Use of lecture recordings in dental education: assessment of status quo and recommendations

This research project was part of a planned initiative at the University of Pittsburgh School of Dental Medicine to incorporate lecture recordings as standard educational support technologies. The goal of an institutional survey was 1) to gather current data about how dental educators across the United States and Canada use lecture recordings; 2) determine dental educators' perceived value and outcomes of using lecture recordings; and 3) develop recommendations based on #1 and #2 for the dental education community. Of the sixty-six North American dental schools at the time of the study, forty-five schools responded to the survey, for a 68 percent response rate. Of the respondents, twenty-eight schools were found to currently conduct lecture recording; these comprised the study sample. This study focused on the dental schools' past experiences with lecture recording; thus, those not currently engaged in lecture recording were excluded from further analysis. The survey questions covered a wide range of topics, such as the scope of the lecture recording, logistics, instructional design considerations, outcomes related to student learning, evaluation and reception, barriers to lecture recording, and issues related to copyright and intellectual property. The literature review and results from the survey showed that no common guidelines for best practice were available regarding lecture recordings in dental education. The article concludes with some preliminary recommendations based on this study.

Use of social media by dental educators

Social networking applications have become an established means of communication; applications that did not exist ten years ago are now used daily. Social media can be used for a myriad of reasons including instructional tools to supplement learning. This project was designed to assess the usage of social media applications by dental school faculty members and identify the types of accounts they prefer. Four hundred forty-three full-time dental and dental hygiene faculty members from five U.S. dental schools were invited to complete a twelve-item online survey regarding their social media usage. The response rate was 50 percent (n=221). Of the respondents, nearly half were dentists, and 62 percent were ≥51 years of age. Facebook was the most popular social network, reportedly used by 111 respondents. The most often reported frequency of use was weekly (20.4 percent, n=221); users indicated utilizing a network primarily for personal rather than professional purposes. However, 37 percent of the respondents reported not using any social media. The most frequently cited barriers to the use of social media were time (48 percent) and privacy concerns (48 percent). Although few would dispute the influence social media has on today's students, the suitability and appropriateness of social media technology and its integration into dental curricula require further evaluation.

The impact of active versus passive use of 3D technology: a study of dental students at Wuhan University, China

A variety of computer-based 3D applications are becoming regular tools for dental students for self-learning. This study investigated the learning effectiveness of junior dental students in passively versus actively controlling the 3D virtual scenes of implant dentistry. Participants were randomized into three groups and were exposed to three designs of educational materials: traditional 2D webpages (2D); active-controlling 3D webpages (A3); and passive-controlling 3D webpages (P3). After reviewing the webpages, the participants were asked to complete a posttest to assess the relative quality of information acquisition. Their responses were compared and analyzed. The results indicated that the P3 group received the highest score of 26.4±3.1 on the post-test, significantly better than the A3 group, which had the worst performance with a score of 20.3±4.0. The 2D group received a score of 24.2±4.6. There was a significant correlation between the scores on a mental rotations test and the subjects' performance on the posttest (p<0.001). A serious disadvantage of active control was indicated for individuals with low spatial ability. In 3D virtual reality assisted self-learning, passive control produces higher learning effects compared to active control. Too much active control may generate significantly negative impacts on students, especially for individuals with low spatial ability.

Testing manual dexterity using a virtual reality simulator: reliability and validity

Virtual reality dental training simulators, unlike traditional human-based assessment, have the potential to enable consistent and reliable assessment. The purpose of this study was to determine whether a haptic simulator (IDEA Dental(®) ) could provide a reliable and valid assessment of manual dexterity. A total of 106 participants were divided into three groups differing in dental manual dexterity experience: (i) 63 dental students, (ii) 28 dentists, (iii) 14 non-dentists. The groups, which were expected to display various performance levels, were required to perform virtual drilling tasks in different geometric shapes. The following task parameters were registered: (i) Time to completion (ii) accuracy (iii) number of trials to successful completion and (iv) score provided by the simulator. The reliability of the tasks was calculated for each parameter. The simulator and its scoring algorithm showed high reliability in all the parameters measured. The simulator was able to differentiate between non-professionals and dental students or non-professionals and dentists. Our study suggests that for improved construct validity, shorter working times and more difficult tasks should be introduced. The device should also be designed to provide greater sensitivity in measuring the accuracy of the task.

