Audience
Response
Systems

Fam Med. 2005 Jan;37(1):12-4.
!-->Use of an audience response system to augment interactive learning.
Latessa R, Mouw D.

Mountain Area Health Education Center, 118 W.T. Weaver Boulevard, Asheville, NC 28804, USA. robyn1@mtn.ncahec.org

BACKGROUND AND OBJECTIVES: Little data exist about the use of an Audience Response System (ARS) as an interactive educational tool in medical teaching. The goals of our pilot study were to determine whether an ARS can enhance educational experiences of health care providers. METHODS: The learners in the study were mainly physicians, and the educational topic was treating self, family, and friends. RESULTS: The learners reported that the ARS made the presentation more fun, helped them be more attentive, and allowed them to learn more than in traditional lecture formats. CONCLUSIONS: An ARS has potential as a teaching tool in this setting.

Fam Med. 2004 Jul-Aug;36(7):496-504.
Audience response system: effect on learning in family medicine residents.
Schackow TE, Chavez M, Loya L, Friedman M.

Family Practice Residency Program, St Elizabeth Hospital, and Department of Family Medicine, University of Illinois at Chicago, 60622, USA. schackow@uic.edu.

BACKGROUND AND OBJECTIVES: The use of an electronic audience response system (ARS) that promotes active participation during lectures has been shown to improve retention rates of factual information in nonmedical settings. This study (1) tested the hypothesis that the use of an ARS during didactic lectures can improve learning outcomes by family medicine residents and (2) identified factors influencing ARS-assisted learning outcomes in family medicine residents. METHODS: We conducted a prospective controlled crossover study of 24 family medicine residents, comparing quiz scores after didactic lectures delivered either as ordinary didactic lectures that contained no interactive component, lectures with an interactive component (asking questions to participants), or lectures with ARS. RESULTS: Post-lecture quiz scores (maximum score 7) were 4.25 +/- 0.28 (61% correct) with non-interactive lectures, 6.50 +/- 0.13 (n=22, 93% correct) following interactive lectures without ARS, and 6.70 +/- 0.13 (n=23, 96% correct) following ARS lectures. The difference in scores following ARS or interactive lectures versus non-interactive lectures was significant (P <.001). Mean quiz scores declined over 1 month in all three of the lecture groups but remained highest in the ARS group. Neither lecture factors (monthly sequence number) nor resident factors (crossover group, postgraduate training year, In-Training Examination score, or post-call status) contributed to these differences, although postcall residents performed worse in all lecture groups. CONCLUSIONS: Both audience interaction and ARS equipment were associated with improved learning outcomes following lectures to family medicine residents.

Bibliographic
searching

 J Gen Intern Med. 2001 Dec;16(12):838-44.
Resident utilization of information technology.
Cabell CH, Schardt C, Sanders L, Corey GR, Keitz SA.

Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA. chris.cabell@duke.edu

OBJECTIVE: To determine if a simple educational intervention can increase resident physician literature search activity. DESIGN: Randomized controlled trial. SETTING: University hospital-based internal medicine training program. PATIENTS/PARTICIPANTS: Forty-eight medical residents rotating on the general internal medicine service. INTERVENTIONS: One-hour didactic session, the use of well-built clinical question cards, and practical sessions in clinical question building. MEASUREMENTS AND MAIN RESULTS: Objective data from the library information system that included the number of log-ons to medline, searching volume, abstracts viewed, full-text articles viewed, and time spent searching. Median search activity as measured per person per week (control vs intervention): number of log-ons to medline (2.1 vs 4.4, P <.001); total number of search sets (24.0 vs 74.2, P <.001); abstracts viewed (5.8 vs 17.7, P=.001); articles viewed (1.0 vs 2.6, P=.005); and hours spent searching (0.8 vs 2.4, P <.001). CONCLUSIONS: A simple educational intervention can markedly increase resident searching activity.

Decision
Support

JAMA. 1999 Nov 17;282(19):1851-6.

Enhancement of clinicians' diagnostic reasoning by computer-based consultation: a multisite study of 2 systems.
Friedman CP, Elstein AS, Wolf FM, Murphy GC, Franz TM, Heckerling PS, Fine PL, Miller TM, Abraham V.

Center for Biomedical Informatics and Department of Medicine, University of Pittsburgh, PA 15213, USA. cpf@cbmi.upmc.edu

CONTEXT: Computer-based diagnostic decision support systems (DSSs) were developed to improve health care quality by providing accurate, useful, and timely diagnostic information to clinicians. However, most studies have emphasized the accuracy of the computer system alone, without placing clinicians in the role of direct users. OBJECTIVE: To explore the extent to which consultations with DSSs improve clinicians' diagnostic hypotheses in a set of diagnostically challenging cases. DESIGN: Partially randomized controlled trial conducted in a laboratory setting, using a prospective balanced experimental design in 1995-1998. SETTING: Three academic medical centers, none of which were involved in the development of the DSSs. PARTICIPANTS: A total of 216 physicians: 72 at each site, including 24 internal medicine faculty members, 24 senior residents, and 24 fourth-year medical students. One physician's data were lost to analysis. INTERVENTION: Two DSSs, ILIAD (version 4.2) and Quick Medical Reference (QMR; version 3.7.1), were used by participants for diagnostic evaluation of a total of 36 cases based on actual patients. After training, each subject evaluated 9 of the 36 cases, first without and then using a DSS, and suggested an ordered list of diagnostic hypotheses after each evaluation. MAIN OUTCOME MEASURE: Diagnostic accuracy, measured as the presence of the correct diagnosis on the hypothesis list and also using a derived diagnostic quality score, before and after consultation with the DSSs. RESULTS: Correct diagnoses appeared in subjects' hypothesis lists for 39.5% of cases prior to consultation and 45.4% of cases after consultation. Subjects' mean diagnostic quality scores increased from 5.7 (95% confidence interval [CI], 5.5-5.9) to 6.1 (95% CI, 5.9-6.3) (effect size: Cohen d = 0.32; 95% CI, 0.23-0.41; P<.001). Larger increases (P = .048) were observed for students than for residents and faculty. Effect size varied significantly (P<.02) by DSS (Cohen d = 0.20; 95% CI, 0.08-0.32 for ILIAD vs Cohen d = 0.45; 95% CI, 0.31-0.59 for QMR). CONCLUSIONS: Our study supports the idea that "hands-on" use of diagnostic DSSs can influence diagnostic reasoning of clinicians. The larger effect for students suggests a possible educational role for these systems.

Med Educ. 2003 May;37(5):429-33.
Learning support for the consultation: information support and decision support should be placed in an educational framework.
Robinson P, Purves I, Wilson R.

