The University of Texas Medical School at Houston, Department of Pathology and Laboratory Medicine
We hypothesized that self instructional multimedia electronic texts would provide more efficient study tools and increase the student's retention of material. The standard four year medical school curriculum has a finite amount of time which must be distributed between lecture hours, laboratory , clinical rotations and self-instructional/study time. This rigid curriculum is not flexible enough to accommodate the need for a student to learn an ever increasing amount of medical science. To attempt to resolve this dilemma the provision of more efficient study in less time with a corresponding increase in material retention is highly desirable.
To test the hypothesis, a sample program on aplastic anemia was prepared in HTML format utilizing multimedia tools including high resolution images, sound files, and graphic illustrations either embedded or linked to the file. One of the distinct advantages of these materials is the ability to incorporate areas of study that was limited to review only in the laboratory due to the precious nature of some materials or the need for instruments such as a microscope. Rare specimens and material limited in number must be shared among 200 students and is seldom available after a laboratory exercise for later review. The use of high resolution graphic images can provide, in some areas, a satisfactory replacement for these materials and, in others, a review of previously experienced laboratory exercises.
Multimedia programs can also provide a cohesive and comprehensive on-line format for review of this material in an organized fashion. Many medical students fail to perform well due to their inability to organize the material sufficiently in the time allowed for study and retention. The hypertext links provide an inherent tree structure to web documents and are an excellent means to organize information for efficient review. Since organization of the material is built into the web document, the time spent with traditional study materials in unproductive organization in preparation for study - pulling related pieces of information presented in lecture, discussion groups, or laboratory together - can be redirected to actual study and comprehension of the material .
To compare to the multimedia file on aplastic anemia, a corresponding traditional set of instructional materials were also prepared in lecture and syllabus formats. These traditional materials were designed in the same scope and fashion as those currently given to first and second year medical students. For this study, second year medical students were divided into two groups in a randomized manner, one group given traditional instruction and the other given the multimedia program. The actual time spent in study was recorded and a test for material retention was delivered to both groups.
Test scores demonstrated no significant difference in retention between the two groups. Since the students were not involved in the study of required curricula, it is possible that this affected their dedication to the study routine and testing . Further study of randomized groups of students involved in required curriculum may yield differences in the two modes of study which could not be detected in the current study. The best conclusion allowed by this study is that the multimedia program was equivalent to the standard lecture/syllabi format of medical teaching. Time spent in study of the multimedia program was on average 15 minutes longer than for the syllabus. Responses in the evaluation indicated that this was due partially due to the excitement in using the on-line material as well as the incorporation of high resolution color graphic images which were not available in the same format in the traditional materials for study. There was an apparent difference in the expression of enjoyment of learning with the on-line materials over the traditional materials, but this is a factor which is difficult to quantitative. Evaluation responses by the students were extremely positive and indicated a desire to have electronic texts available for required courses.
At the core of medicine in the future will be highly integrated medical information databases and servers. The use of electronic on-line educational materials has the cursory benefit of beginning to prepare the student in the use of this type of technology in medicine. Currently most hospitals have integrated information systems supporting the hospital practices with patient medical information, laboratory processing and results, and radiological study results. In addition to the current systems, future systems will provide medical decision analysis support and medical information libraries. Both will be available to the physician on the hospital ward for review. The familiarization of current medical students even to a small degree with this type of technology will provide them with a valuable tool set for their future.
While the focus of our study was directed towards first and second year medical education, comparable problems occur for post-graduate physicians and a similar solution may be applicable to these problems as well. To provide current and appropriate therapies to patients, physicians must keep abreast of the constant advances and discoveries in medical sciences which requires a dedication to life-long learning. This need is complicated by an increasing economic pressure on physicians to see more patients which leaves less time for continuing medical education. Current forms of continuing education involve self study of written texts and journal articles or participation in meetings which are often requires time-off and travel. Multimedia materials provided over the internet could resolve many of the current issues. A web server providing multimedia materials could be accessed by physicians at times appropriate for their schedule. This educational process would not require the loss of productive time due to travel. It also has the advantage of providing a forum which can be rapidly updated as changes occur and does not have the production delays of written textbooks and journals. This point may be particularly useful in the managed care arena. One of the underlying requirements for managed care to be successful in cost reduction is the rapid communication to physicians of information regarding clinical outcome analysis and recommendations. A web server to a group of networked managed care physicians would be an ideal delivery vehicle.
Managed care can also benefit in another manner through patient self education. The most successful managed care practices will actually be those which can prevent patients from becoming ill. This requires heightening the community awareness of health issues in the area of health promotion or healthy lifestyles. A web server could provide accessible information to patients over a community health information network to meet this need.
In conclusion, self instructional electronic texts are an alternative to traditional self-study tools and may provide a student an increased knowledge base without necessarily increasing time spent in research. One of the distinct advantages of these materials is the ability to incorporate areas of study that were previously limited to review only in the laboratory due to the precious nature of some materials or the need for instruments such as a microscope.
Section Chief, Laboratory Computer Services, Hermann Hospital
Medical Director, Core Laboratory for Immunology, Molecular Pathology, and Esoterics,
UT Department of Pathology and Laboratory Medicine.