ABSTRACT
OBJECTIVE: To examine clinical outcomes before and after implementation of a telemedicine program in the intensive care units of a five-hospital healthcare system. DESIGN: Observational study with the baseline period of 1 yr before the start of a telemedicine intensive care unit program implementation at each of 5 hospitals. The post periods are 1, 2, and 3 yrs after telemedicine intensive care unit program implementation at each hospital. SETTING: Ten adult intensive care units (114 beds) in five community hospitals in south Florida. A telemedicine intensive care unit program with remote 24/7 intensivist and critical care nurse electronic monitoring was implemented by a phased approach between December 2005 and July 2007. MEASUREMENTS AND MAIN RESULTS: Records from 24,656 adult intensive care unit patients were analyzed. Hospital length of stay, intensive care unit length of stay, hospital mortality, and Case Mix Index were measured. Severity of illness using All Patient Refined-Diagnosis Related Groups scores was used as a covariate. From the baseline year to year 3 postimplementation, the severity-adjusted hospital length of stay was lowered from 11.86 days (95% confidence interval [CI] 11.55-12.21) to 10.16 days (95% CI 9.80-10.53; p < .001), severity-adjusted intensive care unit length of stay was lowered from 4.35 days (95% CI 4.22-4.49) to 3.80 days (95% CI 3.65-3.94; p < .001), and the relative risk of hospital mortality decreased to 0.77 (95% CI 0.69-0.87; p < .001). CONCLUSIONS: After 3 yrs of deployment of a telemedicine intensive care unit program, this retrospective observational study of mortality and length of stay outcomes included all cases admitted to an adult intensive care unit and found statistically significant decreases in severity-adjusted hospital length of stay of 14.2%, intensive care unit length of stay of 12.6%, and relative risk of hospital mortality of 23%, respectively, in a multihospital healthcare system.
Subject(s)
Critical Illness/mortality , Hospital Mortality , Intensive Care Units/organization & administration , Length of Stay , Telemedicine/organization & administration , Adult , Analysis of Variance , Chi-Square Distribution , Confidence Intervals , Critical Care/organization & administration , Critical Illness/therapy , Female , Florida , Health Plan Implementation , Humans , Logistic Models , Male , Program Development , Program Evaluation , Retrospective Studies , Risk Assessment , Survival Analysis , Time Factors , Treatment OutcomeSubject(s)
Foreign Medical Graduates/statistics & numerical data , Internship and Residency/trends , Schools, Medical/trends , Adult , Caribbean Region , Clinical Competence , Education, Medical, Graduate , Education, Medical, Undergraduate , Female , Forecasting , Foreign Medical Graduates/trends , General Surgery/education , Humans , Male , Schools, Medical/standards , Students, Medical/statistics & numerical dataABSTRACT
BACKGROUND: Online quizzes are simple, cost-effective methods to provide formative assessment, but their effectiveness in enhancing learning and performance in medical education is unclear. PURPOSE: The purpose of this article is to determine the extent to which online quiz performance and participation enhances students' performance on summative examinations. METHODS: A retrospective case study investigating relationships between formative and summative assessment in terms of use and outcomes. RESULTS: Online quiz scores and the rates of quiz participation were significantly correlated with corresponding performance on summative examinations. However, correlations were not dependent on the specific quiz content, and changes in patterns of quiz use were not reflected in corresponding changes in summative examination performance. CONCLUSIONS: The voluntary use of online quizzes, as well as the score attained, provides a useful general indicator of student performance but is unlikely to be sensitive enough to direct an individual student's learning plan.
Subject(s)
Educational Measurement/methods , Internet , Students, Medical , Adult , Educational Measurement/standards , Female , Florida , Humans , Male , Retrospective Studies , Young AdultABSTRACT
This study used qualitative and quantitative approaches to evaluate the effectiveness of self-learning modules (SLMs) developed to facilitate and individualize students' learning of basic medical sciences. Twenty physiology and nineteen microanatomy SLMs were designed with interactive images, animations, narrations, and self-assessments. Of 41 medical students, 40 students voluntarily completed a questionnaire with open-ended and closed-ended items to evaluate students' attitudes and perspectives on the learning value of SLMs. Closed-ended items were assessed on a five-point Likert scale (5 = high score) and the data were expressed as mean ± standard deviation. Open-ended questions further evaluated students' perspectives on the effectiveness of SLMs; student responses to open-ended questions were analyzed to identify shared patterns or themes in their experience using SLMs. The results of the midterm examination were also analyzed to compare student performance on items related to SLMs and traditional sessions. Students positively evaluated their experience using the SLMs with an overall mean score of 4.25 (SD ± 0.84). Most students (97%) indicated that the SLMs improved understanding and facilitated learning basic science concepts. SLMs were reported to allow learner control, to help in preparation for subsequent in-class discussion, and to improve understanding and retention. A significant difference in students' performance was observed when comparing SLM-related items with non-SLM items in the midterm examination (P < 0.05). In conclusion, the use of SLMs in an integrated basic science curriculum has the potential to individualize the teaching and improve the learning of basic sciences.
