Investigating Medical Student’s Technology Habits

May 5, 2010

My previous postings involved uses of technology in medical school curriculums. For this blog I am investigating if medical students are prepared for the technology infusion programs and how receptive students are to online learning management systems.

Many medical schools are in the process of constructing technological add-ons to support of content delivery. Technology has advanced so much that clinical simulations programs have evolved to the point where the software can provide instant feedback to students and instructors. The customized formats of on-line learning systems can be personalize by the instructor and developed into an individualized lesson plans for the students. This interactivity of on-line content delivery has created a paradigm shift in the relationship between students and teachers. Using technology and simulation resources in medical schools is preparing students to use the interactive, individualized and informative environment as a way to prepare for post-graduate activities, like treating patients or even adapting to the proposed changes in healthcare reform.

So, were the students ready for the technology infusion? Emory School of Medicine in Atlanta, Georgia created an Information Technology committee to investigate the medical school program of study during the 2004-05 scholastic year. The group’s recommendation was made to reform the program to include technology and simulation activities into the 2007-08 academic year. The committee members included a wide spectrum of individuals such:

Clinical and basic science faculty, librarians, IT staff, students,
University Administrators from the medical and nursing schools,
And affiliated hospitals.[1]

The committees where further divided into 6 general committees:

1. Learning spaces and technology infrastructures
2. Clinical enterprise
3. Office of Medical Education needs and perceptive
4. Student needs and perspective
5. Simulation
6. Library
7. Bioinformatics

Collectively the committee created a survey to examine demographics, existing technology intelligence, and attitude towards technology and simulation. The survey was sent to 440 medical students, out of which 214 questionnaires were returned, thus creating a response rate of 49%. The mean age was 25.7 years and was compromised of 54% male and 46% female. The class breakdown was 34% freshman, 31% sophomore, 18% juniors and 17% seniors who contributed to the survey.

Although the medical school did not require laptop equipment as a student aid, over 75% of the students owned them. Charted below is the breakdown of the weekly computer usage of the medical students.

Furthermore, the survey revealed little use of simulation technology employed in medical school courses during the 2004-05 academic school year.

Further committee discussion identified a few emerging trends to be included in medical school training.

1. Student’s dependence on technology and group learning
2. Lack of student confidence in medical informatics
3. Demand for simulation clinical technologies
4. Technology application for academic and personal use
5. Portable technology devices for wireless connectivity
6. The need to develop flexible platforms for emerging technologies

A series of questions in the survey inquired about the students opinions on how technology and simulation programs could facilitate learn processes with the medical school courses. More than 50% of the students believed technology would helped them with a ‘greater ability to recall information learned’, over 70% assumed technology would ‘builds confidence and knowledge in areas where students are less confident’, over 80% alleged technology ‘allows students to practice fundamental skills and receive feedback before entering the clinical environment’ and over 85% of the strongly thought technology infusion with medical school programs would ‘identifies strengths and weakness’ of the student.

Inclusion, medical students anticipate the use of technology to be included within their program of study. Incoming students are tech savvy; coming to school with technology skills learned through years of computerized social interaction. Medical schools around the country should be prepared to instruct and simulate the incoming classes through technology involvement built into the curriculum.

[1]

Assessment of student learning behaviors to guide the integration of technology in curriculum reform, Information Services, IOS Press, DOI 10.3233/ISU-2009-0591

3D visualization for medical education

5/1/2010

Linköping University in Sweden realized healthcare students were having problems with understanding the connection between physical anatomy and physiological processes. The University faculty members worked together with the Information Technology department to form a team to look at various learning tools to augment the health care curriculum. The objective of the educational development team was to enhance traditional methods of instruction, such as lectures, dissections, and textbooks with dynamic interactive visual content format. The decision to use 3D visualization as a delivery method to improve student understanding of complex materials was supported by the interactive components of the software.

Traditionally, meaning before the infusion of technology in the education, medical students learned about anatomy and physiology processes from static text book images or via dissecting corpses. The ability to study a live human body during tests was limited by the 2D inert images which in fact could hide structures or functions due to the flat format. Linköping University proposed to increase student learning by incorporating 3D visualizations into the medical and physiotherapy programs. Listed below are the goals of the educational development team:


(1) To develop different presentations formats of high quality 3D visualizations for educational use and integrate the technology in various learning situations in regular healthcare curriculum.

