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PubMed2003

Techniques used by "expert" and "non-expert" tutors to facilitate problem-based learning tutorials in an undergraduate medical curriculum.

BACKGROUND: There is inconclusive debate within the literature as to whether the best problem-based learning (PBL) tutors are subject experts or not. The debate hinges on whether knowledgeable tutors are tempted to intervene too often in PBL discussions compared to non-expert tutors, and whether the latter may not be able to sufficiently challenge the students' level of understanding. PURPOSE: To describe approaches used by tutors in PBL tutorials and to identify differences between tutors from medical and non-medical backgrounds. METHODS: The research reported in this paper was undertaken during the academic session 1999-2000 at the University of Liverpool Faculty of Medicine. A qualitative exploratory case study method was used and two PBL groups were observed. One of these groups had a medically qualified tutor and the other had a tutor from a humanities background. The focus of the observation was the discourse between tutor and students, which was analysed using a framework drawn from linguistics. Results were fed back to both the tutors and the students to check their perceptions of the interactions. RESULTS: Analysis of the tutorial group interaction revealed that tutors from both backgrounds used similar techniques to raise students' awareness, facilitate the group process and direct students' learning. Differences were noted between the two tutors: the medical tutor set out to raise students' awareness by using questioning techniques herself, whereas the non-medical tutor expected students to question each other. The non-medical tutor was observed to facilitate the group process more often than the medical tutor. CONCLUSIONS: Qualitative analysis of spoken discourse in PBL tutorials provides valuable insights into the processes involved in PBL, thereby generating material which is useful for both training of and giving feedback to PBL tutors.

Cohort Studies↗

PubMed2006

A brief individualized computer-delivered sexual risk reduction intervention increases HIV/AIDS preventive behavior.

PURPOSE: One objective of translational science is to identify elements of human immunodeficiency virus (HIV) risk-reduction interventions that have been shown to be effective and find new ways of delivering these interventions to the community to ensure that they reach the widest possible audience of at-risk individuals. The current study reports the development and evaluation of a computer-delivered, theory-based, individually tailored HIV risk-reduction intervention. METHODS: This study evaluated the effectiveness of a custom computerized HIV/AIDS risk reduction intervention at increasing HIV/AIDS preventive behaviors in a randomized trial with 157 college students. The intervention content and delivery were based on the Information-Motivation-Behavioral Skills Model of Health Behavior Change and used Motivational Interviewing techniques. Participants completed a baseline assessment of HIV prevention information, motivation, behavioral skills and behavior, attended two brief computer-delivered intervention sessions, and completed a follow-up assessment. RESULTS: As compared to the control group (a nutrition education tutorial), participants who interacted with the computer-delivered HIV/AIDS risk reduction intervention exhibited a significant increase in risk reduction behavior. Specifically, participants reported a greater frequency of keeping condoms available and displayed greater condom-related knowledge at a four-week follow-up session; among sexually active participants, there was a significant increase in self-reported condom use. CONCLUSIONS: Delivery of brief individually tailored HIV/AIDS risk reduction interventions via computer may be an effective HIV/AIDS prevention approach for adolescents. More research is needed to further support the effectiveness of this type of intervention and determine the generalizability of these findings to economically and educationally disadvantaged adolescents.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Hierarchical self-assembly of columnar aggregates.

Biology often uses hierarchical self-assembly to produce complex functional structures from smaller components. At each level of this stepwise process, non-covalent interactions bring together the subunits of a lower level of complexity, using the information encoded in their structures. Applying this approach to synthetic systems represents a formidable challenge, because it requires a high degree of command of non-covalent interactions. In this tutorial review, recent developments in the hierarchical self-assembly of discrete columnar aggregates are discussed.

Alkanes↗

PubMed2004

Integration of a problem-based multidisciplinary clinical cancer management course into undergraduate education.

BACKGROUND: Undergraduate cancer education programs usually involve diagnosis and treatment of various organs and tissues of the body that are invaded by this disease. Teaching organ system-based oncology by different disciplines causes a fragmented structure of knowledge with difficulty on reuniting the knowledge for the real patient. METHODS: Along with the reorganization process of the curriculum, an integrated, problem-based multidisciplinary clinical cancer management course has been introduced to fifth-year students. The course has consisted of group studies, panel discussions, site visits to departments involved in diagnosis and treatment of cancer, and lecture tutorials enriched with interactive learning methods. RESULTS AND CONCLUSION: Overall assessment of the course has been encouraging in terms of a clinical approach for students to the cancer patient, and innovations for better learning have been implemented for the following year.

