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Albertine David A. Morton, K. Bo Foreman, Patricia A. Goede ...

  1. 1. 31:55-61, 2007. doi:10.1152/advan.00036.2006Advan Physiol Educ Albertine David A. Morton, K. Bo Foreman, Patricia A. Goede, John L. Bezzant and Kurt H. You might find this additional information useful... 14 articles, 2 of which you can access free at:This article cites http://ajpadvan.physiology.org/cgi/content/full/31/1/55#BIBL on the following topics: http://highwire.stanford.edu/lists/artbytopic.dtlcan be found atMedline items on this article's topics Research Methods .. Questionnaires Education .. Course Content Criminology .. Education (Criminology) Communication .. Computer Technology Communication .. Multimedia Medicine .. Medical Students including high-resolution figures, can be found at:Updated information and services http://ajpadvan.physiology.org/cgi/content/full/31/1/55 can be found at:Advances in Physiology EducationaboutAdditional material and information http://www.the-aps.org/publications/advan This information is current as of November 10, 2010 . http://www.the-aps.org/.American Physiological Society. ISSN: 1043-4046, ESSN: 1522-1229. Visit our website at December by the American Physiological Society, 9650 Rockville Pike, Bethesda MD 20814-3991. Copyright © 2007 by the courses and in the broader context of general biology education. It is published four times a year in March, June, September and is dedicated to the improvement of teaching and learning physiology, both in specializedAdvances in Physiology Education onNovember10,2010ajpadvan.physiology.orgDownloadedfrom
  2. 2. Teaching With Technology TK3 eBook software to author, distribute, and use electronic course content for medical education David A. Morton,1 K. Bo Foreman,1 Patricia A. Goede,3 John L. Bezzant,2 and Kurt H. Albertine1,3 Departments of 1 Neurobiology and Anatomy, 2 Dermatology, and 3 Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah Morton DA, Foreman KB, Goede PA, Bezzant JL, Albertine KH. TK3 eBook software to author, distribute, and use electronic course content for medical education. Adv Physiol Educ 31: 55–61, 2007; doi:10.1152/advan.00036.2006.—The methods for authoring and distributing course content are undergoing substantial changes due to advancement in computer technology. Paper has been the traditional method to author and distribute course content. Paper enables students to personalize content through highlighting and note taking but does not enable the incorporation of multimedia elements. Computers enable multimedia content but lack the capability of the user to personalize the content. Therefore, we investigated TK3 eBooks as a potential solution to incorporate the benefits of both paper and computer technology. The objective of our study was to assess the utility of TK3 eBooks in the context of authoring and distributing dermatology course content for use by second-year medical students at the University of Utah School of Medicine during the spring of 2004. We incorporated all dermatology course content into TK3 eBook format. TK3 eBooks enable students to personalize informa- tion through tools such as “notebook,” “hiliter,” “stickies,” mark pages, and keyword search. Students were given the course content in both paper and eBook formats. At the conclusion of the dermatology course, students completed a questionnaire designed to evaluate the effectiveness of the eBooks compared with paper. Students perceived eBooks as an effective way to distribute course content and as a study tool. However, students preferred paper over eBooks to take notes during lecture. In conclusion, the present study demonstrated that eBooks provide a convenient method for authoring, distributing, and using course content but that students preferred paper to take notes during lecture. computer-assisted learning; dermatology; electronic book; human anatomy THE COMPUTER has globally influenced education as a document medium (1). In 2003, ϳ76% of all children in America lived in a household with a computer, and 83% of the 57 million enrolled children used a computer at school (3). Medical education, whether didactically based such as phys- iology or dermatology lectures or clinically based such as residency programs, have also been impacted by advancements in computer-based media (5). The method by which professors author and distribute course content (e.g., lecture notes, im- ages, video, and audio) is undergoing significant change through resources such as Microsoft PowerPoint (12), com- puter programs (11), CD-ROM (14), and the internet (4), to name a few. Some health professional schools have a manda- tory laptop computer requirement to correspond with their e-curriculum (6). Each year, student demand for computer- based course content is increasing (16). Course content is usually presented to students through a combination of paper and web-based media. Word processing software (i.e., Microsoft Word) has facilitated the distribution of lecture handouts and study aids both on paper and electron- ically. Typically, students prefer paper lecture handouts to follow lectures and personalize the content for self-study through note taking, highlighting, and marking pages (10). Although paper enables users to personalize content, paper does not enable multimedia components. Web authoring software has become less expensive and easier to use, making the web an effective and convenient means for authoring and distributing course content, including multimedia content. The web enables all aspects of multimedia technology, such as text, color, animation, and sound. The web also includes the convenience of accessing information with a computer when the internet is available. However, with all of the benefits of the web, users are still unable to personalize web content as they would with paper. The pedagogical problem addressed by our study is how to efficiently blend, into one document, the advantages of paper content for a course, which enables students to personalize content through highlighting and note taking, and electronic content, which incorporates multimedia, interactive elements for students to gain a greater perspective. The need for ad- dressing this problem is growing as educational institutions, including medical schools, shift to an electronic delivery of course content (8, 17). The potential solution we investigated was electronic books (eBooks). eBooks became a focus of our study because all course content could be wrapped into a single, self-contained, electronic format (an eBook file) and distributed via a CD or the internet. Earlier eBooks required the use of special hardware to view digital text and images. eBooks requiring hardware, such as Gemstar, were not commercially successful (9). Other commercial entities, such as Adobe, also have experimented in the eBook field by introducing “Adobe eBook Reader.” Adobe eBook Reader opened portable docu- ment format (PDF) files and viewed them within the reader (15). Adobe eBook Reader enabled the user to view color digital images and to personalize content by highlighting text, adding electronic “stickies,” zooming in/out, and hyperlinking content to the web, if the computer was connected to the internet. However, the insertion of self-contained multimedia elements, such as audio, video, and animation, was not possi- ble. As a result, we investigated software developed by Night Kitchen (New York, NY; www.nightkitchen.com) that intro- duced the TK3 eBook (7). “TK3 Author” is web-based soft- ware for authoring multimedia TK3 eBooks. TK3 Author software enables the user to incorporate text, color digital images, audio, video, and animations, using drag-and-drop techniques, and publish a multimedia eBook. eBooks are viewed by “TK3 Reader,” which is freeware. TK3 Reader Address for reprint requests and other correspondence: D. A. Morton, Dept. of Neurobiology and Anatomy, Univ. of Utah School of Medicine, 401 MREB 20 N 1900 E, Salt Lake City, UT 84132 (e-mail: david.morton@hsc.utah.edu). Adv Physiol Educ 31: 55–61, 2007; doi:10.1152/advan.00036.2006. 551043-4046/07 $8.00 Copyright © 2007 The American Physiological Society onNovember10,2010ajpadvan.physiology.orgDownloadedfrom
  3. 3. enables the viewer to personalize content by highlighting, inserting electronic stickies, and creating electronic notebooks as well as by searching for keywords, linking to the internet, and marking pages for future reference. The objective of our study was to assess the utility of TK3 eBooks in the context of authoring and distributing dermatol- ogy course content for use by second-year medical students. We authored original content and posted it on our course website for the students to use during lectures and for self- study. At the conclusion of the course, an Institutional Review Board-approved questionnaire was used for student assess- ment. The principal results showed that authoring was easy and intuitive, and student use was extensive. However, student preference for eBook versus paper educational material de- pended on the educational setting. Students preferred the eBook to receive course content in its full variety and for self-study. On the other hand, they preferred paper lecture syllabus content for use during lectures, especially for taking notes. We conclude that TK3 eBooks offer a reasonable ap- proach to author and distribute course content electronically for use by students. We speculate that student use of such content will increase as more students acquire portable computers and get accustomed to lectures with interactive electronic media. METHODS Software. To