Sowerby Centre for Health Informatics, University of Newcastle, UK. p.j.robinson@ncl.ac.uk

BACKGROUND: Advances in information technology mean that it is now possible to provide contextually relevant, evidence-based information during the course of the consultation. As a consequence, the practitioner has to consider the new information (from the computer) in the situation of the present consultation and in the light of his or her own experience. This task has to be carried out in a short time, in the presence of the patient. METHOD: Drawing on experience of the development of one decision support system, this paper places that task for the practitioner in an educational framework. We begin by reviewing theories of professional experience and knowledge and go on to look at schema theory and the role of cognitive dissonance and reflection in learning. CONCLUSION: This paper considers the provision of real time decision support in the light of learning and the experienced practitioner. We conclude that framing the implementation of decision support in this way provides useful insights. The key process is learning by the practitioner, in the course of the consultation. This process should be supported by decision support and information support software. There are implications here for the design of such software, and also for the way in which practitioners are trained to use it.

Digital
images

J Pathol. 2004 Dec;204(5):613-8.
Virtual microscopy for learning and assessment in pathology.
Kumar RK, Velan GM, Korell SO, Kandara M, Dee FR, Wakefield D.

Department of Pathology, University of New South Wales, Sydney, NSW 2052, Australia. R.Kumar@unsw.edu.au

Virtual slides are high-magnification digital images of tissue sections, stored in a multi-resolution file format. Using appropriate software, these slides can be viewed in a web browser in a manner that closely simulates examination of glass slides with a real microscope. We describe the successful implementation of teaching microscopic pathology with virtual slides and, for the first time, their use in summative assessment. Both students and teaching staff readily adapted to the use of virtual microscopy. Questionnaire feedback from students strongly indicated that virtual slides solved a number of problems in their learning, while providing good to excellent image quality. A deliberate policy of allocating two students per workstation promoted collaboration and helped to maintain interest in microscopic pathology. The use of a secure browser facilitated assessment using virtual slides, with no technical or security issues arising despite high peak demand. The new Medicine programme at the University of New South Wales will exclusively utilize virtual microscopy for the study of both histology and histopathology. We believe that the use of high-quality learning resources such as virtual slides can ensure that microscopic examination of tissues remains both meaningful and interesting. Copyright (c) 2004 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Fam Med. 2004 Feb;36(2):89-91.
Digital technology enhances dermatology teaching in a family medicine residency.
Fawcett RS, Widmaier EJ, Cavanaugh SH.

York Hospital Family Practice Residency, York, PA 17405, USA. rfawcett@wellspan.org

BACKGROUND AND OBJECTIVES: Exposure of family medicine residents to dermatology is inconsistent. We encourage residents to record skin lesions using digital photographs, which are made into posters displaying clinical information. METHODS: Residents submit diagnoses for each poster, and correct diagnoses are then posted. A semiannual 10-case quiz compares the scores of participating residents with nonparticipants. RESULTS: On the first three semiannual quizzes, participants and nonparticipants have scored, respectively, 68% and 48%, 73% and 55%, and 77% and 65%. CONCLUSIONS: Residents' ability to make dermatologic diagnoses improved from participation in an inexpensive, easily administered program using digitally displayed skin problems.

Information
technology
adoption

Interactive
White Boards

Ann Surg. 2004 Apr;239(4):567-73.
Digital video capture and synchronous consultation in open surgery.
Rafiq A, Moore JA, Zhao X, Doarn CR, Merrell RC.

Medical Informatics and Technology Applications Consortium, Department of Surgery, Virginia Commonwealth University, Richmond 23298, USA. arafiq@hsc.vcu.edu

OBJECTIVE: To achieve real-time or simultaneous surgical consultation and education to students in distant locations, we report the successful integration of robotics, video-teleconferencing, and intranet transmission using currently available hardware and Internet capabilities. SUMMARY BACKGROUND DATA: Accurate visualization of the surgical field with high-resolution video imaging cameras such as the closed-coupled device (CCD) of the laparoscope can serve to insure clear visual observation of surgery and share the surgical procedure with trainees and, or consultants in a distant location. Prior work has successfully applied optics and technical advances to achieve precise visualization in laparoscopy. METHODS: Twenty-five thyroidectomy explorations in 15 patients were monitored and transmitted bidirectionally with audio and video data in real-time. Remotely located surgical trainees (n = 4) and medical students (n = 3) confirmed 7 different anatomic landmarks during each surgical procedure. The study used the Socrates System (Computer Motion, Inc. [CMI], Goleta, CA), an interactive telementoring system inclusive of a telestration whiteboard, in conjunction with the AESOP robotic arm and Hermes voice command system (CMI). A 10-mm flat laparoscopic telescope was used to capture the optical surgical field. As voice, telestrator, or marker confirmed each anatomic landmark the image parameters of resolution, chroma (light position and intensity), and luminance were assessed with survey responses. RESULTS: Confirmation of greater than 90% was achieved for the majority of relevant anatomic landmarks, which were viewed by the remote audience. CONCLUSION: The data presented in this study support the feasibility for mentoring and consultation to a remote audience with visual transmission of the surgical field, which is otherwise very difficult to share. Additionally, validation of technical protocols as teaching tools for robotic instrumentation and computer imaging of surgical fields was documented.

Med Educ. 2004 Jun;38(6):599-608.
Learning management systems: technology to measure the medical knowledge competency of the ACGME.
Johnson CE, Hurtubise LC, Castrop J, French G, Groner J, Ladinsky M, McLaughlin D, Plachta L, Mahan JD.

Columbus Children's Hospital, Columbus, Ohio, USA. carl.johnson@mssm.edu

AIMS: We report how the learning management system (LMS) Web Course Tools (WebCT) was used to design, implement and evaluate the web-based course "Principles of Ambulatory Paediatrics", taken by paediatric residents during an ambulatory block rotation. This report also illustrates how WebCT can be used to measure the medical knowledge competency required by the Accreditation Council for Graduate Medical Education (ACGME). METHODS: Eighty paediatric residents completed a 1-month outpatient rotation between July 1, 2001 and June 30, 2002. During this rotation residents were required to complete 4 modules in asthma, otitis media, gastroenteritis and fever, respectively. Each module was evaluated using a standard questionnaire. RESULTS: Completion rates for the required modules ranged from 64-72%. Residents in all 3 years of training showed improvement between the pre- and post-test scores for each module, except for postgraduate Year 2 residents in the asthma module. Most residents somewhat agreed, agreed or strongly agreed that the module components were useful and that the experience of completing the modules would improve their ability to take care of patients. CONCLUSIONS: The LMS WebCT is an innovative and adaptable approach for designing a web-based course for primary care education in paediatrics. The LMS addresses the educational needs of both a clinical division and a residency programme. The LMS also provides an information technology infrastructure to measure the medical knowledge competency required by the ACGME.