Education, Medical, Undergraduate↗

PubMed2000

The primary care clinic as a setting for continuing medical education: program description.

The Mexican Institute of Social Security (IMSS) is Mexico's Largest state-financed health care system, providing care to 50 million people. This system comprises 1450 family medicine clinics staffed by 14,000 family physicians, as well as 240 secondary care hospitals and 10 tertiary care medical centres. We developed a program of continuing medical education (CME) for IMSS family physicians. The program had 4 stages, which were completed over a 7-month period: development of clinical guidelines, training of clinical instructors, an educational intervention (consisting of interactive workshops, individual tutorials and peer group sessions), and evaluation of both physicians' performance and patients' health status. The pilot study was conducted in an IMSS family medicine clinic providing care to 45,000 people; 20 family physicians and 4 clinical instructors participated. The 2 main reasons for visits to IMSS family medicine clinics are acute respiratory infections and type 2 diabetes mellitus. Therefore, patients being treated at the clinic for either of these illnesses were included in the study. The sources of data were interviews with physicians and patients, clinical records and written prescriptions. A 1-group pretest-posttest design was used to compare physicians' performance in treating the 2 illnesses of interest. We found that the daily activities of the clinic could be reorganized to accommodate the CME program and that usual provision of health care services was maintained. Physicians accepted and participated actively in the program, and their performance improved over the course of the study. We conclude that this CME strategy is feasible, is acceptable to family physicians and may improve the quality of health care provided at IMSS primary care facilities. The effectiveness and sustainability of the strategy should be measured through an evaluative study.

Acute Disease↗

PubMed1989

Interactive computer-video modules for health sciences education.

Advances in electronic image recording and computer technology have resulted in a remarkable increase in the power and flexibility of interactive computer-video teaching systems. The University of Washington Health Science Videodisc Development Group first demonstrated a laser videodisc controlled by a remote central computer in 1980. Even this rudimentary unit highlighted basic medical informatics principles including: rapid accessibility; a "generic" or multi-purposed format; ease of computer control; and large collections of valid, rigorously reviewed images. Advances in medical informatics have led to the development of the following previously undescribed series of teaching units: 1. The hypertext programs Hypercard, Linkway, and Guide have been used with videodiscs to develop easy-to-use instructional and reference materials. These materials demonstrate the ease with which a computer-naive instructor may develop new programs and the advantages that the intuitive nature of these programs brings to student users. 2. Patient simulations using single and double screens plus pre-defined knowledge structures; 3. Interactive single topic tutorials using preset knowledge structures; 4. A key-word-based disc searching system; 5. Electronic video microscopy; 6. A series of programs developed independently by health science faculty who have purchased multi-purpose videodiscs that demonstrate the flexibility of the multi-purpose or "generic": collection concept.

Computer Simulation↗

PubMed1998

Development and evaluation of the use of the Internet as an educational tool in occupational and environmental health and medicine.

The Internet, and specifically the World Wide Web (WWW), has an important role as a method of learning in occupational and environmental health and medicine. This paper provides a systematic overview of the demands and merits of this approach to learning in a range of higher education courses in these disciplines. Drawing on a relevant theoretical framework for understanding how students learn, it describes the design and evaluation of specific resources developed for students to learn using the WWW. The occupational and environmental health or medicine components of two undergraduate degree courses and of two postgraduate courses were reviewed to determine what learning objectives would be achievable by adapting extant conventional material, or by developing new teaching and learning resources for the WWW. Depending on the objectives, various learning resource formats were developed including descriptive, interactive (such as case study or data-based), reference and self-assessment. One WWW based tutorial consisting of an interactive resource with defined objectives, linked to constantly updated, in-house information and external links, was chosen as a representative for detailed evaluation. Process evaluation was based on student feedback, and outcome evaluation on group reports submitted on completion of the tutorial. Twelve of the 13 students who completed the tutorial returned the feedback questionnaire. All but one student rated it as 'good' or 'very good', with the majority of students reporting that it was easy to follow. Open-ended comments suggested that students valued the flexibility, timeliness, efficiency and breadth of access to relevant information offered by the WWW. The outcome evaluation showed that all the main learning objectives had been achieved. This work indicates that the WWW can be a valuable learning resource for occupational and environmental health and medicine.

