The University of Vermont College of Medicine was established in 1822 as the nation’s seventh medical school. It is one of 125 medical schools in the country and is ranked in the top third of U.S. medical schools for research grants per faculty member. It is a hallmark of traditional face-to-face education, like all colleges of medicine.

In August 2003, after seven years in the making, the College of Medicine launched a new integrated curriculum that merged tradition and innovation. Part of this curriculum change included the development of an 18-month Foundations-oriented program (it typically takes seven-years to complete the MD/PhD program) that puts students in a series of courses that emphasize basic science in the context of clinically relevant issues, with laboratory experiences over two summer sessions. After completing the Foundations courses, students then take a clinical clerkship block (e.g. Medicine, Psychiatry, and Neurology).

In addition to the new curriculum, for the first time in the College of Medicine’s history, incoming students were given laptops and have been introduced to educational technologies in a new hybrid learning environment loaded with reusable learning objects, virtual reality models, streaming audio and video, high-stakes online exams, and more.

The development of the educational technology part of all this started about six months prior to the August 2003 launch of the new integrated curriculum through the creation of COMET (College of Medicine Education Tools), a team of people responsible for creating "an integrated teaching and learning environment to foster the productivity and growth of world class medical students, graduates and faculty."

COMET Manager Jill Jemison calls this period of growth and transformation "a nexus of change" in which the departments within the College of Medicine came together and saw the integration of educational technologies as "this really amazing opportunity."

She enthusiastically describes the growth of COMET as "the art of the possible" that began with the basics of creating online syllabi, lecture notes and PowerPoints and grew into the development of sophisticated online learning modules, particularly inside a 31-hour imaging component of the overall curriculum, and then further spread out from there.

"We infused visual learning inside physical learning," she says, explaining that COMET’s work is ongoing and in a state of continuous improvement.

Overall, COMET and the College of Medicine are a great example of how a sophisticated and wide-spread hybrid/blended learning environment can be created inside a traditional education system over a relatively short period of time, provided that the right infrastructure and support philosophies are in place.

The COMET infrastructure includes a team comprised of Jemison, 2.5 multimedia developers, 1.5 system administrators, one database person, one technical manager, access to a medical photography department with a photographer and videographer, and the support of a College of Medicine Information Technology Department. Their philosophy is basically one of inclusion and based on a "buy, build or borrow" mentality, whereby COMET advances the educational desires of the College of Medicine faculty and students. "We facilitate what they want," says Jemison, "and we articulate best practices. I will do research for them and bring them a bunch of assets. For example, we bought an entire database of cases that the faculty members can customize; we bought a bunch of image data banks that they can add to their lectures."

Jemison adds that faculty are encouraged to explain their teaching concepts to the COMET staff so that they can find or create educational assets, typically in the from of multimedia tools, that can be fitted into courses. Some of the interesting learning tools that COMET creates include animated lessons and modules, created with Macromedia Flash, in which students are told specifically what they should learn, how long it will take to go through the interactive images and diagrams that have been built into the lesson/module, and then quizzed on what they should have learned.

The Interactive images and diagrams created by COMET - such as one on the structure of the eye, another on autogenic control of blood flow, and another on how to identify radiological images of normal and diseased images adrenal glands - provide students with a hands-on way to learn difficult concepts. Contrary to linear animations, users determine how the animation behaves and can see the cause and effect relationships first-hand.

COMET also creates 3D and virtual reality models that are put online, such as an online virtual explorer, created in Macromedia Shockwave, that allows viewers to click, drag and rotate around three-dimensional images of the main structures of the knee.

COMET also creates a variety of special projects, including web-based applications, such as a "Case Builder" tool that allows faculty to author and deploy case studies in the popular Problem Based Learning Module (PBLM) format, and "Nutrient Analyzer" that uses a database of food nutritional information provided by the USDA. Users enter foods consumed in a day and get detailed information on nutritional totals.

Overall, the addition of such educational technology tools have helped to move the conversations COMET has with the College of Medicine faculty toward a hybrid model, says Jemison. "We ask them what are the concepts you want to teach? What are the objectives that the students need to learn in the online environment, and what are the individual assets that we are going to wrap together? Either we are going to put them into a multimedia format, or maybe they are static and time released. Maybe they are journal articles that have notes embedded in them from the faculty member. Maybe it is just a small animation - a five-slide power point module, but it is contextualized to say that you need to review it; here are the learning objectives; here is a post module quiz so that you know that you learned what you needed to learn."

Students interact with these self-directed educational tools at their own speed on their own time prior to attending face-to-face lectures, allowing faculty to focus their face-to-face time more efficiently. Jemison tells faculty that if they find themselves drawing on a board and using their hands a lot to describe something during their lecture, "that could be converted to multimedia. Come here and move your hands in front of us, and let’s see if we can mock something up for you."

Another big change that was incorporated into the new integrated curriculum was moving high-stakes test, that are common within all colleges of medicine, to the online environment. Exams are delivered inside Blackboard and integrated with two additional products, SecureExam Browser and Respondus. SecureExam Browser is a security application that locks down any web-based tool or platform, transforming school specific applications into secure testing vehicles. It creates a secure test environment by locking down the Windows operating system on the test-taker’s laptop or desktop computer, only allowing access to the test application. Respondus is a test authoring and management tool. Jemison calls the conversion to online testing a "massive, but very validating experience. This is all framed in the context of how our medical students are going to face their licensing exams because they take them on a computer. They are now unflappable when it comes to taking online exams."

Finally, Jemison explains that "if anyone had come to the COMET staff and said ‘we are thinking about changing our curriculum, moving to laptops, putting in a hybrid learning system, and having all exams online,’ we would have all said ‘don’t do it.’" However, "we did not know any better at the time, so we jumped in collectively. We have a great working team. We sit hand and glove with the technology people. I sit on the curriculum implementation team. I meet with the manager of the office of medical education. I work with the director of standardized patients. We all meet (regularly). We are good friends and colleagues. A lot has happened because of our relationships. There were not a lot of barriers."

University of Vermont College of Medicine
www.med.uvm.