Optimizing computer-based system use in health professions' education programs

The use of computer-based systems to support training in health profession education programs has been discussed and analyzed for more than 10 years. The literature is rich with examples of how using these systems can benefit programs by more effectively distributing human resources, by making the delivery of instruction more individual and more flexible, by expanding the professional and technical competence of trainees, and by improving the monitoring of trainee performance. Obstacles to and conventional recommendations for the broadened use of computer-based systems are discussed, and an additional set of system design characteristics are described that health care educators can use in their preview and specifications for procurement of more effective computer-based systems in their training settings.

Evaluation of a labor and delivery videodisc simulation

The purpose of this project was to determine the impact of an interactive videodisc (IVD) simulation in labor and delivery on the learning and clinical confidence of junior-level nursing students. Two clinical groups of students were created from the total 39 and both groups were pretested on knowledge and clinical confidence. Group 1 (n = 18) completed the IVD program before the first clinical experience in the labor and delivery setting. Group 2 (n = 21) received a traditional clinical experience first and then completed the IVD program. Students completing the IVD program plus the clinical experience had significantly greater clinical confidence and learning than those students completing only the clinical experience. Evaluation comments provided suggestions for improvements and were filled with positive comments about the program.

AI/LEARN/Rheumatology. A comparative study of computer-assisted instruction for rheumatology

OBJECTIVE

To assess the effectiveness of AI/LEARN/Rheumatology, a computer-controlled interactive videodisc system for teaching.

METHODS

We assessed improvement in knowledge about rheumatic diseases, using a pretest and posttest in a control year and a treatment year. The subjects were medical students and postgraduate trainees taking the rheumatology elective. The control year used traditional lectures and the standard rheumatology curriculum. The treatment year used AI/LEARN/Rheumatology in place of lectures on rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis.

RESULTS

The trainees showed significant improvement in knowledge in both the control year and the treatment year (P < 0.0001 for both). The average time spent using AI/LEARN/Rheumatology was similar to the time spent in lectures (3 hours). The number of patient consultations in which trainees participated was lower in the treatment year than in the control year; however, the adjusted posttest scores using the pretest as a covariate tended to be higher in the treatment year (P = 0.10). Analysis of covariance of the adjusted posttest scores for the treatment year only showed that the trainees who spent more time using AI/LEARN/Rheumatology learned more (r = 0.57). Trainees felt that AI/LEARN/Rheumatology was the most helpful educational experience of the elective.

CONCLUSION

AI/LEARN/Rheumatology is an effective means of teaching about the rheumatic diseases. It has many advantages: availability for independent study, effective use of trainee's time, and liberation of faculty time from lectures. Trainees enjoyed using AI/LEARN/Rheumatology.

Computer-based patient education: a progress report

Computer-based teaching can help patients make informed decisions and protect both patients and physicians from the serious consequences of poor communication. This article discusses the benefits of computer-based patient education and its role in the emerging field of "patient informatics."

EXTEND: a prototype expert system for teaching nursing diagnosis

In this article, the development and uses of EXTEND (Expert system for Education in Nursing Diagnosis), a computer assisted instruction package for teaching nursing diagnosis using the categories proposed by the North American Nursing Diagnosis Association, are described. EXTEND provides a knowledge base that is able to deduce a nursing diagnosis from case factors and extends the normal use of expert systems beyond diagnosis to diagnosis education by providing answers to student questions about a simulated client and by guiding them through the diagnostic task. Furthermore, EXTEND allows the teacher to record the steps taken by students in the assessment and diagnosis of the simulated client, and use this as the focus of further discussion. The system is a response to the problems of teaching nursing diagnoses cited in the professional literature.

The relationship between performance on computer-based clinical simulations and two written methods of evaluation: cognitive examination and self-evaluation of expertise

The purpose of this study was to explore the relationship between computer-based clinical simulation performance and two commonly used methods of evaluation: cognitive examination and self-evaluation of expertise. The convenience sample of 68 critical care nurses completed the Basic Knowledge Assessment Tool for Critical Care (BKAT), a cardiovascular self-assessment tool (CST), and two computer-based clinical simulations requiring the management of myocardial infarction patients with tachydysrhythmias (atrial flutter and ventricular tachycardia). Simulation performance was measured by proficiency score and patient outcome (live/die). Proficiency on the atrial simulation was significantly correlated with knowledge as measured by the BKAT (r = 0.46, p 0.001) and with self-evaluation of clinical expertise (r = 0.32, p = 0.008). Atrial patient outcome was also significantly correlated with the BKAT (r = 0.28, p = 0.006) and the CST score (r = 0.22, p = 0.036). However, in the ventricular simulation only proficiency score and self-evaluation of expertise were significantly correlated (r = 0.24, p = 0.049). The modest relationships found in this study may indicate that, while clinical simulation performance is related to knowledge and self-evaluation of expertise, the constructs measured are not synonymous. This evidence provides support for the use of clinical simulations as an adjunct to other methods of evaluation.

