. Interested readers are directed to Roach and Attardi’s¹⁹ outline of how to apply this concept to optimize their online teaching.

To enhance learning, it is important to create a sense of community among students.^20,21 The term “community of inquiry” has been used to describe the learning process that occurs through the interaction of the 3 core elements of social, cognitive, and teaching presence.²² Social presence is the ability of the teacher and learners to project themselves as a real person within the online environment.²² Effective social presence promotes an engaging learning experience by giving learners permission to express themselves and form a cohesive group. Cognitive presence describes the learners’ capacity to develop knowledge through communication and reflection. The teacher can improve cognitive presence by involving learners in critical thinking and allowing them to discuss problems openly and reflect on the learning process.²² Teaching presence includes the course material’s design and delivery.²²

Finally, one must also consider that learners are not passive recipients of information but are instead independent individuals using technology to enhance their learning. The teacher’s role is to facilitate knowledge acquisition by motivating them and designing the learning experience to foster independence.¹⁷

In summary, these 3 concepts are helpful in guiding the medical teacher and educator in enhancing their teaching within the digital environment, developing courses, and deciding on how to use digital technologies for educational purposes.

Further to these comments, it is important to stress that in creating online educational material, attention should be paid to sound instructional design to facilitate TEL. There is a wealth of literature on the appropriate use of design within TEL. Prominent among them is Mayer’s²³ “multimedia principles,” which provide clear evidence-based guidelines for the design of TEL material. Originating from the cognitive theory of multimedia learning, these guidelines are outlined in Table 1.

Table 1.

Mayer’s 15 principles of multimedia design^∗

Principles for reducing extraneous processing
1.Coherence principle	Learning is improved when extraneous material is excluded rather than included
2.Signalling principle	Learning is improved when cues are added that highlight the organization of the essential material
3.Redundancy	Learners retain information better from graphics and narration than from graphics, narration, and printed text
4.Spatial contiguity principle	Learning is improved when corresponding words and pictures are presented near rather than far from each other on a screen
5.Temporal contiguity principle	Learning is improved when corresponding words and pictures are presented simultaneously rather than successively
Principles for managing essential processing
6.Segmenting principle	Learning is improved when a multimedia lesson is presented in user-paced segments rather than a continuous unit
7.Pretraining principle	Learning is improved when learners already know the names and characteristics of the main concepts
8.Modality principle	Students learn better from graphics and narration than from graphics and onscreen text
Principles for fostering generative processing
9.Multimedia principle	Students learn better from words and pictures than from words alone
10.Personalization principle	Students learn better when words are conversational in style
11.Voice principle	Students learn better when a friendly human voice is used rather than a machine voice
12.Image principle	Students do not necessarily learn better from the inclusion of the speaker's image to the screen
13.Embodiment principle	Students learn more deeply from a presentation when the onscreen instructor displays high embodiment (eg, the instructor online incorporates or exhibits appropriate visual gestures and eye gaze)
14.Immersion principle	Students do not necessarily learn better in 3D immersive reality than a corresponding 2D desktop presentation
15.Generative activity principle	Students learn better when they are guided to carry out generative principles

^∗These 15 evidence-based principles should be incorporated into designing and creating materials to optimize technology-enhanced learning.

So, what digital technologies or tools are currently available for cardiology trainees to enhance their learning, and what tools can the faculty member use to engage with learners appropriately? In the following sections, several technologies are highlighted that can be used, with insights into how these tools are currently used in educational practice.

Digital Learning Resources

A plethora of digital resources or tools are available to the medical learner and teacher. These can broadly be divided into applications and social media networks. Applications include e-learning websites such as Medscape (New York, NY), peer-reviewed journals, and podcasts. Social media networks include video-based channels such as YouTube (San Bruno, CA) and instant message applications such as Twitter (San Francisco, CA), Facebook (Menlo Park, CA), WhatsApp (Mountain View, CA), and Slack (Canada), among others. The adoption of social media within medical education has steadily grown.^24,25 The utilization of social media platforms in TEL brings with it both opportunities and challenges. Their use is supported by the educational theoretical principles of constructivism, which posits that learners acquire knowledge through experience and social discourse.²⁶ Social media platforms allow for the development of communities of practice through their ability to facilitate conversations, classes, and conferences.27, 28, 29 Connectivism, a new educational theory that mirrors constructivism, arose from TEL.³⁰ Social media usage also has known disadvantages, including unprofessional behaviour and effects on the users’ health.^31,32 Poor health behaviours have been noted that include skipping meals, bathroom breaks, and disturbed sleep due to late-night use.³¹ Headaches, muscle pain, and eye irritation have been reported, as well as an increased risk of anxiety, depression, and social isolation.33, 34, 35

