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PubMed1992

Instructional multimedia computing in the health sciences.

This article focuses on the development and utilization of interactive videodisc (IVD) and multimedia instruction in the health sciences. The characteristics of IVD and multimedia are outlined and the four levels of IVD systems that can be used in health science education are described. The advantages of utilization of videodisc or multimedia materials are presented, as well as instructional approaches. Potential applications such as simulations, tutorials, role-modeling, and drill-and-practice are described. Research findings, levels of curricular integration, instructional delivery, and courseware networking are also described. The article concludes with suggestions for institutional development of IVD materials or the incorporation of off-the-shelf programs into health science curricula.

Computer-Assisted Instruction↗

PubMed2004

Research applications of the Cambridge Structural Database (CSD).

Crystal structure data are of fundamental importance in a wide spectrum of scientific activities. This tutorial review summarises the principal application areas, so far, for the data from more than 300,000 crystal structures of small organic and metal-organic compounds that are stored in the Cambridge Structural Database (CSD). Direct use of the accumulated data is valuable in establishing standard molecular dimensions, determining conformational preferences and in the study of intermolecular interactions, all of which are crucial in structural chemistry and rational drug design. More recently, information derived from the CSD has been used to construct two dynamic libraries of structural knowledge: Mogul, which stores intramolecular information, and IsoStar, which stores information about intermolecular interactions. These electronic libraries provide information "at the touch of a button". In their turn, the libraries also serve as sources of structural knowledge for applications software that address specific problems in small-molecule and biological chemistry.

Journal Article↗

PubMed1995

Investigating the development of self-evaluation skills in a problem-based tutorial course.

PURPOSE: To compare students' self-evaluations of their performances with the evaluations they received from their tutors in a problem-based course. METHOD: In the Occupational Therapy and Physiotherapy Programme of the McMaster University Faculty of Health Sciences in 1993-94, a study was conducted of the self-evaluation skills of 30 students in five tutorial groups. Repeated-measures analyses of variance, factor analyses, and Pearson correlations were used to examine the student's self-evaluations in comparison with their tutors' evaluations on six consecutive occasions over a 14-week period. RESULTS: Significant (p < .01) increases were found for both students' and tutors' evaluation scores over the six evaluations. A significant interaction was also found, with the tutors' evaluations being initially lower but eventually higher than the students' self-evaluations. Correlations between students' and tutors' evaluations rose in a sawtooth manner from .49 on the first evaluation to .84 by the sixth evaluation. There was a pattern of diminishing oscillations in the interobserver correlations over the six evaluations. CONCLUSION: When combined with the steady increase in evaluation scores, the pattern of diminishing oscillations in interobserver correlations was interpreted more as evidence of a negotiation process between students and their tutors than as evidence of improvement in self-evaluation skills.

Educational Measurement↗

PubMed2005

People with HIV as educators of health professionals.

This qualitative study examined the impact upon people living with HIV (PHAs), of being trained and utilized as educators of health professionals. PHAs participated in a training program to help them develop skills to facilitate learners in problem-based educational events. After training the PHAs participated in small group problem-based tutorials with separate groups of physiotherapy and occupational therapy students and family medicine residents. Content analyses of the PHAs' reflective journals and semistructured interviews conducted at completion of the project indicated there was a positive impact on their teaching skills, self-awareness, personal understanding of HIV, confidence in teaching, and everyday life. Learner feedback indicated that they valued their interactions with the PHAs. This model of education has the potential to positively benefit patients living with a variety of illnesses and disabilities.