Computer-Assisted Instruction↗

PubMedDate not supplied

A CD-ROM tutorial for physical examination.

In 1998 the Committee for University Teaching and Staff Development (CUTSD) awarded a grant of $47,975 to develop an interactive CD-ROM tutorial program to facilitate teaching the process of physical examination of the abdomen, lungs and thorax, to students of nursing. This program was developed to complement current teaching methods and make it possible for tutors to use the available class time to further address students' individual learning needs. It was developed to enable flexible delivery of content, to provide a front seat view of the demonstration of the procedures, and simulated practice opportunities in the safety and privacy of computer simulation. The program was not intended to replace hands-on practice as this learning medium does not address the kinaesthetic component of performing physical examination but it is expected to hasten the development of confidence in practice by strengthening the user's knowledge of the techniques and the sequence of physical examination. Through providing the opportunity to elicit inspection, palpation, percussion and auscultation examination findings in the context of 10 case studies of patients with health problems, it is also expected to facilitate recognition of abnormalities and their significance for health care students who have little clinical experience. The program has been evaluated by senior nursing students for technical problems, effectiveness as a learning aid and user friendliness. Over all, 92% (n=38) of the students considered that the program assisted them to learn physical examination of the abdomen, thorax and lungs and 95% were satisfied with the quality of the product and found that the sounds and images helped their understanding. The content of the program was considered to be logically sequenced, to have assisted understanding, and the case studies were a valuable learning aid. The evaluation data from this trial also indicates that students would like to learn about physical examination of other body systems using this medium.

Attitude of Health Personnel↗

PubMed1998

2 barrier-1 site pore: an interactive spreadsheet model for two permeating ions.

An interactive ion channel permeation tutorial was developed using a Microsoft Excel v5.0 spreadsheet to describe a two barrier, one site channel model by means of Eyring rate theory (ERT). The spreadsheet is inherently interactive so that the user receives immediate feedback about how changes in the energy barrier profile or ion concentrations affect current-voltage relations and single channel conductance. The spreadsheet model is easy to use, allows direct access to intermediate calculated values and all equations, contains graphical displays of parameters and lends itself to customization by a user having only a basic knowledge of spreadsheet operations.

Algorithms↗

PubMed2004

Exploration of a method to analyze group interactions in problem-based learning.

Many educational institutions use instructional approaches such as problem-based learning (PBL), in which collaborative learning plays an important role. There is little research, however, that describes which factors are responsible for the success of collaboration. The purpose of this study was twofold, i.e. to explore cognitive interactions taking place between students in tutorial groups and to examine whether the coding system of is usable to analyze these interactions. The focus was on elaborations and co-constructions, which are indicators of individual and collaborative knowledge construction in a group. Videotapes of three PBL sessions were transcribed, in which tutorial groups of the Maastricht Medical School were discussing a problem. The results showed that cognitive interactions could be found in the tutorial groups and that it was possible to analyze them. Co-constructions seemed most easy to elicit from the transcripts.

Adult↗

PubMed1998

Audiology in an ecological perspective--development of a conceptual framework.

The conceptual framework for describing an audiological communication handicap and its underlying processes is built in analogy to a biological, ecological system and uses the following primary concepts: interaction, internal milieu, preferendum (preferred communication features) and optimal resource utilization. From these primary concepts secondary concepts and processes are formulated: signal, message/dialogue and behavior are three levels of interaction; adjustment and release of mental resources are specifications for preferendum (influenced by contextual and social conditions); specificity and facilitation underlie optimal resource utilization. The internal environment contains afferent, central and efferent speech and language processing, cognitive and emotional processes. The main components of audiology and rehabilitation (impairment, disability, handicap) are deduced from these concepts and processes. Examples of studies based on this conceptual framework are presented briefly. These include an environmental test chamber where realistic acoustic environments and communication situations can be directly studied, and a rehabilitation programme based on tutorial education for structured interaction at the behaviour level between hearing-impaired and normal-hearing persons. A vibratory-based event localization system for deaf-blind is described which improves specificity and thereby mental resource utilization.