Patient outcomes in simulation-based medical education: a systematic review

OBJECTIVES

Evaluating the patient impact of health professions education is a societal priority with many challenges. Researchers would benefit from a summary of topics studied and potential methodological problems. We sought to summarize key information on patient outcomes identified in a comprehensive systematic review of simulation-based instruction.

DATA SOURCES

Systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, key journals, and bibliographies of previous reviews through May 2011.

STUDY ELIGIBILITY

Original research in any language measuring the direct effects on patients of simulation-based instruction for health professionals, in comparison with no intervention or other instruction.

APPRAISAL AND SYNTHESIS

Two reviewers independently abstracted information on learners, topics, study quality including unit of analysis, and validity evidence. We pooled outcomes using random effects.

RESULTS

From 10,903 articles screened, we identified 50 studies reporting patient outcomes for at least 3,221 trainees and 16,742 patients. Clinical topics included airway management (14 studies), gastrointestinal endoscopy (12), and central venous catheter insertion (8). There were 31 studies involving postgraduate physicians and seven studies each involving practicing physicians, nurses, and emergency medicine technicians. Fourteen studies (28 %) used an appropriate unit of analysis. Measurement validity was supported in seven studies reporting content evidence, three reporting internal structure, and three reporting relations with other variables. The pooled Hedges' g effect size for 33 comparisons with no intervention was 0.47 (95 % confidence interval [CI], 0.31-0.63); and for nine comparisons with non-simulation instruction, it was 0.36 (95 % CI, -0.06 to 0.78).

LIMITATIONS

Focused field in education; high inconsistency (I(2) > 50 % in most analyses).

CONCLUSIONS

Simulation-based education was associated with small-moderate patient benefits in comparison with no intervention and non-simulation instruction, although the latter did not reach statistical significance. Unit of analysis errors were common, and validity evidence was infrequently reported.

Automated detection of heuristics and biases among pathologists in a computer-based system

The purpose of this study is threefold: (1) to develop an automated, computer-based method to detect heuristics and biases as pathologists examine virtual slide cases, (2) to measure the frequency and distribution of heuristics and errors across three levels of training, and (3) to examine relationships of heuristics to biases, and biases to diagnostic errors. The authors conducted the study using a computer-based system to view and diagnose virtual slide cases. The software recorded participant responses throughout the diagnostic process, and automatically classified participant actions based on definitions of eight common heuristics and/or biases. The authors measured frequency of heuristic use and bias across three levels of training. Biases studied were detected at varying frequencies, with availability and search satisficing observed most frequently. There were few significant differences by level of training. For representativeness and anchoring, the heuristic was used appropriately as often or more often than it was used in biased judgment. Approximately half of the diagnostic errors were associated with one or more biases. We conclude that heuristic use and biases were observed among physicians at all levels of training using the virtual slide system, although their frequencies varied. The system can be employed to detect heuristic use and to test methods for decreasing diagnostic errors resulting from cognitive biases.

Teaching with technology: learning outcomes for a combined dental and dental hygiene online hybrid oral histology course

Among the challenges leaders in dental and allied dental education have faced in recent years is a shortage of well-qualified faculty members, especially in some specialty areas of dentistry. One proposed solution has been the use of technology. At the University of Missouri-Kansas City School of Dentistry, the departure of a faculty member who taught the highly specialized content in oral histology and embryology provided the opportunity to implement distance delivery of that course. The course is taught once a year to a combined group of dental and dental hygiene students. Previous to spring semester of 2009, the course was taught using traditional face-to-face, in-class lectures and multiple-choice examinations. During the spring semesters of 2009, 2010, and 2011, the course was taught using synchronous and asynchronous distance delivery technology. Outcomes for these courses (including course grades and performance on the National Board Dental Examination Part I) were compared to those from the 2006, 2007, and 2008 courses. Students participating in the online hybrid course were also given an author-designed survey, and the perceptions of the faculty member who made the transition from teaching the course in a traditional face-to-face format to teaching in an online hybrid format were solicited. Overall, student and faculty perceptions and student outcomes and course reviews have been positive. The results of this study can provide guidance to those seeking to use technology as one method of curricular delivery.

Perceptions of pharmacy students, faculty members, and administrators on the use of technology in the classroom

OBJECTIVES

To gather and evaluate the perceptions of students, faculty members, and administrators regarding the frequency and appropriateness of classroom technology use.

