Implementing a Requirement for Computer Ownership: One Medical School’s Experience*

Amy V. Blue, PhD^*+, Carol L. Elam, EdD^*, Robert Rubeck, PhD^*, Lois M. Nora, MD, JD^{*¯ *}Office of Academic Affairs, ⁺Department of Surgery, and ^¯Department of Neurology University of Kentucky College of Medicine, Lexington, KY

Abstract: The need for training physicians in the use of computers and the increased presence of computing in medical education suggest that medical schools should determine what kind of computer accessibility and support should be offered to students so that they can acquire sufficient computer skills and use computing applications in the curriculum. At the University of Kentucky College of Medicine, a requirement for ownership of computers by students was adopted in 1995. On the basis our experience, this paper discusses the assessment of institutional readiness for such a requirement, the technical and support issues related to such a requirement, the development of computer applications in the curriculum, and a framework used to evaluate the impact of such a requirement. Recommendations for other institutions interested in adopting a requirement for computer ownership by students are included.

    In recognition of the increased relevance of computers to medical practice, the panels filing both the report on the General Professional Education of the Physician¹ and the report on Assessing Change in Medical Education ¾ The Road to Implementation² suggested that physicians acquire computer skills. The development of computer-assisted instruction and computer-based instruction in medical education provides students with one means by which to acquire computer skills.^3,4 Additionally, Koschman advocates students’ daily use of computers in response to curricular demands as an approach toward fostering their computer skills.⁵

    The need for training physicians in the use of computers and the increased presence of computing in medical education suggest that medical schools should determine what kind of computer accessibility and support should be offered to students so that they can acquire sufficient computer skills and use computing applications in the curriculum. Providing students with computer access by placing computer stations in the library or by developing a dedicated computer laboratory space have been the most common solutions adopted by institutions. Recently, however, some medical schools have considered policies recommending that students acquire a personal computer for their medical education, or even requiring them to do so.⁵

    Several general factors should be considered in determining a medical school’s readiness to adopt a requirement for ownership of computers by students. The increased use of computers in medical practice makes it important for medical school graduates to develop and enhance computer skills for their future practices. The advances in technology provide greater ease of access and use to exploit the benefits of computing for educational purposes. The availability of quality applications for medical education in both the basic and clinical sciences makes it feasible for an institution to incorporate such applications into the curriculum without an investment in on-site software development.

    Specific institutional factors will also play a role in the consideration of a requirement for computer ownership by students. These factors are often interrelated and affect one another. The existence of a computing infrastructure sufficient to support the computing activities of faculty, staff, and students indicates that at least a minimum of interaction among these three groups can occur (i.e., use of electronic mail). At institutions with limited availability of personal computers for faculty members, the demands of faculty members for computers are an important indication that the academic computing infrastructure needs improvement. At some institutions, faculty members begin to encourage or demand that students own a computer for educational purposes, such as communicating electronically for course discussions or information, using software applications in courses, and taking computerized examinations. When these events begin to occur, a requirement for computer ownership by students should be considered. Similarly, when students perceive and articulate their own needs for ready access to a personal computer because such access enhances their education, uses skills they have already acquired, and fosters the development of new skills they know they will use in future medical practice, a requirement for computer ownership by students should be considered.

    At the University of Kentucky College of Medicine (UKCOM), a requirement for computer ownership by students was implemented in 1995. In this paper, we discuss, on the basis of our experience, the assessment of institutional readiness for such a requirement, the technical and support issues related to such a requirement, the development of computer applications in the curriculum, and a framework used to evaluate the impact of such a requirement. On the basis of lessons we have learned, we include recommendations for others interested in adopting such an institutional requirement.

    The adoption of a requirement for students’ ownership of computers resulted from UKCOM’s increased computing activity in the curriculum and from the institutional philosophy that students need to acquire computer skills for future medical practice. Initial financial support was provided by alumni who responded to fund-raising requests for purposes including academic computing. Substantial financial support for increased development of academic computing was made available to the institution in 1992 through the Robert Wood Johnson Foundation Preparing Physicians for the Twenty-First Century grant supporting curricular revision. Curricular objectives, including the need for students to acquire computer skills, were strongly influenced by the 1984 GPEP Report. The Academic Computing in Medical Education (ACME) support unit was established at our institution to facilitate the application of computer technology in the curriculum. This unit’s initial charge was multi-fold and included 1) the establishment of computer workstations throughout the College of Medicine and at selected rural Area Health Education Center (AHEC) sites throughout eastern and southeastern Kentucky to foster small-group instructional sessions and self-study assignments; 2) demonstrations to faculty members about the potentials of computer technology; and 3) the development with faculty members of institutionally designed software packages to support individual UKCOM course objectives.