HyperCard to SPSS: improving data integrity

This article describes a database design that captures responses in a HyperCard stack and moves the data to SPSS for the Macintosh without the need to rekey data. Pregnant women used an interactive computer application with a touch screen to answer questions and receive educational information about fetal alcohol syndrome. A database design was created to capture survey responses through interaction with a computer by a sample of prenatal women during formative evaluation trials. The author does not compare this method of data collection to other methods. This article simply describes the method of data collection as a useful research tool.

Development of a diagnostic and therapeutic simulation system based on patient data and specialist's knowledge. I. Simulation of diagnostic process

A new simulation system of diagnostic and therapeutic processes is developed. The aim is to train medical students for the practical use of their knowledge, utilizing patient data in a total hospital information system. The knowledge in the system is presented by the specialists for every case. In medical school there are many specialists in various fields. With their cooperation the system can grow up to a comprehensive CAI system for clinical education. The system is designed to work on the mainframe for easiness of development, maintenance and extensions of the system. The present framework has been applied to the simulation of diagnostic process. The usefulness of the present system has been confirmed by specialists and students.

Evaluating computer assisted learning for renal patients

Healthcare professionals have become increasingly concerned with evaluating the impact of their interventions. Consumerism, quality initiatives and financial constraints have contributed in large measure to this concern. Consequently, the focus of many studies which involve the introduction of new and untried techniques is often on demonstrating their relative usefulness. This study sought to evaluate the usefulness and acceptability of computer assisted learning (CAL) for use in the education of renal patients on continuous ambulatory peritoneal dialysis. However, several problems were encountered which limited or impaired the evaluation process. We describe these problems and use them to illustrate the difficulties inherent in evaluative research.

AI/Learn/Rheumatology. A computer-assisted educational system for teaching about rheumatic diseases

Education of health professionals about the rheumatic diseases is in need of improvement. The computer is an instrument that can be used efficiently to educate large numbers of users. With specific educational principles in mind, we developed AI/Learn/Rheumatology, a computer-assisted interactive videodisc system for teaching the rheumatic diseases. While interacting with the user, it conveys knowledge using visual and problem-solving techniques. The system is efficient, enjoyable to use, and useful for small groups and independent study. It is applicable for teaching medical and allied health professional students, postgraduate trainees, and primary care physicians.

Patient on-line access to medical records in general practice

Many patients want more information about health and the computer offers tremendous potential for interactive patient education. However, patient education and the provision of information to patients will be most effective if it can be tailored to the individual patient by linkage to the medical record. Furthermore the Data Protection Act requires that patients can have access to explained versions of their computer-held medical record. We have examined the practicality and possible benefits of giving patients on-line access to their medical records in general practice. Seventy patients (20 males; 50 females) took part in the study. Sixty five of these used the computer to obtain information. The section on medical history was most popular, with 52 people accessing it. More than one in four of the problems were not understood until the further explanation screen had been seen. One in four also queried items or thought that something was incorrect. Most patients obviously enjoyed the opportunity to use the computer to see their own medical record and talk to the researcher. Many patients commented that because the General Practitioner (GP) didn't have enough time, the computer would be useful. Sixty one (87%) (95% CI: 79-95%) thought the computer easy to use and 59 (84%) would use it again. This is despite the fact that 43 (61%) thought they obtained enough information from their GP. This small study has shown that patients find this computer interface easy to use, and would use the computer to look at explanations of their medical record if it was routinely available.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of a computer tutorial with other methods for teaching well-newborn care

Research using a computer-assisted instructional program developed for teaching well-newborn care is described. Third-year medical students were randomly assigned during their week-long nursery rotation into three groups to study the acceptability and effectiveness of using the computer-assisted instructional lessons. Group A, the control group, was not required to complete any additional educational task. Group B was assigned specific reading material. Group C completed the microcomputer-based tutorial. (The term tutorial is often used interchangeably to describe the computer-assisted instructional program.) Both groups B and C improved dramatically on a posttest in comparison with group A. There was no statistically significant difference between groups B and C on the improvement from pretest to posttest scores. However, significantly less time was spent by group C completing the tutorial compared with the total time spent reading by group B. The results of this study provide further illustration of the feasibility and effectiveness of using a computer-assisted instructional program for medical student education.

