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MEDICAL EDUCATOR
VOL 3, No 4, April 2001 Internet + classroom = better grasp of topic, MUSC study showsIn the past, if you wanted to stay on the teacher’s good side, you brought her or him an apple.In the future, you may want to throw in 256 megabytes of memory or broadband access—not for the teacher, but for the teacher’s aide—the computer. Computers, of course, have been involved in the educational process for many years, primarily to teach data and word processing. More and more, however, computers, in conjunction with the Internet, are being used as the means by which faculty and students communicate through a virtual classroom. The results, according to one study conducted by a joint MUSC faculty-student group, may be surprising—online learning outperformed the traditional classroom method. The study, among the first of its kind, was conducted during the fall of 1998. It focused on Introduction to Clinical Ethics (ICE), a required sophomore medical school course that teaches a specific method for analyzing clinical ethical issues. The second-year medical students were randomly assigned to either the traditional classroom-only group or the classroom-plus-Internet (cyberethics) group. “The cyberethics group had significantly better understanding of ethical analysis (at the course’s conclusion) than the traditional group,” said Robert Sade, M.D., professor of surgery and senior author of the study. The first author on the report of the study was Andrew J. Lipman, M.D., at the time a fourth-year medical student. Co-authors, in addition to Sade, were Angela L. Glotzbach, a student and research assistant in bioethics; Carol J. Lancaster, Ph.D., an associate professor and Mary Faith Marshall, Ph.D., assistant professor and director of the Program in Biomedical Ethics. The course is a required one which teaches students a specific four-step method of identifying ethical situations, analyzing them and bringing them to a resolution. Both the traditional and cyberethics groups used the same textbook, prepared classroom discussions and held a two-hour classroom session each week. Both groups also had to write a detailed case analysis at the end of the course. There the similarities ended. The traditional group was required to turn in a mid-term case analysis which the cyberethics group did not. The cyberethics group, on the other hand, was required to regularly visit WebCT, an internet site for university-level courses, and participate in an online discussion of four different ethical situations. Traditional students did not have access to this forum, which was accessible only by password. Although the groups had different requirements, Sade said, the workload for students was judged to be roughly equivalent. For faculty, however, the workload differed. Instructors for the cyberethics group reported spending about 50 per cent more time on their course, probably due to the fact that they facilitated the online discussions as well as the classroom sessions. However, Sade added, they also reported a higher level of satisfaction in their participation. “They found teaching the course more enjoyable,” he said. For purposes of this study, two external reviewers, an English professor and a philosophy professor not associated with the course and unfamiliar with any of the students, were asked to evaluate the case analyses submitted by the students at the end of the course. To grade the case analyses, the reviewers used specific criteria provided by the investigators, Sade said. Analysis of their grading showed nearly complete lack of bias, broad distribution of scores on the grading scale and good inter-observer reliability. The grades for the case analysis were therefore considered to be the “gold standard” for judging the outcome of the study. In the final analysis, the cyberethics group scored higher overall than the traditional group. “That indicates a better mastery of the four-step process by the cyberethics group than the group that did not have the benefit of WebCT,” Sade explained. In preparation for this study, investigators could find little in the way of corroborative information, Sade said. “There was virtually no evidence in the literature that showed an advantage for Internet-based teaching. This study may be the first to document that Internet education has advantages over more traditional methods.” The study is scheduled to be published later this year in “Academic Medicine,” the country’s leading journal of medical educational research. MUSC among 10 schools to continue Standardized Patient Project in 2002by Maura Carey, M.A.Director, Center for Clinical Evaluation and Teaching The primary function of the Center for Clinical Evaluation and Teaching (CCET) at the Medical University of South Carolina is to assess the clinical competence of students in training. Historically, the field of medical education has been challenged by developing a method of assessment that consistently and adequately measures a student's knowledge base, performance level and communication skills. One of the most dramatic and successful innovations in this area is the objective structured clinical examination (OSCE), which combines the reality of a live clinical interaction with patients, the standardization