(2) To enhance the knowledge about students’ views and attitudes concerning the educational value of 3D visualizations in learning anatomy and physiology.[1]

The development team studied methods of incorporating CAT (Computer assisted tomography) and MRI (Magnetic resonance imaging) scans with ultrasound images. Recent strides in technology using computer graphics with diagnostic images created a 3D visualization solution called volume rendering. The technology was transformed into QuickTime VR (QTVR) format, thus enabling the user to mouse over and turn the image to gain an understanding of the spatial anatomic relationship of physiological processes. Click on the links below to see the examples of the technology:

http://pubimage.hcuge.ch:8080/ and http://cmiv.liu.se/

Two pilot studies were carried out at Linköping University during the years 2005 and 2006, using second and third year students studying the cardiovascular system. The study provided the following:

1. Education on how to interpreted visualizations
2. Opportunities to apply newly gained knowledge
3. Stimulate the students’ curiosity and interest to learn
4. Clinical evaluation of normal, normal variation and pathological structures of the heart and disease progression
5. Demonstration of virtual reality theatre
6. Demonstration of self-study modules

The self-study modules were designed to give the students the ability to view the visualizations by using interactivity methods to gain a deeper understanding of the complexities of the heart.

The results of the studies confirmed the aim of the 3D visualization project. The students noticed increase ease in reading images and found the presentation stimulating. Many of the students experienced an ‘aha’ moment when viewing the stimulations - which reinforced functional anatomy concepts. The students also found the visualizations aided in understanding anatomy more so than physiology and made the students realize supplemental resources were needed to expand the learning know-how.

Student follow-up questionnaires on 3D visualizations revealed the following:

1. Great product but lack of time prevented usage
2. Positive reaction to the ability to rotate images for different views
3. Unlimited access to visualizations materials
4. Self-pace capabilities
5. New appreciation for the spatial proximity of bones and organs
6. Repetitive viewing increased content understandingSome students indicated
requiring help with interpreting images and asked for tutors or written explanations

In conclusion, the use of 3D visualizations in conjunction with traditional teaching modalities provides medical students with the ability to interact electronically with course concepts.

See example of 3D visualization application using Osirix software on an iPhone.


[1] Web Paper Advance 3D visualizations in student-centered medical education, Charlotte Silén, Staffan Wirell, Joanna Kvist, Eva Nylander and Örjan Smebdy, Medical Teacher, 2008, 30: e115-e124.

Evaluation of an interactive, case-based review session in teaching medical microbiology

Posted 4/26/10

Medical schools across the globe are striving to use communication technology to appendage traditional face-to-face lecture practices. At University Hospital in Lausanne Switzerland, the Department of Internal Medicine has developed a pedagogical technique for teaching 3rd level students how to facilitate theoretical concepts with clinical situations. The faculty was interested in cultivating a clear connection between core concepts of biological changes of body fluids such as electrolyte and acid-based with disease manifestations. Previous investigation by the faculty at University Hospital noted students demonstrated a weakness in understanding basic academic Pathophysiology elements of connecting the physiological and biological changes which occur during the disease process.

In the past, the University Hospital faculty taught face-to-face Pathophysiology courses using lectures, summative exam (multiple choice questions) and interactive discussion (practicum). The ‘interactive discussion session’ is the module on which the faculty desired to improve. Listed below are the three phase processes cultivated to improve teaching techniques, strengthen core academic theories and develop understanding of pathophysiological effects of the disease fluids.

Part 1: Four patient’s clinical histories simulations were posted on the web fifteen days prior to the interactive discussion session. The histories exemplify common pathophysiological events and from the list of symptoms, the third year students would select the most suitable laboratory tests to be conducted. The results page would show only the correct tests required as predetermined by the faculty member. In addition, the students could correlate the correct responses to all the cases and print out the document for the interactive session.

Part 2: Two days before the session, the clinical case studies would be removed from the Internet by the course administrator. The data captured by the site trends provided statistical information about the number of students who studied each case and the breakdown on who asked for each laboratory tests. From this information the instructor would devise a lesson plan uniquely prepared for the students.

Part 3: Post class case discussion and documents will be available for students up to fifteen days after the interactive session to review or print out.

After a two year study, the results indicated the students who took advantage of the Web-based simulations that is was an effective content delivery system for the medical school. Other notable comments are listed below:

1. Students liked the Web-based format
2. Students tended to return numerous times to visit the site
3. Students liked to work independently
4. Students liked the anonymous feedback during the student-teacher interactive discussion session

After receive high ratings from faculty and students on the effectiveness of Web-based simulation learning activities, the Medical e-learning coordinator at the University Hospital, plans to extent pedagogical content delivery system into other curriculums.

Example of MSF (Doctors without borders) e-learning system.

American example of e-learning system:
Evaluation of an interactive, case-based review session in teaching medical microbiology

Podcasts: building Learning and Simulation Virtual Centers

Updated: 4/25/10

Medical student's supplementing traditional teaching methods

Entering into the lobby of Johns Hopkins Hospital Medical Campus, a visitor can see many people wearing headphones. Are they all listening to music or listening to the JHH’s Weekly Podcast discussing the top medical stories of the week? Who are these people: students or patients?

Since the early 2005, podcasts have been used to inform the masses about current trends and news events. Podcasts are audio or video files which can be placed on the Internet and downloaded to a computer or mobile devices like MP3 players and iPods. Initially Podcasts were in audio format but with the increase use of screened mobile devices, many people have been adding video components to enhance the audio presentation.


