Authenticity of instruction and student performance: a prospective randomised trial

Medical Education 2011: 45 : 807–817 Objectives This study aimed to investigate the relationship between the authenticity of instructional formats and outcome measures within a pre‐clerkship clinical reasoning course. Methods We conducted a randomised, prospective, crossover study with Year 2 medical students taking a pre‐clerkship clinical reasoning course. Students were randomised to small groups and exposed to three formats of differing instructional authenticity (paper case, DVD presentation, standardised patient [SP] presentation) across three subject areas (abdominal pain, anaemia, polyuria). Three student cohorts were taught using one instructional format per subject area so that each cohort received a different instructional format for each of the three subject areas. Outcome measures (objective structured clinical examination, video quiz, written examination) were selected to determine the effect of each instructional format on the clinical reasoning of students. Results Increasingly authentic instructional formats did not significantly improve clinical reasoning performance across all outcome measures and subject areas. However, the results of the video quiz showed significant differences in the anaemia subject area between students who had been instructed using the paper case and live SP‐based formats (scores of 47.4 and 57.6, respectively; p = 0.01) and in the abdominal pain subject area, in which students instructed using the DVD format scored higher than students instructed using either the paper case or SP‐based formats (scores of 41.6, 34.9 and 31.2, respectively; p = 0.002). Conclusions Increasing the authenticity of instructional formats does not appear to significantly improve clinical reasoning performance in a pre‐clerkship course. Medical educators should balance increases in authenticity with factors such as cognitive load, subject area and learner experience when designing new instructional formats.     

Techniques for teaching electrocardiogram interpretation: self-directed learning is less effective than a workshop or lecture

Medical Education 2011: 45 : 347–353 Context Teaching 12‐lead electrocardiogram (ECG) interpretation to students and residents is a challenge for medical educators. To date, few studies have compared the effectiveness of different techniques used for ECG teaching. Objectives This study aimed to determine if common teaching techniques, such as those involving workshops, lectures and self‐directed learning (SDL), increase medical students’ ability to correctly interpret ECGs. It also aimed to compare the effectiveness of these formats. Methods This was a prospective randomised study conducted over a 28‐month period. Year 4 medical students were randomised to receive teaching in ECG interpretation using one of three teaching formats: workshop, lecture or SDL. All three formats covered the same content. Students were administered three tests: a pre‐test (before teaching); a post‐test (immediately after teaching), and a retention test (1 week after teaching). Each tested the same content using 25 questions worth 1 point each. A mixed‐model repeated‐measures analysis of variance (anova ) with least squares post hoc analysis was conducted to determine if differences in test scores between the formats were statistically significant. Results Of the 223 students for whom data were analysed, 79 were randomised to a workshop, 82 to a lecture‐based format and 62 to SDL. All three teaching formats resulted in a statistically significant improvement in individual test scores (p < 0.001). Comparison of the lecture‐ and workshop‐based formats demonstrated no difference in test scores (marginal mean [MM] for both formats = 12.4, 95% confidence interval [95% CI] 11.7–13.2]; p = 0.99). Test scores of students using SDL (MM = 10.7, 95% CI 9.8–11.5) were lower than those of students in the workshop (p = 0.003) and lecture (p = 0.002) groups. Conclusions Compared with those taught using workshop‐ and lecture‐based formats, medical students learning ECG interpretation by SDL had lower test scores.     

A comparison of telehealth and face-to-face presentation for school professionals supporting students with chronic illness

We compared the perceptions of school professionals who received education about students with chronic illness by videoconference (VC) or by face-to-face (FTF) presentation. Forty-five different one-hour presentations were provided by a paediatric educator to a total of 1389 subjects - 919 viewed FTF presentations and 417 viewed VC presentations. Subjects completed a 10-item survey to assess satisfaction and other perceptions, such as access and convenience of the sessions, on a 5-point Likert scale. The results for the two different modalities were compared using analysis of variance. Participants at the FTF presentations (mean 4.6, SD = 0.6) and VC presentations (mean 4.3, SD = 0.7) indicated that they were very satisfied with the instruction they received. The FTF participants were significantly more satisfied than the VC participants (P < 0.001). Similarly, comfort with the sessions, perceived preparedness, convenience and other items were also highly rated in both groups, although the FTF group rated many of these perceptions significantly higher. Regression analysis showed that the comfort level with the presentations was a predictor of satisfaction, suggesting that people might not be familiar enough with VC sessions to be comfortable and satisfied with this delivery mechanism. Nonetheless, VC delivery appears to be a viable alternative when FTF is not possible, particularly in rural areas.     

