Trend Manuscripts - Medical Education Online

Trend Articles are manuscripts presenting new ideas, studies and programs in the early stages of development. The articles are provided in HTML (Browser) format and PDF format which can be viewed and printed with Adobe's Acrobat Reader (TM). PDF files provide a higher quality print format. To obtain Acrobat Reader software at no charge, press here.

Department of Medicine, University of Pennsylvania School of Medicine and Veterans Affairs Medical Center, Philadelphia, Pennsylvania

Abstract: Expanding primary care and ambulatory experiences in internal medicine training programs is limited by insufficient resources devoted to their development and implementation, heavy inpatient service demands and loyalty to the traditional inpatient based training model. Overcoming these barriers is a challenge likely to create new approaches to ambulatory education. The Pilot Education and Ambulatory Care (PACE) program at the Sepulveda VA is one such initiative that represents a multidisciplinary approach to primary care services, improving quality and access to patient care services, as well as the quality of primary care education. We describe the development of a similar model for resident training and primary care service, also funded through the Veterans Affairs (VA), but implemented with fewer resources. The program redirects faculty and administrative resources to a new clinical environment centered around primary care. We believe this educational model has broad implications for the future of medical training because it is achievable and thus exportable to other programs.

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^*Ż

^*Office of Academic Affairs,
⁺Department of Surgery, and
^ŻDepartment 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.

Mandatory Microcomputers: Potential Effects on Medical School Recruitment and Admissions

^*Office of Medical Education Research and Development,⁺The Office of Admissions, College of Human Medicine, Michigan State University

Abstract: To inform discussions about a proposal that required incoming medical students own a microcomputer, applicants accepted for admission to the College of Human Medicine at Michigan State University were mailed a survey which focused on microcomputer literacy, ownership and perceptions of a mandatory microcomputer proposal. The response rate was 79%. Two-thirds of respondents had access to a microcomputer at home; more had access at school. Microcomputer ownership ranged from 95% for respondents with graduate education to 28% for underrepresented minorities. Reactions to the proposal were mixed: male and graduate-educated respondents were most in favor whereas underrepresented minority respondents reported that such a policy would negatively influence their decision to attend our medical school. Cost was a concern for respondents independent of their support for the proposal. The results suggest that despite increased computer literacy, this proposal could undermine efforts to recruit a diverse matriculating class. Other computer-based innovations in medical school admissions will favor computer literate students.

Videoconferencing for Instructional and Administrative Purposes: The Audience Reacts

Office of Medical Education Research and Development, College of Human Medicine, Michigan State University

Abstract: Reduced funds for medical student and resident training have prompted the College of Human Medicine at Michigan State University to explore innovative instructional delivery and administrative support systems. The Office of Medical Education Research and Development conducted a demonstration project in the use videoconferencing technology to connect the main campus to three outstate sites. The objectives of the project were to provide instructional experiences for students, residents, and faculty using videoconferencing; to conduct administrative meetings; and to evaluate the use of videoconferencing in these contexts. The results of the demonstration project lend strong support to the use of videoconferencing technology for instruction and administrative support, even in light of technical constraints. Lessons were learned in the areas of working with vendors effectively, preparing presenters to use the system, and the need to test system peripherals and connections before the actual videoconference.

An Analysis of Web-Based Instruction in a Neurosciences Course, Chris Candler, MD and Robert Blair, PhD, University of Oklahoma College of Medicine.

Abstract - Among the recent trends in medical education is the increased use of computer-aided instruction (CAI), particularly via the World Wide Web. While there have been many studies comparing CAI to traditional instruction, there are relatively few studies that analyze the benefits of web-assisted instruction. Presently, many medical schools have initiatives to web-enable significant portions of their curriculum. To maximize the potential of the medium, educators must carefully plan and design their educational materials and do more than put their syllabus online. Technical issues such as user interface design, access and availability play an important role in determining how students will receive such materials. Furthermore, the web-based portion of a course must be properly integrated with more traditional educational modalities such as lectures and labs. The following paper describes the planning and implementation of web-based materials in a pilot project involving a medical neurosciences course.