author, distribute, and use TK3 eBooks, both “TK3 Author 1.1” and “TK3 Reader 1.1” software were needed. Both software were developed and marketed by Night Kitchen. TK3 Author is commercial software and is used to create and publish TK3 eBooks, whereas TK3 Reader is freeware used to open, view, and personalize TK3 eBooks. Night Kitchen provides customer support and tutorials for both TK3 Author and TK3 Reader. Curriculum information. The first 2 yr of medical school training at the University of Utah School of Medicine cover the basic sciences. The first year curriculum includes gross anatomy, embryology, his- tology, psychiatry, biochemistry, genetics, physiology, pharmacology, pathology, microbiology, and immunology. The second year curricu- lum includes neuroscience, cardiovascular, geriatrics, musculoskele- tal, pathology, pulmonary, dermatology, gastroenterology, nephrol- ogy, pediatrics, reproductive, endocrinology, and hematology oncol- ogy. No course uses a centralized course management system (such as WebCT); however, each course offered during the first 2 yr includes web content that organizes the course via a schedule. All but two courses during the first year and two courses during the second year have their own website that offers additional electronic course con- tent, including PowerPoint lectures, URLs to other websites, flash cards, old exams, animated tutorials, images, clinical cases, and other e-learning content. Course information. We created a TK3 eBook for the dermatology course taught to second-year medical students at the University of Utah School of Medicine. The dermatology course is taught over 4 days, with the final examination on the fifth day. The course consists of 12 1-h lectures, clinical applications, and a medical procedure laboratory session. The course’s content includes PowerPoint lectures, paper lecture handouts, digital images, video clips, clinical cases, and a variety of supplementary websites. Our goal was to incorporate the course content into a central resource: a TK3 eBook. Our study was conducted in the spring of 2004. Study subjects. One hundred and four second-year medical students enrolled in dermatology at the Univeristy of Utah School of Medicine were invited to voluntarily participate in the study; 91 of the 104 students (88%) participated. Each participating student owned and used either a desktop and/or laptop computer. We did not assess computer proficiency and presumed that proficiency was not equiva- lent among the participants. This study was approved by the Univer- sity of Utah Institutional Review Board. eBook composition. TK3 Author was used to author and publish TK3 eBooks. The dermatology course website was used to distribute dermatology eBooks to the medical students. The procedure for preparing the TK3 eBooks is as follows. Content is imported into TK3 Author’s “Media Resources Library” (MRL). The author stores and organizes media elements by folders, including text, digital images, video, and audio. Text is imported as “.rtf” or “.html” files or entered directly. The “Text Formatter” tool provides control for font style, size, format (bold, italics, underline, superscript, subscript, etc.), spacing, paragraphs, custom tabs, margins, color, and alignment of text. Digital images are imported as “.jpg,” “.bmp,” or “.gif” file formats. Video files are imported as “.mov,” “.avi,” or “.mpg” (MPEG1) file formats. Audio files are imported as “.wav,” “.aif,” “.mov,” or “.mp3” file formats. QuickTime is required to access the multimedia content imported into TK3 eBooks and is available as a free download (http://www.apple.com/quicktime/). Flash files (www- .macromedia.com) can be used as long as they have been exported as QuickTime movies and have the suffix on the flash file changed from “.swf” to “.mov.” All media elements are stored in the MRL, where they can be selected for import into the eBook. Media elements that have been stored in the MRL can be organized to facilitate their management and insertion into pages of TK3 Author. This process is repeated to assemble the text, images, video, and audio content into a multimedia eBook. TK3 Author also constructs triggers (text or graphics within the eBook) that use hyperlinks to open graphical elements, such as a histological image, or to link to external web-based content. Dermatology course eBook. An eBook was created for each of the 4 days of the course to minimize the digital file size. We kept the size of the eBooks small (below 10.0 MB) so that remote access would be possible through the internet, which we tested and verified. Once the four dermatology eBooks were completed, they were uploaded to the dermatology course website. Availability of the course content in eBook format was announced via e-mail to the students a week before the course began. The announcement