education technologies
DESCRIPTION
Beyond the Blackboard: Using Computers to Enhance Psychiatric Education Sudha Prathikanti, MD Lee Rawitscher, MD Amy Berlin, MD. Education Technologies. Search Tools & Electronic Databases Hand-held Devices Presentation Software Interactive Case Modules Virtual Classrooms Telepsychiatry - PowerPoint PPT PresentationTRANSCRIPT
Beyond the Blackboard:
Using Computers to Enhance Psychiatric Education
Sudha Prathikanti, MDLee Rawitscher, MDAmy Berlin, MD
Education Technologies
Search Tools & Electronic DatabasesHand-held Devices Presentation SoftwareInteractive Case ModulesVirtual ClassroomsTelepsychiatryOnline Evaluation ToolsCurriculum Management ToolsComputer-aided Decisionmaking Tools
Computer-aided Education:Possible Advantages
“Universal” AccessibilityRemoval of Time/Geography Barriers
Self-directed EducationHyperlink Capability
Standardization of ContentEase of Updating Content
Efficiency in Didactic InstructionEfficiency in Course CoordinationEfficiency in Content Distribution
Computer-Aided Education:Possible Disadvantages
Hardware/Software RequirementsBandwidth Requirements
Technical Maintenance & SupportTime-Intensive Course Development
Asynchronous CommunicationUni-dimensional Communication
Faculty Knowledge DeficitStudent Knowledge Deficit
Evaluation of Web-Based Learning
Still in infancyValuable Addition to EducationNo Clear Evidence of SuperiorityWell-designed Curriculum Best Indicator of Satisfaction, Web-based or NotConnection Speed/Bandwidth Critical Possible Increase in Learning Efficiency?Relative Costs Must be Better Examined
Computers and StudentsComputers and Students
Lee Rawitscher, M.D.Lee Rawitscher, M.D.
OverviewOverview
Ilios – UCSF designed databaseIlios – UCSF designed database
iRocket – Online curriculumiRocket – Online curriculum
Colorado University Case SoftwareColorado University Case Software
Evalue – Commercial evaluation softwareEvalue – Commercial evaluation software
IliosIlios
Developed entirely by UCSFDeveloped entirely by UCSF
Data storage programData storage program– Faculty, resident and student dataFaculty, resident and student data– Course schedulesCourse schedules– Search engineSearch engine
Primary method for module creationPrimary method for module creation
iRocketiRocket
Based on a commercial product called Based on a commercial product called Web CTWeb CT
Modified by UCSF to fit culture and needsModified by UCSF to fit culture and needs
Online CurriculumOnline Curriculum– Learning objectivesLearning objectives– Site informationSite information– Discussion forumDiscussion forum– Key linksKey links
Colorado University Case SoftwareColorado University Case Software
Developed by University of Colorado Developed by University of Colorado Department of PediatricsDepartment of Pediatrics
Offered free of chargeOffered free of charge
Self contained teaching unitsSelf contained teaching units– UCSF uses a CD Rom in conjunctionUCSF uses a CD Rom in conjunction– Video ClipsVideo Clips– QuizzesQuizzes
Allows for standardization of curriculumAllows for standardization of curriculum
E-ValueE-Value
Purely commercial (UCSF subscribes)Purely commercial (UCSF subscribes)
Online evaluationOnline evaluation– Attendings and residents evaluate studentsAttendings and residents evaluate students– Students evaluate all their teachersStudents evaluate all their teachers– Teachers can be rankedTeachers can be ranked– Evaluations reviewed by directorsEvaluations reviewed by directors
Increases number of evaluatorsIncreases number of evaluators
Simplifies reading your evaluationsSimplifies reading your evaluations
Areas of EvaluationAreas of Evaluation
Fund of KnowledgeFund of KnowledgeHistory TakingHistory TakingMental Status ExamMental Status ExamOral Case PresentationsOral Case PresentationsRecord KeepingRecord KeepingProblem SolvingProblem SolvingProfessional Attributes ResponsibilitiesProfessional Attributes ResponsibilitiesSelf ImprovementSelf ImprovementRelationships with Patients and FamilyRelationships with Patients and FamilyRelationships with Members of the Health Care TeamRelationships with Members of the Health Care TeamSummary CommentsSummary Comments
SummarySummary
Data Storage and Search EngineData Storage and Search Engine
Course Descriptions and Internet LinksCourse Descriptions and Internet Links
Standardized Teaching ModulesStandardized Teaching Modules
System for EvaluationSystem for Evaluation
Behavioral Medicine Behavioral Medicine Curriculum for Curriculum for
Primary Care Residents Primary Care Residents
Sudha Prathikanti, MDSudha Prathikanti, MD
Limitations ofLimitations ofMany Behavioral Health Many Behavioral Health
CurriculaCurricula
Often more emphasis on communication Often more emphasis on communication than on diagnosis and treatment.than on diagnosis and treatment.
Rarely incorporate significant audiovisual Rarely incorporate significant audiovisual components.components.
Often lack the algorithm-based teaching Often lack the algorithm-based teaching approach commonly used in other areas of approach commonly used in other areas of medicine.medicine.
Web-DVD Module: Clinical ScenarioWeb-DVD Module: Clinical Scenario
Video Clip of Clinical Encounter
QuickTime™ and aDV/DVCPRO - NTSC decompressor
are needed to see this picture.