Medical teachers and educators should also be aware that the social media industry is particularly chaotic, with many platforms rising to prominence before disappearing from the scene.³⁶ With such constant evolution, the reader is reminded that skills learned from one social media platform can be used in others.

In considering the application of digital tools within TEL, categorization can be based on the teaching activities each predominantly supports. Some tools are more pertinent for content delivery, whereas others offer more versatility to discussion or guiding activities. A podcast or a YouTube video–based lecture helps deliver content directly to a learner. In contrast, a social media application such as WhatsApp or Slack can be used to form an online discussion group. There is considerable overlap in such tools; for example, a video-based Zoom meet can be used for a standard lecture to a large audience or to facilitate small group discussion. Table 2 outlines several digital tools and offers examples of how they can support educational activities.

Table 2.

Examples of digital tools and resources and the education activities they can support

Digital tool/resource	Examples of uses in medical education
Video conferencing tools (eg, Zoom)	Small group teaching Lectures Webinars
Microblogging tools (eg, Twitter, Mastodon)	Promotion of scientific articles and conferences Virtual journal clubs Dissemination of medical knowledge—tweetorials
Semiprivate mobile applications (eg, WhatsApp, Slack, Vibe)	Small group teaching Problem-based learning Mentoring
Image-based social media platforms (eg, Snapchat, Instagram, TiKTok)	Small group teaching Image interpretation
Video-based platforms (eg, YouTube)	Lectures Demonstration
E-learning websites (eg, Heart University)	Curated video–based learning Assessment-based learning
Social network applications (eg, Facebook)	Small group teaching Lectures Webinars
E-newsletter (eg, CHIP Network)	Knowledge content delivery
Virtual and augmented reality tools	Demonstrate complex anatomy Simulation

CHIP, Congenital Heart International Professionals.

Digital Tools in Current Usage

Virtual teaching and webinars

The COVID pandemic saw a marked rise in the use of video conference tools such as Zoom and Microsoft Teams, among many others. These allowed local grand rounds, lectures, and small group teaching to continue. In delivering virtual teaching, it is vital to incorporate the foundational concepts previously outlined to optimize learning.¹⁷ Learners have reported increased tiredness and anxiety resulting from the overuse of these platforms, the so-called Zoom fatigue.^37,38 Recent advances in neuroscience explain the cognitive processes that account for these changes.³⁹ Virtual learning can generate a sense of placelessness, directly impacting episodic memory and personal and professional identity.³⁹ A lack of eye contact and nonverbal cues has been shown to reduce group engagement and performance.³⁹ These effects can be ameliorated by developing a strong sense of community within the learning group and incorporating strategies that promote vocal exchanges and visual attention.⁴⁰

Webinars have also become an increasingly popular tool to deliver medical education to learners. A webinar is a live web-based video conference that uses the internet to connect individuals hosting a webinar to an audience of learners that can be local or even global. Speakers from various locations can participate and deliver education to an essentially limitless audience. Several organizations within congenital cardiology adopted this method to fill the gap posed by traditional teaching methods in the early stages of the pandemic. The power of the webinar format to reach a wide global audience was demonstrated by the attendance of 1374 learners from 100 countries to the first webinar Heart University delivered in May 2020.¹⁶ Such webinars can be subsequently archived and are available for learners to access on e-learning platforms. “Congenital Heart Academy” and the “World University for Paediatric and Congenital Heart Surgery” have created similar webinars on their websites.

