Faculty Bibliography

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

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

The evaluation and assessment of physicians-in-training (house staff) is a complex task. Residency training programs are under increasing pressure [1] to provide accurate and comprehensive evaluations of performance of resident physicians [2,3]. For many years, the Internal Medicine training program at NYU School of Medicine used a single standardized paper form for all evaluation scenarios. This strategy was inadequate as physicians train in multiple diverse settings; evaluation of physicians in the intensive care unit is quite different from those in the general clinics. The paper system resulted in poor compliance by house staff and faculty in the completion of evaluations. In addition, the data being collected from the paper forms was of poor quality due to the non-specific nature of the questions. A committee was formed in 2001, which created a new strategy for evaluating the core competencies of house staff. Given the ubiquity of web accessible computers in the clinical and non-clinical areas of hospitals and the flexibility a computerized system would provide, a web-based evaluation system was designed and implemented. This system allows for on-the-spot evaluations tailored to the evaluator, evaluatee and the venue of the evaluation. During the 2002 residency year, data was collected on satisfaction and use of the system and compared with the previous paper evaluations

This paper describes an innovative approach to the evaluation of a handheld prescription writing application. Participants (10 physicians) were asked to perform a series of tasks involving entering prescriptions into the application from a medication list. The study procedure involved the collection of data consisting of transcripts of the subjects who were asked to 'think aloud' while interacting with the prescription writing program to enter medications. All user interactions with the device were video and audio recorded. Analysis of the protocols was conducted in two phases: (1) usability problems were identified from coding of the transcripts and video data (2) actual errors in entering prescription data were also identified. The results indicated that there were a variety of usability problems, with most related to issues of ease of use. In addition, other problems were identified which were related to limitations of the content of the program. In examining the relationship between usability problems and errors, it was found that certain types of usability problems were closely associated with the occurrence of specific types of errors in prescription of medications. Implications for the improvement of safety of health care information systems are discussed

The Accreditation Council of Graduate Medical Education (ACGME) and the Residency Review Committee require a competency-based, accessible evaluation system. The paper system at our institution did not meet these demands and suffered from low compliance. A diverse committee of internal medicine faculty, program directors, and house staff designed a new clinical evaluation strategy based on ACGME competencies and utilizing a modular web-based system called ResEval. ResEval more effectively met requirements and provided useful data for program and curriculum development. The system is paperless, allows for evaluations at any time, and produces customized evaluation reports, dramatically improving our ability to analyze evaluation data. The use of this novel system and the inclusion of a robust technology infrastructure, repeated training and e-mail reminders, and program leadership commitment resulted in an increase in clinical skills evaluations performed and a rapid change in the workflow and culture of evaluation at our residency program

NYU School of Medicine, in conjunction with the Centers for Disease Control and Prevention and the Association of American Medical Colleges, has developed a CME workshop to prepare primary care physicians to respond to the psychosocial effects of bioterrorism and disasters and to address patient responses to terrorist threats or attacks. The workshop utilizes standardized patients (SP), allowing participants to have realistic simulated patient interactions. We sought to recreate the SP interaction on the web using a virtual patient. Special emphasis was given to the development of a new feedback system for this online interaction

The quantitative evaluation of pathogen transmission in the medical intensive care unit (MICU) is difficult given the small number of patients and the complexity and severity of illness. We sought to evaluate the suitability of a probabilistic computer model of our MICU, with which we could rapidly simulate infection control measures and other clinical interventions that would be impossible to perform in the real clinical setting

Terrorist attacks and other catastrophic events will create demands that severely challenge the capacity of the medical/public health system. To meet the surge, a cadre of professionals should be trained to operate around the nucleus of medical/public health officials. At New York University, an inter-institutional team is considering specific roles for and an approach to training dentists to enable these health care professionals to supplement medical/public surge needs based upon informatics systems that provide critical information.