described the purpose of the eBooks, the course website, and instructions to download and view the dermatology eBooks. On the morning of the first lecture, the instructions were repeated, and directions for using TK3 eBook Reader were given. In addition, each student received a paper copy of the eBooks. In this way, each student could choose eBook, paper content, or both throughout the course. Evaluation. At the conclusion of the dermatology course’s final exam, each student completed a 15-point, Institutional Review Board- approved questionnaire designed to evaluate the effectiveness of the dermatology eBooks. Using a 7-point Likert scale, students were asked to evaluate the eBooks with respect to efficiency of course content distribution, effectiveness for note taking, and usefulness in education. Open-ended questions were also placed at the end of the questionnaire for additional comments regarding the advantages or disadvantages of the TK3 eBooks during the dermatology course. Descriptive statistics were calculated, and analysis of the compiled data was performed (Microsoft Excel 2000, Microsoft). RESULTS Four TK3 eBooks, one eBook for each day, were composed using the eBook software TK3 Author. The eBook screen dimensions were 800 ϫ 450 pixels, with a background tem- plate provided by the TK3 eBook software. Text, hundreds of digital images, video clips, and PowerPoint files were consol- idated into the four dermatology eBooks. Hyperlinks to sup- plementary internet resources were also included (Fig. 1). TK3 Reader enabled the students to do the following: enter textual information into the “Notebook tool,” highlight words and Teaching With Technology 56 TK3 eBOOK SOFTWARE Advances in Physiology Education • VOL 31 • MARCH 2007 onNovember10,2010ajpadvan.physiology.orgDownloadedfrom
  4. 4. phrases with yellow or green color (“Hilite tool”), insert boxes of text on pages (“Stickies tool”), electronically mark pages for future reference (“Mark pages tool”), search the entire eBook for keywords (“Find tool”), and view the history of pages and media viewed (“History tool”) in the exact order viewed (“Retrace tool”) as well as hyperlink to images, video, and specific sites on the internet (“Hotlinks tool”) (Fig. 2). Student assessment of eBooks. One hundred and four sec- ond-year medical students were enrolled in the dermatology course in the spring of 2004; 91 of the students participated in our eBook project and completed the questionnaire at the conclusion of the course. The mean age of the participating students was 28 yr (range: 23–42 yr old), with 58 men and 33 women. A sampling of the evaluation statements on the ques- tionnaire are shown in Table 1. A 7-point Likert scale was used to evaluate the aspects of the dermatology eBooks ranging from 1 (strongly disagree) to 7 (strongly agree). Students indicated that eBooks were an effective way to distribute course content, with a mean score of 5.1 Ϯ 1.6 of 7 (Fig. 3A). When the subjects were asked if eBook lecture notes were an effective self-study tool, their mean response was 5.6 Ϯ 1.4, indicating that they preferred eBooks as a self-study aid (Fig. 3B). On the other hand, students did not favor using eBooks during lectures. For example, students disagreed with the statement that eBooks provided an effective means to take notes during lecture (3.2 Ϯ 1.8; Fig. 3C). Thus, students disagreed with the statement that they preferred the eBook over paper lecture notes (mean score of 3.2 Ϯ 1.9; Fig. 3D). Students were asked to evaluate whether TK3 Reader tools, such as the “Hilite tool” and “Stickies tool” were helpful. Student perceptions of the tools were either neutral or favor- able (see Fig. 4). From the qualitative survey, 19 students noted that regardless of the annotation tools, to annotate and take notes on a computer screen was more difficult than it was on paper. In fact, 11 students commented that they never used the annotation tools provided by TK3 eBook Reader. As one student commented, “I like to write things down during lecture because I can write my thoughts faster and more efficiently than I can type . . . but maybe I am just old fashioned.” Forty-seven students indicated that one of the advantages of the eBook was the availability of the images. These students indicated that it was helpful to have so many images organized into one study tool and that the images were accessible without need to connect to the internet. Twelve students indicated that Fig. 1. Screen capture of the TK3 eBook template in full-page view. The vertical column along the left side shows the tools for interacting with the TK3 eBook. The triangles on the bottom right corner indicate buttons to advance forward and backward in the eBook with the current page number displayed between the triangles. A tool bar along the top horizontal column also facilitates user interactivity. The text in red font indicates a hyperlink to an embedded graphic (image, audio, or video) or to external web-based content. The window labeled “Lecture: Layers of the Skin” demonstrates a PowerPoint presentation linked to text within the eBook. Teaching With Technology 57TK3 eBOOK SOFTWARE Advances in Physiology Education • VOL 31 • MARCH 2007 onNovember10,2010ajpadvan.physiology.orgDownloadedfrom