Multiple Methods

Acad Emerg Med. 2004 Nov;11(11):1149-54.
See one, do one, teach one: advanced technology in medical education.
Vozenilek J, Huff JS, Reznek M, Gordon JA.

Evanston-Northwestern Health Care Center for Simulation Technology Academics and Research, Division of Emergency Medicine, 2650 Ridge Avenue, Evanston, IL 60201, USA. vozonline@ameritech.net

The concept of "learning by doing" has become less acceptable, particularly when invasive procedures and high-risk care are required. Restrictions on medical educators have prompted them to seek alternative methods to teach medical knowledge and gain procedural experience. Fortunately, the last decade has seen an explosion of the number of tools available to enhance medical education: web-based education, virtual reality, and high fidelity patient simulation. This paper presents some of the consensus statements in regard to these tools agreed upon by members of the Educational Technology Section of the 2004 AEM Consensus Conference for Informatics and Technology in Emergency Department Health Care, held in Orlando, Florida. Findings: Web-based teaching: 1) Every ED should have access to medical educational materials via the Internet, computer-based training, and other effective education methods for point-of-service information, continuing medical education, and training. 2) Real-time automated tools should be integrated into Emergency Department Information Systems [EDIS] for contemporaneous education. Virtual reality [VR]: 1) Emergency physicians and emergency medicine societies should become more involved in VR development and assessment. 2) Nationally accepted protocols for the proper assessment of VR applications should be adopted and large multi-center groups should be formed to perform these studies. High-fidelity simulation: Emergency medicine residency programs should consider the use of high-fidelity patient simulators to enhance the teaching and evaluation of core competencies among trainees. CONCLUSIONS: Across specialties, patient simulation, virtual reality, and the Web will soon enable medical students and residents to... see one, simulate many, do one competently, and teach everyone.

Am J Obstet Gynecol. 2003 Mar;188(3):849-53.
Medical education as a science: the quality of evidence for computer-assisted instruction.
Letterie GS.

Department of Obstetrics and Gynecology, University of Washington, Seattle, USA.

OBJECTIVE: A marked increase in the number of computer programs for computer-assisted instruction in the medical sciences has occurred over the past 10 years. The quality of both the programs and the literature that describe these programs has varied considerably. The purposes of this study were to evaluate the published literature that described computer-assisted instruction in medical education and to assess the quality of evidence for its implementation, with particular emphasis on obstetrics and gynecology. STUDY DESIGN: Reports published between 1988 and 2000 on computer-assisted instruction in medical education were identified through a search of MEDLINE and Educational Resource Identification Center and a review of the bibliographies of the articles that were identified. Studies were selected if they included a description of computer-assisted instruction in medical education, regardless of the type of computer program. Data were extracted with a content analysis of 210 reports. The reports were categorized according to study design (comparative, prospective, descriptive, review, or editorial), type of computer-assisted instruction, medical specialty, and measures of effectiveness. RESULTS: Computer-assisted instruction programs included online technologies, CD-ROMs, video laser disks, multimedia work stations, virtual reality, and simulation testing. Studies were identified in all medical specialties, with a preponderance in internal medicine, general surgery, radiology, obstetrics and gynecology, pediatrics, and pathology. Ninety-six percent of the articles described a favorable impact of computer-assisted instruction in medical education, regardless of the quality of the evidence. Of the 210 reports that were identified, 60% were noncomparative, descriptive reports of new techniques in computer-assisted instruction, and 15% and 14% were reviews and editorials, respectively, of existing technology. Eleven percent of studies were comparative and included some form of assessment of the effectiveness of the computer program. These assessments included pre- and posttesting and questionnaires to score program quality, perceptions of the medical students and/or residents regarding the program, and impact on learning. In one half of these comparative studies, computer-assisted instruction was compared with traditional modes of teaching, such as text and lectures. Six studies compared performance before and after the computer-assisted instruction. Improvements were shown in 5 of the studies. In the remainder of the studies, computer-assisted instruction appeared to result in similar test performance. Despite study design or outcome, most articles described enthusiastic endorsement of the programs by the participants, including medical students, residents, and practicing physicians. Only 1 study included cost analysis. Thirteen of the articles were in obstetrics and gynecology. CONCLUSION: Computer-assisted instruction has assumed to have an increasing role in medical education. In spite of enthusiastic endorsement and continued improvements in software, few studies of good design clearly demonstrate improvement in medical education over traditional modalities. There are no comparative studies in obstetrics and gynecology that demonstrate a clear-cut advantage. Future studies of computer-assisted instruction that include comparisons and cost assessments to gauge their effectiveness over traditional methods may better define their precise role.

Acad Med. 2006 Mar;81(3):213-23. 
Guidelines for cognitively efficient multimedia learning tools: educational strategies, cognitive load, and interface design.
Grunwald T, Corsbie-Massay C.

Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA. grunwald@usc.edu

The field of medical education has consistently embraced new technologies in an attempt to improve the training process of our nation's doctors. There are thousands of available multimedia learning tools (MMLTs), but no quantitative scale exists to assess their efficiency and overall educational value. The authors review existing literature and suggest guidelines for creating cognitively efficient medical MMLTs. In 2004, the authors searched PubMed to identify articles regarding mutimedia learning, including educational strategies and existing MMLTs. The primary search terms included "multimedia learning," "cognitive load," and "surgical education." The resulting articles were evaluated and reviewed for educational and interface design techniques, and a list of common features was generated. The authors cross-referenced these features with extensive theories of cognitive load to create a list of methods that demonstrated improved learning. Techniques common to existing MMLTs often neglect to account for theories of cognitive load and may be detrimental to the learning process. The authors outlined important educational considerations and guidelines for the design of effective MMLTs. With large resources being spent to produce MMLTs, more research is necessary to establish successful design techniques. The authors summarized existing research, outlined educational issues in multimedia design, and proposed future directions for study.

American Journal of Obstetrics and Gynecology April 2006, 194(4):1064-1069
To the Point: Reviews in medical education online computer assisted instruction materials

Maya Hammoud MD, Larry Gruppen PhD, Sonya S. Erickson MD, Susan M. Cox MD, Eve Espey MD, Alice Goepfert MD, Nadine T. Katz MD and for the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee

Fam Med. 2005 Jan;37(1):27-9.
Comparison of knowledge acquired by students in small-group seminars with and without a formal didactic component.
Xakeliis GC, Rickner S, Stevenson F.

