May 2002
Volume 66 |
Number 5
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| Educational Technology
2002 |
Jeffrey M. Taekman, M.D.
Committee on Electronic Media and Information Technology
Medicine is an information-rich profession. The amount of medical
information doubles every five to seven years. Advanced technologies
are fundamentally changing the way we study and practice medicine.
This information explosion demands new ways of educating and assessing
medical professionals.
Interestingly, the way we teach in medicine has not changed significantly
in hundreds of years. Numerous studies have shown lectures to
be an ineffective means of changing health professional practice.1,2
Yet lectures retain prominence throughout the entire medical education
continuum.
Computers and computer networks, a subset of educational technologies,
will likely change this quandary. There are several driving forces
behind these changes. First and foremost are our learners. Computers
and computer networks have become entwined in the very fabric
of our day-to-day lives. Our younger practitioners have grown
up with computers and are quite proficient in their use. Likewise,
our patients are increasingly turning to computerized resources
for their own health education.
There are other driving forces as well. The Institute of Medicine
(IOM) published the reports To Err Is Human and Crossing the Quality
Chasm,3,4 both of which identified information technology as an
integral component of a medical system redesigned for patient
safety.
The work-learn-work model (where information is obtained "just
in time") has been popularized in many industries. Computer
technologies are extending this paradigm to medicine. Learning
at the "point-of-care" is expected to improve the understanding
and retention of complex medical concepts as well as improve patient
safety.
It would be presumptuous to think that the breadth of educational
technologies could be covered in a short newsletter article, so
for the sake of succinctness, this article will briefly cover
e-learning, handheld computers and simulation.
Web-based Education (e-learning)
The Internet has enabled the educational process to be delivered
anywhere at any time. Several commercial companies have developed
"course-ware" to support distance education (or e-learning).
These products facilitate the administrative and organizational
functions needed to deliver online courses. Blackboard and WebCT
are the two leading companies producing course-ware
for educational institutions.
We used Blackboard to build an educational resource called the
Duke University Anesthesiology Didactic Site. This password-protected
Web site houses all our department's grand rounds and resident
lectures, journal clubs and more. Our faculty, residents and interns
all have access to the resource. The Blackboard shell allows ongoing
discussions of the lectures, interactive testing, e-mail, live
teaching and more. Regional ABC is a new hands-on, Web-based regional
anesthesiology guide in development that can be viewed at <anesthesia.mc.duke.edu/regional/abc/index.html>.
Regional ABC is both an educational tool and a patient care resource.
Much of the information on this site will be enabled to allow
learners to carry the resource with them on their handheld computers
to the patient bedside.
Digiscript™ <www.digiscript.com>
is working with a multitude of medical societies to capture, transcribe,
convert and deliver didactic materials, such as Annual Meeting
Refresher Courses, over the Internet.
Other companies such as ic.axon offer outstanding case-based
continuing medical education resources <www.mypatient.com>.
A personal favorite site of mine is the Answer Page <www.theanswerpage.com>.
This outstanding resource covers a single anesthesia topic each
day. The Answer Page is available in a Web format or can be downloaded
to your handheld computer.
PDA Resources
Handheld computers, or personal digital assistants (PDAs), have
become ubiquitous in medicine. Handheld computers allow the end-user
to carry a wealth of reference and learning material in his or
her pocket. As wireless-computing technologies continue to improve,
these handheld devices will be our conduit to a vast array of
information resources on the Internet. Development in this space
is progressing at a rapid pace.
AvantGo® <www.avantgo.com>
is a versatile tool for delivering content to handheld devices.
AvantGo may be used to deliver lecture notes, clinical pathways,
keyword discussions and more. The AnswerPage is an excellent example
of AvantGo's delivery capabilities.
The enterprise version of AvantGo also may be used to collect
and aggregate information from handheld devices. Bi-direction
transfer of data opens up new possibilities in the educational
process, including new ways of delivering and interacting with
learning material and assessing performance.
A company called ArcStream™ <www.arcstream.com>
is developing a mobile client for Blackboard called BlackBoard ToGo. This
program, also based on AvantGo, will allow transfer of learning
and administrative material from an existing didactic site onto
a handheld computer.