International travel was severely curtailed during the pandemic, and cardiovascular conferences turned to online formats to deliver content. Although the virtual conference may never completely replace the traditional in-person conference, adopting hybrid options, whether live online sessions or recorded sessions for later viewing, has several benefits. For both faculty and learners, it reduces costs in both time and travel. It also allows individuals from lower resource settings to attend when such costs can be prohibitively expensive. Notably, the virtual conference has a role in a more sustainable future. Unsurprisingly, Duane et al.⁴¹ calculated that the environmental footprint of a paediatric cardiology webinar was significantly less (4 tons CO₂ equivalent) than the traditional international face-to-face conference (192 tons CO₂ equivalent). Their findings of a 98% reduction in climate change impact when meetings are held virtually make a strong scientific and moral case for the cardiovascular community to not simply return to prepandemic norms. However, this is occurring though some conferences offer a hybrid model. Returning attendees highlight networking, change of scenery, the ability to escape the distractions of work and home life, and the ability to eliminate screen fatigue as just some of the reasons why they prefer in-person conferences.⁴² Careful analysis of online conferences and attention to sound instructional design that may improve the digital experience may help and lead to a more hybrid approach to conference participation.⁴³

Podcasts

Although audio recordings of lectures have been used for medical education for almost 70 years, it is only recently that audio learning in the form of podcasts has taken off. In 2004, the term podcast was derived from the fusion of iPod and broadcast. Though audio podcasts were created before the advent of social media, the coordination of these platforms allowed for an explosion in the utilization of the medium. The current wave of podcast development in medical education is primarily driven by individual medical educators working independently from the traditional model of medical education.⁴⁴ The current generation of learners has a strong appetite for on-demand, asynchronous learning. A 2014 survey of emergency medicine residents found that 35% listened to podcasts regularly, making it the most popular method to acquire new knowledge.⁴⁵

The content delivered via medical podcasts is driven mainly by the interests of the individuals who create them.⁴⁶ This variety extends into formats that range from interviews, discussions, and lectures.⁴⁷ There is no standard length of time for a podcast. A review of the literature found a wide range in the length from 4 to 55 minutes with the median length being approximately 35 minutes.⁴⁷ Although the effectiveness of medical education podcasts has not been studied extensively, there is limited qualitative evaluation suggesting positive attitudes towards this technology. Listeners of the Rounds Table Podcast, a weekly internal medicine podcast that reviews journal articles, felt that the podcast format was a more efficient use of their time and the information was more digestible than traditional formats.⁴⁸ A similar study of internal medicine residents found that they valued the ease of use, engagement, and entertainment values that podcasts afforded them. Interestingly, listeners of podcasts have also reported that it has increased their sense of professional identity.⁴⁹

The wide variety of podcast formats and content seen throughout medicine is also seen within cardiology. These vary from podcasts supported by major cardiology journals (eg, Dr Valentin Fuster's commentaries on the weekly articles within the Journal of American College of Cardiology) to the phenomenon that has been the CardioNerds program, producing podcasts covering a wide range of cardiovascular topics geared to the cardiology trainee. Within congenital cardiology, the most prominent podcast series is Pediheart: Pediatric Cardiology Today created and hosted by Dr Robert Pass. In his podcasts, Dr Pass reviews the latest literature in paediatric and congenital cardiovascular care by interviewing experts in the field. For those medical teachers and educators considering creating a medical education podcast, Berk et al.⁵⁰ highlight the steps that should be taken into consideration.

Video content YouTube learning channels

YouTube is an online video-sharing platform with more than 2.5 billion monthly users who collectively watch more than 1 billion hours of videos each day.⁵¹ After Google search, it is the second most visited site in the world. A recent review of the medical education literature by Curran et al.⁵² noted that many medical, educational YouTube videos exist. Curran et al.⁵² found that despite the significant potential for such material, only a few studies evaluate YouTube videos as a learning resource in medical education. Although sparse, the existing literature suggests that these videos result in high learner satisfaction, confidence, and knowledge levels. With the growing adoption of YouTube in medical education, these studies suggest that promoting the evaluation of video learning in medical education is required to improve future practice. For those individuals considering creating video material for their learners, sound pedagogical advice is outlined by Dong et al.⁵³