Medical Students As Standardized Patients In A Second-Year Performance-Based Assessment Experience

Kathryn L. Lovell, PhD*, Brian E. Mavis, PhD^†, Jane L. Turner, MD^‡§, Karen S. Ogle, MD^ś, Marilee Griffith^§,

*Department of Pathology and Neuroscience Program
^†Office of Medical Education Research and Development
^‡Department of Pediatrics & Human Development
^§Office of Academic Programs
^śDepartment of Family Practice, College of Human Medicine, Michigan State University

Abstract: Performance-based assessments of medical students using standardized patients (SPs) have been conducted in a variety of formats during both pre-clinical and clinical years. At Michigan State University College of Human Medicine, a series of performance-based assessment (PBA) experiences have been established in the second year to evaluate students' abilities to integrate basic skills and medical knowledge. The format developed was based on classmates acting as SPs. The PBA experiences were perceived by students as being effective in reinforcing the goals of the curriculum and the format was viewed positively. The small-group learning experience provided by the patient training session was valued by students, and was an important part of their positive attitude toward the time required for acting as an SP. Thus using students as SPs can be an excellent cost-effective approach for performance-based assessments used as formative evaluation.

The Multidimensional Learning Model: A Novel Cognitive Psychology-Based Model for Computer Assisted Instruction in order to Improve Learning in Medical Students

Medical Education Development Office, The University of Auckland School of Medicine and Health Science

Abstract - In the recent years there has been a huge increase in the amount of information needed to be understood and memorized by medical students. Many authors have advocated the need for utilizing cognitive psychology strategies to allow students learn the expanding medical information in a more effective and efficient manner. The present paper describes a novel and interactive method for teaching and learning (the Multidimensional Learning Model) that allows the students to ‘think’ to generate the information. The model integrates different memory strategies to facilitate the learning process and is heavily dependent on illustrations and graphics. Furthermore, the model is potentially suitable for designing Computer Assisted Instruction. A pilot study was performed on the model and the preliminary results are promising.

The Development of a Collaborative Distance Learning Program to Facilitate Pediatric Problem-based Learning,

Carol S. Kamin, Ed.D^*., Robin D. Deterding, M.D^*, Brent Wilson, Ph.D^†,., Michael Armacost, M.A^†., Tom Breedon, M.A^†.,

Abstract - Introduction. A team of pediatric educators at the University of Colorado School of Medicine teamed with faculty and graduate students from the University of Colorado-Denver to develop a prototype program to support medical students’ learning of national pediatric curricular objectives, regardless of their clinical location and variable patient exposure. Description. This hybrid Web/CD-ROM program allows "virtual" problem-based learning teams composed of four to five students and a faculty member to collaborate asynchronously through a digital video patient case. One prototype case has been developed and funding has been secured to develop a bank of cases to support the national pediatric curriculum. Discussion. Cases delivered by digital video provide a rich medium for visual and auditory cues to patient evaluation, which in turn encourage the development of visual recognition skills needed in clinical practice. Such cases also model appropriate professional behavior and allow students to solve clinical problems in authentic clinical situations.

The Role of Faculty Development in a College of Medicine’s Promotion and Tenure Process

Department of Medical Education (M/C 591), University of Illinois at Chicago College of Medicine

Abstract - The history and genesis of an institutionalized approach to faculty development are discussed. The paper describes the development of a new program to improve the teaching skills of junior clinical faculty, Scholars for Teaching Excellence (STE) and how it was able to help faculty as they worked toward promotion and tenure under modified promotion and tenure procedures. The paper describes the origin of STE, changes in its original design, the theoretical bases for these changes, and initial program evaluation data. Implications for any program in a higher education setting are drawn. These may provide a practical and adaptable process for institutions confronting the research versus teaching controversy in the advancement of its faculty members.

Using E-mail based Continuing Medical Education for Family Physicians — Can it work?

