This document discusses the use of computers in medical education. It outlines the goals of medical education and how computers can help achieve these goals through various learning methods like drill and practice, didactic lectures, and clinical simulations. The document provides a historical overview of computer-based education in medicine from the 1960s onward. It then discusses advantages like increased access to information and the ability to simulate real-world scenarios. The document concludes by discussing considerations for design, development, and evaluating the effectiveness and impact of computer-based learning programs.

1. Computers in
Medical
Education
Rodolfo T. Rafael,M.D.

2. Learning Objectives:
• Demonstrate the advantages of computer-aided instruction over
traditional lecture-style
• Identify the different learning methods that can be implemented in
computer-based education.
• Discuss how computer-based simulations supplement students’
exposure to clinical practice.
• Identify the issues to be considered when developing computer-
based educational programs.
• Recognize barriers to widespread integration of computer-aided
instruction into the medical curriculum.

4. The goals of medical education are :
1. to provide students and graduate clinicians specific facts and information
2. to teach strategies for applying this knowledge appropriately to the
situations that arise in medical practice
3. to encourage development of skills necessary to acquire new knowledge
over a lifetime of practice

5. Students must learn..
• physiological processes and understand the relationships
between their observations and the underlying processes.
•learn to perform medical procedures, and they must
understand the effects of different interventions on health
outcomes.
•student must learn “softer” skills and knowledge, such as
interpersonal and interviewing skills and the ethics of
medical care.

6. A Historical Look at the Use of Computers in
Medical Education
• Piemme (1988)
• 1960
• Ohio State University (OSU)
• Massachusetts General Hospital (MGH)
• University of Illinois
• 1967- Tutorial Evaluation System (TES)
• 1969- Independent Study Program
• COURSEWRITER III
• 1970- TES had a library of over 350 interactive hours of instructional
programs

7. • 1970- Barnett and coworkers at the MGH Laboratory of
Computer Science
• Simulate clinical encounters
• 1971- Harless
• Computer-Aided Simulation of the Clinical Encounter (CASE)
• 1974
• 362 programs- 23 different languages (BASIC, FORTRAN, and
MUMPS to COURSEWRITER III and Programmed Logic for
Automated Teaching Operations (PLATO)

8. • 1972- NLM
• MGH, OSU, and the University of Illinois Medical College
• 80 institutions
• 1983- MGH program offered as (CME) to AMA
• By the mid-1980s
• 100,000 physicians, medical students, nurses, and
other people had used the MGH CBE programs
over a network

9. • PLATO system developed at the
University of Illinois
• High cost
The GUIDON system

10. Advantages of Using Computers in Medical
Education
• augment, enhance, or replace traditional teaching strategies
• extension of the student’s memory
• present rapidly a much larger number of images, static images with
sounds, video clips, and interactive teaching modules
• Immersive interfaces
• “Any time, any place, any pace” learning becomes practical

11. Modes of Computer-Based Learning

12. Drill and Practice

13. Didactic: The Lecture
Howard Hughes
Medical Institute Web
site on teaching
genetics

14. Discrimination Learning

15. Exploration Versus Structured Interaction
• Drill-and-practice programs usually teach important facts and
concepts but do not allow students to deviate from the prescribed
course or to explore areas of special interest.
• Exploratory environment- allow students to choose any actions in any
order encourage experimentation and self-discovery

16. Constrained Versus Unconstrained Response
•The use of a predefined set of responses has two disadvantages:
• It cues the student (suggests ideas that otherwise might not have occurred to
him)
• it detracts from the realism of the simulation.
•Unconstrained
• free to query and to specify actions

17. Construction
http://cyber-anatomy.com/product_CAHA.php

18. Simulation
Static
Dynamic

19. Feedback and Guidance

20. Intelligent Tutoring Systems

21. Current Applications

22. Preclinical Applications

23. The Digital Anatomist, at the University of Washington, Seattle

24. The Visible Human Male and Female

25. HeartLab

26. Clinical Teaching Applications

27. Continuing Medical Education

28. Consumer Health Education

29. Distance Learning

30. Design, Development, and
Technology

31. Design of Computer-Based Learning
Applications
• Structured Content
• Query, Retrieval, and Indexing
• Authoring and Presentation

32. Application Development
• Definition of the Need
• Assessment of the Resources
• Prototyping and Formative Evaluation
• Production
• Integration in the Curriculum
• Maintenance and Upgrades
• Standards

33. Technology Considerations
• cost and availability of the final teaching product
• Web client
• Windows or the Macintosh operating system.
• Internet versus processing on a local machine.

34. Evaluation
1. The reaction of the student population to the new teaching
method and how well the method is assimilated into the
existing process of teaching.
2. The usability of the teaching program.
3. Measures whether the new teaching method actually had
any impact on what the students learned.
4. Measures whether the new method results in behavioral
change because, in the final analysis, content and
procedures learned by students should affect how they
practice medicine.

35. Reaction and Assimilation
• Questionnaires
• subjective reports
• measurement of actual usage

36. Usability and Cognitive Evaluation
Transition graph showing how one student moved between different types of information
in the neuroanatomy program BrainStorm. Of the 900 transitions, almost one-half were
from one cross-sectional image to another. Even though there were a large number (345) of text
screens, with many available hyperlinks between the screens, there was little movement from one
text screen to another. Analyses such as these clarify usage and suggest program design strategies.

37. Knowledge Acquisition
• Is this computer program more effective than traditional methods of
teaching the same material?
•In what ways is computer-based learning different from traditional
methods of learning?
•Can computers enable learning in ways never before possible?
•Can computers perform evaluations of knowledge acquisition that
would be impossible using traditional written or oral examination
techniques?

38. Problem Solving and Behavioral
Change

39. Conclusion
• CBE systems have the potential to help students to master subject
matter and to develop problem-solving skills.
• The barriers to success are both technical and practical.

40. Reference:
• Biomedical Informatics: Computer Applications in Health Care and
Biomedicine by Edward H. Shortliffe and James J. Cimino

41. Suggested Readings
• Chueh H.C., Barnett G.O. (1997). “Just in time” clinical information. Academic Medicine,
72(6):512–517.
• Gaba D.M. (1997). Simulators in anesthesiology. Advances in Anesthesia, 14:55–94.
• Kirkpatrick D.L. (1994). Evaluating Training Programs. San Francisco: Berrett-Koehler.
• Lyon H.C., Healy J.C., Bell J.R., O’Donnell J.F., Shultz E.K., Moore-West M.,Wigton R.S., Hirai
• F., Beck J.R. (1992). PlanAlyzer, an interactive computer-assisted program to teach clinical problem
solving in diagnosing anemia and coronary artery disease. Academic Medicine, 67(12):821–828.
• Pugh C.M., Youngblood P. (2002). Development and validation of assessment measures for a
newly developed physical examination simulator. Journal of the American Medical Informatics
Association, 9:448–460.
• Vosniadou S., DeCorte E., Glaser R., Mandl H. (1996). International Perspectives on the Design of
Technology-Supported Learning Environments. Mahwah, NJ: Lawrence Erlbaum.
• Westwood J.D., Hoffman H.M., Stredney D., Weghorst S.J. (1998). Medicine Meets Virtual Reality.
Amsterdam: IOS Press.