Communication↗

PubMed2004

Computer-aided learning in the real world of medical education: does the quality of interaction with the computer affect student learning?

BACKGROUND: Computerised learning clearly offers exciting potential for improving student learning, either as an aid to or as a replacement for traditional formats, or for the development of innovative approaches. However, rigorous evaluation of the utility of computer-aided learning (CAL) in enhancing student learning can be difficult. Many studies have compared CAL to more traditional learning formats, but there is little evidence to show which style of CAL leads to the best learning outcomes. AIM: This study aimed to test the hypothesis that a CAL tutorial, in which the learner actively interacts with the computer, will result in superior learning (ability to apply and retain knowledge) to that obtained in more passive CAL formats. METHODS: Third year medical undergraduates at Adelaide University, South Australia were randomly assigned to 4 groups. Following a pretest, only students in the "didactic", "problem-based" and "free text" groups had 2 weeks of free access to a neuroradiology CAL tutorial in their assigned format. Tutorial access was denied to all students 2 weeks before post-testing. Learning was quantified by comparing the post- to pretest scores for each of the 4 groups. RESULTS: After active interaction with the computer material, students in the free text group demonstrated a statistically significant improvement in their ability to apply and retain knowledge compared to the control group, but no advantage compared to the didactic group. CONCLUSIONS: While users of an interactive CAL tutorial demonstrated significant learning gains compared to non-CAL users, these gains were not superior to those achieved from non-interactive CAL. When evaluating education interventions such as CAL packages, it is important to use a valid assessment tool to measure learning.

Australia↗

PubMed1995

Interactive multimedia for prenatal ultrasound training.

This demonstration project examines the utility of interactive multimedia for prenatal ultrasound training. A laser-disc library was linked to a three-dimensional (3-D) heart model and other computer-based training materials through interactive multimedia. A testing module presented ultrasound anomalies and related questions to house-staff physicians through the image library. Users were asked to evaluate these training materials on the basis of perceived instructional value, question content, subjects covered, graphics interface, and ease of use; users were also asked for their comments. House-staff physicians indicated that they consider interactive multimedia to be a helpful adjunct to their core fetal imaging rotation. During a 9-month period, 16 house-staff physicians correctly diagnosed 78 +/- 4% of unknown cases presented through the testing module. The 3-D heart model was also perceived to be a useful teaching aid for spatial orientation skills. Our findings suggest that interactive multimedia and volume visualization models can be used to supplement traditional prenatal ultrasound training. The system provides a broad exposure to ultrasound anomalies, increases opportunities for postnatal correlation, emphasizes motion video for ultrasound training, encourages development of independent diagnostic ability, and helps physicians understand anatomic orientation. We hypothesize that interactive multimedia-based tutorials provide a better overall training experience for house-staff physicians. However, these supplementary methods will require formal evaluation of effectiveness to better understand their potential educational impact.

Computer Simulation↗

PubMed2003

Pre-frontal executive committee for perception, working memory, attention, long-term memory, motor control, and thinking: a tutorial review.

As an explicit organizing metaphor, memory aid, and conceptual framework, the prefrontal cortex may be viewed as a five-member 'Executive Committee,' as the prefrontal-control extensions of five sub-and-posterior-cortical systems: (1) the 'Perceiver' (dominant-right-hemisphere ventral-lateral prefrontal cortex--VL/PERC-PFC) is the frontal extension of the ventral perceptual stream (the VL/PERC system) which represents the world and self in object coordinates; (2) the 'Verbalizer' (dominant-left-hemisphere ventral-lateral prefrontal cortex system--VL/VERB-PFC) is the frontal extension of the language stream (the VL/VERB system) which represents the world and self in language coordinates; (3) the 'Motivator' (ventral/medial-orbital pre-frontal cortex--VMO-PFC) is the frontal cortical extension of a subcortical extended-amygdala stream (the VMO system) which represents the world and self in motivational/emotional coordinates; (4) the 'Attender' (dorsal-medial/anterior cingulate--DM/AC-PFC) is the frontal cortical extension of a subcortical extended-hippocampal stream (the DM/AC system) which represents the world and self in spatiotemporal coordinates and directs attention to internal and external events; and (5) the 'Coordinator' (the dorsolateral prefrontal cortex--DL-PFC) is the frontal extension of the dorsal perceptual stream (the DL system) which represents the world and self in body- and eye-coordinates and controls willed action and working memory. This tutorial review examines the interacting roles of these five systems in perception, working memory, attention, long-term memory, motor control, and thinking.