Adult↗

PubMedDate not supplied

Computerized training and proficiency testing. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: Computerized technologies probably will revolutionize the field of gynecologic cytology in the next century. Such technologies will be useful in both training and evaluating proficiency. However, manual screening/review of gynecologic cytology preparations is the current "gold standard" for both training and assessment of proficiency. CONSENSUS POSITION: Training programs for cytotechnologists and pathologists should provide instruction and experience in new technologies, but their introduction may depend on the availability of equipment and staff. Advantages of digital images for training include standardization of teaching sets and interactive capabilities, allowing educational feedback. Computerized support/assistance devices aid in complete screening of the slide during training and provide feedback to cytologists on screening techniques. Liquid-based cytopreparatory instruments facilitate multiple glass slides for teaching or testing. Proficiency testing (PT) in cytology has similar quality assurance goals as in other areas of the laboratory, but the subjective nature of cytologic analysis poses many challenges for implementation. There is consensus that all cytology practitioners would like to know the proficiency of the laboratory. However, the majority question the value and validity of any large-scale formal testing programs. Locator and diagnostic skills are both critical in cytology, but assessment of each skill may occur in different ways using computerized technologies. Any type of assessment should provide educational feedback to participants. Psychometric issues in PT include the consideration of different types of validity, including face, content, construct and criterion related. The reliability or consistency of the testing event is also critical. A valid and reliable correlation between work performance and performance on a PT needs to be established. The goal is to ensure that PT will identify submarginal practitioners and that persons successful on PT are in fact competent. Any cytology PT program should also be considered in the context of other laboratory quality assurance tools and the entire cervical cancer screening program. Regulatory agencies should evaluate entire laboratory performance, while each laboratory director should assume primary responsibility for evaluating and documenting the competency and daily performance of each practicing cytologist. Professional scientific organizations should take the lead in recommending methods and standards of performance assessment. ONGOING ISSUES: A reliable method of correlating daily competency with results on PT is not yet established. Methods may evolve ever time using new technologies. The use of computerized techniques and images for assessment will require careful deliberation by experts as well as validation by practicing cytologists. Variables include diagnostic categories for testing, numbers of challenges per testing event, types of slide preparations and characteristics of the digital images. Availability of equipment and staff will affect the introduction of new technologies in different regions.

Cell Biology↗

PubMed2006

[Striking a new path in medical education. CAMPUS, an interactive, case-based training system].

BACKGROUND AND PURPOSE: Computer-assisted teaching and learning tools offer new opportunities for improving education and training of medical professionals. CAMPUS represents a software for computer-based, problem-oriented learning. It is a case-based training system which provides the patient's history within a highly realistic, multimedia format. Thus, the interactive design is expected to challenge, test and improve the medical knowledge and the diagnostic skills of the students. The objective of the present study was to introduce CAMPUS as a computer-based learning tool and to present preliminary results with regard to acceptance and user-friendliness. METHODS: CAMPUS was evaluated by 52 students regarding quality and experienced learning success. A tutorial was conducted within separate, small-numbered groups of students, each working on one learning case. The virtual case started with a summary of the patient's leading symptoms. The students independently took the patient history and carried out the physical examination. Then, they were asked to suggest differential diagnoses, refer the patient to appropriate diagnostic examinations and were encouraged to choose adequate therapeutic strategies. Subsequently, the quality of CAMPUS and the subjective learning success were evaluated with a standardized questionnaire. RESULTS: Nearly all students described the user interface as visually attractive (51/52) and clearly structured (52/52). In particular, the students found the use of videos to be advantageous. A marked learning success was described by most students (46/52) and all students considered learning with CAMPUS to be effective. CONCLUSION: CAMPUS offers an innovative training program to improve medical education and to enhance conventional teaching methods efficiently.

Attitude of Health Personnel↗

PubMed2004

An application of visible human database in radiotherapy: tutorial for image guided external radiotherapy (TIGER).