Spaced education improves the retention of clinical knowledge by medical students: a randomised controlled trial

Purpose Medical knowledge learned by trainees is often quickly forgotten. How can the educational process be tailored to shift learning into longer‐term memory? We investigated whether ‘spaced education’, consisting of weekly e‐mailed case scenarios and clinical questions, could improve the retention of students' learning. Methods During the 2004–5 surgery clerkships, 3rd‐year students completed a mandatory 1‐week clinical rotation in urology and validated web‐based teaching programme on 4 core urology topics. Spaced educational e‐mails were constructed on all 4 topics based on a validated urology curriculum. Each consisted of a short clinically relevant question or clinical case scenario in multiple‐choice question format, followed by the answer, teaching point summary and explanations of the answers. Students were randomised to receive weekly e‐mailed case scenarios in only 2 of the 4 urology topics upon completion of their urology rotation. Students completed a validated 28‐item test (Cronbach's α = 0.76) on all 4 topics prior to and after the rotation and at the end of the academic year. Results A total of 95 of 133 students (71%) completed the end‐of‐year test. There were no significant differences in baseline characteristics between randomised cohorts. Spaced education significantly improved composite end‐of‐year test scores (P < 0.001, paired t‐test). The impact of the spaced educational e‐mails was largest for those students who completed their urology education 6–8 and 9–11 months previously (Cohen's effect sizes of 1.01 and 0.73, respectively). Conclusion Spaced education consisting of clinical scenarios and questions distributed weekly via e‐mail can significantly improve students' retention of medical knowledge.     

A note on clinical presentations of amebic liver abscess: an overview from 62 Thai patients

Background  

Amebic liver abscess is a tropical disease with a wide spectrum of clinical presentations. Given the often nonspecific nature of the complaints related to amebic abscess, a retrospective review of patients with confirmed disease to recognize the most common patterns of presentation is useful. Here, we study the clinical presentations of 62 Thai patients with amebic liver abscess. We also compare the clinical presentations of Anti HIV seronegative and Anti HIV seropositive patients.     

Knowledge among German and Turkish women about specifically female bodily functions, contraception, preventative medical examinations and menopause

The legally binding consent of a patient to surgical operations of certain diagnostic measures during hospitalisation is actually guaranteed only in cases where the medical information is oriented to the individual level of understanding of the patient. The real extent of actual knowledge about health relevant aspects is not always known. Immigrant women constitute a large portion of the patients in big German cities. In most clinics the difficulties in communication caused by persistent language barriers are not presently being solved in a satisfactory manner. In light of this situation, it seemed necessary to ascertain the knowledge of German and Turkish women with respect to specifically female bodily functions, contraception, preventative medical examinations and menopause. The study included a total of 320 German and 262 Turkish patients of both gynaecological units at the Virchow Women's Clinic in Berlin during the 1 1/2-year inquiry period (1997/98). The questionnaire we used was laid out in multiple choice format, whereby each question was provided with a list of possible answers (level of significance p < 0.05). Only a small portion of the general female populace (approximately 13% of the study population, 22% of German patients) is well-to-very-well informed about 'specific female bodily functions, anatomy, preventative health care and contraception', and this proportion is even smaller among Turkish female patients (3% of Turkish women surveyed). While the understanding demonstrated by immigrants who possessed strong writing skills in German is nearly as great as that of the German group, the proportion of patients who demonstrated less sophisticated understanding was still twice as high with 32.5% as compared to that of the German group (15%). According to the opinion of approximately one-third of the Turkish immigrants (German women 8.2%) surveyed, there are no (increased) health risks associated with menopause.     