Web-DVD Module: Decision TreeWeb-DVD Module: Decision Tree
OPTION A“You’re going thru a rough period, but you’ll be fine.”
OPTION B“You seem overwhelmed; do you ever think of ending your life?”
OPTION C“Hmm…I think some meds will make you feel better.”
Negative consequences seen on video clipExplanation & optional content module offeredRe-direct to Decision #1
Patient confirms severity of psych symptom on video clipTrainee congratulated & optional content module offeredProceed with case
Negative consequences seen on video clipExplanation & optional content module offeredRe-direct to Decision #1
Video Clip of Clinical Encounter
Decision #1: What will you do now?
OPTION C“Hmm…I think some meds will make you feel better.”
Negative consequences discussedOptional content module offeredRe-direct to Decision #1
QuickTime™ and aDV/DVCPRO - NTSC decompressor
are needed to see this picture.
Web-DVD ModuleWeb-DVD Module(continue Decision Tree)(continue Decision Tree)
Decision #2: What will you do now?
Decision #3: What will you do now?
OPTION AOverlooks medical etiologies:“This guy must have Major Depression!”
OPTION BConsiders wide differential:“Let’s review all the possible causes for these mood symptoms.”
OPTION COverlooks psych etiologies:“This is probably just steroid-induced.”
Negative consequences seen on video clipExplanation & optional content module offeredRe-direct to Decision #1
Patient elaborates upon symptom severity on video clipTrainee congratulated & optional content module offeredProceed with case
Negative consequences seen on video clipExplanation & optional content module offeredRe-direct to Decision #1
Web-DVD Modules asWeb-DVD Modules asTeaching ToolsTeaching Tools
In traditional classroom.In traditional classroom.
In web-based course for independent In web-based course for independent studystudy
In virtual classroomsIn virtual classrooms
Web-DVD Modules: Web-DVD Modules: Resource IntensiveResource Intensive
Authoring RequirementsAuthoring Requirements
Lots of Time!Lots of Time! Actors to Simulate Patients Actors to Simulate Patients Software Programmer/Web DesignerSoftware Programmer/Web Designer
Digital Video Camera & Filming AccessoriesDigital Video Camera & Filming Accessories Computer with Firewire, DVD Drive & Disk SpaceComputer with Firewire, DVD Drive & Disk Space DVD BurnerDVD Burner
Digital Video Editing ProgramDigital Video Editing Program HTML Editing ProgramHTML Editing Program (Custom) Web Application Program(Custom) Web Application Program
Web-DVD Modules: Web-DVD Modules: Resource IntensiveResource Intensive
Deployment RequirementsDeployment Requirements
InstructorInstructor Administrative access to large Web ServerAdministrative access to large Web Server Technical support to manage user problemsTechnical support to manage user problems
StudentStudent Computer with DVD DriveComputer with DVD Drive Internet Connection Internet Connection Recent Browser with JavascriptRecent Browser with Javascript
Web-DVD Modules: Web-DVD Modules: One Part of Overall One Part of Overall
CurriculumCurriculum Classroom DidacticsClassroom Didactics Classroom PBL with Movie ClipsClassroom PBL with Movie Clips Live Patient InterviewLive Patient Interview Clinic PreceptorshipClinic Preceptorship Downloadable Reading Assignments Downloadable Reading Assignments Web-based Discussion Group Web-based Discussion Group Web-based Multiple-choice ExamsWeb-based Multiple-choice Exams Web-DVD Interactive Case ModulesWeb-DVD Interactive Case Modules
COMPUTERS & MEDICINE: FANTASY vs. REALITY
Amy Berlin, MD
How does improving the technological sophistication
with which we deliver educational material affect
the quality of the educational experience?
CLINICAL DECISION SUPPORT SYSTEM =
CDSS
SCENARIO
YOU: YOUR CLINIC:
Electronic Medical Record
ONLINE • Problem list• Medication list• Allergies
AT EACH VISIT…
Patient completes questionnaire
Have you suffered from depressed mood more often than not over the past 4 weeks?
Do you have trouble sleeping?
Have you had any weight loss or weight gain?
Have you lost interest in activities which generally give you pleasure?
+ depression screen
Generates email
message
1
2
3
Three arms of the studyArm #1
Questionnaire with positive depression screen generates email
Arm #2
Depression reminder on encounter form
Arm #3
Patient-specific recommendations on encounter form
Which group of patients do we predict will have the lowest Hamilton Rating Scale for Depression
scores, at three and six months?
Patients identified as having a major depression flagged for return visit within four weeks
Patients identified as having a major depression flagged for return visit within four weeks AND paper-based encounter form includes reminder to address depression
Patients identified as having a major depression flagged for return visit within four weeks AND paper-based encounter form includes guideline-based, patient-specific recommendations
NO difference in outcome among all three 3 groups
• Mean Hamilton scores at time 0 ranged from 19.7-20.7, with no significant differences among groups
• Mean Hamilton scores at both 3 and 6 months ranged from 14-16, with no significant differences among groups
• PMDs with more intensive decision support saw their patients more frequently
• No difference in frequency of SSRI prescription among groups
Adding technology to a problem does not
necessarily generate its solution
When implementing computer-based
educational instruments, remember to evaluate your
system using objective measures
References
Rollman, Bruce et al. A Randomized Trial Using Computerized Decision Support to Improve Treatment of Major Depression in Primary Care. Journal of General Internal Medicine 2002; 17:493-503.