A randomized comparison of alternative formats for clinical simulations

Computer-based clinical simulations for medical education vary widely in structure and format, yet few studies have examined which formats are optimal for particular educational settings. This study is a randomized comparison of the same simulated case in three formats: a "pedagogic" format offering explicit educational support, a "high-fidelity" format attempting to model clinical reasoning in the real world, and a "problem-solving" format that requires students to express specific diagnostic hypotheses. Data were collected from rising third-year medical students using a posttest, attitudinal questionnaire, students' write-ups of the case, and log files of students' progress through the simulation. Student performances on all measures differed significantly by format. In general, students using the pedagogic format were more proficient but less efficient. They acquired more information but were able to do proportionately less with it. The results suggest that the format of computer-based simulations is an important educational variable.

Nurses' opinions of the introduction of computer-assisted learning for use in patient education

Computers have only recently begun to find a place in the everyday work of health care staff. The use of computer-assisted learning (CAL) in patient education is in its infancy. However, the medium appears to offer several advantages to patients. The successful integration of the medium into clinical practice requires the acceptance and support of staff members. Little research exists to date which examines staff responses to the introduction of CAL into their workplace. This small study (n = 14) aims to explore the reactions of staff to the introduction of an experimental CAL package for use in the education of renal patients on continuous ambulatory peritoneal dialysis (CAPD). The opinions of staff members to CAL are probed and their views ascertained regarding the usefulness of CAL to both staff and patients. Results suggest that, despite their initial reservations about CAL, staff were generally positive about the medium.

Testing airway management skills: interactive video courseware vs ACLS instructor

Lectures and demonstrations have been the teaching and testing strategies most often employed by the American Heart Association in Advanced Cardiac Life Support (ACLS) training. I compared the abilities of interactive videodisc (IVD) courseware and ACLS instructors to evaluate airway management skills.

METHODS & MATERIALS

Twenty-two subjects were simultaneously tested during 30 attempts at endotracheal (ET) intubation and 34 attempts at esophageal obturator airway or esophageal gastric tube airway (EOA/EGTA) insertion. The instructors were blind to the visual and auditory messages produced.

RESULTS

The IVD program and the ACLS instructors showed high agreement in their evaluation of student performance for time of intubation (95.5% ET; 100% EOA/EGTA), proper tube placement (91% ET; 93% EOA/EGTA), appropriate tube assessment (95.5% ET; 100% EOA/EGTA), and correct EOA/EGTA cuff inflation (100%). Lower levels of agreement were noted with ET and EOA/EGTA appropriate head positioning, and the evaluation of tooth pressure with ET intubation (60.5%, 76.5%, and 66.0%, respectively). The IVD system was unable to detect certain procedural errors associated with appropriate intubation procedure--syringe attachment, syringe removal after cuff inflation, and control of tube after intubation. The low agreement for tooth pressure suggests that the sensor-equipped manikin may better evaluate tooth pressure than does the observer.

CONCLUSIONS

Although the IVD system shows promise as an adjunct method for instruction and testing, it cannot be considered suitable for 'stand-alone' instruction. Further research is needed to explore costs, skills retention, and possible impact of the medium for training hospital and prehospital-care personnel.

Establishing criterion validity of a computer-based clinical simulation

Clinical simulations, depictions of real-life patient care situations, have been used extensively in medical education. This study determined the criterion validity of a computer-based simulation which permits natural language interface and runs interactively with videotape to be fair to good (K = .61).

Automated continuing education and patient education

This article discusses the use of a computer network to provide instruction for health care providers and patients and provides examples of screens from the educational modules developed for the project. The continuing nursing education and patient education modules were developed as a portion of the components for KARENET (Kellogg Affiliated Remote Environments Network), linking rural Morton, Texas, and the Health Sciences Center at Lubbock, Texas. Both health care providers and patient participants are benefiting from knowledge provided by the methodology of CAI/CMI provided by the network.