Chapter 6 – Wanjiku Kabiru-Musindi

Learning Technologies in Undergraduate Medical Education at Kenyatta University Medical School

Introduction

 http://ku.ac.ke/

Technology in education has permeated the way we learn, teach and assess learning. In my role as a medical educator, I have experienced the impact of technology in the curriculum creation, implementation and assessment. The learners I interact with expect to have multiple modalities to experience learning and desire increasing autonomy in the way they learn. I was born in Kenya and while I have lived most of my life in a developed country, I was curious about the role of learning technologies in medical education in a lower income country.

The purpose of this chapter is to explore the use of technology in undergraduate medical education at Kenyatta University School of Medicine, a relatively new college in a well-established University System. I plan review the types of technology used, the role of technology, the challenges encountered and the potential future directions. In this context, I hope to describe the evolution or integration of technology in medical education over the past decade and the associated influences. I will incorporate any debates encountered regarding the use of technology in this context and the benefits and challenges that have been met.

The use of technology in the context of selected pedagogical models such as in didactic, instructor centered pedagogy, programmed instruction, constructionism, connectivist pedagogical model or mixed approaches will be described where relevant. Furthermore, the use of technology in the teaching of knowledge, skill and attitude will be examined.

The international/global perspectives of technology are an integral part of the use of technology in education in a lower income country. Factors that influenced the implementation of learning technologies, the global partnerships involved, economic and social factors that have driven the process and the impact, if known, of learning technologies on medical education and society will be delineated.

Background

https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html

Kenya is located in Eastern Africa bordering the Indian Ocean. It is about five times the size of Ohio and has a population of almost 47 million. More than 40% of Kenyans are under the age of 15. The country is a former British colony and English is one of the official languages. About 78% of the population over age 15 can read and write.

Kenya is considered a lower middle income country by the World Bank and agriculture is the largest contributor of Gross Domestic Product. In 2015 it was estimated that subscriptions to mobile cellular phones per 100 inhabitants is 82 (teledensity) compared to an average of 35 per 100 inhabitants in the world. There is a boom in the mobile cellular segment that has led to the high teledensity. In addition, 46.5% of the population are internet users.

Undergraduate Medical Education

Interactive map of Kenya with medical schools http://www.gfmer.ch/Maps/Kenya_medical_schools.htm

Kenyatta University is the second largest public university and is located about 20 miles from the capital city, Nairobi. Kenyatta University School of Medicine is one of seven undergraduate medical education institutions. I visited Kenyatta University in 2013 and was interested with the integration of technology in the medical education curriculum. http://medicine.ku.ac.ke/

The School of Medicine is relatively young college and therefore lends itself the advantage of building a curriculum during the growth of technology infrastructure in Kenya. There are about 600 students enrolled in the bachelor of medicine and surgery.  Information regarding the use of education technology with the curriculum for knowledge acquisition, skills or attitudes was limited. Investigation included the medical School website, Research on Open Educational Resources for Development (ROER4D), Eric and Kenyatta University Institutional Repository.

http://medicine.ku.ac.ke/index.php/component/content/article/86-about-us/101-welcome-to-school-of-health

Harun Mugo in 2011 published a white paper on the role of interactive media from a user perspective in another medical school in Kenya. I chose to review this article in this section because it may provide insight into the use of technology at Kenyatta University School of Medicine. Mugo described that while the technology was used to deliver or access content, there was a lack of technology use within the academic curriculum. He noted that students desired interactive multimedia modalities to enhance medical knowledge and skills. This included the introduction of  video recordings of procedures and simulation to provide “real life environment” for enhanced learning and skills. Furthermore, students desired autonomously directed learning enhanced by technology with the teacher as a guide.

Kyalo et al in 2013 described the acceptability of online learning for continuous professional development at another medical school in Kenya. Using a cross sectional study survey design, the authors reported that almost 70% of faculties were not engaged in online learning and nearly 90% reported some basic computer skills. They concluded that there appeared to be emotional factors involved in adoption of online learning. Faculty demonstrated some hesitation and uncertainties about the benefits of online learning.