J. Neil Marshall MB CCFP*, Pamela J. Brett MA†, Moira A Stewart BSc,PhD‡, Truls Řstbye MD,MPH§,

* Thames Valley Family Practice Research Unit and University of Western Ontario Department of Family Medicine,
†University of British Columbia Department of Family Medicine
‡ Centre for Studies in Family Medicine, Family Medicine and Epidemiology and Biostatistics, University of Western Ontario
§Epidemiology and Biostatistics at the University of Western Ontario

Abstract - Objective: In 1994, the Family medicine Education and Research Network (FERN) was developed to support on-line discussion among London and area family physicians. FERN-D (FERN Dissemination) was introduced as a closed sub-group of FERN to support educational case discussions focused on prevention. The present study reports results of a pilot FERN-D intervention. Design: Pre- and Post- intervention mail-out surveys combined with an e-mail feedback questionnaire and a modified focus group. Setting: Rural and urban family physicians in the London Ontario area. Participants: Initial survey mailed to all area family physicians (N=480). 40 volunteer physicians recruited to the intervention group. Response rate was 50.4% to the pre-survey, and 68% to the follow-up survey (only mailed to responders) Main findings: A higher percentage of the FERN-D group indicated accurate knowledge for seven of the items than the comparison group. Both groups improved their preventive practice scores from pre- to post intervention. The majority of the FERN-D group felt that they had become aware of new techniques or relevant research (58.8%) and had made changes in their practice (64.7%). In both the e-mail feedback and the modified focus group convenience (89.2%) and interaction with family physician colleagues (86.5%) were cited as advantages to this method of CME. Conclusion: On-line case-based discussion is a promising strategy for enhanced research transfer to family physicians: more research is needed to determine if it can be effectively utilized to change physician behavior.

Walter Edinger, Ph.D, JoDee Robertson, Joy Skeel, M.Div, Judith Schoonmaker, M.D.

Abstract: A literature search shows multiple uses for standardized patients for teaching and evaluating clinical skills. However, there is little written about the use of standardized patients for teaching clinical ethics. When the Standardized Patient Program was organized at the Medical College of Ohio at Toledo in 1991, the Ethics Program realized the potential for innovative and interactive learning opportunities for medical students. Topics including ethical issues in psychiatry, domestic violence, physician assisted suicide, taking a sexual history, giving bad news and discussing DNR status have been incorporated into cases in which standardized patients are trained. These cases are then used to help students learn about these difficult issues. Student interaction with standardized patients in the second year teaches them how to communicate with a manic patient refusing psychotropic medication; and how to take a sexual history without embarrassment. In the third year medicine clerkship, students have to discuss "bad news" with a patient and try to obtain a "code status" decision. By using standardized patients, we make our teaching more clinically relevant for students. We build didactic presentations around case studies to demonstrate what physicians are likely to encounter in the clinical setting. In this paper we will describe how the synergistic relationship between the standardized patient and ethics programs has enhanced the educational process for our medical students.

Dr Arun Midha^*, Mrs Kathryn Redway^†, Dr. Hilary Fielder^*, Professor Stephen Palmer^*, Dr. Cerilan Rogers^*, Dr. Dorothy Wright^‡,

^* Division of Public Health, University of Wales College of Medicine
^†Henwick Old Farm, Thatcham Kent
^‡Morgannwg, Health Authority, 41 High Street, Swansea

Abstract - In the United Kingdom, a qualified medical doctor needs to undertake a five year training programme to reach Consultant status (Medical Specialists in a particular area such as public health, surgery, obstetrics etc.) During this period of training they are known as 'Specialist Registrars'. Consultants in Public Health Medicine have a key training role acting as Trainers assisting these Specialist Registrars to acquire epidemiological public health skills necessary to attain Consultant status. In addition to formal Public Health Medicine training, Trainers have a pastoral role that can mean that they need to be sensitive to the emotional needs of their Specialist Registrars. Praising or reprimanding adults is not an easy task and few people are trained for it. In this training role, Consultants themselves need to be equipped to undertake this effectively. The 'Wales' training model, developed by the Faculty of Public Health Medicine in Wales, has sought to address this need and could be replicated to train Trainers in other medical specialties and in other parts of the world

Generating Productive Learning Issues in PBL Tutorials: An Exercise to Help Tutors Help Students

Office of Educational Development, College of Veterinary Medicine, Cornell University

Abstract: The development of productive, manageable, appropriate learning issues is central to students’ achievement of content objectives in problem-based learning. Students’ reflection on their learning issues is also an important part of the development of their self-directed learning skills. The use of an exercise to support tutors in helping students develop and apply criteria for productive learning issues is described and analyzed. According to feedback from tutors, the forty five minute preparatory workshop for tutors, followed by a 15 to 20 minute "mini-workshop" with students in their tutorials was a successful format for achieving the objectives of the exercise in a first year problem-based learning course. By integrating the activity into the tutorial process, the student participation rate was much higher than previous, stand-alone workshops for students on educational process. Several modifications to the exercise and proposals for related future research are offered.