METHODS

Third-year pharmacy students and faculty members at 6 colleges and schools of pharmacy were surveyed to assess their perceptions about the type, frequency, and appropriateness of using technology in the classroom. Upper-level administrators and information technology professionals were also interviewed to ascertain overall technology goals and identify criteria used to adopt new classroom technologies.

RESULTS

Four hundred sixty-six students, 124 faculty members, and 12 administrators participated in the survey. The most frequently used and valued types of classroom technology were course management systems, audience response systems, and lecture capture. Faculty members and students agreed that faculty members appropriately used course management systems and audience response systems. Compared with their counterparts, tech-savvy, and male students reported significantly greater preference for increased use of classroom technology. Eighty-six percent of faculty members reported having changed their teaching methodologies to meet student needs, and 91% of the students agreed that the use of technology met their needs.

CONCLUSIONS

Pharmacy colleges and schools use a variety of technologies in their teaching methods, which have evolved to meet the needs of the current generation of students. Students are satisfied with the appropriateness of technology, but many exhibit preferences for even greater use of technology in the classroom.

E4D compare software: an alternative to faculty grading in dental education

The traditional method of evaluating student tooth preparations in preclinical courses has relied on the judgment of experienced clinicians primarily utilizing visual inspection. At times, certain aids such as reduction matrices or reduction instruments of known dimension are used to assist the evaluator in determining the grade. Despite the skill and experience of the evaluator, there is still a significant element of uncertainty and inconsistency in these methods. Students may perceive this inconsistency as a form of subjective, arbitrary, and empirical evaluation, which often results in students' focusing more on the grade than the actual learning or developing skills necessary to accomplish the preparation properly. Perceptions of favoritism, discrimination, and unfairness (whether verbalized or not) may interfere with the learning process. This study reports the use of a new experimental scanning and evaluation software program (E4D Compare) that can consistently and reliably scan a student's tooth preparation and compare it to a known (faculty-determined) standardized preparation. An actual numerical evaluation is generated by the E4D Compare software, thereby making subjective judgments by the faculty unnecessary. In this study, the computer-generated result was found to be more precise than the hand-graded method.

Effects of pre-training using serious game technology on CPR performance--an exploratory quasi-experimental transfer study

BACKGROUND

Multiplayer virtual world (MVW) technology creates opportunities to practice medical procedures and team interactions using serious game software. This study aims to explore medical students' retention of knowledge and skills as well as their proficiency gain after pre-training using a MVW with avatars for cardio-pulmonary resuscitation (CPR) team training.

METHODS

Three groups of pre-clinical medical students, n = 30, were assessed and further trained using a high fidelity full-scale medical simulator: Two groups were pre-trained 6 and 18 months before assessment. A reference control group consisting of matched peers had no MVW pre-training. The groups consisted of 8, 12 and 10 subjects, respectively. The session started and ended with assessment scenarios, with 3 training scenarios in between. All scenarios were video-recorded for analysis of CPR performance.

RESULTS

The 6 months group displayed greater CPR-related knowledge than the control group, 93 (±11)% compared to 65 (±28)% (p < 0.05), the 18 months group scored in between (73 (±23)%).At start the pre-trained groups adhered better to guidelines than the control group; mean violations 0.2 (±0.5), 1.5 (±1.0) and 4.5 (±1.0) for the 6 months, 18 months and control group respectively. Likewise, in the 6 months group no chest compression cycles were delivered at incorrect frequencies whereas 54 (±44)% in the control group (p < 0.05) and 44 (±49)% in 18 months group where incorrectly paced; differences that disappeared during training.

CONCLUSIONS

This study supports the beneficial effects of MVW-CPR team training with avatars as a method for pre-training, or repetitive training, on CPR-skills among medical students.

Health and wellness technology use by historically underserved health consumers: systematic review

BACKGROUND

The implementation of health technology is a national priority in the United States and widely discussed in the literature. However, literature about the use of this technology by historically underserved populations is limited. Information on culturally informed health and wellness technology and the use of these technologies to reduce health disparities facing historically underserved populations in the United States is sparse in the literature.

OBJECTIVE

To examine ways in which technology is being used by historically underserved populations to decrease health disparities through facilitating or improving health care access and health and wellness outcomes.

METHODS

We conducted a systematic review in four library databases (PubMed, PsycINFO, Web of Science, and Engineering Village) to investigate the use of technology by historically underserved populations. Search strings consisted of three topics (eg, technology, historically underserved populations, and health).