BACKGROUND AND PURPOSE: Three-dimensional conformal radiotherapy and intensity modulated radiotherapy allow accurate dose delivery on target volumes. Due to the different background among specialists involved in target volume definition, the contouring emerges as one of the most questionable steps in treatment planning procedures. A software tool devoted to contouring training, named tutorial for image guided external radiotherapy ('TIGER'), based on the Visible Human Project images data-set, is described. MATERIALS AND METHODS: TIGER is addressed to facilitate the learning of axial anatomical images, to promote the training and reproducibility in contouring process, to allow the availability of a tool to enhance the 'drill and practice' approach in training programs. TIGER includes three different environments: Anatomic tutorial devoted to facilitate a self-learning approach to axial body sections; Contouring tutorial addressed to practice contouring process of anatomical structures and to undergo a test program prepared by tutors; Teacher's tools to offer to tutors the opportunity to insert new outlines in TIGER-database, according to local needs or conventions, and to use them in tutorial programs. TIGER-database is grouped in six main anatomical sections: head and neck, male thorax, female thorax, abdomen, male pelvis, and female pelvis. Overall 432 corresponding CT-VH images and 1189 contours of 134 different anatomical structures and lymphatic drainage areas are available. The access to the TIGER software is allowed by ESTRO web site (http://www.estro.be). CONCLUSIONS: TIGER provides an interactive human anatomy cross-sectional oriented source to facilitate the interpretation of CT scan images usually contoured in daily practice. It offers a drill tool to facilitate the learning of a reproducible contouring procedure.

Databases as Topic↗

PubMed2006

Probing hydrogen-rich molecular systems at high pressures and temperatures.

Information on the behavior of hydrogen-containing simple molecular systems at high pressures and temperatures is central to many problems in chemistry and allied sciences. The combination of increasing pressure and temperature causes a redistribution of the electronic density, and the resulting alterations in interatomic interactions give rise to changes in macroscopic properties. Experimental studies of hydrogen-rich systems under extreme conditions have advanced considerably in recent years as a result of improvements in diamond anvil cell technology in combination with resistive- and laser-heating techniques. These experimental methods are combined with spectroscopic and diffraction techniques, and the results interpreted with the aid of molecular simulations. In this tutorial review we discuss recent findings in hydrogen, water, and other selected hydrogen-rich systems including compounds formed from these materials. The results are examined in terms of the evolution of effective potentials and interatomic vibrational coupling, molecular dissociation and recombination, ionization and polymerization, quantum effects, and order-disorder phenomena.

Journal Article↗

PubMed2006

W3MAMCAT: a world wide web based tool for mammillary and catenary compartmental modeling and expert system distinguishability.

W(3)MAMCAT is a new web-based and interactive system for building and quantifying the parameters or parameter ranges of n-compartment mammillary and catenary model structures, with input and output in the first compartment, from unstructured multiexponential (sum-of-n-exponentials) models. It handles unidentifiable as well as identifiable models and, as such, provides finite parameter interval solutions for unidentifiable models, whereas direct parameter search programs typically do not. It also tutorially develops the theory of model distinguishability for same order mammillary versus catenary models, as did its desktop application predecessor MAMCAT+. This includes expert system analysis for distinguishing mammillary from catenary structures, given input and output in similarly numbered compartments. W(3)MAMCAT provides for universal deployment via the internet and enhanced application error checking. It uses supported Microsoft technologies to form an extensible application framework for maintaining a stable and easily updatable application. Most important, anybody, anywhere, is welcome to access it using Internet Explorer 6.0 over the internet for their teaching or research needs. It is available on the Biocybernetics Laboratory website at UCLA: www.biocyb.cs.ucla.edu.

Algorithms↗

PubMed1978

MEDLEARN: a computer-assisted instruction (CAI) program for MEDLARS.