Dennis Paul Valenzeno, PhD^*, Thomas Brennan, PhD^†, Francis Gasparro, PhD^‡, Christopher Lambert, Ph.D^§, Kendric Smith, PhD^** , ^*University of Kansas Medical Center,

^†Dickinson College,
^‡Thomas Jefferson University
^§Connecticut College
^**Stanford University

Abstract - The Digital Compendium is a new concept in education, andis described here for the science of photobiology, a Digital Photobiology Compendium (DPC). Medical school is the start of a lifelong learning endeavor. Increasingly computer- and web-based resources will facilitate this process. Yet there are currently few resources that span the range of knowledge from student through practicing professional. To this end we are developing a technologically advanced, scientifically up-to-date learning tool, with the initial effort in the field of photobiology. Photobiology is a young interdisciplinary field that is growing in importance because of its relevance to laser/light therapies and the biological consequences of increased UV radiation due to ozone depletion. The DPC will be web-based, consisting of a matrix of more than 100 instructional modules in all subdisciplines of photobiology. The modules will be mutually compatible to allow the user (learner or instructor) to connect a set of modules in a user-defined Work. Standard Works will also be predefined. The matrix will include modules suitable for learners at various levels from advanced undergraduate through practicing.

University of Pécs, Faculty of Medicine, Institute of Kinesiology, Pécs, Hungary

Abstract - The purpose of this article is to describe a program to incorporate kinesiology into medical education. An institute of kinesiology was established in our Faculty of Medicine, its mission being to develop, teach and apply knowledge about the nature and consequences of regular physical activity. Kinesiology, the science of human motion, was initially offered in the medical curriculum as an optional credit course. Three main points were considered when preparing the subject matter: 1. the fundamentals of kinesiology, 2. its connection with the other subjects in the curriculum, and 3. suggestions from family physicians. At the end of the course the students take a written exam and are asked to evaluate the course.

Sybille K Lechner BDS, MDS FRACDS, FPFA, FICD*, Peter Kandlbinder BEd (SCAE), MEd (UTS)†, Shalinie Gonsalkorale BDS (Hons), FRACDS*, Michael Bradshaw‡, Katherine M Harris (Lechner) B Soc Sci, MBA**, Tracey Winning BDSc (Hons) GradDipHEd PhD††

*School of Dental Studies, University of Sydney Australia
†Institute for Teaching and Learning University of Sydney, Australia
‡Multimedia programmer, Click Here Design Sydney, Australia
**The Leading Edge Sydney, Australia
††Dental School, Faculty of Health Sciences, Adelaide University, Australia

Abstract: The module was developed as an elective to give motivated senior dental students an opportunity to expand their horizons in planning oral rehabilitation. It comprised one tutor and 12 students, from five universities world-wide, communicating on the World Wide Web (WWW), to develop oral rehabilitation plans for simulated patients. Trigger material came from one of two Case Profiles and consisted of diagnostic casts and details of the clinical and radiographic examination in WWW/CD-ROM form. No background material was supplied as to the "patient's" age, sex, history or main concern(s). Students worked in groups of three, each student from a different location. Individual students were given a role within the group: "Patient", who developed a "personal background" belonging to the trigger examination material, "Academic" who identified state-of-the-art treatment options available for the dental treatment needs identified by the group and "General Practitioner" who tailored these options to the "patient's" needs and wants. Student feedback focused on their perception of their experience with the program in response to a questionnaire comprising 11 structured and four "open" questions. All students felt that the program increased their confidence in planning oral rehabilitation. Ten students felt that the "best thing about the program" was the interaction with students from other universities and the exposure to different philosophies from the different schools. Eight students mentioned their increased awareness of the importance of patient input into holistic planning. Under the heading "What was the worst thing", students cited some technical hitches and the snowball effect of two sluggish students who were not identified early enough and thus impacted negatively on the working of their groups. Student feedback showed that the module succeeded in its aims but needed modification to improve the logistics of working with an extended campus

