Interinstitutional study to compare the effectiveness of a radiology-anatomy module of instruction.

RATIONALE AND OBJECTIVES: The purpose of this study was to validate the effectiveness of a proven radiology-anatomy instructional module during I st-year gross anatomy courses at Emory University College of Medicine and the University of Iowa College of Medicine. MATERIALS AND METHODS: This prospective study involved 108 Emory students and 177 Iowa students. The instructional content was the same at both institutions. Each student was randomly assigned into one of three groups at each institution, and each group received a unique, randomized, five-item pretest. All students were posttested as part of their gross anatomy laboratory examination, and the posttests consisted of all 15 items used in the three five-item pretests. RESULTS: No statistically significant pretest effects were demonstrated by t tests. Posttest performances across items ranged from 73% to 96% correct for Emory students and 67% to 98% for Iowa students. Performance levels on the posttests were significantly higher than on pretests, and few significant differences were found in the performance of the two populations. CONCLUSION: The radiology-anatomy instructional module integrated into the gross anatomy courses for 1st-year Emory University and University of Iowa students was not instructor or institution dependent.

The Virtual Hospital: experiences in creating and sustaining a digital library.

A university and its faculty encompass a wealth of content, which is often freely supplied to commercial publishers who profit from it. Emerging digital library technology holds promise for allowing the creation of digital libraries and digital presses that can allow faculty and universities to bypass commercial publishers, retain control of their content, and distribute it directly to users, allowing the university and faculty to better serve their constituencies. The purpose of this paper is to show how this can be done. A methodology for overcoming the technical, social, political, and economic barriers involved in creating, distributing and organizing a digital library was developed, implemented, and refined over seven years. Over the seven years, 120 textbooks and booklets were placed in the Virtual Hospital digital library, from 159 authors in twenty-nine departments and four colleges at The University of Iowa. The digital library received extensive use by individuals around the world. A new paradigm for academic publishing was created, involving a university and faculty owned peer reviewed digital press implemented using digital library technology. The concept has been embraced by The University of Iowa, and it has pledged to sustain the digital press in order to allow. The University of Iowa to fulfill its mission of creating, organizing, and disseminating information better.

A performance comparison of communication links between rural hospitals and a digital health sciences library.

BACKGROUND: Rural physicians need access to digital health sciences libraries (DHSLs) that is easy and reasonably rapid. The goal of this project was to study rural hospitals' access to a DHSL on the Internet, by comparing differing access speeds with differing costs and their acceptability for retrieving text, image, and video information in a DHSL. METHODS: DHSL system response time was measured at three different times during the day over three different types of network connections (T1, Frame Relay, Modem). Text, image, and video information was retrieved. Costs were determined for installation and operation of the different types of network connections. RESULTS: System response times were consistent at the three different testing times for each media type retrieved by each of the three network connection types. System response times for text retrieval met literature standards for all connections. Image retrieval met literature standards for T1 and Frame relay connections. No connection met literature standards for video retrieval. CONCLUSIONS: High speed access to DHSLs is preferable; Frame relay connections provide substantively similar service as T1 connections at less cost. However, access via modem to a DHSL can provide access to the majority of information--text--in a DHSL with an acceptable system response time.

Evaluating overall usage of a digital health sciences library.

BACKGROUND: Digital health sciences library (DHSL) evaluation involves studying the usage of the DHSL by individuals as well as populations. The purpose of this study was to evaluate trends in overall usage of a DHSL as part of a process of continuous quality improvement in order to learn how to enhance a DHSL in order to meet its users' needs better. METHODS: Web server log file analysis was performed on a prototype DHSL, the Virtual Hospital, using two log file analysis programs on data from the month of February over four consecutive years, 1995 to 1998. RESULTS: Overall DHSL usage increased between 1995 and 1997 and leveled off in 1998. Fifteen percent of usage came from countries outside the United States. A broad spectrum of medical information for health care providers and patients was accessed and centered around specialty medical information. CONCLUSIONS: To be of optimal assistance to users, DHSLs should (1) contain a broad base of information on common and uncommon medical problems, (2) accommodate the needs of the significant percentage of users that are international through content translation and mirroring, and (3) ensure they are indexed and catalogued in the major Web search engines and Web general and medical indices so they can be easily found by users.

Barriers to rural physician use of a digital health sciences library.

