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Biomedical subjects

David A Cook

Publications and source records attributed to David A Cook.

10 recordsLinked to original sources
PubMed2005

Web-based learning in residents' continuity clinics: a randomized, controlled trial.

PURPOSE: To determine whether internal medicine residents prefer learning from Web-based (WB) modules or printed material, and to compare the effect of these teaching formats on knowledge. METHOD: The authors conducted a randomized, controlled, crossover study in the internal medicine resident continuity clinics of the Mayo School of Graduate Medical Education during the 2002-03 academic year. Participants studied two topics of ambulatory medicine using WB modules and two topics using paper practice guidelines in randomly assigned sequences. Primary outcomes were format preference (assessed by an end-of-course questionnaire) and score changes from pre- to postintervention tests of knowledge. RESULTS: A total of 109 consented and 75 (69%) completed the postintervention test. Fifty-seven of 73 (78% [95% CI, 67-86%]) preferred the WB format (p < .001). Test scores improved for both formats (67.7% to 75.0% for WB, 66.0% to 73.3% for paper), but score change was not different between formats both before (p = .718) and after (p = .080) adjusting for topic, clinic site, study group, postgraduate year, and gender. Residents spent less time on WB modules (mean = 47 +/- 26 minutes) than paper (mean = 59 +/- 35, p = .024). Difficulties with passwords limited their use of WB modules for 71% (59-80%) of residents. CONCLUSION: No difference was found between WB and paper-based formats in knowledge-test score change, but residents preferred learning with WB modules and spent less time doing so. Passwords appeared to impede use of WB modules. WB learning is effective, well accepted, and efficient. Research should focus on aspects of WB instruction that will enhance its power as a learning tool and better define its role in specific settings.

Attitude of Health Personnel↗
PubMed2004

A practical guide to developing effective web-based learning.

OBJECTIVE: Online learning has changed medical education, but many "educational" websites do not employ principles of effective learning. This article will assist readers in developing effective educational websites by integrating principles of active learning with the unique features of the Web. DESIGN: Narrative review. RESULTS: The key steps in developing an effective educational website are: Perform a needs analysis and specify goals and objectives; determine technical resources and needs; evaluate preexisting software and use it if it fully meets your needs; secure commitment from all participants and identify and address potential barriers to implementation; develop content in close coordination with website design (appropriately use multimedia, hyperlinks, and online communication) and follow a timeline; encourage active learning (self-assessment, reflection, self-directed learning, problem-based learning, learner interaction, and feedback); facilitate and plan to encourage use by the learner (make website accessible and user-friendly, provide time for learning, and motivate learners); evaluate learners and course; pilot the website before full implementation; and plan to monitor online communication and maintain the site by resolving technical problems, periodically verifying hyperlinks, and regularly updating content. CONCLUSION: Teaching on the Web involves more than putting together a colorful webpage. By consistently employing principles of effective learning, educators will unlock the full potential of Web-based medical education.

Computer-Assisted Instruction↗
PubMed2004

How reliable are assessments of clinical teaching? A review of the published instruments.

BACKGROUND: Learner feedback is the primary method for evaluating clinical faculty, despite few existing standards for measuring learner assessments. OBJECTIVE: To review the published literature on instruments for evaluating clinical teachers and to summarize themes that will aid in developing universally appealing tools. DESIGN: Searching 5 electronic databases revealed over 330 articles. Excluded were reviews, editorials, and qualitative studies. Twenty-one articles describing instruments designed for evaluating clinical faculty by learners were found. Three investigators studied these papers and tabulated characteristics of the learning environments and validation methods. Salient themes among the evaluation studies were determined. MAIN RESULTS: Many studies combined evaluations from both outpatient and inpatient settings and some authors combined evaluations from different learner levels. Wide ranges in numbers of teachers, evaluators, evaluations, and scale items were observed. The most frequently encountered statistical methods were factor analysis and determining internal consistency reliability with Cronbach's alpha. Less common methods were the use of test-retest reliability, interrater reliability, and convergent validity between validated instruments. Fourteen domains of teaching were identified and the most frequently studied domains were interpersonal and clinical-teaching skills. CONCLUSIONS: Characteristics of teacher evaluations vary between educational settings and between different learner levels, indicating that future studies should utilize more narrowly defined study populations. A variety of validation methods including temporal stability, interrater reliability, and convergent validity should be considered. Finally, existing data support the validation of instruments comprised solely of interpersonal and clinical-teaching domains.