The Brachial Plexus: Development and Assessment of a Computer Based Learning Tool

Abstract - The objective of the present study is to evaluate the use of multimedia technology to simplify study of the brachial plexus. A combination of newly-rendered illustrations, animations, explanatory text, and a set of printable sample questions were combined into a program to provide a tutorial for the brachial plexus. One aspect of the program is an animation showing the development of the brachial plexus from its developmental origins that illustrates limb rotation and the resulting adult anatomy and dermatomal arrangement. The cross-platform program requires Quicktime 3.0 and is packaged on CD-ROM. Student evaluation of the program highlights its ease of use and intuitive navigation. User evaluation provides validation that the use of illustrations and animations is beneficial to user’s understanding and retention of the material. Future plans involve incorporation of pathologic images in order to enhance the clinical relevance of the product.

An Integrated Approach for Evaluating Students' Achievement of Clinical Objectives

Patrick D. Bridge, PhD^*, and Kenneth A. Ginsburg, MD^†

^*Department of Family Medicine
^†Department of Obstetrics and Gynecology
Wayne State University
Detroit, MI

Abstract - During the clinical phase of undergraduate medical education (UME) students are often geographically disbursed and assigned to preceptors throughout the community. Monitoring, documenting, and evaluating their clinical experiences and achievement of clinical objectives in this venue becomes a challenge, especially for large UME programs. The purpose of this manuscript is to discuss a method for developing and implementing a school-wide evaluation system for the clinical phase of UME. This type of evaluation system links students' clinical experiential data with the objectives of a clerkship, using technological advances, such as the Personal Digital Assistant (PDA), Internet, and intranet. Clerkship directors are provided real-time reports on student's progress toward achieving clerkship objectives and are able to monitor the clinical activities of the clerkship. Students on the other hand, will be empowered to take more control of their educational experiences by monitoring their own progress.

^*Family Healthcare Associates, Garland, TX
^†Fort Collins Family Medicine Residency Program, Fort Collins, CO

Abstract - Purpose: Despite the associated health consequences, obesity is infrequently documented as a problem in medical charts. The purpose of this study is to determine whether a simple intervention (routine listing of the BMI on the medical chart) will increase physician documentation of obesity in the medical record.
Methods: Participants were resident physicians in a family medicine residency program. Participants were randomly assigned to either an experimental group or a control group. For experimental group physicians, the Body Mass Index was listed alongside other vital signs of patients seen in an ambulatory setting. Physician documentation of patient obesity was assessed by chart review after patient visits. Documentation was defined as inclusion of obesity on the problem list or in the progress note.
Results: The intervention did not significantly increase the rate of documentation of obesity in the medical chart. Several reasons for the lack of change are explored, including the difficulty of treating obesity successfully.

R. Gregg Dwyer, M.D., Ed.D., Linda A. Deloney, Ed.D(c), Mary J. Cantrell, M.A.,
C. James Graham, M.D.

University of Arkansas for Medical Sciences
College of Medicine
Little Rock, Arkansas

Abstract: Transition from the role of passive student to medical practitioner begins with learning the first clinical skill. This transition can be stressful for those experiencing it and to some extent by those coordinating it. Logistically, it requires demonstration of the techniques to the entire class by a single practitioner or to smaller groups of students by multiple practitioners. The former reduces the opportunity for close observation of technique and is less conducive to questions, while the latter requires multiple practitioners, which can be prohibitive given their already dense schedules. To reduce the stress for all involved and to maximize learning opportunities, an innovative approach to teaching the first skill, vital signs measurement, was developed. Small group instruction and practice were facilitated by senior medical student volunteers in a simulated outpatient clinic using actual equipment. Instruction was provided in a relaxed, but guided format. Students were provided with a lesson plan that detailed both, technique and brief physiology points, as well as check sheets to use during the lab and later as a refresher guide. The lesson plan, instructions for facilitators, and student check sheets were developed by a senior medical student and reviewed by the course faculty. Recruitment and briefing of student facilitators and conduct of the lab were also performed by the senior student. The purpose of this trend article is to describe the development of a new course format and to report our experience with implementation of the new format. It is intended to spark interest in applying similar approaches to other curricular issues.