Department of Family Medicine, University of California-Davis, 4860 Y Street, Sacramento, CA 95819, USA. george.xakeliis@ucdmc.ucdavis.edu

BACKGROUND AND OBJECTIVES: This study compared student knowledge gain from using a CD-ROM-based lecture only, from attending small-group seminars only, and from using a combination of both methodologies. METHODS: During a required second-year case-based seminar about falls in the elderly, one third of the 96 second-year medical students were randomized into each of three study groups. One group viewed a 12-minute CD-ROM didactic presentation on falls in the elderly, another group participated in the small-group seminars, and the third group did both. All three groups took a pretest and posttest to assess any change in knowledge. The timing of the viewing of the CD-ROM and of the pretests and posttests were varied to test the effects of each modality separately and of the modalities combined. RESULTS: The difference between the pretest and the posttest scores was significantly different among groups. Post hoc analysis showed that the change from pretest to posttest was greater for students who participated in the combined modalities than in those who viewed the CD-ROM only or participated in case-based seminars only. DISCUSSION: The addition of a 12-minute CD-ROM on the topic to a small-group seminar appears to increase student knowledge of the material being taught.

J Pain Symptom Manage. 2004 Apr;27(4):333-42.
Equipping medical students to manage cancer pain: a comparison of three educational methods.
Sloan PA, Plymale M, LaFountain P, Johnson M, Snapp J, Sloan DA.

Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, 40536-0293, USA.

A Cancer Pain Structured Clinical Instruction Module (SCIM), with skills stations incorporating actual cancer patients, has been developed to enhance cancer pain education among our medical students. The Cancer Pain SCIM has not been compared with more traditional cancer pain education, thus the purpose of this study was to assess the effectiveness and durability of three educational methods for teaching cancer pain management to medical students compared with a control group. Four consecutive rotations of 32 third-year medical students participated in one of four cancer pain educational strategies: 1) control group with no formal cancer pain education, 2) CD-ROM self-instruction module on cancer pain, 3) a 2-hour Cancer Pain SCIM plus the CD-ROM information, and 4) Cancer Pain SCIM, plus CD-ROM, plus a structured home-hospice patient visit. The effectiveness of the educational interventions was assessed at 4 months post-instruction using a 4-component Cancer Pain Objective Structured Clinical Examination (OSCE). The main findings of this educational study are that: 1) all three educational groups performed better on the Cancer Pain OSCE at 4 months than the control group (P<0.05); 2) medical students receiving structured education on cancer pain management significantly out-performed students at 4 months compared with control or traditional instructional formats; 3) students receiving the Cancer Pain SCIM plus home visit performed highest on the pain management, physical exam, and communication stations of the OSCE; and 4) the SCIM format of education shows durability as assessed at 4 months post-instruction. The Cancer Pain SCIM has a unique potential to substantially improve the quality of cancer pain education.

Med Educ. 2004 Feb;38(2):145-57.
Use of an innovative video feedback technique to enhance communication skills training
Roter DL, Larson S, Shinitzky H, Chernoff R, Serwint JR, Adamo G, Wissow L.

Department of Health Policy and Management, Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 750, Baltimore, Maryland, USA. droter@jhsph.edu

CONTEXT: Despite growing interest in medical communication by certification bodies, significant methodological and logistic challenges are evident in experiential methods of instruction. OBJECTIVE: There were three study objectives: 1) to explore the acceptability of an innovative video feedback programme to residents and faculty; 2) to evaluate a brief teaching intervention comprising the video feedback innovation when linked to a one-hour didactic and role-play teaching session on paediatric residents' communication with a simulated patient; and 3) to explore the impact of resident gender on communication change. DESIGN: Pre/post comparison of residents' performance in videotaped interviews with simulated patients before and after the teaching intervention. Individually tailored feedback on targeted communication skills was facilitated by embedding the Roter Interaction Analysis System (RIAS) within a software platform that presents a fully coded interview with instant search and review features. SETTING/PARTICIPANTS: 28 first year residents in a large, urban, paediatric residency programme. RESULTS: Communication changes following the teaching intervention were demonstrated through significant improvements in residents' performance with simulated patients pre and post teaching and feedback. Using paired t-tests, differences include: reduced verbal dominance; increased use of open-ended questions; increased use of empathy; and increased partnership building and problem solving for therapeutic regimen adherence. Female residents demonstrated greater communication change than males. CONCLUSIONS: The RIAS embedded CD-ROM provides a flexible structure for individually tailoring feedback of targeted communication skills that is effective in facilitating communication change as part of a very brief teaching intervention.

Acad Med.2006 Mar;81(3):207-12. 
The impact of E-learning in medical education.
Ruiz JG, Mintzer MJ, Leipzig RM .

Division of Gerontology, University of Miami Miller School of Medicine, Miami, FL, USA. jruiz2@med.miami.edu

The authors provide an introduction to e-learning and its role in medical education by outlining key terms, the components of e-learning, the evidence for its effectiveness, faculty development needs for implementation, evaluation strategies for e-learning and its technology, and how e-learning might be considered evidence of academic scholarship. E-learning is the use of Internet technologies to enhance knowledge and performance. E-learning technologies offer learners control over content, learning sequence, pace of learning, time, and often media, allowing them to tailor their experiences to meet their personal learning objectives. In diverse medical education contexts, e-learning appears to be at least as effective as traditional instructor-led methods such as lectures. Students do not see e-learning as replacing traditional instructor-led training but as a complement to it, forming part of a blended-learning strategy. A developing infrastructure to support e-learning within medical education includes repositories, or digital libraries, to manage access to e-learning materials, consensus on technical standardization, and methods for peer review of these resources. E-learning presents numerous research opportunities for faculty, along with continuing challenges for documenting scholarship. Innovations in e-learning technologies point toward a revolution in education, allowing learning to be individualized (adaptive learning), enhancing learners' interactions with others (collaborative learning), and transforming the role of the teacher. The integration of e-learning into medical education can catalyze the shift toward applying adult learning theory, where educators will no longer serve mainly as the distributors of content, but will become more involved as facilitators of learning and assessors of competency.

Ann Thorac Surg. 2006 May;81(5):1760-6.

Multimedia-driven teaching significantly improves students' performance when compared with a print medium.
Friedl R, Hoppler H, Ecard K, Scholz W, Hannekum A, Ochsner W, Stracke S.

Department of Heart Surgery, University Hospital of Ulm, Ulm, Germany. reinhard.friedl@medizin.uni-ulm.de

BACKGROUND: In this study, we compared the educational value of a multimedia module about aortic valve replacement as a preparation for the operating room with a print medium of identical content. METHODS: One hundred twenty-six students were randomly assigned in a prospective study to either use the multimedia course (n = 69) or a print version (n = 57). A 20-item multiple-choice test was performed before and after learning with the respective medium. Both groups participated in an operation during which they were evaluated with 28 standardized tasks and questions. Individual motivation, computer literacy, and didactic quality of both media were assessed with psychometric tests. RESULTS: There were no significant differences in the multiple-choice pretest (multimedia, 30.6% +/- 12.4% versus print, 27.9% +/- 11.4%) and posttest responses (multimedia, 76.7% +/- 13.3% versus print, 76.9% +/- 11.1). Mean percentage of correct answers during the operation was 82.9% +/- 10% in the online group and 64.7% +/- 12% in the print group (p < 0.0001). The multimedia group needed significantly (p < 0.001) less study time (105 +/- 24 minutes) when compared with the text group (122 +/- 30 minutes). There were no statistically significant differences in motivation, computer literacy, and didactic quality of either medium. CONCLUSIONS: Regarding factual knowledge, there is no difference between multimedia-driven learning and a print medium. During heart operations, when understanding of complex temporal and spatial events is essential, students' performance is significantly improved by multimedia-enhanced teaching. The latter further proved to be more efficient in terms of study time.