    From 1992 to 1994, academic computing activities increased substantially in the curriculum. The increased availability of high-quality, commercially developed computer-assisted instructional programs that enhanced basic science and clinical instruction provided new curricular opportunities of interest to both faculty members and students. The establishment of electronic communication systems (electronic mail) provided new, efficient avenues through which faculty members, administration, staff, and students could communicate with each other. Students’ ready access to computers became increasingly imperative in light of the increased use of technology for instructional purposes and for educational communication. By 1994, UKCOM had a computer laboratory with 30 computer stations, six of which were available for students’ use 24 hours a day. Support staff were available in the laboratory for assistance 12 hours a day. Though the contribution of this space and budget was substantial (and has been continuing), the number of stations in the computer laboratory, size of the staff and currency of equipment was inadequate for a student body of 375. The limited availability of space to increase the size of the computer facilities and the lack of available funding for additional equipment required freezing the College’s contribution at the current level. Increasing curricular applications, the rapid evolution of newer, less expensive technology, and the recognition that graduates would increasingly rely on computers in their clinical practices prompted UKCOM to consider adopting a requirement for student ownership of computers. To assure appropriate timing, the ownership requirement was phased in over two years. In 1994, computer ownership was strongly recommended. Then, beginning in 1995, student ownership of computers became a requirement. The requirement was put in place to ensure that each student had ready access to current technology in a convenient location for study and productivity.

    Incoming students are initially informed of the computer ownership requirement at an admission reception held seven months before matriculation. Specific details about the requirement are then provided through a special mailing in the spring before matriculation. The requirement stipulates that students purchase either a desktop or a laptop model running on either the Windows or the Macintosh platform. The information packet mailed to students also details the minimum features of each type of machine and provides information about the advantages and disadvantages of each platform and of each model, about prices from local vendors, and about the technical support available at UKCOM. For the 1997 academic year, each student will purchase access to the Internet through the institution’s carrier for a nominal monthly fee. Before 1997, a local gateway computer was used. At the time of matriculation, students receive an electronic mail account from the university.

    During orientation for matriculating students, students are provided with computer training sessions. Sessions cover access to curriculum software, to the facility’s equipment, and to support for student computing. Advanced features in word processing, presentation graphics, and computer telecommunication, including MEDLINE and the Internet, are also discussed. Optional introductory sessions are also available for students who are unskilled in basic operation of computers, use of generic computer applications, or use of remote communications capabilities. All students also receive training in the use of the university’s electronic mail system. At the beginning of each academic year, students also receive a UKCOM CD-ROM containing course software, communications applications, and computer utilities.

    Increasing instructional needs throughout the curriculum and limited availability of computer workstations within the college prompted UKCOM to consider a requirement for student ownership of computers. Before the requirement could be adopted, endorsement and approval were required from several key faculty groups. UKCOM’s governance structure assigns responsibility for the curriculum both to the faculty members and to the administration of the college. The Curriculum Committee, a standing committee of the Faculty Council, is responsible for monitoring the entire medical curriculum. Information from both students and faculty members is used by the Curriculum Committee to make decisions regarding the use and distribution of curriculum time.

    To propel the computer ownership requirement through UKCOM’s governance structure, a series of meetings were held with the Faculty Council, the Curriculum Committee, course directors, interested faculty members, and administrators. These meetings were designed to promote institutional awareness of the computing applications already in use in the curriculum and to outline potential uses of additional applications and electronic communication for educational purposes. A checklist outlining considerations for adopting a requirement for student ownership of computers was developed and used during these meetings. This checklist guided discussions about the feasibility of the proposition and clarified the breadth of measures already established to justify the computer ownership requirement. Figure 1 presents the checklist. Fully informing faculty members in a clear and organized manner about the rationale for the requirement, the current and future educational applications of computing, and the available support allowed for reasoned consideration of the requirement. Meeting with faculty members to increase their awareness of the need for the requirement and providing accurate information led to consensus and support from the Curriculum Committee and the course directors, who recommended adoption of the requirement. In the end, the Faculty Council voted to formally approve the requirement.