The role of Prof. Olive Mugenda – the first female Vice Chancellor of a public university in Kenya

Professor Olive Mugenda was the Vice Chancellor of Kenyatta University from 2006 to 2016, the first woman to lead a public university in the African Great lakes area. During her tenure, she committed educational and financial resources to improving the accessibility and quality of education in the university by introducing information and communication technology (ICT).

Partnership for Higher Education (PHEA) is a joint venture with Carnegie Corporation of New York, The Ford Foundation, The John D. and Catherine T. MacArthur Foundation, the Rockefeller Foundation among others. PHEA provided Prof. Mugenda the opportunity to explore what technology could mean for Kenyatta University. She successfully convinced the University of the strategic importance of ICT, as well as the necessity of allocating requisite funding. In 2007, the university began to focus on enhancing technology infrastructure, hardware and administration systems with a focus on using technology for e-learning.

In a white paper at a University Leaders Forum in Cape Town in 2006, Prof. Mugenda described the ICT initiatives at Kenyatta University and the collective university roles in ICT and economic development. She described the 2003 launch of open Learning and teaching. This resulted in increased access and enrollment at the University. Student enrollment doubled from 10,000 in 2000/2001 to 21,000 in 2005/2006. Over 4000 of these students were enrolled in open learning programs. in 2005, the e-Learning management system (LMS), Blackboard software introduced. Prof. Mugenda described a 10 year strategic and Vison plan and policy that was the foundation of the ICT initiative within the university.

The Digital School of Virtual and Open Learning (DSVOL) at Kenyatta University was launched in 2014 with the goal of use technology in education to provide flexibility in learning modalities for training and professional development. While there is emerging data on the use of technology for several undergraduate and master’s level programs, there is a paucity of data on the use of technology in undergraduate medical education.

Literature review regarding use of technology in pedagogical models

Makokha et al in 2006 described the status of eLearning in public universities in Kenya. Social challenges encountered in the implementation and utilization of technology in education included a lack of national and university e-learning policies, lack of faculty and student development and low number of courses offered online.

The pedagogical models appeared to be poorly defined as a result of a lack of faculty development. In their 2016 study, about 1/3 of faculty in public universities used e-learning as a mode of pedagogy that was mostly restricted to dissemination of data and a smaller proportion used technology to provide continuous assessment tests. Over 1/3 of students in this survey used the e-learning tools to download materials, submit assignments and complete assessments. Kenyatta University was identified as having a higher proportion of students, 60%, when compared to other universities, with students engaged in some form of online learning. Kenyatta University had more than double the number of interactive modules when compared to the six other public universities in the survey.

This survey suggests that the incorporation of technology into various pedagogical styles may still be in the early states in public universities in Kenya. Kenyatta University appears to be leading in the implementation of ICT in education. However, the use of technology as more than a dissemination tool is a complex challenge that requires faculty and student development and building the complementary infrastructure to support progression of learning.

National perspectives

Social and Economic Factors

The story of education technology at Kenyatta University is woven in the social and economic fabric of social and economic factors in the local and national region. Disparities in access to education, income, security and healthcare are factors that impact the growth of learning technologies. Public undergraduate education is subsidized by the government however; access is limited by the university infrastructure. About  30% of eligible candidates are able to matriculate into university, whether private or public (Mulongo, 2013). Furthermore, ability to matriculate is impacted by a student’s socio-economic status, gender and region. This inequality in access to education has the downstream effect on stunting economic growth across the regions that need it the most within Kenya.

ICT requires infrastructure and reliable connectivity in order to thrive and blossom. Mobile phones are ubiquitous and the number of internet users is increasing. Nonetheless, Kenya does not have adequate connectivity and network infrastructure. Economic constraints such as the lack of communication hardware and infrastructure hinder connectivity and progress in this region.

The Ministry of Health in Kenya had spearheaded the implementation of standard electronic medical records across facilities. This introduces additional challenge of providing medical students electronic health training to optimize health care delivery. Yet another social and economic factor in an undergraduate medical education system in the earlier states of technology integration. (Kang’a, 2016)

Kenya’s Vision 2030 (http://www.vision2030.go.ke/) seeks to address the social and economic challenges associated with incorporating technology in learning in a granular and effective way.