Evaluation of a surgical simulator for learning clinical anatomy

BACKGROUND: New techniques in imaging and surgery have made 3-dimensional anatomical knowledge an increasingly important goal of medical education. This study compared the efficacy of 2 supplemental, self-study methods for learning shoulder joint anatomy to determine which method provides for greater transfer of learning to the clinical setting. METHODS: Two groups of medical students studied shoulder joint anatomy using either a second-generation virtual reality surgical simulator or images from a textbook. They were then asked to identify anatomical structures of the shoulder joint as they appeared in a videotape of a live arthroscopic procedure. RESULTS: The mean identification scores, out of a possible score of 7, were 3.1 +/- 1.3 for the simulator group and 2.9 +/- 1.5 for the textbook group (P = 0.70). Student ratings of the 2 methods on a 5-point Likert scale were significantly different. The simulator group rated the simulator more highly as an effective learning tool than the textbook group rated the textbook (means of 3.2 +/- 0.7 and 2.6 +/- 0.5, respectively, P = 0.02). Furthermore, the simulator group indicated that they were more likely to use the simulator as a learning tool if it were available to them than the textbook group was willing to use the textbook (means of 4.0 +/- 1.2 and 3.0 +/- 0.9, respectively, P = 0.02). CONCLUSION: Our results show that this surgical simulator is at least as effective as textbook images for learning anatomy and could enhance student learning through increased motivation. These findings provide insight into simulator development and strategies for learning anatomy. Possible explanations and future research directions are discussed.     

College student reactions to health warning labels: sociodemographic and psychosocial factors related to perceived effectiveness of different approaches

Objective

To examine factors associated with perceiving different types of pictorial cigarette health warning labels as most effective in motivating smokers to quit or preventing smoking initiation among college students.

Method

We administered an online survey to 24,055 students attending six Southeast colleges in Fall, 2010. We obtained complete data for the current analyses from 2600.

Results

Current smoking prevalence was 23.5%. The largest majority (78.6%) consistently rated gruesome images as most effective, 19.5% rated testimonial images as most effective, and only a small proportion rated either standard (1.6%) or human suffering images (0.3%) as most effective. Subsequent analyses focused on differences between those endorsing gruesome images or testimonials as most effective. Factors related to ranking testimonials versus gruesome images as most effective included being female (p < 0.01), White (p < 0.01), and nonsmokers (p = 0.04), lower perceived smoking prevalence (p < 0.01), and greater receptivity to laws/restrictions around smoking (p < 0.01) and tobacco marketing (p = 0.01). Among smokers, factors related to ranking testimonials as most effective versus gruesome images included being female (p = 0.03), being White (p = 0.03), higher autonomous motivation (p = 0.03), and greater extrinsic self-efficacy (p = 0.02).

Conclusions

Understanding factors related to perceived effectiveness of different pictorial warnings among subpopulations should inform health warning labels released by the FDA.     

An education program to increase teacher knowledge about sickle cell disease

This program evaluated the effectiveness of a sickle cell disease (SCD) education program for teachers of students with SCD in their classroom. Teachers with students in a remediation program for students participated in an educational program consisting of four domains: Inheritance and Prevalence, Common Complications, Strokes, and Individual Education Plans (IEP). A 30- to 45-minute presentation was given with a pretest and posttest. Eighty-one teachers who taught grades K-12 completed the program. Most teachers understood the complications of fever and pain, risks of strokes occurring at any age, and the purpose of IEPs. Overall the rate of correct answers increased from 72.5% to 83.1%, p = 0.0001. Teachers improved their understanding of heredity (32% vs. 66%, p = 0.0001), prevalence (81% vs. 94%, p = 0.039), silent stroke diagnosis (21% vs. 80%, p = 0.0001) and overt stroke therapy (40% vs. 75%, p = 0.0001). No significant impact on teacher knowledge occurred for the contents of IEPs (80% vs. 87%, p = 0.227). Teachers of students with SCD increased knowledge about SCD following the program.     

Using electronic flashcards to promote learning in medical students: retesting versus restudying

Medical Education 2011: 45 : 1101–1110 Context The superiority of retesting over restudying in terms of knowledge retention and skills acquisition has been proven in both laboratory and classroom settings, as well as in doctors’ practice. However, it is still unclear how important retesting strategies are to the learning of relevant factual knowledge in undergraduate medical education. Methods Eighty students in Years 3–5 of medical school in Munich participated in a prospective, randomised, double‐blinded, controlled study in which they were exposed to 30 electronic flashcards designed to help them memorise key factual knowledge in the domain of clinical nephrology. The flashcards were presented in four successive learning cycles, each consisting of a study period and a subsequent test period. Half of all participants were randomised to repetitive studying (restudy group) and half were randomised to repetitive testing (retest group) of successfully memorised flashcards. Knowledge retention was assessed after 1 week and 6 months. Additionally, personal data, self‐reflection on the efficacy of the learning strategies and judgements of learning were obtained by questionnaires. Results Repetitive testing promoted better recall than repetitive studying after 1 week (p < 0.001). However, after 6 months general recall was poor and no difference between the restudy and retest groups was observed. Time on task and number of trials, in addition to sex, age, performance and psycho‐social background, did not vary between the groups. Self‐predictions of student performance did not correlate with actual performance. Conclusions In the context of using electronic flashcards, repetitive testing is a more potent learning strategy than repetitive studying for short‐term but not long‐term knowledge retention in clinical medical students. Although students use testing as a learning strategy, they seem to be unaware of its superiority in supporting short‐term knowledge retention.     