Attention↗

PubMed1999

Web-based training: a new paradigm in computer-assisted instruction in medicine.

Computer-assisted instruction (CAI) programs based on internet technologies, especially on the world wide web (WWW), provide new opportunities in medical education. The aim of this paper is to examine different aspects of such programs, which we call 'web-based training (WBT) programs', and to differentiate them from conventional CAI programs. First, we will distinguish five different interaction types: presentation; browsing; tutorial dialogue; drill and practice; and simulation. In contrast to conventional CAI, there are four architectural types of WBT programs: client-based; remote data and knowledge; distributed teaching; and server-based. We will discuss the implications of the different architectures for developing WBT software. WBT programs have to meet other requirements than conventional CAI programs. The most important tools and programming languages for developing WBT programs will be listed and assigned to the architecture types. For the future, we expect a trend from conventional CAI towards WBT programs.

Artificial Intelligence↗

PubMed2003

Sample Power and ExpDesign: tools for improving design of animal experiments.

Proper experimental design, involving the correct number of animals, should be a basic skill for any scientist working with animals. The authors describe a university-developed and freely available tutorial program and an interactive computer-assisted learning program, both of which guide students through the steps necessary for designing animal experiments and estimating optimal sample sizes.

Analgesics↗

PubMed2006

A web-based smoking cessation and prevention curriculum for medical students: why, how, what, and what next.

This paper summarises some major developments in medical education relating to the health risks of tobacco and to training in tobacco cessation and prevention strategies, and discusses some of the barriers to training. We also describe a project whose purpose was to design, implement and evaluate a web-based self-study tobacco curriculum for medical students to teach medical students to assist smokers to quit and to counsel non-smoking adolescents not to start smoking. This curriculum addresses some of the barriers, namely lack of curriculum time, lack of access to materials and experts, and relevance of the materials. The project was designed and evaluated at two medical schools in Georgia: Morehouse School of Medicine and Mercer University School of Medicine. A curriculum on tobacco control strategies and techniques designed for use in clinical settings was made available to first-year medical students as interactive computer-based tutorials. The curriculum, based on the US Public Health Service Clinical Guideline for Treating Tobacco Use and Dependence, was divided into two parts: the tutorial and practicum sections. Pre- and post-exposure measures were collected for the evaluation. The mean differences for correctly answered knowledge items in the two schools were similar: mean for Morehouse was +2.07 and for Mercer +1.67, indicating improvements in knowledge for both schools. There were statistically significant improvements in all categories of self-rated ability to perform six counselling skills, except for Mercer students for the 'Ask' skill category (p=0.069). The amount of exposure (measured only at Morehouse) was not related to overall change in scores but was associated with self-reported improvement in skill in assisting patients to quit smoking, confidence in counselling patients not interested in quitting, and confidence in counselling teens. The web-based curriculum successfully improved the students' self-rated counselling skills. Given the need and desire on the part of practitioners for training, the curriculum may be found useful by practising physicians and other health-care professionals who wish to improve their skills in smoking prevention and cessation.

Adult↗

PubMed2001

An integrated multi-media package for learning clinical phonetics and linguistics.

Competence in the phonetic and linguistic analysis of normal and disordered spoken language is a basic requirement for all students and practitioners of speech and language therapy. This paper presents a learning package specifically designed for individuals who need to acquire or update practical skills and theoretical knowledge in clinical linguistic analysis. VISUAL-CLIP (VIdeo SUpported Active Learning in Clinical LInguistics and Phonetics) is a student-centred, interactive, multi-media tutorial in clinical linguistics and phonetics, based on digitised video- and audio-taped speech data from a child with a complex communication disorder. Data can be analysed from different perspectives and at different levels of difficulty using separate but inter-linked modules on phonetics, phonology, grammar, semantics and pragmatics. Case history information, formal assessment results, theoretical background and an annotated bibliography are also integrated into the CD-ROM based package.

Communication Disorders↗