BACKGROUND: Rural physicians need access to quality medical information, but accessing information is difficult in rural settings. Digital health sciences libraries (DHSLs) offer the potential to make information more accessible to rural physicians. A telemedicine network was deployed to six rural hospitals in Iowa. Computers were installed allowing access to a DHSL and training sessions were held. The purpose of this study was to examine the barriers to use of a DHSL by rural physicians. METHODS: Approximately one year after deployment of the telemedicine network, physicians were surveyed using a modified critical incident technique. RESULTS: Seventy percent of the eligible physicians responded and 33% had used the DHSL. Primary barriers included insufficient training, being too time consuming to use, and distance of computers from physicians' practice sites. Non-DHSL users cited the difficulty of using the DHSL as their greatest barrier, while DHSL users cited the quality of the information resources. CONCLUSIONS: This study identifies a number of barriers that exist to rural physicians use of a DHSL. Potential solutions to these barriers are discussed. DHSLs will finally reach their potential when they can be delivered by easy to use handheld computers seamlessly integrated into the rural physician's workflow.

Performing continuous quality improvement for a digital health sciences library through an electronic mail analysis.

BACKGROUND: The goal of this prospective, cross-sectional study was to determine the user demographics of a digital health sciences library (DHSL), motives for use, the nature of users information requests, and success rate in finding answers. METHODS: The content of 500 consecutive electronic mail messages (e-mails) submitted to a DHSL were analyzed using a predetermined coding scheme. Data were entered into a database and frequency analysis was performed. RESULTS: The number of information requests from the 500 e-mail messages was 751. The largest sender category was patients and laypersons followed by students, then physicians. Motivations for use were primarily medical advice (42.8%) and patient care (13.8%). E-mail subject areas were mainly medical (61.8%) and technical (20.6%). Answers to information requests were found 54.3% of the time and senders felt the DHSL was valuable (97.8%). CONCLUSIONS: A DHSL is a valuable medical resource. DHSLs must serve the broad information needs of patients and laypersons in addition to health care providers. Developers and managers of DHSLs can use this information to guide future development of DHSL information content and services, as has been done at The University of Iowa.

Teaching physical examination of the adult liver with use of real-time sonography.

RATIONALE AND OBJECTIVES: The authors developed and evaluated an approach to teaching examination of the liver that incorporates real-time ultrasound (US) imaging as immediate feedback to improve diagnostic accuracy. MATERIALS AND METHODS: Second-year medical students participating in a course in physical examination were assigned to receive instruction in measuring liver span without (group 1) or with (group 2) real-time sonography. Students from each group attended a practice session given by one of two physicians who were board certified in radiology and internal medicine with special expertise in US. During the practice session for group 2, students were shown the boundaries of the liver of the practice patient with real-time US. Both groups of students then made three measurements each of the liver span of a healthy practice patient and a single healthy test patient without US. The vertical liver span reference standard was determined by one of the authors. RESULTS: Students in group 2 showed greater accuracy in measuring liver span during both the practice and the test sessions than did students in group 1. The differences were significant for the third practice measurement and all three test measurements (P < .05). CONCLUSION: The use of real-time US as an aid in teaching physical examination improves students' accuracy in measuring liver size.

Longitudinal follow-up comparison of educational interventions: multimedia textbook, traditional lecture, and printed textbook.

RATIONALE AND OBJECTIVES: The goal of this prospective, interinstitutional study was to compare the long-term instructional effectiveness of a pediatric multimedia textbook (MMTB) to that of a standard lecture and a printed textbook. MATERIALS AND METHODS: A randomized cohort of 89 3rd-year medical students from two institutions were initially evaluated from June 1992 to June 1993 and reevaluated in May 1994. Students were randomly assigned to one of four instructional groups: computer-aided instruction by means of MMTBs (n = 21), traditional lecture (n = 23), printed textbook (n = 19), and a control group (n = 26). After instruction, all groups were tested by means of a multiple choice test at the end of their pediatric clerkship; they were given this same test 11-22 months later. RESULTS: The long-term instructional effectiveness of the MMTB, printed textbook, and lecture were the same as that in the control group, as determined by analysis of variance of mean test scores. CONCLUSION: The educational advantage of MMTBs observed immediately after instruction was not detected 1 year later. Because attrition reduced statistical power, further research is necessary to determine how educational fading affects these instructional formats.

The Virtual Hospital: an IAIMS integrating continuing education into the work flow.

Researchers at the University of Iowa are developing an integrated academic information management system (IAIMS) for use on the World Wide Web. The focus is on integrating continuing medical education (CME) into the clinicians' daily work and incorporating consumer health information into patients' life styles. Phase I of the project consists of loosely integrating patients' data, printed library information, and digital library information. Phase II consists of more tightly integrating the three types of information, and Phase III consists of awarding CME credits for reviewing educational, material at the point of patient care, when it has the most potential for improving outcomes. This IAIMS serves a statewide population. Its design and evolution have been heavily influenced by user-centered evaluation.

