Multimedia computer-assisted instruction in cardiology.

BACKGROUND: Medical education faces problems caused by increasing restraints on resources. A multicenter consortium combined simulation and multimedia computer-assisted instruction (MCAI) to develop unique interactive teaching programs that can address a number of these problems. We describe the consortium, the MCAI system, the programs, and a multicenter evaluation of technical and educational performance. METHODS: The MCAI system uses computer-controlled access to full-screen, full-motion, and full-color laser disc video in combination with digitized sound, images, and graphics stored on removable media. The Socratic teaching method enhances interaction and guides learners through the patient's history, cardiovascular physical examination, laboratory evaluation, and therapy. Self-instruction and instructor-led modes of function are possible. The first five programs, based on simulations of specific cardiology problems, were distributed to four medical centers. Questionnaires evaluated technical function and medical student opinions, while behaviors and scores were automatically tracked and tabulated by program administration software. RESULTS: The MCAI system functioned reliably and accurately in all modes and at all sites. The programs were highly rated. Student ratings, scores, and behaviors were independent of institution and mode of use. CONCLUSION: A multicenter educational consortium developed a system to produce unique, sophisticated MCAI programs in cardiology. Both system and programs functioned reliably at four institutions and were highly rated by fourth-year medical students. With this enthusiastic reception, the economies and strengths associated with MCAI make it an attractive solution to a number of problem areas, and it will likely play an increasingly important role.

How to set up your program in international health.

The foregoing delineation on the rationale, structure, and process for development of a program or institute in international health is not meant to be prescriptive. Flexibility, relevance, and sensitivity to the local context-the academic health center setting--are crucial, just as these characteristics are the hallmark of successful international projects. The present era offers significant challenges in improving the health and well-being of the world's population. Fortunately, there is an enlightened climate for the development of innovative and collaborative approaches to meet these challenges within a framework of social justice and overall human development. It is the unique and unparalleled opportunity for US academic health centers to work with international colleagues toward this goal.

Cardiology patient simulator and computer-assisted instruction technologies in bedside teaching.

The design and uses of an innovative technology-based approach which addresses critical problems with bedside teaching during ward rounds in the current health care situation are described. A cardiology patient simulator (HARVEY) and an accompanying computer-based interactive laserdisk system provide medical students, house officers and other health professionals with the opportunity to encounter a wide variety of clinical problems for learning and assessment. A group of cardiologists and medical educators from a consortium of US medical schools has guided the development and formal assessment of the entire system over the past 10 years. The system and simulator can be configured and programmed to provide appropriate heart sounds, laboratory data, and test results upon request; hands-on experience to practise examination skills is also available. The system, whole or in part, can be used in a variety of instructional modes from self-instruction to demonstration teaching, and from self-assessment to the final clinical examination. The system's effectiveness for teaching medical clerks is summarized, as is its use in providing continuing education for primary care doctors in rural practice.

Test of a cardiology patient simulator with students in fourth-year electives.

A total of 208 fourth-year students at five medical schools participated in an evaluation of a cardiology patient simulator (CPS). One group (116 students) used the CPS during a fourth-year cardiology elective, while another group (92 students) completed a cardiology elective that did not include use of the CPS. There were no differences between the two groups on a multiple-choice test on cardiology and a skills test on the CPS at the beginning of the clerkship. After the clerkship, the students in the CPS group achieved significantly higher scores on a multiple-choice test, a skills test on the CPS, and a skills test on cardiology patients. Both the students and faculty members expressed very favorable attitudes toward the CPS, but the patients perceived no differences between the two student groups. These data demonstrate that the CPS enhances learning both the knowledge and the skills necessary to perform a bedside cardiovascular evaluation and that the skills obtained from use of the simulator are transferable to use with patients.

Freestanding emergency centers and the patient population of internists.

To compare the characteristics of patients seeking care in freestanding emergency centers with the patients seen by internists, we studied the adult populations of two freestanding emergency centers (FECs) through an audit of medical records for 20 days randomly selected throughout 1983. We recorded the age, sex, time of visit, whether the patient claimed a family physician, diagnosis, laboratory tests, and charges, and compared the data with those from earlier national studies of internists' practices. Of the 1,061 FEC visits audited, 78% were by patients 20 to 44 years of age. Only 3.2% of FEC patients were 65 or older, an age group that accounted for more than a third (35.2%) of the patients seen by a national sample of internists. More than half (55.3%) of the FEC patients claimed family physicians. Visits to FECs were most frequently trauma-related (34.1%) or for medical or special examinations (17.1%). Laboratory tests were ordered in 35.5% of FEC encounters. Fees for 62.1% of FEC visits were less than $41.

Free-standing emergency centers and the patient population of family physicians.

To determine whether the patients of free-standing emergency centers are similar to the patients seen by family physicians, the age, sex, time of visit, diagnoses, laboratory work, and charges for 1,062 patients from two free-standing emergency centers were compared with available data on the patients seen by a national sample of family physicians. Patients from the emergency centers were predominantly in the 20- to 44-year age range (73.8 percent), were male (56.5 percent), and sought trauma-related treatment or medical examinations (51.7 percent). Laboratory tests were ordered for 30.2 percent of these patients. In contrast, family practice patients were more evenly distributed by age, were more often female (57.6 percent), and had a wide variety of diagnoses. Laboratory tests were ordered for 40.3 percent of the patients. The median free-standing emergency center charge was approximately $10 higher than initial visit fees to family physicians in the same area.

Effectiveness of audio-based instruction in medical pharmacology.

An audio-based method of instruction on the topic of diuretic drugs was compared with the lecture method using a random sample of 66 sophomore medical students. A cognitive test given to measure achievement as a result of the two treatments showed that the average score of 80 percent for the audio group was significantly higher (p smaller than 0.25) than the 75 percent for the lecture group. A comparison of the lowest quartile scores in each group revealed that the audio-based group also scored higher 13 points, p smaller than .05) than the lecture group; however, no difference was noted in the upper three quartile scores of the two groups. The amount of time spent studying did not appear to be a factor. A second test given to meausre attitudes toward the audio method showed strong positive views among students.