As discussed by Thomas Friedman, author of The World Is Flat, podcasts can be used to illustrate one of flattening forces in Globalization 3.0. One flattener, #9 in-forming, entails the idea of collective intelligence. Friedman defines in-forming as


“the ability to build and deploy our own personal supply chain…..
of information, knowledge and entertainment. In-forming is about
self-collaboration -becoming your own self-directed researcher, editor
and selector”[1]

Net Generation students habituated use the Internet for communication, entertainment and news events. Why not invest into content delivery systems, such as a Podcast, to augment learning styles? Well, many schools across the country, like Duke University, have been using Apple’s iPod for academic pursuits. Here are a few ideas on how mobile media devices can help students:

1. Convenience format for faculty and students to utilize for file storage
2. Provide independent access to digit content
3. Simple recording tools – classroom lectures, field notes, interviews
4. House Audio or electronic text books
5. Individualized custom learning system[1]

When you have a chance, listen to the Podcast created by Richard Lindstrom, Director, Academic Infrastructure Development at the Charles Drew University of Medicine and Science. He describes a major shift in teaching students in medical schools. Mr. Lindstrom concludes based on his knowledge of the informatics, ‘the human mind just cannot hold all the information out there’. [3] Educators need to change from the ‘apprentice model’ -retaining fundamental knowledge of teaching medical students to the ‘analytical model’ – learning how to build a repository of knowledge and how to use critical thinking to best synthesized the data into information.

These modes of information delivery can be developed into Decision Support Systems or clinical stimulation applications. Medical schools can have more control over the content presented to impressionable students but creating a custom Podcasts. As Mr. Lindstrom stated, by creating clinical simulation events, a student can analyze and critically asset the correct method of handling a procedure by viewing a podcast, not in ad hoc world of a clinic training environment.

So, if Podcasts can be useful for medical students by amalgamating the content delivery system with traditional educational methods to teach subjects areas, then can not the same type of delivery arrangement be used to inform patients about their healthcare? Lucky for the members of the JHH Health System the technology is already in place. Located on http://www.hopkinsmedicine.org/mediaii/podcasts.html, patients can access subject matter content ranging from how to treat the common cold to heart surgery. The podcast can be downloaded via iTunes for immediate viewing, delayed viewing or even repeated viewing.

Now, look again at the people using iPods. Can you tell if they are medical students or JHH patients?

[1] The World is Flat by Thomas Friedman, p. 153.
[2] Emerging Technology Center by Diane J. Skba presented in Nursing Education Perspectives
[3] Richard Lindstrom, Director, Academic Infrastructure Development at the Charles Drew University of Medicine, http://www.educause.edu/blog/gbayne/InterviewPodcastRichardLindstr/203581.

Podcast example viewings:

Med student Podcast: Pregnant Robot Trains Students

Hopkins Podcasts for the week of April 23, 2010.

Computerized learning systems for medical students? Are X-Box surgical simulation games the next step?

Back in the day.... as consumers we knew which hospitals were teaching hospitals and which ones were not. The stigma associated with being a patient of a student practicing to be a doctor, brought doubt into the minds of many. Even thought the students were supervised by the attending staff, I myself did not like being part of the learning cycle. Could there be another learning tool for students to use instead of human guinea pigs?
The infiltration of computers into daily tasks has blended people and processes together to provide information and infrastructure to our homes, education, corporate and leisure worlds. We are guided by computers from the minute we open our eyes to when we close our eyes. Computers are an integral part of our life no matter where we are located. Instead of reaching for a pencil, we reach for an electronic device.
Medical schools have revamped curriculums to allow computer integration with courses. The introduction of computerized training programs began as early as 2000. Around the same time, hospital trends revealed a decrease in the hospitalization intervals and an increase in medical student’s numbers. The combined result exemplifies the reduction of available instructional time and decline of on-hand hospitalized patients.
For instance, surgeons are required to take in-depth health histories of patients, which aids in diagnosing. A group called United Kingdom Medical Research Group created Simulated Patients (SP) modules on health history protocols for third year medical students. The module focused on two parts. First the program created a checklist layout on how to systemically take a health history and to make a diagnosis. Secondly, the program helped students learn how to effectively conduct a consultation. The program was developed into scenario based SP tutorials. Positive feedback from medical students indicated the SR program was well received. As a matter of fact, many of the students noted the SP tutorials encourage active discussions between themselves and instructors. In addition, since the SP is automated, students could repeat modules to gain confidence in the subject material.
Now back to the X-Box comment. Can med students train on computers to develop operating room techniques and practice what if scenarios? Student airline pilots practice many hours on simulated games to learn how to handle a large expense aircrafts. I know for sure that the Navy Seals are trained with simulated programs and play X-Box Navy Seals games off duty. So…I do not think it is a far stretch to image medical students practicing surgical procedures on SP applications. Who knows maybe Microsoft would develop a Surgical Duty game for the practicing students.