*MEDLEARN*, a second-generation computer-assisted instruction (CAI) program available (nationally) since October 1976, provides on-line training for MEDLINE, one of the National Library of Medicine's (NLM) Medical Literature Analysis and Retrieval System (MEDLARS) data base. *MEDLEARN* was developed as a joint effort between NLM and The George Washington University Medical Center. Using MEDLINE formats throughout, *MEDLEARN* combines tutorial dialogue, drill and practice, testing, and simulation. The program was designed in three tracks oriented to basic methods, advanced techniques, and new developments. Each topic is presented on two levels, permitting an alternate explanation for users encountering difficulty. *MEDLEARN*, coded in the computer language PILOT, was developed with a modular structure which promotes ease of writing and revision. A versatile control structure maximizes student control. Frequent interactions check immediate recall, general comprehension, and integration of knowledge. Two MEDLINE simulations are included, providing the student an opportunity to formulate and execute a search, have it evaluated, and then perform the search in MEDLINE. Commenting, news broadcasting, and monitoring (with permission only) capabilities are also available. Subjective field appraisals have been positive and NLM plans to expand *MEDLEARN* and produce similar programs for other data bases.

Computer-Assisted Instruction↗

PubMed1994

Teaching individualized antibiotic dosage regimens by means of two computer-assisted learning programs.

We developed two multidisciplinary tutorial programs (TOBRA-DIDACT and VANCO-DIDACT) for teaching the basic principles of antibiotic drug monitoring by simulation of repeated administrations to fictitious patients whose physio-pathologic characteristics were pre-defined in the programs. To illustrate the two types of bactericidal kinetics, we have chosen one time-dependent (vancomycin) and one concentration-dependent (tobramycin) antibiotic. These computer-assisted programs operate on an interactive mode. In each of them, three main steps are connected: (1) Various types of clinical cases are submitted to the student: for each of them, case report includes clinical characteristics, location of infection, bacterial strain and minimal bactericidal concentration. These data must be taken into account during the following steps. (2) The student has to establish the treatment schedule: route of administration, dose for each injection, intervals between injections and duration of infusion. (3) The result of the dosage scheme proposed by the student is represented by a simulation of plotting antibiotic plasma concentrations vs. time during the first 4 days of treatment. These curves are obtained by a monoexponential (TOBRA-DIDACT) or biexponential (VANCO-DIDACT) pharmacokinetic model. Peak and trough concentrations are calculated at steady-state. An expert system provides a commentary with each result to evaluate the efficacy of the treatment and to assist the student in improving his prescription. TOBRA-DIDACT and VANCO-DIDACT illustrate the influence of age, obesity, renal impairment, location of infection and bacterial strain on antibiotic therapy. They also show the role of route of administration, dosing and intervals between injections on therapeutic response.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗

PubMed1993

Laryngeal biomechanics: an overview of mucosal wave mechanics.

The biomechanics of wave propagation in viscoelastic materials can be useful in understanding the nature of normal and pathologic vocal fold vibration. Mucosal wave movement is the primary means by which the larynx transforms the egressive pulmonary air flow into sound. This short tutorial describes a number of concepts fundamental to the understanding of the vocal fold traveling wave. The displacement velocity of the vocal folds is shown to be proportional to the wave speed, which in turn is proportional to the elastic modulus or stiffness of the vocal folds. Finally, a few cases of unilateral paralysis are used to demonstrate how vocal fold stiffness, entrainment, and degree of vocal fold closure interact to create the complex vibratory patterns that occur in disordered laryngeal states. It is emphasized that surgical voice restoration must consider these properties of the mucosal wave to improve phonatory function.

Biomechanical Phenomena↗

PubMed2006

Intraoperative applications of the H-reflex and F-response: a tutorial.

