A comparison of hypertext and Boolean access to biomedical information.

This study explored which of two modes of access to a biomedical database better supported problem solving in bacteriology. Boolean access, which allowed subjects to frame their queries as combinations of keywords, was compared to hypertext access, which allowed subjects to navigate from one database node to another. The accessible biomedical data were identical across systems. Data were collected from 42 first year medical students, each randomized to the Boolean or hypertext system, before and after their bacteriology course. Subjects worked eight clinical case problems, first using only their personal knowledge and, subsequently, with aid from the database. Database retrievals enabled students to answer questions they could not answer based on personal knowledge only. This effect was greater when personal knowledge of bacteriology was lower. The results also suggest that hypertext was superior to Boolean access in helping subjects identify possible infectious agents in these clinical case problems.

The college student, the dentist, and the North Carolina senator: risk analysis and risk management of HIV transmission from health care worker to patient.

The risk of acquiring human immunodeficiency virus (HIV) infection from a health care worker is 2,000 times less than that of dying from a car accident. It is 700 times less probable than perishing from being struck by lightning or suffering a fatal fall. Despite the rarity of this occurrence, reduction of the risk of health-care-worker-to-patient HIV transmission in the workplace has been the focus of congressional, federal, state, and local agencies. If all HIV transmission from health care workers to patients were prevented using current guidelines and legislation, the epidemic of AIDS would be reduced by 0.0006%. Current efforts to prevent HIV transmission from health care workers to patients are the result of incomplete risk analysis and management. In a society of limiting resources and of cherished freedoms, sanctions imposed on health care workers to prevent HIV transmission to patients may benefit no one.

Information retrieved from a database and the augmentation of personal knowledge.

OBJECTIVE: To assess the degree to which information retrieved from a biomedical database can augment personal knowledge in addressing novel problems, and how the ability to retrieve information evolves over time. DESIGN: This longitudinal study comprised three assessments of two cohorts of medical students. The first assessment occurred just before student course experience in bacteriology, the second occurred just after the course, and the third occurred five months later. At each assessment, the students were initially given a set of bacteriology problems to solve using their personal knowledge only. Each student was then reassigned a sample of problems he or she had answered incorrectly, to work again with assistance from a database containing information about bacteria and bacteriologic concepts. The initial pass through the problems generated a "personal knowledge" score; the second pass generated a "database-assisted" score for each student at each assessment. RESULTS: Over two cohorts, students' personal knowledge scores were very low (approximately 12%) at the first assessment. They rose substantially at the second assessment (approximately 48%) but decreased six months later (approximately 25%). By contrast, database-assisted scores rose linearly: from approximately 44% at the first assessment to approximately 57% at the second assessment, to approximately 75% at the third assessment. CONCLUSION: The persistent increase in database-assisted scores, even when personal knowledge had attenuated, was the most remarkable finding of this study. While some of the increase may be attributed to artifacts of the design, the pattern seems to result from the retained ability to recognize problem-relevant information in a database even when it cannot be recalled.

Information-seeking behaviors of medical students: a classification of questions asked of librarians and physicians.

To solve a problem, a person often asks questions of someone with more expertise. This paper reports on a study of the types of questions asked and how the experts are chosen. In the study, sixty-three first-year medical students responded to clinical scenarios, each describing a patient affected by a toxin and asking questions concerning the identity of the toxin and its characteristics. After answering those questions, the students were asked to imagine that they had access to a medical reference librarian and an internist specializing in toxicology. The students then generated two questions for each expert about each clinical scenario. Each question was categorized according to the type of information requested, and the frequency of each type of question was calculated. The study found that students most often asked for the identification of the toxin(s), references about the scenario, or the effects of the toxin; an explanation of the patient's symptoms; or a description of the appropriate treatment. Students were more likely to address questions on the identity of the toxin and references to the hypothetical librarian; they were more likely to ask the internist for explanations of the symptoms and descriptions of the treatment. The implications of these results for the design of information and educational systems are discussed.

Database access and problem solving in the basic sciences.

This study examined the potential contribution that access to a database of biomedical information may offer in support of problem-solving exercises when personal knowledge is inadequate. Thirty-six medical students were assessed over four occasions and three domains in the basic sciences: bacteriology, pharmacology, and toxicology. Each assessment consisted of a two-pass protocol in which students were first assessed for their personal knowledge of a domain with a short-answer problem set. Then, for a sample of problems they had missed, they were asked to use a database, INQUIRER, to respond to questions which they had been unable to address with their personal knowledge. Results indicate that for a domain in which the database is well-integrated in course activities, useful retrieval of information which augmented personal knowledge increased over three assessment occasions, even continuing to increase several months after course exposure and experience with the database. For all domains, even at assessments prior to course exposure, students were able to moderately extend their ability to solve problems through access to the INQUIRER database.

Influence of a computer database and problem exercises on students' knowledge of bacteriology.

This study compared the performances of students at the University of North Carolina at Chapel Hill School of Medicine who had access to sets of problem exercises and a computer database to support their learning of bacteriology with the performances of students at the University of Iowa College of Medicine who did not have such access. The study also examined the extent of a student's database use as a predictor of posttest performance. The students studied were randomly selected groups of 32-44 first-year students per year at each school; the study was conducted in three academic years (1988-1990) with some modifications in the intervention as the host environment evolved. The criterion measure was a posttest created from the same pool of problems used to generate the problem sets. The students at the intervention school scored significantly higher on the posttest in two of the three years, and overall. Also in two of the three years and overall, there was a significant relationship between the extent of a student's database use and his or her posttest score. Although the observed effects may have been due to other factors in this quasi-experimental design, the authors conclude that the use of problem sets and a computer database had a positive influence on the students' learning.

Hypermedia in medical decision analysis: HyperDecision.

Early in the evolution of medical decision analysis, computers were employed to remove the tedium and insure the accuracy of repetitive calculations, a capacity they still serve today. However, user interfaces could be so complex as to be overwhelming, except for the capable few who designed them or used them often. HyperDecision is a hypercard-based decision analysis program with a simple user interface. A comprehensive tutorial and generic decision tree are integrated so that the fledgling user, whether medical student or seasoned clinician lacking evolved computer and/or decision analysis skills, can reap the benefits of computer support in their clinical practice. In the current political environment surrounding the practice of medicine, having easily accessible tools for both teaching and using medical decision analysis to evaluate and present the rational for medical decisions has taken on a new importance which the medical community must remain abreast of as we move toward the 21st century.

Charting the winds of change: evaluating innovative medical curricula.

The increased interest, in North America and around the world, in problem-based and community-oriented medical curricula has sparked interest in the evaluation of these innovative programs. In January 1989, the Josiah Macy Jr. Foundation sponsored a conference to consider designs for evaluation studies and the potential distinctive outcomes of the innovative curricula that might be foci of these studies. After defining an "innovative curriculum," the participants identified seven characteristics of "important evaluation studies," particularly endorsing studies that compare curricula as whole entities. The participants then identified 26 areas where differences between graduates of innovative and traditional curricula might be expected, and five equally important areas where differences are not expected. Distinctive outcomes of innovative curricula were anticipated in areas such as interpersonal skills, continuing learning, and professional satisfaction. Overall, these recommendations are offered to stimulate creative evaluations of the growing number of innovative programs in medical education.

Studying the utilization and effects of a computer-based educational intervention in bacteriology.

We introduced a computerized database as part of a problem-oriented component of bacteriology instruction for first year medical students. This paper explores utilization of the computer resource and its effects on students' knowledge in the field.