  5. 5. the eBook was a good addition to paper but did not replace paper. As one student indicated, “it is a good resource to have, but the most critical resource is still the paper syllabus.” Twenty-eight students commented that a disadvantage of the eBook was the need to have a laptop computer to benefit from the eBook during lecture. Sixteen students commented that the eBook could not replace paper and that they disliked reading on a computer screen for long periods of time. Comments about the eBooks ranged from describing the success of the course “much owing to the eBook” to comments that the eBook made the course “harder for me.” DISCUSSION We investigated whether eBooks are a potential solution to incorporate advantages from both paper and electronic multi- media technology for designing, distributing, and using medi- cal school course content. As a result, we designed TK3 dermatology eBooks for second-year medical students. The dermatology course was conducted over a 5-day period. The study was designed to subjectively assess if eBooks were an effective way to distribute course content, if eBooks were an effective study tool, if eBooks were an effective way to record lecture notes during class, and if students preferred eBooks over paper for lecture notes. From the results of the qualitative questionnaire, TK3 eBooks were perceived as an effective way to distribute course content. Students also liked the eBooks as a self-study tool. The majority of students preferred paper over eBooks to take notes during lecture, either because recording notes electronically did not feel as natural as using paper or Fig. 2. Screen capture of TK3 Reader user tools. The tools include the following: hyper- links (red text), the “hilite” tool (yellow), and “stickies” (green). The notebook tool is opened in the top right corner, and the “find” tool is opened in the bottom right corner as is the history of activity tool. The “marked pages” tool displays “dogeared” pages, the locations of “stickies” and “hilites” (observe the “marked page” at the top right corner). Table 1. Sample of the questionnaire used for this study Put an X in the square that best corresponds to your opinion about the statements below using the following scale as your guide Likert scale questions Strongly Agree Neutral Strongly Disagree 7 6 5 4 3 2 1 A. eBooks are an effective way to distribute course content. B. eBooks are an effective tool for self-study. C. eBooks are an effective way to take notes during lecture. D. I prefer eBook notes over paper notes during lecture. E. How helpful were the following tools in the TK3 eBook reader? Note book Hiliter tool Stickie notes Mark pages Keyword search Retrace History Hot links to websites Qualitative questions A. What was the biggest advantage in using the eBook dermatology lecture notes during lecture and/or self-study? B. What was the biggest disadvantage in using the eBook dermatology lecture notes during lecture and/or self-study? Teaching With Technology 58 TK3 eBOOK SOFTWARE Advances in Physiology Education • VOL 31 • MARCH 2007 onNovember10,2010ajpadvan.physiology.orgDownloadedfrom
  6. 6. because not all participating students owned laptop computers. However, many of the latter students commented on the questionnaire that even if they owned a laptop computer, they still preferred to use paper because that is what they are used to. Students indicated a strong attachment to paper when taking notes during lecture, thus supporting student perceptions from another study (10). Students also commented that they prefer to read from paper as opposed to from a computer screen, which also supports other findings (13). A limitation of our study is that we introduced a novel educational tool after 1.5 yr of medical school. In other words, medical students within the University of Utah School of Medicine system were already accustomed to using paper to record notes during lecture. Our project introduced an addi- tional resource that was only available for 1 wk during one medical school course. We predict that students’ perception and use of interactive electronic lecture notes may change once they are accustomed to them. One of our intentions is to address that possibility by following up this study as more courses adopt interactive electronic lecture notes/content. A strength of TK3 eBooks is they provide a venue for all