Hum Pathol. 2003 May;34(5):423-9.
Self-instructional "virtual pathology" laboratories using web-based technology enhance medical school teaching of pathology.
Marchevsky AM, Relan A, Baillie S.

Department of Pathology and Laboratoy Medicine, Cedars-Sinai medical Center, Los Angeles, CA 90048, USA.

Second-year medical students have traditionally been taught pulmonary pathophysiology at the University of California-Los Angeles (UCLA) School of Medicine using lectures, discussion groups, and laboratory sessions. Since 1998, the laboratory sessions have been replaced by 4 interactive, self-instructional sessions using web-based technology and case-based instruction. This article addresses nature of transformation that occurred from within the course in response to the infusion of new technologies. The vast majority of the course content has been digitized and incorporated into the website of the Pathophysiology of Disease course. The teaching histological slides have been photographed digitally and organized into "cases" with clinical information, digital images and text, and audio descriptions. The students study the materials from these cases at their own pace in 2 "virtual pathology" laboratory, with a few instructors supervising the on-site sessions. The students discuss additional cases available on the website in 2 other laboratory sessions supervised by a pulmonologist and a pathologist. Marked improvement in student participation and satisfaction was seen with the use of web-based instruction. Attendance at laboratory sessions, where the students had previously been required to bring their own microscopes to study histological slides at their own pace, increased from approximately 30% to 40% of the class in previous years to almost 100%. Satisfaction surveys showed progressive improvement over the past 4 years, as various suggestions were implemented. The value of web-based instruction of pathology at the UCLA School of Medicine is discussed.

Online databases

Acad Med. 2003 Mar;78(3):249-53.
Introducing HEAL: the Health Education Assets Library.
Candler CS, Uijtdehaage SH, Dennis SE.

The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma 73104, USA.

Digital multimedia, such as images and videos, are playing an increasingly important role in health sciences education. Educators, however, often do not have the time or resources to create high-quality materials. The authors describe the development of a new Health Education Assets Library (HEAL), a freely accessible, national library of high-quality digital multimedia to support all levels of health sciences education. HEAL's primary mission is to provide educators with high-quality and free multimedia materials (such as images and videos) to augment health science education. In addition, HEAL is working with other organizations to establish a network of distributed databases of high-quality teaching resources. By using state-of-the-art Internet technologies HEAL enables educators across the country to efficiently search and retrieve teaching materials from a variety of sources.

Acad Med. 2003 Mar;78(3):254-64.
Tufts Health Sciences Database: lessons, issues, and opportunities.
Lee MY, Albright SA, Alkasab T, Damassa DA, Wang PJ, Eaton EK.

Office of Educational Affairs, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.

The authors present their seven-year experience with developing the Tufts Health Sciences Database (Tufts HSDB), a database-driven information management system that combines the strengths of a digital library, content delivery tools, and curriculum management. They describe a future where online tools will provide a health sciences learning infrastructure that fosters the work of an increasingly interdisciplinary community of learners and allows content to be shared across institutions as well as with academic and commercial information repositories. The authors note the key partners in Tufts HSDB's success--the close collaboration of the health sciences library, educational affairs, and information technology staff. Tufts HSDB moved quickly from serving the medical curriculum to supporting Tufts' veterinary, dental, biomedical sciences, and nutrition schools, thus leveraging Tufts HSDB research and development with university-wide efforts including Internet2 middleware, wireless access, information security, and digital libraries. The authors identify major effects on teaching and learning, e.g., what is better taught with multimedia, how faculty preparation and student learning time can be more efficient and effective, how content integration for interdisciplinary teaching and learning is promoted, and how continuous improvement methods can be integrated. Also addressed are issues of faculty development, copyright and intellectual property, budgetary concerns, and coordinating IT across schools and hospitals. The authors describe Tufts' recent experience with sharing its infrastructure with other schools, and welcome inquiries from those wishing to explore national and international partnerships to create a truly open and integrated infrastructure for education across the health sciences.

Acad Med. 2004 Mar;79(3):229-35.
New directions in medical e-curricula and the use of digital repositories.
Fleiszer DM, Posel NH, Steacy SP.

McGill University, Montreal, Quebec, Canada.

Medical educators involved in the growth of multimedia-enhanced e-curricula are increasingly aware of the need for digital repositories to catalogue, store and ensure access to learning objects that are integrated within their online material. The experience at the Faculty of Medicine at McGill University during initial development of a mainstream electronic curriculum reflects this growing recognition that repositories can facilitate the development of a more comprehensive as well as effective electronic curricula. Also, digital repositories can help to ensure efficient utilization of resources through the use, re-use, and reprocessing of multimedia learning, addressing the potential for collaboration among repositories and increasing available material exponentially. The authors review different approaches to the development of a digital repository application, as well as global and specific issues that should be examined in the initial requirements definition and development phase, to ensure current initiatives meet long-term requirements. Often, decisions regarding creation of e-curricula and associated digital repositories are left to interested faculty and their individual development teams. However, the development of an e-curricula and digital repository is not predominantly a technical exercise, but rather one that affects global pedagogical strategies and curricular content and involves a commitment of large-scale resources. Outcomes of these decisions can have long-term consequences and as such, should involve faculty at the highest levels including the dean.

PDA

Acad Med. 2004 Nov;79(11):1114-9.
Handheld computer use in a family medicine clerkship.
Sutton J, Stockton L, McCord G, Gilchrist VJ, Fedyna D.