Global partnerships

Kenyatta University has benefited from partnerships and funding from several international interests. There is a need for trained professionals to provide faculty development for effective use of educational technological resources. Research regarding the implementation of ICT or best practices is also lagging behind. There are a plethora of partnerships that range from international aid organizations, universities and for- profit institutions. The Kenyatta University-Syracuse University Partnership sought to provide faculty development with a focus on technology from 2011 to 2014 and was funded by United States Agency International Development, one of many USAID projects. The Partnership for Higher Education in Africa, a joint project of seven American non-profit foundations, has provided Kenyatta university grants to accelerate the academic reform and technology transformation process.  Medical Education Partnership Initiative (MEPI), a Fogarty program of the National Institutes of Health,  funds institutions in sub-Saharan Africa to enhance models of medical education.

Assessment of sources

Primary sources of data were peer reviewed and non-peer reviewed articles collated from databases including Eric, ROER4D, EBSCOhost and Kenyatta University Institutional Repository. Mesh terns included ‘Kenya, medical, education, technology, Kenyatta and ICT’. Organizational websites provided background information and additional resources to corroborate information gathered from primary or secondary sources. White papers and news articles published on the internet were included as secondary sources of information.

Strengths of history

Based on the literature search, there does not appear to be a comprehensive published evaluation of ICT at the university and paucity of data on ICT in undergraduate medical education. This history has uncovered an area of need with regards to collating information about education technology in this university in a systematic and accurate way. The sources are diverse but not easily accessible. The strength of this history is in placing on a spotlight on the need for a peer reviewed and well documented history that addresses the research question.

Limitations

There was a paucity of evidence based literature on the use of technology to teach undergraduate medical education at Kenyatta University. Much of the literature focussed on information and communication technology at the institution as a whole. Therefore, the specific focus of the research question regarding the role of technology in teaching clinical education was not adequately addressed.

Conclusion

The University has made much progress and invested in information and communication technologies to enhance e-learning opportunities. There are numerous challenges including faculty and staff development in basic computing skills, building infrastructure and increasing computing devices. Other challenges include addressing security issues, access to libraries and computing centers and support services for digital services. Based on the literature review, it would appear that the university is building a good foundation and has yet a long road ahead in achieving its vision.

Future Directions

Technology as a delivery system for educational content is but a step in realizing the full potential of this modality as a learning machine. Further investigation regarding the research question may require collaborating with key players in the KU School of Medicine to obtain and publish further information about the history of technology in undergraduate medical education at this institution. As a medical educator with interest in utilizing learning technologies to teach clinical skills, my goal is to collaborate with medical educators in lower income countries in the future to enhance and advance the way we teach clinical medicine.

References

1. https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html
2. http://www.gfmer.ch/Maps/Kenya_medical_schools.htm
3. http://www.ku.ac.ke/ict/about-us/history
4. http://7.https://www.ndsu.edu/fileadmin/vpedgo/DR._ONDIGI_LINKAGE_PRESENTATION_USA.pdf
5. http://medicine.ku.ac.ke/index.php/component/content/article/86-about-us/101-welcome-to-school-of-health
6. Mugo, Harun Kamau. The Role of Interactive Multimedia (IMM) Resourses in Enhancing Delivery of Medical Information and Knowledge to Student Users: A Case Study of Medical School, University Of Nairobi. 2001 http://ir-library.ku.ac.ke/handle/123456789/1781
7. Kyalo IW,, Hopkins S. Exploring the Acceptability of Online Learning for Continuous Professional Development at Kenya Medical Training Colleges. The Electronic Journal of E-learning 2013; 11(2):82-90
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17. Kenya Vision 2030. http://www.vision2030.go.ke/
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22. Partnership for Higher Education http://www.foundation-partnership.org/index.php
23. DSVOL http://www.ku.ac.ke/dsvol/index.php/about-us.html
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    Databases

    • EBSCOhost http://web.a.ebscohost.com/ehost/results?sid=2dc61496-299e-4612-ab3c-d4e1abf6c769%40sessionmgr4010&vid=1&hid=4207&bquery=(kenya+AND+medical+AND+education)&bdata=JmRiPWVoaCZ0eXBlPTAmc2l0ZT1laG9zdC1saXZl
    • Research on Open Educational Resources for Development http://roer4d.org/
    • Kenyatta University Repository http://ir-library.ku.ac.ke/
    • Institute of Education https://eric.ed.gov/?