The utility of the frontal chest radiograph in the evaluation of chest drain placement.

AIM: To define the utility of the frontal chest radiograph in the assessment of chest drain position. PATIENTS AND METHODS: Fifty-six frontal chest radiographs in 45 patients with 61 chest drains (18 anterior, 9 interlobar, and 34 posterior position) were reviewed retrospectively to determine radiographic characteristics. RESULTS: Eighty-nine percent of the anterior drains demonstrated a curved appearance at the insertion site, while 50% of posterior drains and all interlobar drains were straight at the insertion site. A curved intrapleural drain was a common finding when positioned anteriorly and posteriorly (67% and 59%, respectively). Interlobar drains were often straight throughout their course (89%). The tips of interlobar drains were usually positioned at the hilum (89%). CONCLUSION: Results suggest that interlobar positioning can be suspected on the frontal chest radiograph. A curving chest drain with straight appearance at the insertion site was indicative of a posterior location.

The virtual hospital. Providing multimedia decision support tools via the Internet.

Physicians in the clinical setting remain isolated from important sources of medical information. The authors have created a multimedia database known as The Virtual Hospital that improves access to current medical data, which is used to improve patient care decisions. The Virtual Hospital is a digital health sciences library stored on a server (computer) at The University of Iowa and delivered via the Internet to inexpensive personal computers in the workplace. The emerging standard of the World Wide Web is used to provide cross-platform distribution.

A comparison of educational interventions. Multimedia textbook, standard lecture, and printed textbook.

OBJECTIVE: To compare the instructional effectiveness and efficiency of a pediatric multimedia textbook (MMTB) with that of a standard lecture and of a printed textbook in a prospective, interinstitutional study. DESIGN: Randomized, prospective cohort. SETTINGS: An urban and a rural medical school affiliated with tertiary care hospitals. POPULATION: Third- and fourth-year medical students from June 1992 to June 1993. INTERVENTIONS/OUTCOME MEASURES: Students were randomized to one of four treatment groups: (1) computer-aided instruction with MMTBs (n = 39), (2) traditional lecture (n = 39), (3) printed textbook (n = 39), or (4) a control group (n = 62). Only the control group was pretested. Following their randomized instruction, all groups were tested via a 26-question multiple-choice test. Statistical analysis was accomplished by analysis of variance of mean post-test scores. The amount of time that students spent with each educational intervention was recorded. RESULTS: Three hundred two students were eligible for the study, 267 entered the study, and 179 completed the study. The instructional effectiveness of the MMTB was greater than that of the lecture (P < .05), and it was the same as that of the printed textbook. All instructional methods were more effective than the control group (P < .05). The instructional efficiency of the MMTB was equal to that of the lecture and of the printed textbook. The subjective response to the MMTB instruction was positive. CONCLUSION: The MMTBs constitute an educationally sound alternative instructional method and have a promising future in medical education.

Distributing an electronic thoracic imaging teaching file using the Internet, Mosaic, and personal computers.

A high quality film-based teaching file requires effort and expense to create and maintain. The effort is worthwhile because film collections are important vehicles for increasing a radiologist's personal data base of clinical experience. Expert clinical reasoning is to a large extent the process of comparing a current case to a data base of individual cases available in memory. A teaching file would be most helpful if it were available at the view box where it could be used to extend a radiologist's clinical experience. Unfortunately, a film-based file is confined to one area, usually remote from the view box. In addition, searching though a film file is difficult, the films wear out over time, and films are easily lost or stolen. Our goal is the creation of a thoracic imaging teaching file that solves these problems by providing a digital collection of images, videos, and text that can be used in the work place by many users simultaneously. The first part of this teaching file is now continuously available locally within our department and globally to users of the Internet.

Hand-held digital books in radiology: convenient access to information.

Radiologists need constant, convenient access to current information throughout the course of their daily work. Today most learning in radiology is obtained from the printed word in books, journals, and teaching files, supplemented by the spoken word in lectures and conferences. Although learning from printed material and lectures has been proved efficacious over time, these media share the disadvantage of not being conveniently available for reference during the course of daily work at the alternator or in the examination room when accurate and up-to-date information is needed the most. As a result, many important questions about patient care go unanswered. We have developed a technique--hand-held digital books--to lower this barrier to searching and retrieval. When radiologists have a digital library that can be carried with them, they will be able to incorporate current radiology information into their daily decision making. We describe a technique for creating hand-held digital books and their future use in radiology.

The long-term effectiveness of a radiology memorandum.