Department of Family Medicine, Northeastern Ohio Universities College of Medicine, 4209 St., Rt. 44, P.O. Box 95, Rootstown, OH 44272, USA. jds@neoucom.edu

PURPOSE: The objectives of this study were to track students' use of medical and nonmedical personal digital assistant (PDA) software and to obtain students' ratings of the usefulness of PDAs in a family medicine clerkship. METHOD: During the academic year 2001-02, third-year clerkship students at the Northeastern Ohio Universities College of Medicine were loaned PDAs equipped with company-installed software, such as a date book and address book. Additional software was installed (Griffith's 5 Minute Clinical Consult, ePocrates qRx, ePocrates qID, iSilo, HanDBase, MedCalc, and Application Usage). Pre- and post-orientation questionnaires and a post-rotation evaluation measured students' comfort level, the perceived usefulness, and ratings of programs on their PDA. Application Usage tracked the number of minutes and times students used each software program. RESULTS: Eighty-five students completed the study. They rated ePocrates qRx and Griffith's 5 Minute Clinical Consult the most useful medical software programs. PDAs were rated as "almost always" enhancing the clerkship experience. Students reported the PDA altered the way they accessed clinical information and that every few days it helped them understand a clinical discussion. Experience with computer technology was correlated with PDA use. CONCLUSIONS: This study objectively demonstrates clerkship students' use of PDA resources. Students' use mirrors their assessment of the value of the software. Although PDAs and software programs can be an expense, it is a worthwhile educational resource as evaluated by the medical student.

AJR Am J Roentgenol. 2004 Jul;183(1):237-42.
A mobile solution: PDA-based platform for radiology information management.
Busch JM, Barbaras L, Wei J, Nishino M, Yam CS, Hatabu H.

Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA. jmbusch@bid.harvard.edu

OBJECTIVE: We describe how our radiology department set up, integrated, and deployed a personal digital assistant-based mobile platform to deliver updated critical departmental and educational material to our residents. CONCLUSION: We have implemented and described a robust mobile solution that maintains a seamless connection with the departmental intranet. Resident feedback regarding the use of the mobile solution program has confirmed our belief that using this mobile technology is a feasible and clinically practical alternative for accessing time-sensitive and educational materials. Furthermore, our description can help others deploy such digital products and facilitate the transition to soft copy that is already occurring in radiology education.

Int J Med Inform. 2004 Feb;73(1):25-34.
Assessing medical residents' usage and perceived needs for personal digital assistants.
Barrett JR, Strayer SM, Schubart JR.

Department of Health Evaluation Sciences, University of Virginia, P.O. Box 800717, Charlottesville, VA 22908, USA. barrett@virginia.edu

Health care professionals need information delivery tools for accessing information at the point of patient care. Personal digital assistants (PDAs), or hand-held devices demonstrate great promise as point of care information devices. An earlier study [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678] on the use of PDAs at the point of care found that hardware constraints, such as memory capability limited their usefulness, however, they were used frequently for accessing medical references and drug information [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678]. Since this study was completed in 1995, hand-held computer technology has advanced rapidly, and between 26 and 50% of physicians currently use PDAs [Physician's use of hand-helds increases from 15% in 1999 to 26% in 2001: Harris interactive poll results, Harris Poll. 8-24-2002 (electronic citation); ACP-ASIM survey finds nearly half of U.S. members use hand-held computers: ACP-ASIM press release, American College of Physicians, 9-3-2002 (electronic citation)]. This use appears higher among residents, with one recent study finding that over two-thirds of family practice residencies use hand-held computers in their training programs [J. Am. Med. Inform. Assoc. 9 (1) (2002) 80]. In this study, we systematically evaluate PDA usage by residents in our institution using quantitative and qualitative methods. Our evaluation included a brief on-line survey of 88 residents in seven residency programs including primary care and specialty practices. The surveys were completed between 26 October 2001 and 30 April 2002. Follow-up interviews with 15 of the surveyed residents were then conducted between 24 April 2002 and 13 May 2002. The original contributions of this study are the evaluation of residents in primary and specialty programs and evaluation of both medical application software and the conventional personal organizational software (such as calendars and to-do lists). This evaluation was also conducted using significantly advanced hardware and software compared with previous studies [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678]. Results of our survey and follow-up interviews of residents showed most residents use PDAs daily, regardless of practice or whether their program encourages PDAs. Uses include commercial medical references and personal organization software, such as calendars and address books. Concerns and drawbacks mentioned by these residents included physical size of the PDA and the potential for catastrophic data loss. Another issue raised by our results suggests that security and Health Information Portability and Accountability Act (HIPAA) compliance need to be addressed, in part by resident education about securing patient data on PDAs. Overall, PDAs may become even more widely used if two issues can be addressed: (a) providing secure clinical data for the current patients of a given resident, and (b) allaying concerns of catastrophic data loss from their PDAs (e.g. by educating residents about procedures to recover information from PDA backup files).

Department of Radiology, Johns Hopkins University, 601 N Caroline St., Rm. 3251, Baltimore, MD 21287.

OBJECTIVE. "Podcasting" is a relatively new Internet-based broadcast technology with unique characteristics that may prove valuable in radiologic education. In this article, we describe the procedure for generating, distributing, and downloading a podcast.

CONCLUSION. Podcast technology holds promise as an inexpensive method to rapidly and cost effectively disseminate educational Internet audio broadcasts ("audiocasts").

Powerpoint

Plast Reconstr Surg. 2001 Aug;108(2):466-84
The power of PowerPoint. (online damaged - library does not have - sorry)
Niamtu J 3rd.

Oral & Maxillofacial Surgery, Richmond, VA 23235, USA. niamtu@niamtu.com

Carousel slide presentations have been used for academic and clinical presentations since the late 1950s. However, advances in computer technology have caused a paradigm shift, and digital presentations are quickly becoming standard for clinical presentations. The advantages of digital presentations include cost savings; portability; easy updating capability; Internet access; multimedia functions, such as animation, pictures, video, and sound; and customization to augment audience interest and attention. Microsoft PowerPoint has emerged as the most popular digital presentation software and is currently used by many practitioners with and without significant computer expertise. The user-friendly platform of PowerPoint enables even the novice presenter to incorporate digital presentations into his or her profession. PowerPoint offers many advanced options that, with a minimal investment of time, can be used to create more interactive and professional presentations for lectures, patient education, and marketing. Examples of advanced PowerPoint applications are presented in a stepwise manner to unveil the full power of PowerPoint. By incorporating these techniques, medical practitioners can easily personalize, customize, and enhance their PowerPoint presentations. Complications, pitfalls, and caveats are discussed to detour and prevent misadventures in digital presentations. Relevant Web sites are listed to further update, customize, and communicate PowerPoint techniques.

Med Educ. 2005 Apr;39(4):380-7.
Influence of new educational technology on problem-based learning at Harvard Medical School.
Kerfoot BP,Masser BA, Hafler JP.

Boston Veterans Administration Medical Center, Boston, Massachusetts, USA.