RESULTS

A total of 424 search phrases applied in the four databases returned 16,108 papers. After review, 125 papers met the selection criteria. Within the selected papers, 30 types of technology, 19 historically underserved groups, and 23 health issues were discussed. Further, almost half of the papers (62 papers) examined the use of technology to create effective and culturally informed interventions or educational tools. Finally, 12 evaluation techniques were used to assess the technology.

CONCLUSIONS

While the reviewed studies show how technology can be used to positively affect the health of historically underserved populations, the technology must be tailored toward the intended population, as personally relevant and contextually situated health technology is more likely than broader technology to create behavior changes. Social media, cell phones, and videotapes are types of technology that should be used more often in the future. Further, culturally informed health information technology should be used more for chronic diseases and disease management, as it is an innovative way to provide holistic care and reminders to otherwise underserved populations. Additionally, design processes should be stated regularly so that best practices can be created. Finally, the evaluation process should be standardized to create a benchmark for culturally informed health information technology.

Sexual risk avoidance and sexual risk reduction interventions for middle school youth: a randomized controlled trial

PURPOSE

To evaluate the efficacy of two, theory-based, multimedia, middle school sexual education programs in delaying sexual initiation.

METHODS

Three-armed, randomized controlled trial comprising 15 urban middle schools; 1,258 predominantly African American and Hispanic seventh grade students followed into ninth grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes.

RESULTS

Participants were 59.8% females (mean age: 12.6 years). Relative to controls, the RR program delayed any type of sexual initiation (oral, vaginal, or anal sex) in the overall sample (adjusted odds ratio [AOR]: .65, 95% CI: .54-.77), among females (AOR: .43, 95% CI: .31-.60), and among African Americans (AOR: .38, 95% CI: .18-.79). RR students also reduced unprotected sex at last intercourse (AOR: .67, 95% CI: .47-.96), frequency of anal sex in the past 3 months (AOR: .53, 95% CI: .33-.84), and unprotected vaginal sex (AOR: .59, 95% CI: .36-.95). The RA program delayed any sexual initiation among Hispanics (AOR: .40, 95% CI: .19-.86), reduced unprotected sex at last intercourse (AOR: .70, 95% CI: .52-.93), but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01-2.82). Both programs positively affected psychosocial outcomes.

CONCLUSIONS

The RR program positively affected sexually inexperienced and experienced youth, whereas the RA program delayed initiation among Hispanics and had mixed effects among sexually experienced youth.

Using simulation and patient role play to teach electrocardiographic rhythms to physical therapy students

PURPOSE

THE AIMS OF THE STUDY WERE TO DIFFERENTIATE: (1) physical therapy (PT) students' preferred method for learning electrocardiographic (ECG) recognition utilizing standardized patient (SP) and human patient simulation (HPS) approaches, (2) the impact of HPS or SP on confidence in interpreting ECG, and 3) the effect of HPS or SP on students' ability to make clinical decisions based upon ECG interpretation.

METHODS

"Three educational methods were employed to teach ECG recognition to two different years of novice PT students enrolled in a cardiopulmonary physical therapy class. First, all students had a traditional lecture on ECG. Following the lecture, two problem-based learning (PBL) approaches were utilized. One approach used a SP and paper ECG strips, and the second approach utilized HPS with simulated ECG monitoring."(1) Following the two PBL approaches, a post instructional survey regarding the learning experiences was conducted. Following instruction, each cohort (n = 24, n = 29) of PT students was given a mixed methods survey about their experience.

RESULTS

Survey return rate amongst both cohorts was 77%. Independent sample of individual cohort and paired t-tests of combined data comparing HPS to SP revealed a strong preference for HPS (p = 0.003 (2008 cohort) and p = 0.0001 (2010 cohort)) and combined cohort (p = 0.0001). There were no significant differences in responses between cohorts or preference between the HPS method and the use of SP and HPS combined. Additionally, 75% of respondents either strongly agreed or agreed that they felt confident with their skill in ECG interpretation as presented with HPS or SP. 90% either strongly agreed or agreed that they understood how the ECG relates to patient treatment. Summative assessment utilizing HPS revealed that students were competent in their performance in ECG recognition and clinical decision making related to patient treatment.(1)

CONCLUSION

Data support that HPS was the preferred method to improve student confidence in ECG recognition and interpretation.

