Medical student attitudes to computer-assisted learning in anaesthesia

Two methods of data entry for computer-assisted learning (CAL) programs were assessed and the acceptability of two forms of CAL to 100 medical students determined. Sixty-two per cent preferred keyboard entry of data compared with 26% who preferred the light-pen. There was not preference for dynamic simulation programs over patient management programs. The majority of the students preferred using CAL in groups with a supervisor to provide further explanation when required. Ninety-three per cent of students favoured more teaching using this method.     

Scoring the objective structured clinical examination using a microcomputer

The objective structured clinical examination (OSCE) is being used increasingly to assess students' clinical competence in a variety of controlled settings. The OSCE consists of multiple stations composed of a variety of clinically relevant problems (e.g. examining simulated patients, diagnosing X-rays, etc.) Generally, three types of performance data are collected: answers to multiple choice or true/false questions, written short answers, and performance check-lists completed by observers. In most OSCEs these student performance measures are scored by hand. This is time-consuming, increases the probability of mistakes and reduces the amount of data available for analysis. This paper describes a method of computer scoring OSCEs with over 100 students using statistical and test-scoring software regularly used for multiple choice examinations. During the examination, students, markers and raters code answers and performance data directly on optical mark-sheets which are read into the computer using an optical mark reader. The resultant computer data can be efficiently scored and rescored, grouped into different types of subscales, weighted to reflect questions' relative importance, and easily printed in a variety of report formats.     

Self-directed learning in anatomy: incorporation of case-based studies into a conventional medical curriculum

This paper reports an attempt to develop self-directed learning skills in second-year medical students by introducing case-based projects into the gross anatomy course at a long-established medical school. The programme and students' responses to a questionnaire completed at the end of the year are presented. Information on the various resources used by students to find information is given. The performance of students in the case-based components of the course has been evaluated and also in the more traditional end-of-year written examination. The data confirm that students have recognized that the projects were about obtaining a deeper understanding of the anatomy, and the programme appears to have promoted the use and study of library texts.     

Computer-assisted learning in medical education

The advent of cheap and powerful micros has opened the possibility of computer-assisted learning (CAL) in medical education. This article attempts to demonstrate the educational value of CAL, with illustrations of its use. Four styles of CAL are examined, and the danger of trivializing the learning process discussed. The ultimate CAL package which enables students to take charge of their own learning is considered. There are considerable advantages in distance learning, self-assessment, computer-marked examinations and 'audit'. Some of the main problems are considered; these are decisions which must be taken about the choice of hardware and software. The use of various peripheral devices such as slide projectors and videodisc players greatly enhances the value of CAL material, as do alternative input devices. Some thought is given to software style in the presentation of material, and also to the question of the keeping of student records. The use of an author language facilitates program development, and the construction of content-free 'shell' programs enables new material to be added to existing frameworks. Other advantages of CAL include student access to JANET and the possibility of on-line searching of databases. CAL in medical education can help to liberate students from the burden of the rote learning of facts, and enhance the role of reason and imagination in the learning process.     

Learning, retention and recall of clinical information

A representative group of 33 medical students who were entering the junior year clerkships was tested for retention and recall of clinical information 3 months after taking an examination on the same subject. The students were not given an opportunity to review the subject. On 39 identical multiple choice test questions, the students' mean score declined 10 percentile points (P < 0.05) from that on the original examination. On 40 comparable but previously unseen questions, the mean score fell 19 percentile points from that attained 3 months earlier. On open-ended questions of clinical reasoning, a third component of the assessment, the students performed at a level similar to those on the two multiple choice tests, but with greater variability. These assessments give data on retention and recall that have not previously been reported in the literature. Correlations among individual test components were moderate (r = 0.52-0.63). There was inconsistency of individual students in scores on the component tests, and, thus, variability in performance by students was marked. Retention and recall were weakly predicted by results on an initial multiple choice examination. In addition, on a subsequent assessment of knowledge, results from different types of tests were inconsistent, suggesting that these tests evaluate different forms of competence.     