course content, including the multimedia elements of the web, in one central source. However, to benefit from this feature of TK3 eBooks during lecture, a portable laptop computer is required. We do not know the number of students in the study who owned a laptop computer; however, only six medical students consistently brought laptop computers to lecture, de- spite being given advance notification about the TK3 eBook content for the course. Our medical school does not require that students acquire a laptop computer. TK3 eBook software does not operate on all portable computer devices, however. For example, the software is incompatible with tablet laptop com- puters and with personal digital assistants (PDAs). Also, TK3 users are limited to using the keyboard to enter data. Even though using a stylus is not an option for managing informa- tion, users still have the ability to personalize the content using the software tools in TK3 Reader. Users can “hilite” keywords and phrases and insert “stickies” anywhere on an eBook page; the “notebook” feature enables students to record information as though they were using a paper notebook; and users can mark pages for later reference. Student opinion of the TK3 Reader tools were either favorable or neutral (Fig. 4). Perhaps the reason that the overall opinion about the TK3 Reader tools was neutral reflected how students today use and rely on paper content. Another reason may be that students today are not as comfortable or adept at using computers to access electronic content during lectures. In addition to the mentioned attributes of a TK3 eBook, the author has the ability to publish the TK3 eBook through the internet, CD-ROM, and/or DVD-ROM. The author can pro- gram the eBook to expire after a certain date, disable printing and copying if s/he so desires to include protection against copyright infringement. Interactivity is an essential element of a computer-assisted instructional tool because interactivity engages the learner with the educational material. Interactivity should incorporate inter- actions between the learner and interface, learner and content, learner and instructor, and learner and learner (2). TK3 eBooks incorporate interactions among these four elements. The learn- er-interface interaction occurs through the standard TK3 “Tools” menu along the left, vertical, or bottom horizontal border of each eBook page. Interactions include buttons such Fig. 3. Summary of data of student responses to post study questionnaire. A: eBooks are an effective way to distribute course content. B: eBooks are an effective tool for self-study. C: eBooks are an effective way to take notes during lecture. D: Preference for eBook notes over paper notes during lecture. Teaching With Technology 59TK3 eBOOK SOFTWARE Advances in Physiology Education • VOL 31 • MARCH 2007 onNovember10,2010ajpadvan.physiology.orgDownloadedfrom
  7. 7. as next page, previous page, key word search, hiliter, stickies, notebook, page mark, contents, retrace, history, and help. The learner-content interaction occurs by providing text, graphics (photographs, drawings, histology slides, etc.), and video and audio files directly on a page or through a hyperlink. Links to other websites containing related learning materials and edu- cational sites are also included. Learner-instructor interactions are limited to e-mail links to the instructors and web master. Learner-learner interactions are cumbersome but available. Students can save “stickies” and/or “notebook” pages from TK3 Reader and then e-mail them to another student who is also using TK3 Reader. For example, if a student missed lecture, a fellow student could email his/her “stickies” and/or “notebook” pages from within his/her TK3 Reader to the absent classmate. The absent classmate could then import the “stickies” and/or “notebook” pages into his/her own TK3 Reader. TK3 eBooks are cross platform and can be distributed over the web and downloaded to any PC or Mac laptop or desktop Fig. 4. Student perceptions of TK3 Reader user tools. A: the “Stickies” tool. Stickies add unlimited numbers of “stickie” notes to a page or pages. B: the “Find” tool. This allows a search for a word and/or phrase in the body text, annotation, notebook, and stickies. Users can export personalized reader marks (stickies, hilites, and dogears) and send them to another TK3 eBook Reader user. C: the “Mark pages” tool. This tool marks any page by clicking on the top right corner for future reference, like placing a tape flag on a page. D: the “Hotlinks” tool. This tool hyperlinks text or an object to a URL or a graphic, such as an image, text box, or video clip. E: the “Notebook” tool. Students can write in the notebook and export parts or the whole notebook to a friend, word processor, or printer. They can also insert any part of the TK3 document (text and media elements) into the notebook for future reference. F: the “History” tool. The history lists each of the pages in order that the user visited, listing the most recent page first. G: the “Hilite” tool. This tool highlights words and passages with different colors. H: the “Retrace” tool. This tool allows students to return to the previous page(s) viewed in the eBook by clicking on the retrace tool. Teaching With Technology 60 TK3 eBOOK SOFTWARE Advances in Physiology Education • VOL 31 • MARCH 2007 onNovember10,2010ajpadvan.physiology.orgDownloadedfrom