    Faculty members’ interest in building a computing curriculum was an important criterion in assessing our institution’s readiness for this requirement. Institutional mini-grants were awarded to faculty members interested in creating educational computing applications related to their courses. The mini-grants facilitated two important outcomes: 1) they stimulated faculty members’ interest in providing students with ready access to computers so that they could use the educational applications; and 2) they increased the number of course-specific applications in the curriculum. The establishment of a university-wide electronic communications system, which included electronic mail accounts for all faculty and staff members and support for these accounts, further stimulated faculty members’ interest in educational computing. The wide use of electronic communication across university sectors necessitated administrative and faculty communication through electronic mail, forcing use of computers by recalcitrant faculty members. The implementation of the requirement for student ownership of computers was timed to coincide with the provision of faculty-wide electronic mail capability.

    An additional factor stimulating faculty members’ readiness for the computer ownership requirement was the availability of medical education specialists familiar with the educational applications of computer technology. A biomedical education multimedia specialist, computer laboratory specialists, and curriculum consultants, working together, fostered faculty members’ interest in the development of curricular computing applications by suggesting commercially available programs, developing electronic mail communications in courses, and developing course-specific applications. Faculty members’ developed positive attitudes toward use of computing applications and electronic mail for instructional communication, often at course-specific or small-group levels. Faculty members’ interests in computing have often worked synergistically with the development of computing applications in the curriculum: the one fosters the development of the other. In turn, identification and use of computer applications further enhanced the number and variety of computing activities in the curriculum.

Recommendations: Institutional readiness is imperative for the success of a requirement for student ownership of computers. Approval of the requirement needs to be established through the appropriate faculty governance mechanisms. A checklist containing specific criteria is very useful during the process of gaining approval from faculty constituencies because it creates awareness of the institution’s needs and readiness for the requirement. The checklist fosters consensus building among interested constituencies and is a valuable device for deflecting negative comments about a computer ownership requirement because it objectifies the debate.

    With regard to faculty readiness, it is important to recognize that not all course directors and faculty members are comfortable with computer technology and that these people may need guidance about the relevance of computing applications in their courses. Such guidance may be given by educational and technology experts, by fellow colleagues, and even by students. Faculty members’ development in the use of computers for educational purposes is strongly encouraged. To foster the development of educational computing applications by the faculty members within an institution, the availability of institutional funding, such as mini-grants, for small instructional and evaluation projects is suggested. The creation of educational applications also serves to enhance the curriculum with course-specific computing activities. The availability of software development and instructional design specialists is also important.

    Curricular readiness is imperative for a computer ownership requirement. Before the computer ownership requirement is adopted, a modicum of course-related applications should already exist in the curriculum to supplement instructional material or to serve as primary learning material. Students need to perceive that their investment in a computer has educational value vis-à-vis curricular expectations at the beginning of their medical school experience.

    Our computer laboratory contains 30 workstations, compatible with both Macintosh and Windows platforms, and two printers. The availability of dual-platform machines provides students with greater accessibility to on-site computing in relation to their own personal computers. Machines need to be networked, and printing services need to be available. Initially, it was believed that UKCOM machines could languish somewhat with respect to technology developments because students would have their own machines. This belief proved not to be the case. Students expect UKCOM’s machines to be up to the same technological standards as their own. UKCOM computers are leased in recognition of the fact that they reflect not a one-time cost but a continuing fiscal obligation.

    Although many students purchase desktop computers, they often find that they have printing needs between classes during the work day. Initially, students’ printing activities and the associated costs in the computer laboratory were assumed by the institution. In an attempt to reduce paper costs, stocked printers were available for students’ use during the work day. Students supplied their own paper for night and weekend use of printers. The increase in computing applications in the curriculum has created increased student printing demands, in turn necessitating the need for students to shoulder some of their printing expenses. Conversations with students have indicated that they are not opposed to assuming their printing expenses. A reworked printing solution has adopted a print-card system, analogous to the copy-card system for duplicating. Students are issued a print card with a preprogrammed dollar amount. After that amount has been used, the student pays for each printed page.

    The computer ownership requirement and on-site computing activities are supported by two full-time staff members who provide on-site assistance in the computer lab, troubleshoot problems and answer students’ questions about their own computers. As members of the ACME group, the laboratory staff members are intimately involved with the development of computing applications in the curriculum and also assist faculty members in the implementation and administration of academic computing activities. The unique value of these staff members consists of their combined knowledge of computers, the curriculum, the medical students, and the faculty members. Without any one of these components, the staff members would be less effective. When the information packet regarding the computer ownership requirement is mailed to matriculating students in the spring, one of these staff members is assigned to answer questions about the requirement. The designation of one contact person ensures that students receive accurate and consistent information.