Development of standardized clinical training cases for diagnosis of sexual abuse using a secure telehealth application

OBJECTIVES

The training of physicians, nurse examiners, social workers and other health professional on the evidentiary findings of sexual abuse in children is challenging. Our objective was to develop peer reviewed training cases for medical examiners of child sexual abuse, using a secure web based telehealth application (TeleCAM).

METHODS

Sixty de-identified cases developed by 2 child abuse pediatricians, were stratified by availability of information (minimal, moderate, comprehensive) for both positive and negative child sexual abuse findings. These cases were narrowed to a set of 30 cases through an expert peer review process using pediatricians with extensive expertise in the evaluation of child sexual abuse. A previously studied secure web-based telehealth application TeleCAM which contains a child abuse workflow, was used to develop, disseminate and review cases. A series of Free Margin agreement statistics are used to select those cases with the highest rates of agreement. A final set of 30 cases are stratified equally by availability of information and for both positive and negative findings. Mantel Haenszel Chi-square was used for trend analysis of the ordered categorical variables.

RESULTS

The highest degrees of inter-rater reliability was found in cases with moderate to comprehensive information. Cases with minimal data had poor kappa agreement indicating that availability of differing levels and types of information contribute to variability in diagnostic findings.

CONCLUSION

These final cases will be further studied with medical examiners in various settings utilizing TeleCAM as the application for dissemination.

Educational technology use among US colleges and schools of pharmacy

OBJECTIVE

To develop a searchable database of educational technologies used at schools and colleges of pharmacy.

METHODS

A cross-sectional survey design was used to determine what educational technologies were being used and to identify an individual at each institution who could serve as an information resource for peer-to-peer questions.

RESULTS

Eighty-nine survey instruments were returned for a response rate of 75.4%. The resulting data illustrated the almost ubiquitous presence of educational technology. The most frequently used technology was course management systems and the least frequently used technology was microblogging.

CONCLUSIONS

Educational technology use is trending toward fee-based products for enterprise-level applications and free, open-source products for collaboration and presentation. Educational technology is allowing educators to restructure classroom time for something other than simple transmission of factual information and to adopt an evidence-based approach to instructional innovation and reform.

Transforming a large-class lecture course to a smaller-group interactive course

OBJECTIVE

To transition a large pharmacokinetics course that was delivered using a traditional lecture format into a smaller-group course with a discussion format.

DESIGN

An e-book and Web-based multimedia learning modules were utilized to facilitate students' independent learning which allowed the number of classes they were required to attend to be reduced from 3 to 1 per week. Students were assigned randomly to 1 of 3 weekly class sessions. The majority of lecture time was replaced with active-learning activities including discussion, problem solving, and case studies to encourage higher-order learning.

ASSESSMENT

Changes in course delivery were assessed over a 4-year period by comparing students' grades and satisfaction ratings on course evaluations. Although student satisfaction with the course did not improve significantly, students preferred the smaller-group setting to a large lecture-based class. The resources and activities designed to shift responsibility for learning to the students did not affect examination grades even though a larger portion of examination questions focused on higher orders of learning (eg, application) in the smaller-group format.

CONCLUSIONS

Transitioning to a smaller-group discussion format is possible in a pharmacokinetics course by increasing student accountability for acquiring factual content outside of the classroom. Students favored the smaller-class format over a large lecture-based class.

Use of technology for educating melanoma patients

We evaluated the feasibility of using technology for melanoma patient education in a clinic setting. We assessed technology skill level and preferences for education. Data were collected using an adapted version of the Use of Technology Survey. Most participants owned a computer and DVD player and were skilled in the use of these devices, along with Internet and e-mail. Participants preferred the option of using in-clinic and at-home technology versus in-clinic only use. Computer and DVD applications were preferred because they were familiar and convenient. Using technology for patient education intervention is a viable option; however, patients' skill level and preferences for technology should be considered.

