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Pusic MV, Pachev GS, MacDonald WA. Embedding Medical Student
Computer Tutorials into a Busy Emergency Department. Acad Emerg
Med 2007; 14:138-148.
Reviewed by Chris White Medical College of Georgia.
Overview:
The authors wanted to see if focused, brief computer tutorials could
supplement medical student learning when placed in the midst of
the clinical learning environment. They created 6 short computer
tutorials (each designed to be able to be completed in 10-15 minutes),
and placed them on a computer at the nursing station in the pediatric
emergency department.
The study involved senior medical students during their required
2-week pediatric emergency medicine rotation. The students were
asked (not required) to do 3 of the tutorials whenever they could
find a convenient time to do so during the rotation. They were randomized
to do 3 of the 6 cases. Outcome measures included: 1) Statistics
on student usage of the tutorials (how many cases were done, how
long each case took, time of day cases were done, etc.); 2) Student
performance on a 6-item, short-answer written examination. The exam
was given as a pre-test at the start of the rotation, and at the
end of the rotation. The exam did not count toward their final grade.
3) Multiple surveys of student computer experience, attitudes toward
the tutorials, clinical experience during the rotation. 4) Faculty
survey regarding their attitudes toward the intervention. The students'
performance on the written exam was graded by 3 reviewers, two of
whom were blinded to the identity of the student and whether it
was the pretest or posttest. Since the students only did 3 tutorials
but were tested on all 6, they also served as control groups for
the tutorials they were not assigned on the written examination.
The computer cases were designed using a program called Toolbook
II Instructor, version 5.5 (SumTotal Corp., Mountain View, CA).
The topics of the 6 cases were: cervical spine x-rays, febrile seizures,
fever without source, growth plate fractures, oral rehydration solutions
and tissue adhesives.
Results:
74 students took both the pre-test and post-test, and 73% of the
students did all three cases they were assigned. The mean tests
scores improved from 2.9 (1.9) out of 10 to 4.9 (2.4)
from the pre-test to the post-test, which was a large statistically
significant effect size. For 5 of 6 tutorials there was at least
a moderate statistically significant improvement in test scores
by the students who completed the tutorial. Interestingly, the tutorial
where no effect was noted involved growth plate fractures. The authors
postulate that this was due to the dedication of the teaching faculty
to teaching this concept. Most students found the tutorials helpful,
and the location in the middle of the nursing station was not a
problem.
Limitations: Some of the students found ways to do the other
3 cases they were not assigned by signing in under the "residents"
or "other" category (these groups had access to all 6
tutorials). This "contamination" of the control group
might have lessened the impact of the intervention.
Comments:
The authors felt "the single most important finding of the
study was that medical students on rotation in a busy clinical setting
could and would do the computer tutorials." There is an excellent
discussion in the introduction of the paper about the use of multimedia
learning strategies, and using computer-assisted instruction (CAI)
for situational or "just-in-time" learning. They chose
these 6 tutorials because they felt they were important for the
students to learn, lent themselves readily to a computer-based teaching
format, and they involved the kinds of patients that most students
will see in their emergency department. The authors hypothesized
that students who seek to acquire knowledge when they need it most
will have the greatest motivation to learn. Thus having a short,
focused learning module on a specific topic can reinforce a concept
that the student has just seen in an actual patient. Many of us
encourage students to read about the patients they see because they
remember it better. The use of CAI in this study is very analogous
to that concept, and is much different than the use of CLIPP, which
attempts to create a simulated patient with embedded learning issues.
These short computer tutorials lend themselves well to placement
in the clinical environment, as they can be completed in 10-15 minutes.
This type of CAI might also lend itself well to being converted
to a podcast, which could be reviewed by the student as often as
needed and would be readily available.
Editorial Comment:
I can't help but think the newest film in a well-known series
will be called "Fast and Furious: Medical School Edition."
We all are looking for highly interactive education sessions that
minimize faculty student time but maximize adult learning. "Just
in time" learning is hot and many of the tools to create CAI
modules (see http://www.toolbook.com/ or articulate.com) seem easy
to use.
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