Website-based e-learning platforms

An e-learning platform allows learners to interact with learning material in their own time and potentially from anywhere in the world with an internet connection. Such platforms incorporate learning management systems that can create assessment questions, track learners’ progress, and give feedback. One such platform in congenital cardiology is Heart University (https://www.heartuniversity.org/).⁵⁴ Heart University evolved from the Adult Congenital Heart Disease Learning Center, which was created to improve knowledge and understanding of adult CHD among medical physicians and general cardiologists and to overcome the geographic and temporal limitations imposed by the fact that many residency programmes do not have access to adult congenital heart disease (ACHD) specialists.55, 56, 57 A series of video-based lectures with accompanying multiple-choice assessment questions were produced covering the knowledge expected to be known by the general cardiologist. The success of the ACHD learning centre led to the development of the paediatric cardiology learning centre and the current Heart University e-learning platform. With the onset of the COVID pandemic, the need for virtual teaching was accelerated. Heart University noted a marked rise in registered learners to approximately 10,000 from 130 countries. Trainees and fellows who would like to participate in the further development of Heart University can contact the team via email (heartuniversity@cchmc.org).

E-newsletters

Medical online newsletters offer another means of communication between learners and educators. The newsletter content is written and created by an expert and can then be distributed to subscribers interested in the subject matter.⁵⁸ Information in the newsletter usually focuses on a common subject area of interest to the subscribers. Within congenital cardiology, the Congenital Heart International Professionals (CHIP) Network delivers a newsletter that includes a journal watch highlighting and summarizing new research articles in the field. The CHIP Network (https://thechipnetwork.org/about-us/) is a nonprofit and noncommercial organization launched in 2014 whose website is also a rich resource for news in congenital and paediatric cardiology. Heart University also sends out a newsletter to alert subscribers and learners to upcoming educational webinars and courses on the website.

The use of microblogs (Twitter and Mastodon)

Various social media platforms are being used in TEL, but Twitter is currently the most popular platform within the cardiovascular community. Twitter is a microblogging platform that is often used to discuss research articles, conferences, and teach.^28,59, 60, 61, 62 It has become standard practice for journals to have social media editors and ambassadors who use Twitter to promote journal articles. Some studies suggest that the increased number of views of a tweeted article leads to a higher citation, thereby increasing the journal’s impact factor.63, 64, 65

There is an active congenital cardiology presence on Twitter with several physicians, health care providers, programmes, institutions, and patient groups communicating with one another. However, this online presence represents just a small portion of the overall community. Current studies suggest that the actual percentage of cardiologists active on Twitter ranges from 2% to 6%.^66,67 It seems likely that as the percentage of digital native cardiologists grows, social media usage will increase. There is currently little data assessing the use of Twitter within the congenital cardiology community, but a recent paper describing the top 100 Twitter influences in cardiology did not highlight any paediatric or ACHD cardiologists.⁶⁸

Medical educators interested in using Twitter as a platform for teaching can create “tweetorials.”⁶² Through a “collection of carefully threaded tweets aimed at teaching users who engage with them,” “tweetorials” teach core concepts, provide education through narrative, or critically review literature. Tweets can be categorized and targeted to specific groups by using hashtags, which are keywords or phrases. Another microblogging tool, Mastodon is garnering much attention at the time of writing. It is a similar platform to Twitter, but currently, there is no literature describing its use in medical education. Medical educators novice to the use of Twitter who wish to incorporate its use into their educational practice can find useful advice in Forgie et al.⁶⁹ Engagement with this form of social media can be measured and has been used as evidence of digital teaching.^62,70

The use of semiprivate communication applications (WhatsApp, Slack, Viber, Facebook, etc)