PURPOSE: Computers with 50-inch, wall-mounted plasma screens and broadband Internet access were installed in all small group tutorial rooms at Harvard Medical School. This study examines how the introduction of this educational technology impacted on the problem-based learning tutorials. METHOD: A total of 37 tutorial groups, stratified by year of student, were observed at separate timepoints (autumn 2002, spring 2003) to document the patterns of use of the technologies. Based on these observations, end-of-course surveys were developed and distributed to students and tutors. Observational field notes and open-ended survey responses were qualitatively analysed for themes. RESULTS: Using a 5-point rating scale, both students and tutors indicated that the technologies had a positive impact on their tutorials. In autumn 2002, plasma screens were used for an average of 17.8 and 22.1 minutes per 1-hour observation in Year 1 and 2 tutorials, respectively; in spring 2003, usage declined to 6.9 and 5.9 minutes, respectively. Resources utilised included Internet sites (54% total use time), PowerPoint presentations by students (22%), and course-specific postings (24%). Marked course-specific variation in usage was noted. Observational and survey data revealed that the technologies interrupted the flow of tutorial discussion. Students and tutors expressed concerns that the plasma screens might be altering the process of problem solving in the tutorials. CONCLUSIONS: Both students and tutors reported that the introduction of computers and wall-mounted plasma screens had impacted positively on tutorials. Questions were raised as to how this technology might alter tutorial dynamics. Further research will be needed to investigate these pedagogical concerns.

Radiographics. 2004 Jul-Aug;24(4):1185-92.  (get from library)
Education techniques for lifelong learning: giving a PowerPoint presentation: the art of communicating effectively.
Collins J.

Department of Radiology, University of Wisconsin Hospital and Clinics, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA. jcollin4@wisc.edu
Effectiveness of an oral presentation depends on the ability of the speaker to communicate with the audience. An important part of this communication is focusing on two to five key points and emphasizing those points during the presentation. Every aspect of the presentation should be purposeful and directed at facilitating learners' achievement of the objectives. This necessitates that the speaker has carefully developed the objectives and built the presentation around attainment of the objectives. The best presentations are rehearsed, not so that the speaker memorizes exactly what he or she will say, but to facilitate the speaker's ability to interact with the audience and portray a relaxed, professional, and confident demeanor. Rehearsal also helps alleviate stage fright. The most useful method of controlling nervousness is to visualize success. When showing images, it is important to orient the audience with an adequate description, point out the relevant findings, and allow enough time for the audience to assimilate the information before moving on. This can be facilitated with appropriate use of a laser pointer, cursor, or use of builds and transitioning. A presentation should be designed to include as much audience participation as possible, no matter the size of the audience. Techniques to encourage audience participation include questioning, brainstorming, small-group activities, role-playing, case-based examples, and directed listening. It is first necessary to motivate and gain attention of the learner for learning to take place. This can be accomplished through appropriate use of humor, anecdotes, and quotations. Attention should be given to posture, body movement, eye contact, and voice when speaking, as how one appears to the audience will have an impact on their reaction to what is presented. Copyright RSNA, 2004

Recognition/
Credit for
developing
Educational
Technology tools

Acad Med. 2003 Mar;78(3):286-94.
Sharing digital teaching resources: breaking down barriers by addressing the concerns of faculty members.
Uijtdehaage SH, Contini J, Candler CS, Dennis SE.

David Geffen School of Medicine, Center for Health Sciences, University of California, Los Angeles, 90095, USA. bas@mednet.ucla.edu

PURPOSE: Regional and institutional databases have been created to improve access to educational resources and to avert unnecessary duplication. The growth and success of these databases depend upon the willingness of faculty members to contribute their materials. This qualitative study seeks to identify the barriers that block the free exchange of educational multimedia and the incentives that could be created to overcome educators' concerns. METHOD: In 2001, 34 faculty members from 13 U.S. medical schools each participated in one of five focus groups. They responded to three hypothetical scenarios depicting opportunities for sharing educational resources. Participants' responses were categorized hierarchically and sent back to them for feedback. RESULTS: Participants strongly supported multimedia databases, particularly those that serve a national audience. Obstacles for contributing materials included the lack of institutional recognition for educational innovation, confusing intellectual property policies, the hassle involved in sharing materials, and the perceived commercial potential of the materials. Peer review of educational materials was seen as an important incentive. CONCLUSIONS: Medical schools could benefit from the free exchange of high-quality educational multimedia but need to address the concerns of faculty by clarifying institutional copyright rules, streamlining the donation process, and providing assistance with cataloging assets. Removing departmental pressures to commercialize materials and recognizing peer-reviewed donations as academic achievement could foster a culture of sharing.

Simulators

Journal of General Internal Medicine 2006 March,21(3) 251 - 256
Mastery Learning of Advanced Cardiac Life Support Skills by Internal Medicine Residents Using Simulation Technology and Deliberate Practice
Diane B. Wayne, MD, John Butter, MD, Viva J. Siddall, MS, Monica J. Fudala, BA, Leonard D. Wade, MS, Joe Feinglass, PhD, William C. McGaghie, PhD

BACKGROUND: Internal medicine residents must be competent in advanced cardiac life support (ACLS) for board certification.
OBJECTIVE: To use a medical simulator to assess postgraduate year 2 (PGY-2) residents' baseline proficiency in ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards.
DESIGN: Pretest-posttest design without control group. After baseline evaluation, residents received 4, 2-hour ACLS education sessions using a medical simulator. Residents were then retested. Residents who did not achieve a research-derived minimum passing score (MPS) on each ACLS problem had more deliberate practice and were retested until the MPS was reached.
PARTICIPANTS: Forty-one PGY-2 internal medicine residents in a university-affiliated program.
MEASUREMENTS: Observational checklists based on American Heart Association (AHA) guidelines with interrater and internal consistency reliability estimates; deliberate practice time needed for residents to achieve minimum competency standards; demographics; United States Medical Licensing Examination Step 1 and Step 2 scores; and resident ratings of program quality and utility.
RESULTS: Performance improved significantly after simulator training. All residents met or exceeded the mastery competency standard. The amount of practice time needed to reach the MPS was a powerful (negative) predictor of posttest performance. The education program was rated highly.
CONCLUSIONS: A curriculum featuring deliberate practice dramatically increased the skills of residents in ACLS scenarios. Residents needed different amounts of training time to achieve minimum competency standards. Residents enjoy training, evaluation, and feedback in a simulated clinical environment. This mastery learning program and other competency-based efforts illustrate outcome-based medical education that is now prominent in accreditation reform of residency education.

Acad Med. 2004 Jan;79(1):23-7.
Bringing good teaching cases "to life": a simulator-based medical education service.
Gordon JA, Oriol NE, Cooper JB.