The only girl in the room: how paradigmatic trajectories deter female students from surgical careers

Objectives

Over 60% of UK medical students are female, yet only 33% of applicants to surgical training are women. Role modelling, differing educational experiences and disidentification in female medical students have been implicated in this disparity. We are yet to fully understand the mechanisms that link students’ experiences with national trends in career choices. We employ a hitherto unused concept from the theory of communities of practice: paradigmatic trajectories. These are visible career paths provided by a community and are cited by Wenger as potentially the most influential factors shaping the learning of newcomers. We pioneer the use of this theoretical tool in answering the research question: How do paradigmatic trajectories shape female medical students’ experiences of surgery and subsequent career intentions?

Methods

This qualitative study comprised a secondary analysis of data sourced from 19 clinical medical students. During individual, in‐depth, semi‐structured interviews, we explored these students’ experiences at medical school. We carried out thematic analysis using sensitising concepts from communities of practice theory, notably that of ‘paradigmatic trajectories’.

Results

Female students’ experiences of surgery were strongly gendered; they were positioned as ‘other’ in the surgical domain. Four key processes – seeing, hearing, doing and imagining – facilitated the formation of paradigmatic trajectories, on which students could draw when making career decisions. Female students were unable to see or identify with other women in surgery. They heard about challenges to being a female surgeon, lacked experiences of participation, and struggled to imagine a future in which they would be successful surgeons. Thus, based on paradigmatic trajectories constructed from exposure to surgery, they self‐selected out of surgical careers. By contrast, male students had experiences of ‘hands‐in’ participation and were not marginalised by paradigmatic trajectories.

Conclusions

The concept of the paradigmatic trajectory is a useful theoretical tool with which to understand how students’ experiences shape career decisions. Paradigmatic trajectories within surgery deter female students from embarking on careers in surgery.

     

Can virtual reality improve anatomy education? A randomised controlled study of a computer‐generated three‐dimensional anatomical ear model

INTRODUCTION: The use of computer-generated 3-dimensional (3-D) anatomical models to teach anatomy has proliferated. However, there is little evidence that these models are educationally effective. The purpose of this study was to test the educational effectiveness of a computer-generated 3-D model of the middle and inner ear. METHODS: We reconstructed a fully interactive model of the middle and inner ear from a magnetic resonance imaging scan of a human cadaver ear. To test the model's educational usefulness, we conducted a randomised controlled study in which 28 medical students completed a Web-based tutorial on ear anatomy that included the interactive model, while a control group of 29 students took the tutorial without exposure to the model. At the end of the tutorials, both groups were asked a series of 15 quiz questions to evaluate their knowledge of 3-D relationships within the ear. RESULTS: The intervention group's mean score on the quiz was 83%, while that of the control group was 65%. This difference in means was highly significant (P < 0.001). DISCUSSION: Our findings stand in contrast to the handful of previous randomised controlled trials that evaluated the effects of computer-generated 3-D anatomical models on learning. The equivocal and negative results of these previous studies may be due to the limitations of these studies (such as small sample size) as well as the limitations of the models that were studied (such as a lack of full interactivity). Given our positive results, we believe that further research is warranted concerning the educational effectiveness of computer-generated anatomical models.     

Improving stroke knowledge through a ‘volunteer-led’ community education program in Australia

