Computers in Medical Education

Computers in Medical Education
Roles of computers in medical education
* Provide facts and information
* Teach strategies for applying knowledge appropriately in medical situations
* Encourage the development of lifelong learning skills

Goals
* Students must learn about physiological processes
* Must understand the relationship between observed illnesses and underlying processes
* Must learn to perform medical procedures
* Must understand the effects of interventions on health outcomes

Basic curriculum
* Premedical requirements
* Medical school
o Basic
+ Physiology
+ Pathophysiology
o Clinical
* Residency
* CME

Teaching strategies
* Lecture
* Interactive

Process
* Presentation of a situation or body of facts containing core knowledge
* Explanation of important concepts and relationships
* How does one derive the concepts
* Why they are important
* Strategy for guiding interaction with the patient

Weaknesses of traditional approach
* Rapid knowledge growth
* Reliance on memorization rather than problem solving
* Reliance on lecture method

Terms
* Computer assisted learning
* Computer based education
* Computer assisted instruction

Advantages of computers in medical education
* Computer can augment, enhance or replace traditional teaching methods
o Rapid access to body of information
+ Data
+ Images
+ Immersive interfaces
o Any time, any place, any pace
o Simulated clinical situation

Advantages
* Interactive learning
o Active vs. passive solving
* Immediate student specific feedback
o Correct vs. incorrect, tailored response
* Tailored instruction
o Focus on areas of weakness
o Request help in interpretation
* Objective testing
o Permits standardized testing
o Self-evaluation
* Fun!

Experimentation
* Safe exploration of what-if in a well done scenario
o You can do things with simulated patients you can’t do with real ones

Case variety
* The ability to experience disease scenarios one otherwise wouldn’t see
o Simple: diabetes
o Complex: multiple disease, multiple medications
Time
* Manage diseases as they evolve over time
o Rapidly evolving problems
o Chronic diseases

Problem-solving competency
* Book smart vs. real-world
* Memorization vs. thinking
* Testing
* Right answer vs. cost-effective vs. safest vs.quickest (fewest steps)

Board examinations
* USMLE test
* CME testing

History of CAI
* Pioneering research in the 1960’s
o Ohio State
+ Tutorial evaluation system
# Constructed choice, T/F, multiple choice, matching or ranking questions
# Immediate response evaluation
# Positive feedback
# Corrective rerouting
+ Authoring language
History
* Barnett MGH 1970
o Simulated patient encounters
+ 30 simulated cases
o Mathematical modeling of physiology
+ Warfarin, insulin, Marshall
o Dxplain
* University of Illinois
o Computer aided simulation of the patient encounter
+ Computer as patient
+ Natural language encounter
* Illinois 1970’s
o Programmed logic for automated teaching (PLATO)
+ Plasma display (required specialized equipment)
+ Combination of text, graphics and photos
o TUTOR authoring language
* University of Wisconsin
o Used simulated case scenarios and estimated the efficiency of the student in arriving at a diagnosis (cost-effectiveness)
* Initial installations site limited
* Subsequent modem dial-up
* Proliferation of medical CAI, CME development entities
* Development of the internet
o Initial material bandwidth limited
o Increasing use of streaming video

Modes of CAI
* Drill and practice
* Didactic
Modes
* Discrimination learning
* Exploration vs. structures interaction
o Hyperlink analogy
o Requires feedback/guidance
* Constrained vs. unconstrained response
o Student may have a pre-selected set of possible response (learn to answer questions)
o Student may be able to probe system using natural language
* Constructive
o Put the body together from pieces of anatomy
Simulation
* Static vs. dynamic
Static simulation
Dynamic simulation
Feedback and guidance
* Feedback
o Correct vs. incorrect
o Summaries
o References
* Guidance
o Tailored feedback
o Hints
o Interactive help
Intelligent tutoring
* Sophisticated systems can
o Intervene if a student goes down an unproductive path
o Gets stuck
o Appears to misunderstand a detail
o Mixed initiative systems
o Coaching vs. tutoring
Graphics and Video
* Storage of images, video etc as part of a multimedia stream
o General appearance
o Skin lesions
o Xrays
o Sounds (cardiology, breath sounds)
Authoring systems
* Generic authoring systems
o McGraw Hill, Boeing
o Simple (constraints) vs. comprehensive (difficult to master)

Examples
* USMLE
* Lister Hill
* Stanford anatomy
* Digital anatomy
* Penn curriculum
* Medical matrix
Continuing medical education
* Echo
* PAC
* CME
Simulators
* ACLS
* Visible human
* Eye simulator
* Other simulators
Future
* Forces for change
* Impediments
o Cost
o Immaturity of authoring tools
o Bandwidth
o Barriers to sharing
+ Institutional jealousy
+ Copyright
* Lack of standard approach
o Authoring software
o Platform
* Explicit integration of CAI into curriculum
* Access to PC’s and LAN

Computers in Medical Education.ppt