Faculty Bibliography

OBJECTIVES: Most medical procedures have a time element. It is uncommon, however, to explicitly use chronometry, the measurement of time, in the learning of these procedures. This study considered whether instructional designs that include chronometry could improve deliberate practice and be used in meaningful formative assessments. METHODS: A selective review of the medical education literature was undertaken to identify how chronometry was used in a broad sampling of medical education research in the learning of medical procedures. We identified prior publications in which time measurement was used either directly as a pedagogic intervention or as an assessment method in a medical school programme. RESULTS: Our review suggests a number of desirable features of chronometry. For the individual learner, procedural time measurements can demonstrate both improving ability and increasing consistency. Chronometry can enhance instructional designs involving deliberate practice by facilitating overlearning (i.e. learning that goes beyond minimum competence), increasing the challenge level and enhancing self-regulation of learning (e.g. self-competition). Breaking down chronometric data into meaningful interval or split times might further inform instructional designs. CONCLUSIONS: Chronometry has the potential to contribute to instructional designs and assessment methods in medical procedures training. However, more research is needed to elucidate its full potential and describe possible negative consequences of this widely available but underutilised educational tool.

OBJECTIVES: To develop and evaluate a web-based curriculum to introduce first year medical students to the knowledge and attitudes necessary for working with limited English proficient (LEP) patients through interpreters. METHOD: Six hundred and forty first year medical students over 4 consecutive years took this curriculum as part of their Patient Physician and Society course. They viewed 6 patient-physician-interpreter video vignettes, gave open text analyses of each vignette, and compared their responses to those generated by experts, thereby receiving immediate formative feedback. They listened to video commentaries by a cultural expert, lawyer, and ethicist about working with LEP patients, completed pre- and postmodule questionnaires, which tested relevant knowledge and attitudes, and were provided a summative assessment at the end of the module. Students completed an optional survey assessing the educational value of, and providing open text commentary about, the module. RESULTS: Seventy-one percent (n=456) of first year students who completed the module consented to have their data included in this evaluation. Mean knowledge (19 items) scores improved (46% pre- to 62% postmodule, P<.001), reflecting improvements in knowledge about best interpreter practices and immigration demographics and legal issues. Mean scores on 4 of 5 attitude items improved, reflecting attitudes more consistent with culturally sensitive care of LEP patients. Mean satisfaction with the educational value of the module for 155 students who completed the postmodule survey was 2.9 on a scale of 1 to 4. CONCLUSION: Our web-curriculum resulted in short-term improvement in the knowledge and attitudes necessary to interact with LEP patients and interpreters. The interactive format allowed students to receive immediate formative feedback and be cognizant of the challenges and effective strategies in language discordant medical encounters. This is important because studies suggest that the use of these skills in patient encounters leads to greater patient and provider satisfaction and improved health outcomes

INTRODUCTION: Alcoholics Anonymous is not yet fully employed by the medical community as a means to enhance patient outcome. The purpose of this study was to evaluate visitors' use of an Internet course on Alcoholics Anonymous, and to compare how various disciplines learned about, gained access to and participated in the course. METHODS: Demographic information was collected from 414 visitors to the course. RESULTS: 64% of the 414 respondents received their last educational degree within the last 10 years, and had an interest in the topic of addiction prior to their accessing the site. 294 (71%) of those who accessed the course completed it, and those who accessed it learned about it from various sources other than print advertisement in professional journals. Within the 230 physician respondents, 143 (62%) were psychiatrists, 82 (78%) of whom learned about the Internet course via professional journal. DISCUSSION: Given the need for further training among physicians in the use of Alcoholics Anonymous, the Internet can be utilized to make information available to a large number of people. Because it allows the user to access information outside the traditional means, the barriers to its use are minimal, and it has the potential to effectively convey useful clinical information

Teaching medical students about the anatomical principles of surgical procedures is a challenging task. In an effort to design a new tool that allows a third year medical student to explore specific surgical problems, the New York University School of Medicine Department of Surgery and the New York University School of Medicine Advanced Educational Systems lab collaborated to develop a Virtual Surgery Patient (VSP). The VSP is a realistic set of three-dimensional models of human anatomy. Unlike previous applications, our objective was to create lightweight 3-D models with the inherent ability to deform smoothly upon animation, with an architecture that allowed for enhanced texturing as well as polygon reduction. We developed a technique for using reconstructed volume data from the Visible Human Project to create surface models that were easy to manipulate, avoiding artifacts introduced when resurrecting volumes from cadaveric sliced stacks. Surface shading can be used to give the models the appearance of living tissue, as well as allow for enhancements sometimes necessary to achieve an educational goal

Contemporary medical education faces new challenges as the climate of the health care delivery system transforms. Diminished length-of-stay and continuity-of-care have radically altered the way medical students are exposed to and learn about illness. These educational challenges are particularly pronounced in the teaching of surgery. We developed a multimedia application, Surgical Interactive Multimedia Modules (SIMM), to utilize rich media objects and high-resolution video to overcome modern didactic challenges. The SIMM client was created using Macromedia Director MX and communicates using XML with an Oracle database containing the rich-media educational objects. The SIMMs integrate digital video, 3-D models, self-assessment tools, and current medical evidence to generate a dynamic learning environment encompassing core surgery topics. Students can access SIMM modules either via a high-speed network connection or by using a DVD. The interface was designed to focus on a narrative timeline that provided students with a familiar metaphor for interacting with the learning objects. Students on the surgery clerkship are currently using four SIMM modules and feedback indicates that they are regarded as compelling and useful educational tools for learning about complex surgical topics. Future areas of research will address student ability to annotate the learning objects and to maintain a personal repository of medical education resources