BackgroundPublic awareness of stroke risks and warning signs remains poor. The National Stroke Foundation (NSF) in Australia has been undertaking a StrokeSafe Ambassador Education program to raise awareness of stroke. The format includes presentations by volunteers trained to be ‘ambassadors’ to spread standard information about stroke to the public. Our aim was to determine the change in knowledge of participants who attended presentations.MethodsParticipants completed questionnaires before immediately after presentations, and at 3 months following the presentation. Information was collected on knowledge of risk factors and signs of stroke. McNemar's test was used to compare paired-responses over time. A p value of < 0.05 was considered significant.ResultsBetween March and April 2014, 591 participants attended 185 presentations and 591 (100%) completed them before and immediately after presentation questionnaires: 68% were female and 75% were aged 65 years or more. 258 consented for further follow-up with 192 completing follow-up. Comparing immediately after with before presentation showed significantly improved knowledge for all 10 stroke risk factors and all signs of stroke. Significantly improved knowledge for 7/10 risk factors and 1/3 signs of stroke was found when comparing follow-up and immediately after presentation results. Knowledge of 5/10 risk factors and 2/3 signs of stroke improved when comparing follow-up and before presentation.ConclusionThis study describes a novel approach to support the use of trained volunteers to provide a community-based, standardised education program for stroke. This program shows that community presentations can improve immediate and short-term knowledge of signs and risk factors for stroke.     

Magnetic resonance imaging (MRI) of sexual intercourse: second experience in missionary position and initial experience in posterior position

Our objective was to confirm that it is feasible to take images of the male and female genitals during coitus and to compare this present study with previous theories and recent radiological studies of the anatomy during sexual intercourse. Magnetic resonance imaging was used to study the anatomy of the male and female genitals during coitus. Three experiments were performed with one couple in two positions and after male ejaculation. The images obtained confirmed that during intercourse in the missionary position, the penis reaches the anterior fornix with preferential contact of the anterior vaginal wall. The posterior bladder wall was pushed forward and upward and the uterus was pushed upward and backward. The images obtained from the rear-entry position showed for the first time that the penis seems to reach the posterior fornix with preferential contact of the posterior vaginal wall. In this position, the bladder and uterus were pushed forward. A different preferential contact of the penis with the female genitals was observed with each position. These images could contribute to a better understanding of the anatomy of sexual intercourse.     

运动医学教学中PBL教学模式结合3D解剖软件的运用分析

目的 探讨临床见习阶段运动医学教学中PBL(以问题为中心的学习模式)教学模式结合3D解剖软件的运用对教学效果的影响。方法 将40名来本院骨科实习的某医学院校学生,随机分为观察组和对照组,每组20例。观察组采取基于PBL教学模式结合3D解剖软件的教学方法,对照组采用传统教学方法进行教学。比较分析2种模式在临床医学教学中的应用效果。结果 观察组学生在自学能力、临床诊治能力、分析并解决问题能力及团队合作能力方面优于对照组学生,差异有统计学意义(P<0.05);观察组考试成绩为(86.61±5.35)分,优于对照组学生的考试成绩(77.53±6.16) 分,差异有统计学意义(P<0.05)。结论 PBL教学模式结合3D解剖软件的应用可显著提高运动医学教学的效果。     

A randomised controlled trial of the effects of mindfulness practice on medical student stress levels

Medical Education 2011: 45 : 381–388 Objective This study aimed to determine whether the practice of mindfulness reduces the level of stress experienced by senior medical students. Methods We carried out a multicentre, single‐blinded, randomised controlled trial with intention‐to‐treat analysis in three clinical schools attached to the University of Tasmania, Hobart, Tasmania. Participants included 66 medical students in their final 2 years of study in 2009. Participants were block‐randomised to either an intervention or a usual care control group. The intervention used an audio CD of guided mindfulness practice designed and produced for this trial. Participants were advised to use the intervention daily over the 8 weeks of the trial. All participants completed two self‐report questionnaires, at baseline and at 8 weeks, respectively. The intervention group also completed a questionnaire at 16 weeks to provide follow‐up data. The primary outcome measure was the difference over time in scores on the Perceived Stress Scale (PSS). The secondary outcome measure referred to differences over time in scores on the subscales of the Depression, Anxiety and Stress Scale (DASS). Results Mean baseline scores on the PSS and the stress component of the DASS were 15.7 (maximal score of 40) and 13.2 (maximal score of 42), respectively, both of which exceed scores in age‐matched normative control data. Using multivariable analysis, participants in the intervention group demonstrated significant reductions in scores on the PSS (? 3.44, 95% confidence interval [CI] ? 6.20 to ? 0.68; p < 0.05) and the anxiety component of the DASS (? 2.82, 95% CI ? 4.99 to ? 0.64; p < 0.05). A borderline significant effect was demonstrated on the stress component of the DASS (? 3.69, 95% CI ? 7.38 to 0.01; p = 0.05). Follow‐up at 8 weeks post‐trial revealed that the effect was maintained. Conclusions Mindfulness practice reduced stress and anxiety in senior medical students. Stress is prevalent in medical students and can have adverse effects on both student health and patients. A simple, self‐administered, evidence‐based intervention now exists to manage stress in this at‐risk population and should be widely utilised.     