RATIONALE AND OBJECTIVES: This informal prospective study was designed to document the long-term effectiveness of a radiology department policy memorandum as a communication tool. A memorandum outlining the departmental policy regarding radiographic imaging of pregnant or possibly pregnant patients served as the study model. METHODS: A departmental obstetric policy memorandum was distributed to all radiology personnel, including faculty and residents. The effectiveness of the memorandum was measured by the ability of all department personnel to answer specific test questions about the policy 1 year after its distribution. RESULTS: Nine (41%) in the faculty/fellow group and seven (41%) residents gave partially correct answers about policy content. There were no totally correct policy content answers in either group. Thirty-eight (64%) of the technology staff knew the entire policy content. CONCLUSION: Staff radiologists, fellows, and residents demonstrated an unacceptable level of knowledge concerning the policy content and location. Technologists, technology students, and clerks demonstrated a more acceptable level of knowledge of the policy than did radiologists. A single memorandum without repetition or constant surveillance is not an effective communication tool to alert radiologists to the importance of understanding and implementing policy directives.

The networked multimedia textbook: distributing radiology multimedia information across the Internet.

OBJECTIVE: The purpose of this project was to create an approach for global radiology multimedia publishing using the internet that would address the two largest problems facing radiology multimedia publishers today: the high percentage of radiologists who are computer novices and the variety of personal computers (Macintosh, Microsoft Windows/IBM-PC, X-Windows, Amiga) whose software is incompatible. MATERIALS AND METHODS: We developed a client/server approach to multimedia publishing, the networked multimedia textbook, that has a simple booklike user interface to facilitate use by computer novices. Once created, a networked multimedia textbook can be viewed on all current popular personal computers. The networked multimedia textbook is based on the internet, World-Wide Web, Mosaic, and Wide Area Information Servers software technologies, all of which are in the public domain. RESULTS: We created six radiology networked multimedia textbooks. CONCLUSION: This networked multimedia textbook approach for the global distribution of multimedia radiology information brings the benefits of multimedia publishing on the Internet to radiologists today.

Longitudinal comparison of multimedia textbook instruction with a lecture in radiology education.

RATIONALE AND OBJECTIVES: The purpose of this prospective randomized study was to compare the long-term instructional effectiveness of a computer-based radiology multimedia textbook (MMTB) with that of a traditional lecture. METHODS: Volunteer faculty/fellows and residents were randomly assigned to either a computer-based MMTB group or to a lecture group. The course content for each instructional group was the same. Pretests, posttests, and 1-year long-term retention tests were administered to both groups. The same 10 questions were on all tests. The resulting data were analyzed using analysis of variance procedures available on the Statistical Analysis System. RESULTS: A comparison of the long-term instructional effectiveness of an MMTB versus a lecture showed that the MMTB computer instructional method was at least comparable in spite of the initial short-term appearance of lecture superiority. CONCLUSION: These results suggest a promising future for MMTB and other forms of computer-based education in radiologic instruction for medical students and radiologists.

Calculating the costs of undergraduate medical education in radiology.

RATIONALE AND OBJECTIVES: The current stringent financial constraints mandate that radiology departments carefully assess the costs involved in undergraduate medical education. We performed a cost-accounting analysis of the radiology department's participation in an introductory clinical medicine course, which could serve as a methodologic model for realistic cost assessment of any new or existing course. MATERIALS AND METHODS: Each day of the 5-week radiology portion of the second-year course consists of 1 hour of lecture and 5 hours of small-group discussions regarding chest, abdominal, and skeletal radiology; neuroradiology; and nuclear medicine. Marginal cost is defined as the additional real cost involved in creating or conducting a course. Opportunity costs represent alternative use of instructional resources. RESULTS: The marginal cost (additional real cost) of providing the course for the first time was $37,475. Subsequent offerings of the course will cost approximately $24,375. CONCLUSION: Resources expended for any instructional purpose must be weighed in terms of marginal and opportunity costs. It is mandatory that adequate cost analysis for undergraduate education in radiology be developed so that sound choices can be made regarding resource consumption.

The multimedia textbook. A revolutionary tool for pediatric education.

Textbooks are now available via computers. These new electronic or multimedia textbooks appears similar to conventional books but differ in function. In addition to text and images, they contain video and audio clips and allow readers to interact with the content. Multimedia textbooks contain digital media, can be quickly and inexpensively updated and repurposed for lectures and handouts, and are available on-line via computer networks for distance learning. We present the concept of computer-generated multimedia text-books; describe their creation by an easy-to-use, sophisticated authoring system; and describe the underlying instructional design approach to guide future authors of multimedia textbooks.