Students' attitudes towards computer testing in a basic science course

OBJECTIVES: The introduction of computerized testing offers several advantages for test administration, however, little research has examined students' attitudes toward computerized testing. This paper, reports the attitudes of 202 students in a first year cell biology and histology course toward computerized testing and its influence on their study habits over a three year period. DESIGN AND METHODS: Multiple choice and image-based extra credit examinations and summative image-based examinations have been successfully administered in the course. The results indicate that students readily accept computer exams and that their study habits were influenced in a positive manner by the computer administered extra-credit examinations. RESULTS: Our results provide further evidence that medical students like the use of computer administered examinations and that the examinations may actually accentuate the learning experience.     

The use of computerized Learning in intensive care: an evaluation of a new teaching program

A computer-assisted learning program in respiratory intensive care was introduced into the undergraduate curriculum at University College Hospital. Educational effectiveness was assessed. This method of learning was found to be highly acceptable to students. The improvement in students knowledge of the subject was up to three times greater in those who used the computer program, than a control group of students who received only teaching by conventional means, (P = 0 X 016). The results of a questionnaire designed to elicit students' attitudes to this learning experience are discussed.     

Use of commercial ''authoring systems'' for medical education

A recent development in computer-assisted medical instruction has been the introduction of 'authoring systems'. Authoring systems are computer programs which can allow an instructor to prepare computer-based medical instructional materials without the need to know programming languages or have more than minimal familiarity with the computer hardware. This report documents the use of a commercially available authoring system that was used to prepare a tutorial for medical student instruction. This lesson presented information about paediatric developmental disabilities in both a text and question-and-answer format. Significant improvement in knowledge was demonstrated by the pre- and post-test results of the study group compared to the control group. The control group consisted of students who did not view the tutorial but had been assigned to a paediatric developmental disabilities clinic. The medical students who viewed the tutorial generally had very favourable comments about the use of such a system for the presentation of new information.     

Visual memory and auditory recall in anatomy students

The performance of medical students in anatomy assessments of the spot, viva and essay type were compared with their performance in visual memory and auditory recall tests. The results demonstrate that defects in visual memory might be a contributory factor to poor performance in anatomy.     

Performance of medical students in case-based and essay components of written anatomy examinations

This paper reports on second-year medical students' performance in the case-based and traditional essay components of the gross anatomy written examinations at the University of Otago held at the end of 1988 and 1989. The mean marks for these two components of the examinations are presented for the three main categories of student entry. Differential performance on the case-based component relative to the essay component has been determined for each student in the class and ranked in order. The proportions of students in the three entry categories falling in the various quartiles for the class are given. The data show that when an intensive programme of case-based learning was followed, as in 1988, all three categories performed similarly on the case-based component relative to the essay component. When a less intensive programme of case-based learning was used, as in 1989, the differential performance of the preferential undergraduate and graduate categories was different to each other. The findings suggest that the achievement of students in the case-based projects is dependent upon the organization of the programme and the extent to which students and staff become involved in the projects. The writing of reports on the cases by students for assessment in 1988 may have had an important influence on the outcome for this year.     

School results as predictors of medical school achievement

In Queensland, scores in the final 2 years of secondary school scaled by an independent aptitude test are used to determine admission to tertiary education. The validity of this procedure for medical school enrollment has been investigated. Data were from four cohorts which entered the medical school to commence the course in each of the years 1975-1978, a total of 943 students. In addition to the school subject scores, overall order of merit scores and results of an independent aptitude test used to scale these scores were included with the predictors. Criteria were derived from the grades obtained in the 33 medical school subjects over the 6-year course, or from a broad pass/fail classification. We demonstrate that the school science subjects were of moderate value for prediction of preclinical achievement, but that school English was the most important predictor of performance in the clinical years, which is perhaps an indication of the value of communication skills.     

