Journal of Microcomputer Applications (1984) 7, 345-347

COMMUNICATION

Computer-aided learning-the development of interactive microcomputer-based medical teaching programs

Azim Lakhani, Johannes Goldschmidt and Graham Clayden

St Thomas’s Hospital Medical School Campus, United Medical and Dental Schools qf Guys and St ThomasS London SE1 7EH, UK

Computer-aided learning has an advantage over conventional printed and audiovisual self-learning methods by virtue of being interactive and has a potential role in medical education. Software packages, which allow medical lecturers with no previous programming expertise to create their own interactive microcomputer-based lessons, are available. The software enables creation of lessons with features such as the use of colour, graphics, the requirements for input from students, feedback, decision making, creation of summaries and scores. The use of one such package, for the development of community medicine and clinical medicine interative lessons at St Thomas’s Hospital Medical School, London, is described.

Undergraduate and postgraduate students who wish to study at their own pace and in

their own time have in the past had to use either printed material or specially prepared audiovisual programs. The disadvantages of these methods of learning are that they are

passive methods with one-way communication. Computer-aided learning adds an extra

dimension by allowing some input from the student, with immediate assessment of this input and thus two-way communication. While computer-aided learning may not entirely replace a live tutor or lecturer, the hypothesis is that it will be a better learning aid than either printed material or conventional audiovisual aids.

At two workshops on microcomputers in medical education, held by the Association for the Study of Medical Education, a number of medical computer-aided learning

programs were demonstrated. The development of these, however, had required programming from scratch and had been very time consuming and expensive.

Modifications to the programs usually required computer programming expertise and

updating the programs could be difficult. The debate at the end of each workshop centred on whether medical lecturers should learn how to program and create their own

computer-aided learning programs or whether they should ask computer programmers

to create these programs based on the lecturers’ specifications. A general purpose software package is now available that overcomes some of these problems (Bevan & Watson, 1983). This package allows a teacher, with no previous programming expertise, to develop interactive lessons on a mircrocomputer, and to test, edit and modify them as and when required. The teacher is predominantly responsible for the text, format and content of the lesson. The package then allows the manipulation of the text, the

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346 A. Lakhani et al.

interaction and the decision-making process using simple commands that require little effort to master.

We are in the process of developing both community medicine and clinical medicine interactive lessons using a microcomputer and the above mentioned software package. Features of the lessons include the ability:

to present text for information using colour, graphics, varying speeds of presentation, appearance of previously hidden text, flashing and double height characters; to ask questions and require input from the student, either in the form of multiple choice or free text; to make decisions based on the input from the student, to acknowledge correct answers, to correct wrong answers, to provide further information, to proceed with the lesson, to return to a previous section or to branch in different directions depending on the demonstrated ability of the student; to create variables based on the student’s input and use them within the lesson, to use integers and simple arithmetic for decision making and to present information as graphs; to record the student’s input, to store the information, to create scores as the student proceeds with the lesson and to present the student with a summary of input and errors at the end of a lesson.

It is possible to interface lessons with the use of audiotapes, slides and video discs. Considerable ingenuity is required of the teacher in achieving the desired effects within

the constraints of the use of integers, single characters and free text recognition for decision making. Examples of programs and features include the following.

(i) An interactive lesson on the management of a case of child abuse: a case history is followed by a choice of management options. The student is required to press one appropriate key and depending on the choice, led down one management pathway. The different pathways often merge and divide again. In some cases there is more than one appropriate option. This is useful for small group teaching and stimulates discussion. Where the choice is inappropriate, the student is provided with an explanation and allowed a repeat attempt.

(ii) The British Medical Journal published a series of clinical algorithms, for one of which (Hern, 1984) we were given permission by the editor to convert to a computerized algorithm. This algorithm is a clinical management tool, not an educational program but demonstrates the ease with which structured information can be converted to an interactive program using this software package.

(iii) For the teaching of epidemiology, a lesson on variability in biological measures. Explanatory text is followed by a series of questions where the student is required to select an answer from a list provided. A summary of correct and incorrect answers is provided at the end of this session and the student given an opportunity to revise certain sections. This is followed by a practical exercise where the student listens to heart sounds on an audiotape and attempts to identify them from a list provided. Five heart sounds are repeated twice each at random. The computer records the students input, provides correct answers, and plots bar charts of frequencies of responses of previous students. This practical exercise demonstrates the concept of between observer and within observer variations in clinical observations.

We hope to evaluate this method of teaching using a randomized, controlled study of different teaching methods.

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References Bevan, E. & Watson, R. (Eds) 1983. Microtextfor the BBC Microcomputer. Cambridge: Acornsoft

Limited. Hem, J. C. 1984. Clinical algorithms-tremor. British Medical Journal, 288, 1072-1073.

Dr Azim Lakhani, MB BMBCH is currently a lecturer/Honorary Senior Registrar in the Department of Community Medicine at St Thomas’s Hospital Medical School, London. He read medicine at Oxford and graduated in 1978. He has since held a combination of clinical and community medicine posts. He was introduced to the use of mainframe and minicomputers in research early during his career and was later involved in the development of a microcomputer- based health information system in a health district. The experience gained in microcomputing is now being applied to the development of interactive computer-aided learning and a study of its role in medical education.

Johunnes Goldschmidt, BSc MSc MPhif, after graduating in mathematics at the University of Sussex in 1969, has studied and worked in various parts of London University. An MSc in computer science in 1970 was followed by research in pure mathematics, ending with an MPhil in 1973. Four years’ work on transport and environmental problems at Imperial College provided an opportunity for learning to use computers as research tools. Since 1978, Mr Goldschmidt has been in charge of computing at St Thomas’s Hospital Medical School, Department of Community Medicine, where he has built up an interactive computer service which is mainly used for research. He is now exploring the wider use of computing in a medical school.

Dr Graham Clayden, MD FRCP is currently a senior lecturer/Honorary consultant in Paediatrics at St Thomas’s Hospital Medical School, London. His interest in the multifactorial basis of childhood constipation led to the use of firstly, the University of London’s computer, and then, due to availability and easy access, microcomputers. An interest in medical education led to the development of microcomputer-based education programmes. He is at present in the process of co-ordinating an information network on computer-aided learning in medicine for the Association of the Study of Medical Education, and organizing a microcomputer group for paediatricians in the UK.