Development of knowledge in basic sciences: a comparison of two medical curricula

Medical Education 2012: 46 : 1206–1214 Context Basic medical sciences education differs among medicine courses, especially as traditional and integrated problem‐based learning (PBL) curricula teach basic sciences in very different ways. The literature shows no clear differences in the performance of students of these different educational philosophies. The Charité Medical University of Berlin (Charité Universitätsmedizin Berlin) teaches both a traditional medical curriculum (TMC) and a PBL reformed medical curriculum (RMC). Both curricula conduct the Progress Test in Medicine (PTM), which examines competence in the basic and clinical sciences from the first to the last semester. Objectives The aim of this study was to compare the development and retention of knowledge in the basic medical sciences between students on the traditional and reformed undergraduate medical curricula, respectively. Methods For each student and single PTM, relative frequencies of correct answers were computed for basic sciences items only and for the whole curriculum. Frequencies were averaged and grouped by semester and curriculum. Analyses of variance (anova s) were performed at all measurement points with a Bonferroni‐corrected p‐value at the level of p < 0.005. Eta‐squared (η²) was used to classify effect size. Results In the first three semesters, RMC students slightly outperform TMC students in the basic sciences, although TMC students receive more systematic teaching. After this, TMC students develop a peak of knowledge in basic sciences and overtake RMC students. The knowledge of TMC students then decreases over time, but despite this, they perform better in the final semester. Students on the RMC show constant progress throughout their undergraduate studies. Overall, the development of medical knowledge is consistent in both curricula. There is no significant difference in this outcome between the traditional and PBL courses. Conclusions Progress testing as a longitudinal method allows us to better understand the development of knowledge during formal undergraduate education. The main difference between traditional and problem‐based medical education seems to be provoked by the high‐stakes national examination undertaken in the traditional course (the Physikum).     

二维MRC和增强MRC对肝移植胆道显示的比较研究

目的：比较二维MRC水成像（2D-HASTE-T2WI-MRC）与增强MRC（CE-MRC）对活体肝移植供体胆道解剖及变异的显示。方法：32例肝移植供体,术前行2D-HASTE-T2WI-MRC与钆贝葡胺增强MRC检查,将2种方法显示肝内外胆管的图像质量进行比较,以术中胆道造影为标准,比较2种方法诊断胆道变异情况。结果：2种方法对肝内外各胆管的显示有显著性差异（P〈0.05）;对于肝管的显示,CE-MRC优于2D-HASTE-T2WI-MRC（P〉0.05）。术中胆道造影诊断胆道变异17例,2D-HASTE-T2WI-MRC诊断13例,CE-MRC诊断15例,两者联合诊断16例。结论：CE-MRC图像质量优于2D-HASTE-T2WI-MRC,可提供较高质量的影像资料,有助于手术计划的制定,保证手术的成功。     

Participant satisfaction with a school telehealth education program using interactive compressed video delivery methods in rural Arkansas

Socioeconomic and demographic factors can affect the impact of telehealth education programs that use interactive compressed video technology. This study assessed program satisfaction among participants in the University of Arkansas for Medical Sciences' School Telehealth Education Program delivered by interactive compressed video. Variables in the one-group posttest study were age, gender, ethnicity, education, community size, and program topics for years 1997-1999. The convenience sample included 3,319 participants in junior high and high schools. The School Telehealth Education Program provided information about health risks, disease prevention, health promotion, personal growth, and health sciences. Adolescents reported medium to high levels of satisfaction regarding program interest and quality. Significantly higher satisfaction was expressed for programs on muscular dystrophy, anatomy of the heart, and tobacco addiction (p < 0.001 to p = 0.003). Females, African Americans, and junior high school students reported significantly greater satisfaction (p < 0.001 to p = 0.005). High school students reported significantly greater satisfaction than junior high school students regarding the interactive video equipment (p = 0.011). White females (p = 0.025) and African American males (p = 0.004) in smaller, rural communities reported higher satisfaction than White males. The School Telehealth Education Program, delivered by interactive compressed video, promoted program satisfaction among rural and minority populations and among junior high and high school students. Effective program methods included an emphasis on participants' learning needs, increasing access in rural areas among ethnic groups, speaker communication, and clarity of the program presentation.