of patient problems, and the use of multiple observations of each student. OSCEs are rapidly replacing other forms of assessment, especially in medical education, since they allow students to be assessed in an environment similar to the one in which they will eventually practice medicine. Additionally, the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards plans to implement a national licensing OSCE in the near future. The CCET organizes and conducts OSCEs and other clinical programs at MUSC as well as field testing cases for the NBME Standardized Patient Project. Last year MUSC was one of 21 medical schools implementing an NBME clinical practice exam (CPX). This exam consisted of multiple patient encounters and corresponding “write-up” stations. All rising fourth-year students are required to participate in the CPX and achieve a passing score. Students who did not achieve a passing score received individualized remediation with MUSC clinical faculty members to improve the students' deficiencies. Students received two scores from the CPX; first, a checklist score which measures history taking, physical examination and communication/counseling skills and the second an interpersonal score. MUSC received national comparative data regarding our student clinical skills. Overall, MUSC student's performance was in line with the national average for checklist scores and above the national average for interpersonal scores. MUSC is one of 10 schools chosen by the NBME to continue piloting cases for the Standardized Patient Project. The CPX for the class of 2002 will be conducted from late July to early August. Once again it will consist of multiple patient encounters. This year's CPX will introduce the addition of electronic data capture. The standardized patients will be completing all checklists on laptop computers provided by the NBME and students will complete their “write-up” stations on computers as well. The use of electronic data capture should maximize efficiency and allow the NBME to communicate feedback and students scores in a more timely manner. Anyone interested in more information about the CCET and its activities should contact the CCET at 792-7832. Poll shows faculty preference for classroom-Internet teachingA recent poll from WebCT, an Internet provider of integrated systems for higher education, shows strong faculty preference for Web-enhanced classroom instruction over either traditional classroom-only instruction or online-only “distance” education. Faculty also say student learning achievement is maximized in courses that combine online and classroom elements.The e-Learning Poll, the findings of which WebCT released for National Distance Learning Week (April 15-21), shows that 66 percent of respondents rate combination courses as either “above average” or “excellent” in overall quality, versus 52 percent for classroom-only courses and 44 percent for distance courses. Sixty-seven percent of respondents deem combination courses “above average” or “excellent” in terms of student learning achievement, well ahead of the 47 percent figure for classroom-only courses and 37 percent for distance courses. Combination classes also lead by similar margins in terms of student and faculty satisfaction. The e-Learning Poll findings on student learning achievement echo results from research conducted by Murray Goldberg, WebCT founder and President of WebCT/Canada, that became the pedagogical foundation of WebCT. “Good, effective teaching involves lots of interactivity —between faculty and students and between students and students. That's where the learning ‘magic’ takes place,” said Goldberg. “Some students are comfortable participating in the classroom. Others, because of shyness or language barriers or learning style, prefer participating online. Adding online components to a classroom course increases the number of students who participate somehow, which improves student learning outcomes.” Goldberg also noted that the poll results reflect the current state of the higher education e-learning field in several important respects. First, faculty preference for combination online/classroom courses reflects existing institutional usage patterns for online course management systems such as WebCT. Approximately 75 percent of WebCT’s customer base use WebCT to deliver “web-enhanced” classroom-based courses, versus 25 percent, which use WebCT to deliver true distance courses. Second, low faculty satisfaction with distance courses may be attributable to the still-relatively nascent stage of the distance learning field, which has grown and matured dramatically during the past year. Continuing Medical EducationThe following conferences are sponsored by MUSC. All conferences are to be held in Charleston unless otherwise noted.May
24-25
25 - 27
25 - 28
May 30 - June 2
May 31 - June 2
June
4-9
7 - 8
7 - 10
9
16 - 19
Teaching TipsTechniques for Making Your Presentations More “Interactive” (from Franklin Medio, Ph.D., assistant dean for Graduate Medical Education)Limit presentation of information to 15 minutes 1) Focus attention on 2 or 3 important
“take home” points as the learning objectives (ie., what participants will
do or say).
Use a second activity to maintain audience participation
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