The Building Partnerships Program: An Approach to Community-Based Learning for Medical Students in Australia

Frances M. Boyle, PhD, T. Natasha Posner, PhD, Allyson J. Mutch, BA(Hons)
Rebecca M. Farley, BBehSc, Julie H. Dean, MPsych(Clin), Anne-Louise Nilsson, BA

Centre for Primary Health Care
School of Population Health
University of Queensland, Australia

Abstract: - The Building Partnerships Program at the University of Queensland, Australia seeks to address the dual challenge of preparing doctors who are responsive to the community while providing a meaningful context for social sciences learning. Through partnerships with a diverse range of community agencies, the program offers students opportunities to gain non-clinical perspectives on health and illness through structured learning activities including: family visits; community agency visits and attachments; and interview training. Students learn first-hand about psychosocial influences on health and how people manage health problems on a day-to-day basis. They also gain insights into the work of community agencies and how they as future doctors might work in partnership with them to enhance patient care. We outline the main components of the program, identify challenges and successes from student and community agency perspectives, and consider areas that invite further development.

Evaluation of World Wide Web-based Lessons for a First Year Dental Biochemistry Course

Department of Basic Sciences
The University of Texas Dental Branch at Houston
6516 M. D. Anderson Boulevard
Houston, TX 77030

Abstract: First year dental students at The University of Texas Dental Branch at Houston (Dental Branch) are required to take a basic biochemistry course. To facilitate learning and allow student self-assessment of their progress, WWW-based lessons covering intermediary metabolism were developed as a supplement to traditional lectures. Lesson design combined text, graphics, and animations and included learner control, links to other learning resources, and practice exercises and exams with immediate feedback. Results from an on-line questionnaire completed by students in two different classes showed that they completed 50% of the lessons and spent an average of 4 hrs. on-line. A majority of the students either agreed or strongly agreed that practice exercises were helpful, that the ability to control the pace of the lessons was important, that the lesson structure and presentation was easy to follow, that the illustrations, animations, and hyperlinks were helpful, and that the lessons were effective as a review. The very positive response to the WWW-based lessons indicates the usefulness of this approach as a study aid for dental students.

Seth McClennen, MD, Larry A. Nathanson, MD, Charles Safran, MD,
Ary L. Goldberger, MD

Abstract: Purpose: To create a multimedia internet-based ECG teaching tool, with the ability to rapidly incorporate new clinical cases.
Method: We created ECG Wave-Maven (http://ecg.bidmc.harvard.edu), a novel teaching tool with a direct link to an institution-wide clinical repository. We analyzed usage data from the web between December, 2000 and May 2002.
Results: In 17 months, there have been 4105 distinct uses of the program. A majority of users are physicians or medical students (2605, 63%), and almost half report use as an educational tool.
Conclusions: The internet offers an opportunity to provide easily-expandable, open access resources for ECG pedagogy which may be used to complement traditional methods of instruction.

Abstract: This report presents the results of a pilot project using wireless PDAs as teaching tools in an undergraduate medical curriculum. This technology was used to foster a transition from a passive to an interactive learning environment in the classroom and provided a solution for the implementation of computer-based exams for a large class. Wayne State Medical School recently provided model e570 Toshiba PocketPCs^® (personal digital assistants or PDAs), network interface cards, and application software developed by CampusMobility^® to 20 sophomore medical students. The pilot group of preclinical students used the PDAs to access web-based course content, for communication, scheduling, to participate in interactive teaching sessions, and to complete course evaluations. Another part of this pilot has been to utilize the PDAs for computer-based exams in a wireless environment. Server authentication that restricted access during the exams and a proctoring console to monitor and record the PDA screens will be described in this report. Results of a student satisfaction survey will be presented.

