Defining the next generation journal: The NLM-Elsevier interactive publications experiment.

OBJECTIVE: A unique collaborative project to identify interactive enhancements to conventional-print journal articles, and to evaluate their contribution to readers' learning and satisfaction. HYPOTHESIS: It was hypothesized that (a) the enhanced article would yield more knowledge acquisition than the original article; (b) the interactivity aspects of the enhanced article would measurably contribute to the acquisition of knowledge; and (c) the enhancements to the original article would increase reader acceptance. METHODS: Fifteen SNMA medical students, assumed to have a greater generational familiarity and comfort level with interactive electronic media, reviewed 12 articles published in three Elsevier clinical and basic science journals. They used the Student National Medical Association's asynchronous online discussion forum over a four month period to suggest desired enhancements to improve learning. "Prognostic Factors in Stage T1 Bladder Cancer", published in the journal Urology was selected by the investigators as presenting the best opportunity to incorporate many of the students' suggested interactive and presentational enhancements in the limited timeframe available prior to the established test date. Educational, statistical, and medical consultants assisted in designing a test protocol in which 51 second to fourth year medical students were randomly assigned to experimental and control conditions, and were administered either the original or enhanced interactive version of the article on individual computer workstations. Test subjects consisted of 23 participants in the control group (8 males, 15 females) and 28 participants in the experimental group (9 males, 19 females). All subjects completed pre- and post-test instruments which measured their knowledge gain on 30 true-false and multiple-choice questions, along with 7 Likert-type questions measuring acceptance of the articles' format. Time to completion was recorded with the experimental group taking 22 min on average compared to 18 min for the controls; pre- and post-test times were 6 and 7 min, respectively. Statistical comparisons were based on change scores using either the Student t-test or the Two Way Analysis of Variance or Covariance. Significance was set at α = 0.05 or better. RESULTS: on the dependent measure of knowledge acquisition showed no difference overall on the 30 questions, but learning gain was statistically significant for the subset of 10 questions that measured gain on content that was accessible by the user-invoked interactive features of the enhanced article. Further analyses revealed significant interactions by student year and gender. Second year students (11 in the control group, 8 in the experimental group) were the best performers in terms of knowledge acquisition from both articles. The female medical students received a larger learning gain from journal enhancements and interactivity components than their male counterparts. Acceptance overall was greater for the experimental group who rated the experience more favorably than the controls. CONCLUSIONS: Failure to consider human factors such as gender and learning style may obscure underlying differences and their impact on the interactive aspects of scientific publications. Preliminary findings suggest the need for further study to include a heavier focus on interactivity apart from presentational enhancements; a more rigorous treatment of time as a specific variable; and an expanded experimental design that evaluates acquisition, understanding, integration and acceptance as dependent measures.

Evaluation of a virtual dialogue method for breast cancer patient education.

OBJECTIVE: Virtual dialogue--a voice-activated, interactive computer model that enables a user to have an individual virtual conversation with a real person--was evaluated as a method to educate women about breast cancer. Virtual dialogues with breast cancer experts were developed and used in a field study by women with and without the disease to assess the method's effectiveness. METHODS: In a clinical setting, subjects engaged in one-on-one virtual dialogues with an oncologist and a breast surgeon, and completed automated pre-post instruments developed to measure the feasibility of the method, and subjects' knowledge gain and acceptance of the method. RESULTS: Seventy women, 39 with breast cancer and 31 without the disease, participated. The data demonstrated the feasibility and acceptance of the method, and significant learning gain across all subjects. CONCLUSION: Virtual dialogues with knowledgeable health professionals can be a new and effective method for educating women about breast cancer. PRACTICE IMPLICATIONS: Virtual dialogues may systematically comfort patients while providing them with comprehensive and reliable basic information about breast cancer. The method may also give health care providers more time to address their patients' specific concerns.

Primary care physicians' evaluation and treatment of depression: Results of an experimental study using video vignettes.

Little is known about how patient and primary care physician characteristics are associated with quality of depression care. The authors conducted structured interviews of 404 randomly selected primary care physicians after their interaction with CD-ROM vignettes of actors portraying depressed patients. Vignettes varied along the dimensions of medical comorbidity, attributions regarding the cause of depression, style, race/ethnicity, and gender. Results show that physicians showed wide variation in treatment decisions; for example, most did not inquire about suicidal ideation, and most did not state that they would inform the patient that there can be a delay before an antidepressant is therapeutic. Several physician characteristics were significantly associated with management decisions. Notably, physician age was inversely correlated with a number of quality-of-care measures. In conclusion, quality of care varies among primary care physicians and appears to be associated with physician characteristics to a greater extent than patient characteristics.

An assessment of the virtual conversations method for prostate cancer patient education.

INTRODUCTION: Virtual dialogue is a specific educational methodology that employs speech recognition, digital video, and computer technologies in a symbiotic relationship to allow users to have the illusion of a face-to-face conversation with a person in cyberspace. A voice-activated, interactive, virtual dialogue with a prostate cancer specialist was developed and tested in a clinical setting at the Walter Reed Army Medical Center (WRAMC). OBJECTIVES: The purpose of this study was two-fold: (a) to create a prototype virtual dialogue program on the subject of prostate cancer and (b) to evaluate the effectiveness of this method to educate men about their disease and treatment. METHOD: Participants were recruited using a convenience sample of patients attending the Center for Prostate Disease Research multidisciplinary clinic at WRAMC. An automated pretest and post-test instrument was developed by the investigators to assess patients' knowledge before and after the virtual dialogue session. RESULTS: A total of 33 patients volunteered for the study. Results from this convenience sample showed an increase in patients' knowledge and positive acceptance of this innovative method of patient education. CONCLUSIONS: The data resulting from this study provide persuasive evidence that a virtual dialogue with a knowledgeable health professional can be a useful and highly effective method for educating men about prostate cancer. This method may also offer an effective way for health professionals to systematically provide their patients with comprehensive and reliable information.