Teaching from the clinical reasoning literature: combined reasoning strategies help novice diagnosticians overcome misleading information

OBJECTIVE: Previous research has revealed a pedagogical benefit of instructing novice diagnosticians to utilise a combined approach to clinical reasoning (familiarity-driven pattern recognition combined with a careful consideration of the presenting features) when diagnosing electrocardiograms (ECGs). This paper reports 2 studies demonstrating that the combined instructions are especially valuable in helping students overcome biasing influences. METHODS: Undergraduate psychology students were trained to diagnose 10 cardiac conditions via ECG presentation. Half of all participants were instructed to reason in a combined manner and half were given no explicit instruction regarding the diagnostic task. In Study 1 (n = 60), half of each group was biased towards an incorrect diagnosis through presentation of counter-indicative features. In Study 2 (n = 48), a third of the test ECGs were presented with a correct diagnostic suggestion, a third with an incorrect suggestion, and a third without a suggestion. RESULTS: Overall, the instruction to utilise a combined reasoning approach resulted in greater diagnostic accuracy relative to leaving students to their own intuitions regarding how best to approach new cases. The effect was particularly pronounced when cases were made challenging by biasing participants towards an incorrect diagnosis, either through mention of a specific feature or by making an inaccurate diagnostic suggestion. DISCUSSION: These studies advance a growing body of evidence suggesting that various diagnostic strategies identified in the literature on clinical reasoning are not mutually exclusive and that trainees can benefit from explicit guidance regarding the value of both analytic and non-analytic reasoning tendencies.     

Knowledge and clinical problem-solving

A consistent finding in the literature on measures of clinical problem-solving scores is that there are very low correlations across different problems. This phenomenon is commonly labelled 'content-specificity', implying that the scores differ because the content knowledge necessary to solve the problems differs. The present study tests this hypothesis by presenting groups of residents and clinical clerks with a series of simulated patient problems in which content was systematically varied. Each subject also completed a multiple choice test with questions linked to each diagnosis presented in the clinical problems. Three of the four problem-solving scores showed low correlations, even to two presentations of the same problem, and no relationship to content differences. None of the scores were related to performance on the multiple choice test. The results suggest that variability in problem-solving scores is related to factors other than content knowledge, and several possibilities are discussed.     

Learning human anatomy: by dissection or from prosections?

Two matched groups of first-year preclinical medical students studied the gross anatomy of the lower limb by different methods. One group dissected in the traditional manner (as in the existing curriculum) while the other worked according to an experimental programme which excluded dissection by students. Preparatory study guides were supplied to the experimental group and each of their practical classes on soft tissues began with a priming session at which the structures to be encountered were introduced. The instructor then demonstrated these structures to the group on a prosected wet specimen and bones. Thereafter, the students were allowed to handle and discuss the specimens without staff supervision. At the end of the programme, both groups submitted to a 300-item two-choice paper and a practical test. A debriefing questionnaire was also completed by the experimental group. In both tests, the experimental group performed better than the traditional group and the difference was statistically significant (P less than 0.05) in the theory paper. Further, the experimental programme was completed in about 74% of the time taken by the traditional programme. All the participants commented positively on the experimental programme and expressed the opinion that it had helped them understand the lower limb better than dissection had done for the upper limb. These results suggest that working from prosections is a very effective way of learning human gross anatomy. Such a programme is worthy of consideration by departments having to contend with unfavourable student:cadaver ratios and curtailed teaching time.     

