Council on Medical Student Education in Pediatrics

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COMSEP 2012 Indianapolis Meeting

Poster Presentation:


How Does CLIPP Case Usage Affect Outcomes During a Third Year Rotation in Pediatrics?

Authors:
Mark E Harrison, MD - University of Kansas-Wichita

Background
The Computer-assisted Learning in Pediatrics Program is a virtual patient program designed to encompass the learning objectives of the COMSEP curriculum comprehensively [1]. Web based learning has been well established as a complementary method for adult learning [2-7]. Our institution has subscribed to the cases for nearly 5 years. As Clerkship Director, I want to assure that the learning opportunities I provide are beneficial to the students under my supervision. The purpose of this study was to evaluate if competition of more CLIPP cases correlated with better NBME subject exam scores, improved clinical grade points, improved mid-term exam scores, and total grade points earned during the rotation.

Methods
This was a retrospective review of data from the 3rd year KUSM-W medical students during their Pediatrics rotation over the last 5 years. Data was obtained from MedU's databases of our students' usage of their cases, as well as the students' grade reports from our clerkship. The classes were divided into cohorts based on the time of each school year. A minimum time limit spent on each case was defined to minimize giving credit for completing the case to those students that did not use them as they were designed. Credit was given if the student spent greater that that amount of time on the case. A master spreadsheet was developed with each student's information on cases done as well as their scores. Data analysis included a mixed regression model approach using the PROC MIXED facility is SAS version 9.2.

Results
Overall, the number of cases done by each student correlated well with significantly higher NBME subject exam (p value 0.0112), clinical score (p value 0.03), midterm exam score (p value 0.02)), as well as overall grade points (p value 0.0037). There are several significant differences between results between cohorts, as well as a "plataeu" and sometimes decrease in performance past a certain number of cases finished.

Conclusions
Overall, usage of the CLIPP cases during the 3rd year Pediatric Clerkship seemed to improve educational outcomes, but there were some limits to its effect. There are also some significant limitations involved with the retrospective nature of this study. I was not able to control for some potentially significant variables, such as how well each student performed in other rotations, and whether the higher performing students are more likely to do more CLIPP cases, eliminating the cause and effect hypothesis. Further data analysis of this data will explore which cases had more of a postive or negative impact on outcomes than others.

References
1. Fall, L.H., et al., Multi-institutional development and utilization of a computer-assisted learning program for the pediatrics clerkship: the CLIPP Project. Acad Med, 2005. 80(9): p. 847-55.
2. Cook, D.A., Where are we with Web-based learning in medical education? Med Teach, 2006. 28(7): p. 594-8.
3. Cook, D.A., et al., Internet-based learning in the health professions: a meta-analysis. JAMA, 2008. 300(10): p. 1181-96.
4. Curran, V., et al., Evaluation of learning outcomes in Web-based continuing medical education. Acad Med, 2006. 81(10 Suppl): p. S30-4.
5. Murad, M.H., et al., The effectiveness of self-directed learning in health professions education: a systematic review. Med Educ, 2010. 44(11): p. 1057-68.
6. Potomkova, J., V. Mihal, and C. Cihalik, Web-based instruction and its impact on the learning activity of medical students: a review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2006. 150(2): p. 357-61.
7. Schilling, K., et al., An interactive web-based curriculum on evidence-based medicine: design and effectiveness. Fam Med, 2006. 38(2): p. 126-32.