Factors affecting feeling-of-knowing in a medical intelligent tutoring system: the role of immediate feedback as a metacognitive scaffold

Previous studies in our laboratory have shown the benefits of immediate feedback on cognitive performance for pathology residents using an intelligent tutoring system (ITS) in pathology. In this study, we examined the effect of immediate feedback on metacognitive performance, and investigated whether other metacognitive scaffolds will support metacognitive gains when immediate feedback is faded. Twenty-three participants were randomized into intervention and control groups. For both groups, periods working with the ITS under varying conditions were alternated with independent computer-based assessments. On day 1, a within-subjects design was used to evaluate the effect of immediate feedback on cognitive and metacognitive performance. On day 2, a between-subjects design was used to compare the use of other metacognitive scaffolds (intervention group) against no metacognitive scaffolds (control group) on cognitive and metacognitive performance, as immediate feedback was faded. Measurements included learning gains (a measure of cognitive performance), as well as several measures of metacognitive performance, including Goodman-Kruskal gamma correlation (G), bias, and discrimination. For the intervention group, we also computed metacognitive measures during tutoring sessions. Results showed that immediate feedback in an intelligent tutoring system had a statistically significant positive effect on learning gains, G and discrimination. Removal of immediate feedback was associated with decreasing metacognitive performance, and this decline was not prevented when students used a version of the tutoring system that provided other metacognitive scaffolds. Results obtained directly from the ITS suggest that other metacognitive scaffolds do have a positive effect on G and discrimination, as immediate feedback is faded. We conclude that immediate feedback had a positive effect on both metacognitive and cognitive gains in a medical tutoring system. Other metacognitive scaffolds were not sufficient to replace immediate feedback in this study. However, results obtained directly from the tutoring system are not consistent with results obtained from assessments. In order to facilitate transfer to real-world tasks, further research will be needed to determine the optimum methods for supporting metacognition as immediate feedback is faded.

Examining the efficacy of DVD technology compared to print-based material in COPD self-management education of rural patients

A pilot study (n = 41) was conducted to test the effects of three educational treatments (DVD vs. Pamphlet vs. DVD + Pamphlet) on health-related quality of life (HRQoL), COPD information needs and self-efficacy among a referred sample of Certified Federal Rural Health Clinic patients (mean age = 61.51 years ± 6.29 years; ~61% female) suffering from COPD using a randomly-assigned, multiple-group pretest-posttest design with a control group. A MANCOVA testing planned multivariate contrasts determined patients receiving a DVD reported statistically significant higher levels of lung-specific physical functioning as compared to patients receiving a Pamphlet. Additionally, DVD patients reported clinically significant improvements on two dimensions of lung-specific HRQoL. No such improvements occurred within the Pamphlet and Control groups. The provision of self-management education as compared to usual care, however, did not improve the outcome variables examined.

Comparison of two lecture delivery platforms in a hybrid distance education program

OBJECTIVE

To compare students' preferences for and academic performance using 2 different distance education course content delivery platforms.

METHODS

A randomized, crossover research design was used to compare traditional video with a 4-panel platform among learners on multiple campuses within 1 college of pharmacy.(1) The outcomes were students' preferences for delivery platform and examination scores. Rasch analysis was used to assess unidimensionality and the difficulty of examination items. Hierarchical logistic and multiple regression models were used to assess students' preferences and academic performance.

RESULTS

The logistic model predicting preference for the 4-panel or traditional platform was not significant, but African-Americans and Hispanics were more likely to prefer the 4-panel platform than Caucasian and Asian students. The delivery platform did not impact students' academic performance. Students who did well on the semester's previous 2 examinations scored higher on the questions related to schizophrenia. Students with higher Pharmacy College Admission Test (PCAT) scores performed better on the bipolar questions than students who preferred the traditional video platform.

CONCLUSION

The additional faculty time, effort, and cost invested in presenting the class material in a 4-panel platform, and the students' extra time and effort spent viewing the 4-panel platform did not produce a comparable benefit in student preference and performance.

Knowledge retention after an online tutorial: a randomized educational experiment among resident physicians

BACKGROUND

The time course of physicians' knowledge retention after learning activities has not been well characterized. Understanding the time course of retention is critical to optimizing the reinforcement of knowledge.

DESIGN

Educational follow-up experiment with knowledge retention measured at 1 of 6 randomly assigned time intervals (0-55 days) after an online tutorial covering 2 American Diabetes Association guidelines.

PARTICIPANTS

Internal and family medicine residents.

MEASUREMENTS

Multiple-choice knowledge tests, subject characteristics including critical appraisal skills, and learner satisfaction.

RESULTS

Of 197 residents invited, 91 (46%) completed the tutorial and were randomized; of these, 87 (96%) provided complete follow-up data. Ninety-two percent of the subjects rated the tutorial as "very good" or "excellent." Mean knowledge scores increased from 50% before the tutorial to 76% among those tested immediately afterward. Score gains were only half as great at 3-8 days and no significant retention was measurable at 55 days. The shape of the retention curve corresponded with a 1/4-power transformation of the delay interval. In multivariate analyses, critical appraisal skills and participant age were associated with greater initial learning, but no participant characteristic significantly modified the rate of decline in retention.