Academic Medical Centers↗
PubMed2004

Prediction of risk of death using 30-day outcome: a practical end point for quality auditing in intensive care.

STUDY OBJECTIVE: To validate the APACHE (acute physiology and chronic health evaluation) III unadjusted and similar hospital mortality estimate models on 30-day mortality, and to propose a simple approach to modeling local 30-day in-hospital mortality of critically ill hospitalized adults for quality management and risk-adjusted monitoring. DESIGN: Noninterventional, observational study. PATIENTS: A total of 5,278 consecutive eligible hospital admissions between January 1, 1995, and December 31, 1999. MEASUREMENTS: Prospective collection of demographic, diagnostic, physiologic, laboratory, and hospital admission and discharge data. RESULTS: The APACHE III mortality predictions exhibited excellent discrimination (receiver operating characteristic [ROC] curve area) for 30-day outcome (ROC area, 0.89) and hospital outcome (ROC area, 0.89). Calibration curves and Hosmer-Lemeshow statistics demonstrated good calibration of all models on 30-day outcome, except for the unadjusted APACHE III model. New, simplified risk adjustment models showed good discrimination and calibration on development and test data. ROC areas were 0.88 (developmental data) and 0.87 (test data), and the new model calibration was equivalent to the APACHE III model. CONCLUSION: For quality audit, 30-day in-hospital mortality can be used as an alternative outcome to survival to hospital discharge. New logistic regression models provide evidence that local models, possessing good calibration and discrimination, may be built from a few explanatory variables.

APACHE↗
PubMed2003

Flexible teaching for inflexible schedules: an online resident curriculum in acute ambulatory care.

The authors report on a work in progress: a web-based curriculum for residents working shifts, addressing management of common acute outpatient problems. All components of the curriculum are available online, and residents may complete modules and submit tests at a time and from any location. There are few reports of web-based curricula in postgraduate training. Our interactive model avoids scheduling conflicts, is easily updated, encourages self-directed earning and facilitates resident assessment.

Acute Disease↗
PubMed2003

Monitoring the evolutionary process of quality: risk-adjusted charting to track outcomes in intensive care.

OBJECTIVE: To present graphical procedures for prospectively monitoring outcomes in the intensive care unit. DESIGN: Observational study: risk-adjusted control chart analysis of a case series. SETTING: Tertiary referral adult intensive care unit: Princess Alexandra Hospital, Brisbane, Australia. PATIENTS: A total of 3398 intensive care unit admissions from January 1, 1995, to January 1, 1998. CONCLUSIONS: Risk-adjusted process control charting procedures for continuous monitoring of intensive care unit outcomes are proposed as quality management tools. A modified Shewhart p chart and cumulative sum process control chart, using the Acute Physiology and Chronic Health Evaluation III model mortality prediction for risk adjustment, are presented. The risk-adjusted p chart summarizes performance at arbitrary intervals and plots observed against predicted mortality rate to detect large changes in risk-adjusted mortality. The risk-adjusted cumulative sum procedure is a likelihood-based scoring method that adjusts for estimated risk of death, accumulating evidence from outcomes of all previous patients. It formally tests the hypothesis of a change in the odds of death. In this application, we detected a decrease from above to predicted risk-adjusted mortality. This was temporally related to increased senior staffing levels and enhanced ongoing multidisciplinary review of practice, quality improvement, and educational activities. Formulas and analyses are provided as appendices.

Adult↗