Traditional intraoperative monitoring of spinal cord function involves the use of three techniques: 1. Orthodromic ascending somatosensory evoked potentials (SSEPs) and 2. antIDromic descending neurogenic somatosensory evoked potentials (DNSSEPs) monitor long-tract sensory function. SSEPs and DNSSEPs do not monitor interneuronal gray matter function. 3. Transcranial motor evoked potentials (TMEPs) monitor descending long-tract motor function and measure interneuronal gray matter function by activating motor neurons. TMEPs activate from 4-5% of the motor neuron pool. When using TMEPs 95-96% of the motor spinal cord systems activating the motor neurons are not monitored. Our ability to interact with our environment involves not only intact sensation and strength, but also complex coordinated motor behavior. Complex coordinated motor behavior is controlled by groups of electrically-coupled spinal cord central pattern generators (CPGs). The components of CPGs are: descending and propriospinal systems, peripheral input, and segmental interneurons. The point-of-control is the level of excitation of interneurons, which is determined by the integrated activity of the other components. Spinal cord injury (SCI) changes segmental reflex gain by uncoupling these components. Changes in gain are detected by recordings from muscles. SSEPs, DNSSEPs and TMEPs provIDe limited information about the status of CPGs. H-reflexes measure the function of from 20-100% of the motor neuron pool. F-responses measure the function of from 1-5% of the motor neuron pool. H-reflexes and F-responses provIDe information about the degree of coupling between CPG components. Recording H-reflexes and F-responses together with SSEPs and TMEPs not only monitors spinal cord long-tract function, but also provIDes a multiple-systems approach that monitors those spinal cord systems that are responsible for the control of complex coordinated motor behavior. The objective of this paper is to describe how H-reflexes and F-responses can be used to monitor complex coordinated motor behavior.

Diagnostic Techniques, Neurological↗

PubMed2001

Portfolio learning with cancer patients: an integrated module in undergraduate medical education.

A model of undergraduate education based on a one to one relationship between a student and a patient with cancer has become a core module within the University of Wales College of Medicine undergraduate curriculum. The project combines the powerful impact of a one to one interaction with an active investigative and reflective approach to issues triggered from that patient's cancer journey. The aim is to provide each medical student with an understanding of the impact of a malignant disease and its treatment on patients and their families through the experience of one patient with cancer. The benefits of the project cover the areas of attitudes, skills and knowledge. Students are assessed on their involvement with the patient, in tutorials and on their portfolio, in which they record all aspects of the project. Student evaluations indicate high levels of appreciation of the project, despite its potentially strong emotional content.

Adult↗

PubMed2006

Student perceptions of a virtual learning environment for a problem-based learning undergraduate medical curriculum.

OBJECTIVE: To investigate the effects of a virtual learning environment (VLE) on group interaction and consultation of information resources during the preliminary phase, self-study phase and reporting phase of the problem-based learning process in an undergraduate medical curriculum. METHODS: A questionnaire was administered to 355 medical students in Years 1 and 2 to ask them about the perceived usefulness of a virtual learning environment that was created with Blackboard for group interaction and the use of learning resources. RESULTS: The students indicated that the VLE supported face-to-face interaction in the preliminary discussion and in the reporting phase but did not stimulate computer-mediated distance interaction during the self-study phase. They perceived that the use of multimedia in case presentations led to a better quality of group discussion than if case presentations were exclusively text-based. They also indicated that the information resources that were hyperlinked in the VLE stimulated the consultation of these resources during self-study, but not during the reporting phase. CONCLUSIONS: Students indicated that the use of a VLE in the tutorial room and the inclusion of multimedia in case presentations supported processes of active learning in the tutorial groups. However, if we want to exploit the full potential of asynchronous computer-mediated communication to initiate in-depth discussion during the self-study phase, its application will have to be selective and deliberate. Students indicated that the links in the VLE to selected information in library repositories supported their learning.

Attitude of Health Personnel↗

PubMed2005

A brief conceptual tutorial on multilevel analysis in social epidemiology: interpreting neighbourhood differences and the effect of neighbourhood characteristics on individual health.