Vernon Curran, PhD^*, Fran Kirby, MEd^*, Michael Allen, MD^†, Joan Sargeant, MEd^†

Abstract - Introduction: Distance learning technologies have been used for many years to provide CME to rural physicians. The purpose of this study was to evaluate the utility and acceptability of a mixed learning technology approach for providing distance CME. The approach combined audio teleconferencing instruction with a Web-based learning system enabling the live presentation and archiving of instructional material and media, asynchronous computer conferencing discussions, and access to supplemental online learning resources.

Methodology: The study population was comprised of physicians and nurse practitioners who participated in audio teleconference sessions, but did not access the Web-based learning system (non-users); learners who participated in audio teleconferences and accessed the Web-based system (online users); and faculty. The evaluation focused upon faculty and learners’ experiences and perceptions of the mixed learning technology approach; the level of usage; and the effectiveness of the approach in fostering non-mandatory, computer-mediated discussions.

Results and Discussion: The users of the Web-based learning system were satisfied with its features, ease of use, and the ability to access online CME instructional material. Learners who accessed the system reported a higher level of computer skill and comfort than those who did not, and the majority of these users accessed the system at times other than the live audio teleconference sessions. The greatest use of the system appeared to be for self-directed learning. The success of a mixed learning technology approach is dependent on Internet connectivity and computer access; learners and faculty having time to access and use the Web; comfort with computers; and faculty development in the area of Web-based teaching.

A 3 Week Geriatric Education Program for 4th Year Medical Students at
Dalhousie University

Laurie Mallery, M.D., FRCPC, Janet Gordon, M.D., FRCPC, Susan Freter, M.D., FRCPC

Dalhousie University,
Department of Medicine
Division of Geriatric Medicine
Halifax, Nova Scotia, Canada

Abstract: Purpose -Population demographics are shifting towards an increased average age. Yet, many medical schools still do not have mandatory comprehensive education in Geriatric Medicine. In 2001, the Division of Geriatric Medicine at Dalhousie University developed a required three-week geriatric course for fourth year medical students. This paper describes the details of the curriculum so that it can be reproduced in other settings.
Results - The curriculum was successfully implemented. An examination, held at the end of each 3-week rotation, documented extensive learning of important concepts in Geriatric Medicine. The students gave positive feedback about the benefits of this training program.
Conclusion -A well developed formal education program teaches students specific skills in Geriatric Medicine, which may improve the care of the growing elderly population.

Tammy Y. Euliano, MD^*, Amy I. Lee^†, Jeremy Melker, MD^‡, Ilona M. Schmalfuss, MD^§

^*Associate Professor of Anesthesiology
^†Medical Student
^‡Resident in Otolaryngology
^§Assistant Professor of Radiology

Abstract: Airway evaluation and basic management are essential skills for all physicians. Identifying patients for whom mask ventilation or endotracheal intubation will be difficult to impossible is vital for patient safety. Despite this, training in airway evaluation is minimal in the curricula of most medical schools. To ensure a thorough understanding of airway anatomy and evaluation, as well as exposure to various abnormal findings, we developed an Internet-based module including interactive components, graphics, animation, video, and a self-assessment tool. The site received more than 1800 visits in its first nine months of operation, with uniformly laudatory comments. Eighty subjects over a six-month period completed a pre- and post-test quiz structured to evaluate the utility of the site. Of those completing the on-line survey, more than 76% rated the site very useful. Most felt their knowledge of airway examination improved after completion of the site (p<0.00004). The median amount of time spent on the site was 29.5 minutes. Judging from the overwhelming response to this site from around the world and across disciplines, such interactive training tools that exploit the technological capabilities of the Internet provide useful adjuncts to traditional teaching methods.

^†Children’s and Women’s Health Centre of British Columbia,
Oak Street,
Vancouver, Canada.

Abstract: Orientating new junior medical staff can be a complex and time consuming task. Traditional models have typically involved a day or longer of lectures. This involves a large number of senior staff being available on the first day of term. It also means that junior staff not present on the first day had any access to an orientation program at all. Evaluation of our program confirmed the belief that the day was dull and that there was simply too much information for new staff to absorb. As a result of this feedback we extensively updated our orientation program. Pre-reading of the junior staff manual became compulsory. We departed from the traditional lecture style program and devised a new ten- station scenario based interactive program. The stations were designed to cover aspects of the hospital’s mandatory education and key educational requirements in order to function effectively on our campus. Station leaders were selected and trained in the goals of the new process. Several of our secondment sites were engaged in the development of the project topics. We hoped that our secondment sites would be relieved of some orientation responsibility if core material was delivered centrally.