G.S. Beckwith Gilbert and Katharine S. Gilbert Medical Education Program in Medical Simulation, Harvard Medical School, Department of Medicine, Masschusetts General Hospital, Boston, Massachusetts 02114, USA. jgordon3@partners.org

Realistic medical simulation has expanded worldwide over the last decade. Such technology is playing an increasing role in medical education not merely because simulator sessions are enjoyable, but because they can provide an enhanced environment for experiential learning and reflective thought. High-fidelity patient simulators allow students of all levels to "practice" medicine without risk, providing a natural framework for the integration of basic and clinical science in a safe environment. Often described as "flight simulation for doctors," the rationale, utility, and range of medical simulations have been described elsewhere, yet the challenges of integrating this technology into the medical school curriculum have received little attention. The authors report how Harvard Medical School established an on-campus simulator program for students in 2001, building on the work of the Center for Medical Simulation in Boston. As an overarching structure for the process, faculty and residents developed a simulator-based "medical education service"-like any other medical teaching service, but designed exclusively to help students learn on the simulator alongside a clinician-mentor, on demand. Initial evaluations among both preclinical and clinical students suggest that simulation is highly accepted and increasingly demanded. For some learners, simulation may allow complex information to be understood and retained more efficiently than can occur with traditional methods. Moreover, the process outlined here suggests that simulation can be integrated into existing curricula of almost any medical school or teaching hospital in an efficient and cost-effective manner.

J Clin Anesth. 2000 May;12(3):256-61.
Video teleconferencing with realistic simulation for medical education.
Cooper JB, Barron D, Blum R, Davison JK, Feinstein D, Halasz J, Raemer D, Russell R.

Center for Medical Simulation, Boston, MA, USA.

This report describes how realistic patient simulation can be used with video teleconferencing to conduct long-distance clinical case discussions with realistic re-enactments of critical events. By observing what appears to be a real procedure unfolding in real time, it is intended that audience members will better learn and appreciate the lessons from conferences. A commercially available mannequin simulator and video teleconferencing technology were used in nine sessions between a free-standing simulation center and different conference sites throughout the U.S. Transmission was via high-speed telephone lines. In each conference, a clinical scenario was simulated on a screen. Audience members asked questions of a live simulated "patient" and family and later advised the care team on routine treatments and management of urgent clinical problems that arose during management of the mannequin simulator in a highly realistic clinical setting. Ninety-eight percent of respondents from one audience of 150 (response rate 60%) judged the quality of the presentation as "very good or excellent." In response to the statement that "the educational value of the presentation was much greater than that of a standard case conference," 95% scored 4 or 5 on a five-point Likert scale (where 5 is highest agreement). While all conferences were conducted successfully, there were instances of technical challenge in using teleconferencing technology. Technical information about the teleconferencing system and scenario preparation, contingency planning for failures, and other details of using this new teaching modality are described. Although audiences were enthusiastic in their response to this approach to clinical case conferences, further study is needed to assess the added value of interactive simulation for education compared to standard conference formats.

Software Design

Med Teach. 2002 Jul;24(4):417-21.
'Ten golden rules' for designing software in medical education: results from a formative evaluation of DIALOG.
Jha V, Duffy S.

St James's University Hospital, Leeds, UK.

Evaluation of educational material has become very important in a climate where there is increasing concern with assessing and maintaining quality. DIALOG (acronym for Distance Interactive Learning in Obstetrics and Gynaecology) is an electronic program on CD-ROM for continuing education. A formative evaluation of DIALOG was carried out to determine whether DIALOG was achieving its educational objectives. The results of the evaluation helped to suggest '10 golden rules' for designing software for the purpose of CPD for medical practitioners. These 'rules' should help in designing future software in medical education. They highlight the importance of content, presentation, design, use of hypermedia and multimedia and reduced cost in order to facilitate appropriate use of such programmes.

Testing/
assessment

Arch Pathol Lab Med. 2002 Mar;126(3):346-50
Group for research in pathology education online resources to facilitate pathology instruction.
Jones KN, Kreisle R, Geiss RW, Holliman JH, Lill PH, Anderson PG.

Department of Pathology, University of Alabama, Birmingham, USA.

BACKGROUND: The Group for Research in Pathology Education (GRIPE) is an organization of pathology educators whose purpose is to promote and facilitate excellence in pathology education. One important function of GRIPE is the maintenance of image and multiple-choice test question data banks. These resources have recently been made available online via the GRIPE Digital Library Web site. The purpose of the GRIPE Digital Library project was to develop an online searchable database that would facilitate access to the GRIPE resources for pathology education. DESIGN: The GRIPE image bank--containing approximately 3000 peer-reviewed gross and microscopic pathologic images along with textual descriptions--was linked with the GRIPE test question bank using Gossamer Thread's DBMan Web database management program. The search and display templates create a functional user interface that integrates images, image descriptions, and test questions into a single online digital library. Using any Web browser, faculty can access the GRIPE Digital Library and search for images and/or test items that can be used in teaching. RESULTS: In the first 18 months (February 2000 through July 2001), users at 40 GRIPE member institutions signed up and used the GRIPE Digital Library to perform more than 6000 individual searches and view more than 37500 images. These digital images were used to produce lectures and laboratory modules that were posted on Web pages and made available to students remotely. CONCLUSIONS: The GRIPE Digital Library provides a unique resource that can facilitate development of educational materials for pathology instruction and helps to fulfill the educational mission of GRIPE.

SeeVideo teleconferencing with realistic simulation for medical education. (Simulators)

Virtual reality

See See one, do one, teach one: advanced technology in medical education. (multiple methods)

J Surg Res. 2004 Dec;122(2):150-6.
Laparoscopic virtual reality training: are 30 repetitions enough?
Brunner WC, Korndorffer JR Jr, Sierra R, Massarweh NN, Dunne JB, Yau CL, Scott DJ.

Tulane Center for Minimally Invasive Surgery, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.

BACKGROUND: Current literature suggests that novices reach a plateau after two to seven trials when training on the MIST VR laparoscopic virtual reality system. We hypothesize that significant benefit may be gained through additional training. MATERIALS AND METHODS: Second-year medical students (n = 12) voluntarily enrolled under an IRB-approved protocol for MIST VR training. All subjects completed pre- and posttraining questionnaires and performed 30 repetitions of 12 tasks. Performance data were automatically recorded for each trial. Learning curves for each task were generated by fitting spline curves to the mean overall scores for each repetition. Scores were assessed for plateaus by repeated measures, slope, and best score. RESULTS: On average, subjects completed training in 7.1 h. (range, 5.9-9.2). Two to seven performance plateaus were identified for each of the 12 MIST VR tasks. Initial plateaus were found for all tasks by the 8th repetition; however, ultimate plateaus were not reached until 21-29 repetitions. Overall best score was reached between 20 and 30 repetitions and occurred beyond the ultimate plateau for 9 tasks. CONCLUSIONS: These data indicate that a lengthy learning curve exists for novices and may be seen throughout 30 repetitions and possibly beyond. Performance plateaus may not reliably determine training endpoints. We conclude that a significant and variable amount of training may be required to achieve maximal benefit. Neither a predetermined training duration nor an arbitrary number of repetitions may be adequate to ensure laparoscopic proficiency following simulator training. Standards which define performance-based endpoints should be established.