In contrast to Twitter, in which users interact with an extensive group of individuals, semiprivate smartphone communication applications such as WhatsApp, Slack, and Viber can facilitate small-group teaching.⁷¹ An invitation to join the group is required in such apps. This then allows a small group of individuals with similar learning goals to form a tutorial group where information can be shared and discussed. Currently, WhatsApp usage is more predominant in the medical education literature, but Slack and Viber are similar platforms that could also be used in the same manner for teaching. These applications also have end-to-end encryption, allowing participants to share images, video, and sound freely. Although there is little current literature on the use of such applications in cardiology per se, WhatsApp has been used in a variety of settings and has been noted to be convenient and popular.^29,33,72 Medical students have used WhatsApp to improve communication channels between themselves and tutors while on clinical attachment. This resulted in increased learning opportunities and provided an improved educational experience.⁷³ Within cardiology, Kochar et al.⁷⁴ have described their experience creating a WhatsApp teaching group. Their description of its use has several learning points for those wishing to emulate the experience.⁷⁴ Initially comprising 1 faculty lead and 14 fellows, this group grew to 42 fellows and 14 faculty over 5 months. Both faculty and learners posted cases. The authors instituted 4 critical guidelines for participation in this text-based learning. To encourage learners, they set the guideline of “What happens on WhatsApp stays on WhatsApp” and that there are no penalties for wrong answers. To prevent burnout and fatigue, they also suggested that posts only be permitted during business hours (08:00-17:00), that there be no more than 5 cases discussed per day, and that once a post is made, a waiting period of 10 minutes should be maintained before providing answers. A survey of participants revealed that 67% of the fellows actively engaged in the forum, and 86% believed that this learning format enhanced their educational experience. Kochar et al.⁷⁴ highlighted the need for faculty and learning champions to keep such initiatives running smoothly. The description of their experience can act as a framework for faculty and learners wanting to adopt such text-based teaching.

Facebook is also a versatile medical education platform that has been used for small group teaching and to facilitate synchronous and asynchronous teaching.^75,76 Teachers wishing to learn more about its potential uses for their educational practice are directed to the review by Todorovic et al.⁷⁷

Image-based social media platforms such as Snapchat, Instagram, and TikTok are also available. Snapchat has been used in radiology resident small group teaching to review imaging and has shown a high degree of engagement from learners.^78,79 TikTok has been used in dermatology teaching and has the added novelty of producing videos of between 15 and 60 seconds, making it an exciting tool for microteaching.80, 81, 82

The Role of Simulation Tools, Virtual and Augmented Reality in Medical Education

Simulation training is a powerful technique to promote deep learning, and its adoption into medical training has been steadily increasing over the last few years.^83,84 Simulation will likely become more prevalent with greater attention to patient safety and increasing demands on trainees’ time.^83,85 Within cardiology commercial simulation models have been developed to instruct the learner in imaging, electrophysiology, and cardiac catheterization.86, 87, 88 It is important to note that the utilization of these technologies requires a significant investment in money and time. A local champion is required to lead a simulation programme as it is labour intensive to set up and maintain the simulator and to train local faculty to develop the programme.^89,90 Deliberate practice and appropriate feedback are essential to delivering optimal training from simulation.

As an extension of simulation training, augmented and virtual reality technology is starting to be used within medical education. 3D printing of anatomic models has been shown to improve learners’ understanding of complex anatomy, and this can also be demonstrated with virtual reality.⁹¹ In the United Kingdom, Great Ormond Street have developed a novel virtual reality platform (VheaRts) and incorporated its use into their local curriculum to explore 3D models of congenital cardiac anatomy.^92,93 It has also been used to teach gross anatomy and to teach resuscitation skills.94, 95, 96 Although still developing, this technology holds exciting potential to improve training and patient care.⁹⁷

The Role of Technology in Medical Education Assessment

E-portfolios have been used for several years, but they are increasingly important in the current era of competency-based medical education programmes.⁹⁸ Digital assessment systems have the potential to improve assessments by making them easier to perform. Collecting data in a digital form aids future synthesis and analysis, providing a more detailed picture of a learner’s performance.⁹⁸ There is also the potential for learners’ assessment data to be combined with patient outcome data to give further insights into learner performance.⁹⁹ Electronic tools can also allow trainees to provide feedback on their learning experience and faculty.¹⁰⁰ Such digital assessments should not replace face to face feedback. The collection of assessment data should be carefully handled, and institutions should protect learners’ data guaranteeing it is private and secure and cannot be used punitively.¹⁰¹ This is especially important to maintain an honest and reflective learning culture.¹⁰¹