Recommendations: The successful management of infrastructure issues is critical in the implementation of a requirement for student ownership of computers. It is imperative that both students and faculty members are on the same network system and have access to electronic mail at the same time. We recommend that students acquire access to the Internet through commercially available services. The economies associated with on-site printing need to be projected, and strategies for managing costs need to be designed. Our experience indicates that students can be sensitive to costs associated with their on-site printing needs. However, the availability of print-card systems can also decrease student-associated printing costs for the institution. Institutions may be able to negotiate with vendors to achieve rates for hardware, software, and Internet access that are not cost prohibitive.

    The presence of on-site support staff for computing activities is also imperative. Our experience indicates that these staff members need to be able to provide support for on-site workstations and for students’ own computers, because students will call, send electronic mail, or come to the computer lab with questions about their own equipment. Furthermore, the staff should consist of full-time professionals, not part-time employees, and their hours should be staggered to yield a 12-hour day for technical support.

    The advantage of having full-time professional staff is that these people have intimate knowledge of the computer ownership requirement, the on-site technology, and the curricular applications. Students and faculty members can regularly interact with the same support staff and can establish mutually trustworthy working relationships.

    The most critical aspect of a successful computer ownership requirement is the presence of computing applications in the curriculum so that students perceive there is educational value to their ownership of a personal computer. Below we review some of the curricular applications of computing that we have developed, recognizing that there are many avenues through which to include computing in a curriculum. To facilitate the development of our computing curriculum, we developed a set of computer skills that students should acquire (or refine) and use throughout the curriculum (Table 1). This list of skills has served to guide the placement of computing activities in the curriculum.

    Commercially available programs may be purchased to supplement existing course materials or to serve as primary learning resources. Such programs are in use in the human structure, physiology, pathology, and microbiology courses and in the combined medicine-surgery clerkship and the family practice and pediatric clerkships. Locally developed programs provide faculty members with the opportunity to tailor the content of the application to their own presentation needs. We have developed digital lectures that allow faculty members to transform their lecture presentations into an electronic format that students can readily access. Digital lectures provide students with a good overview of lecture material. They are used in pathology, anatomy, histology, pediatrics, and other courses and clerkships.

    The availability of electronic communication systems has created an efficient means of educational communication for faculty, staff, and students, as has been reported elsewhere.⁶ Several of our course directors, staff assistants, and curriculum consultants routinely use electronic mail to send students course announcements, pop quizzes, and other instructional material. Similarly, the Student Affairs office uses electronic mail as a primary means of communication with students. We have also developed electronic mail and Web page on-line course discussion groups that permit students to ask faculty members questions related to course material; the faculty member’s response is subsequently posted on a course Web page so that all students may receive the answer.

    Course Web sites provide students with information about the course and with course-related instructional materials. A template for course Web sites was designed by faculty members, curriculum consultants, and our multimedia biomedical educational specialist. This template features the course syllabus (course goals and objectives, evaluation process and grading policy, reading assignments, schedules, etc.), course materials (lecture objectives, physical examination guides, etc.), an announcements page for updated course information, an on-line course discussion group, and links to Web sites on related disciplines. The course Web site template was created to facilitate course directors’ use of technology, to provide ready access to course materials for students and faculty, and to conserve limited academic computing resources. The course Web site template serves several functions, including 1) providing students and faculty members across the curriculum with uniform presentation of course materials and a uniform method of access to them, 2) establishing a uniform technology that facilitates faculty members’ use of the Web, and 3) complying with University regulations regarding Web site design.

    The existence of numerous Web sites related to biomedical science and medicine’s associated psychosocial, legal, economic, and ethical issues offers students and faculty members new sources of information and learning. When assistance is requested, one of our computer laboratory support staff members performs weekly research of Web sites that are relevant to course topics and sends the locations to students by electronic mail. Web site recommendations are closely matched to curricular topics and are evaluated by student use and faculty feedback. The course Web site template also includes a link to relevant Web sites that have been selected by the course directors. Our UKCOM library also is a resource for pertinent Web site information.