  8. 8. computer. The laptop design enables students to access the TK3 eBook, making the course content conveniently portable, instead of carrying notebooks, textbooks, and atlases. Also, TK3 eBook content is not static. eBooks can be updated, rewritten, and corrected to keep the content current. This is an important attribute because printed documents are static, and, as a result, more effort and cost are incurred to revise and reprint the printed document again. In conclusion, our study demonstrates that eBooks provide a convenient method for authoring, distributing, and using course content. Students expressed their preference for eBooks due to a central location for course content as well as the convenience in accessing the content. They strongly agree that TK3 eBooks are a helpful ancillary study tool. However, the group of students involved in this study still preferred paper to take notes during lecture. Our study emphasizes the strengths that eBooks have in authoring and distributing the course content from a teacher’s side and the effective interactive elements of eBooks on the student’s side. A future step will be to determine if students in years to come still prefer paper to take notes during lecture or if students will gradually become accustomed to using computers during lectures. We are track- ing students annually to determine if such a transition occurs. For example, our gross anatomy course consists of 38 lectures, with 30 associated cadaver laboratory sessions that are taught over a 3-mo period of time. All course content is provided to the first-year medical students as paper content. In addition, an eBook version of the course content is provided to students who prefer computers. In the gross anatomy course, we instruct students about the eBook and let them use it on their own. Each year, 6–12 students use the eBook exclusively. Thus far, we have observed that most students use a combination of both paper and electronic content. Because students continue to use eBooks to access and interact with course content, we will assess correlations between student performance on standard- ized tests, such as United States Medical Licensing Examina- tions, and use of technology, such as eBooks, during medical school education. ACKNOWLEDGMENTS We thank Jasmine Jensen for the help in proofing the eBook as well as collecting the data. GRANTS This work was funded in part by the Dean’s Office Medical Scholars Program and the Dean’s Office as well as the Educational Computing Com- mittee and the Department of Neurobiology and Anatomy at the University of Utah School of Medicine. K. H. Albertine and D. A. Morton were participants in the Medical Scholars Program. REFERENCES 1. Bolter J. Writing Space. Hillsdale, NJ: Erlbaum, 1991. 2. Chou C. Interactivity and interactive functions in web-based learning systems: a technical framework for designers. Br J Educ Technol 34: 265–279, 2003. 3. Day J, Janus A, Davis J. Computer and Internet Use in the United States: 2003, edited by Commerce USDo. Washington, DC: United States Census Bureau, 2005, p. P23–P208. 4. Foreman K, Morton D, Musolino G, Albertine K. Design and utility of a web-based computer-assisted instructional tool for neuroanatomy self- study and review for physical and occupational therapy graduate students. Anat Rec 285B: 26–31, 2005. 5. Greenhalgh T. Computer assisted learning in undergraduate medical education. Br Med J 322: 40–44, 2001. 6. Hendricson WD, Panagakos F, Eisenberg E, McDonald J, Guest G, Jones P, Johnson L, Cintron L. Electronic curriculum implementation at North American dental schools. J Dent Educ 68: 1041–1057, 2004. 7. Hilts P. Night Kitchen offers multimedia authoring tool. Publishers Weekly 248: 54, 2001. 8. Hudson JN. 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Learning preferences, computer attitudes, and student evaluation of computerised instruction. Med Educ 36: 225–232, 2002. 17. Vogel M. Love it or hate it? Medical students’ attitudes to computer- assisted learning. Med Educ 36: 214–215, 2002. Teaching With Technology 61TK3 eBOOK SOFTWARE Advances in Physiology Education • VOL 31 • MARCH 2007 onNovember10,2010ajpadvan.physiology.orgDownloadedfrom

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