CONCLUSIONS

Education that appears successful from immediate posttests and learner evaluations can result in knowledge that is mostly lost to recall over the ensuing days and weeks. To achieve longer-term retention, physicians should review or otherwise reinforce new learning after as little as 1 week.

Interactive spaced-education to teach the physical examination: a randomized controlled trial

BACKGROUND

Several studies have documented that physical examination knowledge and skills are limited among medical trainees.

OBJECTIVES

The objective of the study is to investigate the efficacy and acceptability of a novel online educational methodology termed 'interactive spaced-education' (ISE) as a method to teach the physical examination.

DESIGN

The design of the study is randomized controlled trial.

PARTICIPANTS

All 170 second-year students in the physical examination course at Harvard Medical School were eligible to enroll.

MEASUREMENTS

Spaced-education items (questions and explanations) were developed on core physical examination topics and were content-validated by two experts. Based on pilot-test data, 36 items were selected for inclusion. Students were randomized to start the 18-week program in November 2006 or 12 weeks later. Students were sent 6 spaced-education e-mails each week for 6 weeks (cycle 1) which were then repeated in two subsequent 6-week cycles (cycles 2 and 3). Students submitted answers to the questions online and received immediate feedback. An online end-of-program survey was administered.

RESULTS

One-hundred twenty students enrolled in the trial. Cycles 1, 2, and 3 were completed by 88%, 76%, and 71% of students, respectively. Under an intent-to-treat analysis, cycle 3 scores for cohort A students [mean 74.0 (SD 13.5)] were significantly higher than cycle 1 scores for cohort B students [controls; mean 59.0 (SD 10.5); P < .001], corresponding to a Cohen's effect size of 1.43. Eighty-five percent of participants (102 of 120) recommended the ISE program for students the following year.

CONCLUSIONS

ISE can generate significant improvements in knowledge of the physical examination and is very well-accepted by students.

Human patient simulation in a pharmacotherapy course

OBJECTIVE

To incorporate human patient simulation (HPS) into a pharmacotherapy course and evaluate its impact on students' satisfaction and mastery of course objectives.

DESIGN

Various levels of HPS were used for clinical skills assessments, reinforcement of concepts previously introduced in class, and presentation of simulated patient case scenarios requiring critical-thinking and problem-solving abilities. Pre- and post-simulation examinations and a satisfaction survey instrument were administered.

ASSESSMENT

Significant improvement was seen in students' knowledge on post-simulation examinations. On problem-solving skills, the majority of student groups received a final case grade >95%. Students indicated high levels of satisfaction with the use of HPS in the course and showed increased levels of confidence in their pharmacotherapy/patient care skills.

CONCLUSION

Human patient simulation provided a unique opportunity for students to apply what they learned and allowed them to practice problem-solving skills. Students grew in confidence and knowledge through exposure to realistic simulation of clinical scenarios. Students showed improvement in knowledge and ability to resolve patient treatment problems, as well as in self-confidence.

An instructional seminar for online case-based discussions

OBJECTIVE

To assess a training seminar developed to prepare pharmacy instructors to facilitate online discussions.

DESIGN

A 2-part seminar was developed to train faculty members and teaching assistants to facilitate online case-based discussions. A preseminar survey instrument was distributed to potential attendees and a postseminar survey instrument was given to those who attended the seminar.

ASSESSMENT

Twenty (91%) instructors completed the preseminar survey instrument. Eleven of these instructors attended at least 1 session of the seminar and indicated that the didactic and/or application portions were either "helpful" or "very helpful." These faculty members and teaching assistants also completed the postseminar survey instrument and conveyed a significant increase in level of comfort in their ability to facilitate online case-based discussions (p=0.004). The 3 most frequently perceived barriers to online teaching remained consistent despite training or teaching experience.

CONCLUSIONS

After attending a training seminar and/or facilitating an online case discussion, participants' comfort level in their ability to teach online increased. Further study of the impact of faculty development programs on teaching effectiveness and student satisfaction with online pharmacy education is warranted.

A Mixed Learning Technology Approach for Continuing Medical Education

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 (nonusers); 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.