Recommendations: The decision to purchase or develop computer software programs depends largely upon the anticipated use of the program. When software is to be a primary instructional vehicle, faculty members generally prefer that it be locally developed. When the software is to be used to supplement or enhance course instruction, faculty members are comfortable with a commercial product.

    Faculty members, staff, and students all need training in the effective use of electronic mail (i.e., creating nickname files, attaching documents). This training can occur in large-group settings, such as with an entire class, or can be tailored to the needs of individual instructors, such as training for small-group preceptors and students. Electronic mail is an efficient method of communicating information to individuals and groups, but it is not always the most appropriate for all types of documents. For example, our experience has shown that lengthy newsletters are best printed and distributed to students rather than sent electronically.

    Advances in technology provide a variety of means for electronically organizing instructional materials for students. It is important to use a format that facilitates students’ access to the materials. For example, we started using the PDF format for many instructional materials but found that it was not easily accessed by students. We now use Hyper Text Mark-Up Language (HTML) technology for many locally developed applications. The development of guidelines and templates for course directors and faculty members facilitates the use of uniform technology and presentation of materials to students. We recommend that the use of graphics on Web pages be kept to a minimum to decrease the length of time required for a document to load. Similarly, printing short documents (five pages or less) is not time consuming or cost prohibitive.

    The establishment of Internet Web sites is still unregulated, and students need to be cautioned that not all Web sites provide quality information for medical education purposes. It is imperative that content experts review specific Web sites before these sites are recommended to students in specific courses.

    We have developed categories of formal outcome measures related to the curriculum for evaluating the impact of the computer ownership requirement at UKCOM. These categories are A) Curricular Applications of Computing, B) Student Satisfaction with Academic Computing Activities, and C) Students’ Knowledge of Computer Skills.

    The Curricular Applications of Computing outcome category assesses the presence and use of computers in the curriculum. Specific measures included in this category are 1) the number of new computer products created for courses, 2) the number of course activities, including required and non-required course activities that involve the computer, 3) the number of courses using computers, and 4) the use of individual computer programs in courses. Measures 1 through 3 are assessed through regular review and inventory of course activities. Measure 4 is assessed through a tracking program available in the computer laboratory. Measure 4 is particularly helpful for course directors to evaluate whether students are using a required or recommended program in their course.

    The Student Satisfaction outcome category assesses students’ satisfaction with the computer requirement and the presence of computing activities throughout the curriculum. Specific measures are 1) students’ satisfaction with computers in courses, 2) students’ satisfaction with computers in the curriculum, and 3) the number of student complaints to the administration about computers and the computer requirement. Measure 1 is assessed through individual items on course evaluation forms. Measure 2 is assessed through student focus groups and through items on the graduating senior survey. Measure 3 is assessed through reports from the Office of Academic Affairs. The Students’ Knowledge of Computer Skills outcome category assesses students’ knowledge of the computer and computer skills. Specific measures are 1) pretest and posttest measures of students’ skills and 2) testing of students’ computer skills.

Recommendations: Evaluation of a requirement for student ownership of computers is important to provide incoming and prospective students with information about the value of the requirement, to inform the governance structure about the curricular impact of the requirement, and to assess the relative value of the requirement for the institution. The impact of a computer ownership requirement can be evaluated in several ways, including curricular, technological, and economic dimensions.

    The adoption of a requirement for student ownership of computers at UKCOM has successfully facilitated our curricular objectives of developing students’ computer skills and the enhancing our academic computing curriculum. Before the requirement was adopted, institutional readiness was assessed, and governance, faculty, and curricular issues were addressed through this process. Infrastructure support has been essential for the computer ownership requirement, including both technical aspects (i.e., hardware, software, equipment) and support staff. The ownership of computers by every student has fostered the development of educational computing activities in the curriculum, such as educational electronic communication, course Web sites, the use of Internet Web sites in courses for instructional purposes, and the development of course-specific computing applications. We are currently evaluating the impact of the computer ownership requirement on our curriculum through assessment of computing activities, student satisfaction, and students’ knowledge of computer skills.

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Address correspondence to:

Amy V. Blue, Ph.D.

Office of Academic Affairs
MN104 UKMC
University of Kentucky College of Medicine
Lexington, KY 40536-0084

Phone: (606)-257-4679
Fax: (606)-323-2076

Blue AV, Elam CL, Rubeck R, Nora LM. Implementing a Requirement for Computer Ownership: One Medical School’s Experience Med Educ Online [serial online] 1997;2,4. Available from: URL http://www.Med-Ed-Online.org.