Medical students' learning of anatomy: memorisation, understanding and visualisation

INTRODUCTION: There is much subjective discussion, but few empirical data that explore how students approach the learning of anatomy. AIMS: Students' perceptions of successful approaches to learning anatomy were correlated with their own approaches to learning, quality of learning and grades. METHODS: First-year medical students (n = 97) studying anatomy at an Australian university completed an online survey including a version of the Study Process Questionnaire (SPQ) that measures approaches to learning. The quality of students' written assessment was rated using the Structure of Observed Learning Outcomes (SOLO) taxonomy. Final examination data were used for correlation with approaches and quality of learning. RESULTS: Students perceived successful learning of anatomy as hard work, involving various combinations of memorisation, understanding and visualisation. Students' surface approach (SA) scores (mean 30 +/- 3.4) and deep approach (DA) scores (mean 31 +/- 4.2) reflected the use of both memorisation and understanding as key learning strategies in anatomy. There were significant correlations between SOLO ratings and DA scores (r = 0.24, P < 0.01), between SA scores and final grades (r = - 0.30, P < 0.01) and between SOLO ratings and final grades (r = 0.61, P < 0.01) in the subject. CONCLUSIONS: Approaches to learning correlate positively with the quality of learning. Successful learning of anatomy requires a balance between memorisation with understanding and visualisation. Interrelationships between these three strategies for learning anatomy in medicine and other disciplines require further investigation.     

Library use and academic achievement among medical students

Many factors play a part in determining the performance of students in examinations, but the extent to which students use library facilities does not appear to have been recently considered as a factor, in medicine or in any other academic subject. In this study, the number of books borrowed from the library by undergraduate medical students was used as a simple measure of library use, and significant differences in book-borrowing levels were found between students in different years of the medical course, students from different regions of the world, and men and women students. In the first year of the course, students who borrowed most also performed best in their end-of-year examinations, and this association was only partly explained by regional differences. No such association was found among final-year students, suggesting different study habits and different assessment criteria in the clinical years of the course.     

Evaluation of lectures on medical ethics through students' drawings

Summary. The authors have encouraged medical students to express their impressions of and reactions to lectures on medical ethics by drawing illustrations on their attendance cards. This gives students a sense of participation in the lecture, and also it provides teachers with useful feedback concerning students' understanding of and interest in the subject.     

Teaching decision making to medical undergraduates by computer-assisted learning

Undergraduate medical students improve their ability to make patient management decisions through using computer-assisted learning. With this problem-solving approach an improvement in their factural knowledge also occurs and they retain a significant amount of the content.     

Running a life drawing class for pre-clinical medical students

AIM: To explore the learning possibilities of linking art and anatomy learning. METHOD AND RESULTS: First- and second-year medical students at Southampton University were offered the chance to take part in 3-hour life drawing classes with a life drawing tutor and an anatomist. Attempts were made by the anatomy tutor to link the muscles and bones of the living body in front of the students with their previous learning. The sessions were successful, and enjoyed by students. CONCLUSIONS: Whilst this type of learning cannot take the place of more formal instruction, there does seem to be value in increasing students' interest by providing new points of view and contexts for dry pre-clinical learning. A greater knowledge by the students of anatomy, physiology and clinical medicine at a later stage in their course might have provided further ways to exploit this learning opportunity.     

Introducing medical students to medical informatics

Summary. Medical informatics ( MI ) has been introduced to medical students in several countries. Before outlining a course plan it was necessary to conduct a survey on students' computer literacy. A questionnaire was designed for students, focusing on knowledge and previous computer experience. The questions reproduced a similar questionnaire submitted to medical students from North Carolina University in Chapel Hill ( NCU ). From the results it is clear that although almost 80% of students used computers, less than 30% used general purpose applications, and utilization of computer-aided search of databases or use in the laboratory was exceptional. Men reported more computer experience than women in each area investigated by our questionnaire but this did not appear to be related to academic performance, age or course. Our main objectives when planning an MI course were to give students a general overview of the medical applications of computers and instruct them in the use of computers in future medical practice. As our medical school uses both Apple Macintosh and IBM compatibles, we decided to provide students with basic knowledge of both. The programme was structured with a mix of theoretico-practical lectures and personalized practical sessions in the computer laboratory. As well as providing a basic overview of medical informatics, the course and computer laboratory were intended to encourage other areas of medicine to incorporate the computer into their teaching programmes.