Assessing Medical Education Resources Within the Digital Environment

As illustrated throughout this review, physicians and trainees are increasing their knowledge by using several different social media and online resources. These resources, which are often free and accessible to all, circumvent traditional educational quality assurance measures such as peer review.¹⁰² To remedy this, a growing number of quality assurance tools are being developed to assess these resources. A recent rapid review of quality appraisal and assurance techniques for free open-access medical education from Ting et al.¹⁰² provided differing recommendations to readers and educators. They suggested that readers use the Medical Education Translational Resources: Impact and Quality-8 tool when assessing online content.^102,103 For educators, they suggested using the Academic Life in Emergency Medicine, Approved Instructional Resources score to help assess the quality of digital resources.¹⁰⁴ Ting et al.’s¹⁰² review indicates a growing interest in medical education to critique and review online resources. Such tools will be helpful to educators creating content as they will allow them and others to measure the quality of their work and to be credited accordingly.

Digital Scholarship

The incorporation of digital technology into daily educational practice has impacted scholarship. The concept of digital scholarship has evolved to recognize those online educational activities that fall outside of traditional scholarly output measures.¹⁰⁵ As mentioned throughout this review, there are various digital tools that the medical teachers can use in their educational practice. The measurement of educational activity, its quality, and its impact can be assessed in novel ways. In addition to the quality assurance tools previously mentioned, digital analytics can be used. Social media and website-based learning platforms offer a variety of quantitative analytics that the medical teacher can use.^62,106 Promotion and tenure committees now recognize digital scholarship.¹⁰⁷ Husain et al.¹⁰⁸ have produced consensus guidelines for digital scholarship in academic promotion that can inform the reader in how to effectively demonstrate digital scholarship to a promotion committee. Readers wishing to expand their knowledge on TEL and digital scholarship should also explore online resources such as MedEd Portal (https://www.mededportal.org/). This is a MEDLINE-indexed, open-access journal of teaching and learning resources that provides clinician teachers and educators with a forum to find and share resources on TEL and develop an academic portfolio. Materials published on the site are peer-reviewed and can also count as publications.

Medical Professionalism Within the Digital Environment

Discussion on teaching within the digital environment would only be complete with mention of digital professionalism. The public platform that social media provides allows professionals to deliver information to a very broad audience. Individuals need to realize the significance of how their words and message impart on their reputation, institution, and profession. Digital professionalism is essential to include in general medical training, and medical teachers play an important role in modelling optimal digital behaviour for learners and colleagues.¹⁰⁹ Though formal teaching and mentoring in digital professionalism is not widely taught within the medical community, there are initiatives to develop this.^110,111

Digital professionalism comprises 3 distinctive dimensions: proficiency, reputation, and responsibility.¹⁰⁹ The digital professional should be proficient in the appropriate selection and use of technology, ensuring that it is used safely and effectively. They should maintain their reputation by behaving respectfully and appropriately within the digital realm and not disclose any information they would not be comfortable defending in the future. They should be responsible for their actions and develop and maintain effective behaviour within the digital environment. Attention to each of these dimensions aids the teaching, modelling, and assessment of digital professionalism.¹⁰⁹

Conclusion

TEL is now an established part of medical education. Its ready availability and on-demand nature fit well into the busy lives of health care providers and trainees. Various digital tools have been adopted to disseminate medical knowledge from social media messaging systems such as Twitter giving brief up-to-date information on journal articles and conferences to podcasts delivering nuanced and in-depth discussions and interviews. The wide variety of tools and formats available afford significant flexibility to learners and teachers alike. This review has sought to inform the reader about the current use of digital tools and resources in medical education. It has provided concepts to optimize teaching within the digital environment and sought to explore the advantages and challenges these novel tools provide. Methods of measuring the educational quality and impact of digital resources have been described, and mention has been paid to how this pertains to digital scholarship. Finally, the need for digital professionalism is addressed, given the public nature of conducting education in the digital realm. This review will provide some guidance to the reader as they explore the opportunities teaching in the digital environment affords.