The strength of the new orientation is that it is portable, reproducible and uniform. It is also available via video conferencing. A single person can educate new staff in three hours if the need arises. Most importantly all new staff will have access to the program within a week of starting a term at our hospital.

Medical Student Summer Externship Program: Increasing the Number Matching in Family Practice

Abstract: Background and Objectives. The number of US allopathic medical school graduates choosing a residency in family medicine has fallen from 13.4% in 1999 to 10.5% in 2002. Concern about declining numbers has led to the development of programs to provide medical students exposure to family medicine outside the clerkship. This paper reports on the development and longitudinal achievements of a clinical summer externship program 1993 to 1999.
Methods. The program description, practice settings, students’ experiences, and department commitment are described. The purpose of this prospective study is to determine the percentage of family medicine summer externship participants (n=115) who match into family medicine.
Results. During the six years studied, 49 (43.4%) of the participants matched into family medicine. Program participants viewed the program favorably, mean = 5.82 out of 6.
Conclusions. The Ohio State University Department of Family Medicine Medical Student Summer Externship Program demonstrates an effective educational experience that can increase and/or attain the proportion of students going into family medicine at the time of graduation.

Development, Implementation and Evaluation of an M3 Community Health Curriculum

Barbra Beck, PhD, Marie Wolff PhD, Tovah Bates, PhD, Sarah Beverdorf, MPH/MSW,
Staci Young, MS and Syed Ahmed, MD, MPH, DrPH

Center for Healthy Communities
Department of Family and Community Medicine
Medical College of Wisconsin

Abstract: Objectives: This paper describes the development, implementation and evaluation of an M3 community health curriculum that responds to recent changes within the health care finance and delivery system.
Methods: The new curriculum was developed based on AAMC recommendations, LCME requirements, a national review of undergraduate community health curricula, and an internal review of the integration of community health concepts in M3 clerkships.
Results: The M3 curriculum teaches: 1) the importance of being a community responsive physician; 2) SES factors that influence health; 3) cultural competency; and 4) the role of physicians as health educators. Student evaluations for the first twelve months of implementation indicate that students are most satisfied with presentations and less satisfied with required readings and a patient interview project.
Discussion: Most students agree that at the completion of the course they understand what it means to be a community-responsive physician, and they have developed skills to help them become more community responsive. Evaluation tools need to be developed to assess if students’ behavior has changed due to course participation

Dario M. Torre, MD, MPH^*‡, Kurt J. Pfeifer, MD^*, Geoffrey C. Lamb, MD^*,
Matthew P. Walters ^**, James L. Sebastian, MD^*‡, Deborah E. Simpson, PhD^†

^*Department of Medicine
Division of General Internal Medicine
Medical College of Wisconsin

Abstract: Background: Previous studies have shown that medical students and post-graduate trainees need to improve their proficiency in cardiac auscultation. Technologic advances have created new learner-centered opportunities to enhance proficiency in this important physical examination skill.
Objectives: We sought to determine if technology-based, self-directed learning tools improved the cardiac auscultation skills of third-year medical students.
Methods: Sixteen (16) third-year medical (M3) students were exposed to three educational interventions: a one-hour cardiac auscultation lecture that featured computer-generated heart sounds, a PDA-based heart sounds/murmur form and a web-based cardiac auscultation program. Thirteen (13) internal medicine (IM) residents who served as a comparison group attended a cardiac auscultation lecture identical in content and format to the student lecture. At the end of the study period, we evaluated the ability of both groups to accurately identify heart sounds and cardiac murmurs via a twelve-item performance-based examination utilizing computer-generated heart sounds.
Results: Following our teaching interventions, findingsM3 students correctly identified 80% of the computer-simulated heart sounds/murmurs while the comparison group of IM residents accurately detected 60% of the same cardiac findings (p <. 005). .
Conclusions: The combination of traditional lecture and multi-media, technology-based, self-directed learning tools appears to be an effective and efficient strategy for teaching and reinforcing cardiac auscultation skills to third year medical students.