STUDY OBJECTIVE: Using a conceptual rather than a mathematical approach, this article proposed a link between multilevel regression analysis (MLRA) and social epidemiological concepts. It has been previously explained that the concept of clustering of individual health status within neighbourhoods is useful for operationalising contextual phenomena in social epidemiology. It has been shown that MLRA permits investigating neighbourhood disparities in health without considering any particular neighbourhood characteristic but only information on the neighbourhood to which each person belongs. This article illustrates how to analyse cross level (neighbourhood-individual) interactions, how to investigate associations between neighbourhood characteristics and individual health, and how to use the concept of clustering when interpreting those associations and geographical differences in health. DESIGN AND PARTICIPANTS: A MLRA was performed using hypothetical data pertaining to systolic blood pressure (SBP) from 25 000 subjects living in the 39 neighbourhoods of an imaginary city. Associations between individual characteristics (age, body mass index (BMI), use of antihypertensive drug, income) or neighbourhood characteristic (neighbourhood income) and SBP were analysed. RESULTS: About 8% of the individual differences in SBP were located at the neighbourhood level. SBP disparities and clustering of individual SBP within neighbourhoods increased along individual BMI. Neighbourhood low income was associated with increased SBP over and above the effect of individual characteristics, and explained 22% of the neighbourhood differences in SBP among people of normal BMI. This neighbourhood income effect was more intense in overweight people. CONCLUSIONS: Measures of variance are relevant to understanding geographical and individual disparities in health, and complement the information conveyed by measures of association between neighbourhood characteristics and health.

Antihypertensive Agents↗

PubMed2005

Teaching paediatric residents about learning disorders: use of standardised case discussion versus multimedia computer tutorial.

BACKGROUND: We developed a standardised case-based educational exercise on the topic of childhood learning disorders, and a multimedia computerised adaptation of this exercise, as part of a national curriculum project based on the Bright Futures guidelines. OBJECTIVE: To explore resident perceptions of the facilitated case discussion (FCD) and the computerised tutorial (CT). DESIGN: Quasi-randomised comparison of two educational interventions. SETTING: Preclinic teaching conferences at a large urban children's hospital. PARTICIPANTS: A total of 46 paediatric residents years 1-3 assigned to either FCD (n = 21) or CT (n = 25). INTERVENTIONS: FCD residents met in groups of 8-12 with a trained facilitator for a structured case discussion, while CT residents worked in groups of 2-3 at a computer station linked to an interactive website. OUTCOME MEASURES: Participant responses during semistructured focus group interviews. ANALYSIS: Focus group transcripts, field notes and computer logs were analysed simultaneously using qualitative grounded theory methodology. RESULTS: Residents experienced CT as fun, offering flexibility, greater auditory and visual appeal and more opportunities for active learning. FCD allowed greater contact with expert faculty and made the material more relevant to clinical practice. FCD participants emphasised the clinical skills gleaned and stated that the learning experience would change their future patient management. Both groups reported that case discussion was more interactive than computer learning. Median time spent on learning was slightly shorter for the CT group. All groups of learners arrived at the correct final diagnosis. CONCLUSIONS: FCD and CT stimulate different types of learning among paediatric residents. Future studies are needed to determine how to integrate these two techniques to meet the learning needs of residents in diverse settings.

Boston↗

PubMed1981

Path analysis: a strategy for investigating multivariate causal relationships in communication disorders.

This tutorial paper explains, illustrates, and discusses path analysis, a powerful strategy for examining the plausibility and degree of causal relationships which are postulated to exist among a set of variables. In addition to its strength as a method of theory testing, path analysis is highly compatible with the kind of retrospective research which is so often used to study speech and language pathologies. One of its major advantages is that it allows explicit recognition of multiple, interacting causes of communication disorders and allows the researcher to evaluate the logical consequences of assumptions made about the specific nature of those causal relationships. A summary of the meaning of causal relationships is followed by a presentation of the principles underlying path analysis, as well as an outline of its basic procedures. Also presented is an illustrative example of the application of path analysis to the evaluation of some competing causal theories of a communication disorder. Finally, the general advantages of path analysis and its applicability to the investigation of causal relationships in speech and language pathologies are summarized and discussed.

Humans↗