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Independent learning in pathology. Does it work?

The sophomore pathology course at the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, was substantially modified with the intention of promoting guided, independent learning. The emphasis has been shifted from lectures to other modalities of instruction. This article delineates the curricular changes made, describes the instructional modalities used, and reports student performance after two year's experience with the new curriculum.

Education, Medical, Undergraduate

Computer-assisted reinforcement of instruction: effects on adherence in adult atopic asthmatics.

A randomized comparison group pretest-posttest experimental design was used to determine computer-assisted instruction effects on adherence to implementing house dust mite avoidance measures in adult atopic asthmatics. Fifty-two subjects were randomly assigned to comparison and experimental groups. The comparison group received traditional instruction in avoidance measures while the experimental group received traditional instruction supplemented by identical information provided by computer-assisted reinforcement of instruction. Adherence was measured by subjects' self-ratings and investigators' observations. Data were collected during two home visits 12 weeks apart. The computer group had significantly (p less than .05) greater adherence scores than the comparison group. The results indicate that computer-assisted reinforcement of instruction is an effective method of increasing self-care behaviors about allergen avoidance activities.

Adolescent

Use of a course on self-control behavior techniques to increase adherence to prescribed frequency for self-monitoring blood glucose.

A 12-week behavioral change program consisting of a course on Self-Control Behavior Techniques, which used a self-study format and included self-management techniques, was developed and implemented to evaluate the effectiveness of the course and the behavioral change techniques in helping people with insulin-treated diabetes mellitus to increase adherence to the prescribed frequency for self-monitoring blood glucose (SMBG). A two-group pretest-posttest experimental design was used (treatment n = 11, control n = 14). The treatment group achieved significantly higher posttest scores for the course. However, the control group achieved a significantly higher goal-adherence rate. The course was effective in teaching the knowledge and skills necessary for learning the techniques; the educational approach was an effective method for learning; and the application of the techniques resulted in an increase in frequency of SMBG but did not result in achievement of adherence to the goal for frequency of SMBG.

Adult

Self-help smoking cessation and maintenance programs: a comparative study with 12-month follow-up by the American Lung Association.

One thousand two hundred thirty seven smokers responding to lung association announcements in five geographic areas were randomly assigned to one of four groups and mailed American Lung Association materials: 1) leaflets (L); 2) leaflets plus maintenance manual (L + M); 3) cessation manual (C); and 4) cessation and maintenance manuals (C + M). Five telephone interviews over one year achieved a 95 per cent follow-up completion rate. Nonrespondents as well as exclusive cigar and pipe users were classified as smokers. Twenty per cent quit initially, with 5 per cent continually abstinent in (C + M) at 12 months vs 2 per cent in (L) (p less than .05). Nonsmoking prevalence rates (no tobacco smoking in the past month), on the other hand, gradually increased after six months; at 12 months those with the maintenance component, (L + M) and (C + M), had higher rates (18 per cent) than (L) (12 per cent) or (C) (15 per cent). Leaflets and manual alone were least cost effective. Rising nonsmoking prevalence rates observed in all groups suggest that successful attempts to quit increased over time and that a contributing factor might have been the follow-up method. Although achieving lower quit rates than methods requiring attendance at a course, the self-help intervention has the advantages of greater availability, flexibility, and in some instances lower cost.

Cost-Benefit Analysis

Continuing medical education. The next step.

Traditional continuing medical education (CME) keeps physicians aware of the state of the art. It has limitations, however, as a quality-assurance tool: it is memory based, involves a group endeavor with diffuse goals, often unrelated to practice, is an inappropriate remedy for many problems in patient care, is hampered by poor-quality evaluation, and is governed more by market factors than educational outcomes. The self-study of practice and practice-linked CME offer rich potential for development. The physician's monitoring of his work, with appropriate improvements in performance, is valuable CME. Computers provide facts and guidance at the time and place the physician is developing diagnostic plans, diminishing reliance on memory. The next step in CME is for hospitals, societies, and medical schools to perfect methods of self-study of practice and practice-linked CME.

Computer-Assisted Instruction