Many of us use the program ePocrates™ <www.epocrates.com>
and qID as a reference and learning tool for
pharmaceutical agents. The database for ePocrates is updated weekly.
In my opinion, the most innovative company delivering learning
products for handheld computers is Unbound Medicine <www.unboundmedicine.com>.
Unbound Medicine has developed a suite of tools using a clever
interplay between Web-based and handheld delivery. CogniQ™
downloads personalized table of contents with abstracts from more
than 500 journals. A click on the handheld device saves the corresponding
reference to a personal Web-based library.
CogniQ also performs Medline queries. Merely type search criteria
into your handheld and the next time you synchronize, a list of
articles that match the query will be available. These may then
be saved to your personal library or discarded.
CogniQ has been licensed by OVID for their OVID@Hand
platform. Those that subscribe to OVID's full-text electronic
journal service may have the complete reference delivered to their
personal Web library. A six-month trial of CogniQ is available
for free through the British Medical Journal's Web site <www.bmj.com>.
Unbound is also developing an evidence-based resource called
Unbound Surgery as well as Harrison's OnHand (an extension to
Harrison's Online) and an interesting medical decision-making
program called MedWeaver.™
Simulation
Simulation is being integrated rapidly into anesthesiology teaching
programs throughout the world. Indeed IOM touts simulation as
one of the key technologic components in improving patient safety.4
Simulators range from desktop computerized simulation to full-scale
"high-fidelity" models. The most futuristic simulators
are virtual reality-based.
Desktop simulations include Anesoft's offerings <www.anesoft.com>,
the Gas Man® uptake and distribution simulator
<www.gasmanweb.com> and
the BODY Simulation <www.gasmanweb.com>.
High-fidelity simulators are offered by Medical Educational Technologies,
Inc. <www.meti.com>
and Laerdal™ <www.laerdal.com/simman>.
The high-fidelity simulators are driven by complex computer models.
One may customize patients and scenarios by altering the simulator's
computerized "physiology."
Programming simulations is a complex and time-consuming task.
The Medical SimLibrary < anesthesia.mc.duke.edu/simcenter/library
> (user needs password to access site) was announced in April
2002 to help facilitate the simulation library-building process.
The Medical SimLibrary is a platform that allows geographically
diverse centers to work collaboratively and share simulated patients
and scenarios. The Medical SimLibrary is building an editorial
staff to peer review the uploaded information.
Virtual reality simulators such as Immersion's AccuTouch® Endoscopy
Simulator < www.immersion.com > continue to
improve. Our surgical colleagues have been the most prolific in
the development of virtual reality training. Current models include
simulations of an endovascular repair of abdominal aortic aneurysms,
sinus surgery, gynecologic surgery, orthopedic surgery, prostatic
surgery, amniocentesis and oral surgery. Studies documenting improved
practitioner performance with simulation training are starting
to emerge.
Many believe that simulators will some day be integrated into
our board certification, continuing medical education and recertification
process. One day soon we may practice our care on the simulated
version of a patient scheduled for the following day.
Conclusion
Educational technologies are profoundly influencing the educational
process of health care. Many exciting educational products are
available now. Many more will continue to emerge as computer speed
and network bandwidth continue to improve. The future is limited
only by our imaginations.
References:
1. Davis D, O'Brien MA, Freemantle N, et al. Impact of formal
continuing medical education: Do conferences, workshops, rounds,
and other traditional continuing education activities change physician
behavior or health care outcomes? JAMA. 1999; 282:867-874.
2. Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets:
A systematic review of 102 trials of interventions to improve
professional practice. CMAJ. 1995; 153:1423-1431.
3. Kohn LT, Corrigan J, Donaldson MS. Institute of Medicine.
To Err Is Human: Building a Safer Health System. Washington, D.C.:
National Academy Press; 1999:xxi, 287.
4. Institute of Medicine. Crossing the Quality Chasm: A New Health
System for the 21st Century. Washington, D.C.: National Academy
Press; 2001.
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Jeffrey
M. Taekman, M.D., is Assistant Dean for Educational Technology,
Director of the Human Simulation and Patient Safety Center
and Assistant Professor of Anesthesiology, Duke University
School of Medicine, Duke University Medical Center, Durham,
North Carolina. |
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