A Vertically Integrated Online Radiology Curriculum Developed as a Cognitive Apprenticeship: Impact on Student Performance and Learning.

RATIONALE AND OBJECTIVES: The principles of Collins' cognitive apprenticeship model were used to design a radiology curriculum in which medical students practice radiological skills using online case-based modules. The modules are embedded within clinical third-year clerkships, and students are provided with personalized feedback from the instructors. We describe the development of the vertical online radiology curriculum and evaluate its impact on student achievement and learning process using a mixed method approach. MATERIALS AND METHODS: The curriculum was developed over a 2-year period. Student participation was voluntary in the first year and mandatory in the second year. For quantitative curriculum evaluation, student metrics for voluntary versus mandatory groups were assessed using independent sample t tests and variable entry method regression analysis. For qualitative analysis, responses from a survey of students about the value of the curriculum were organized into defined themes using consensus coding. RESULTS: Mandatory participation significantly improved (p = .001) the mean radiology examination score (82 %) compared to the voluntary group (73%), suggesting that mandatory participation had a beneficial effect on student performance. Potential preexisting differences in underlying general academic performance were accounted for by including mean basic science grades as the first variable in the regression model. The significant increase in R(2) from .16 to .28 when number of radiology cases completed was added to the original model, and the greater value of the standardized beta for this variable, suggest that the curriculum made a significant contribution to students' radiology examination scores beyond their baseline academic performance. Five dominant themes about curricular characteristics that enhanced student learning and beneficial outcomes emerged from consensus coding. These themes were (1) self-paced design, (2) receiving feedback from faculty, (3) clinical relevance of cases, (4) gaining confidence in interpreting radiological images, and (5) transfer of conceptual knowledge to actual practice. CONCLUSIONS: The vertically integrated online radiology curriculum can positively impact student performance and learning process in the context of the cognitive apprenticeship model.

Associations between formative practice quizzes and summative examination outcomes in a medical anatomy course.

Formative practice quizzes have become common resources for self-evaluation and focused reviews of course content in the medical curriculum. We conducted two separate studies to (1) compare the effects of a single or multiple voluntary practice quizzes on subsequent summative examinations and (2) examine when students are most likely to use practice quizzes relative to the summative examinations. In the first study, providing a single on-line practice quiz followed by instructor feedback had no effect on examination average grades compared to the previous year or student performances on similar questions. However, there were significant correlations between student performance on each practice quiz and each summative examination (r = 0.42 and r = 0.24). When students were provided multiple practice quizzes with feedback (second study), there were weak correlations between the frequency of use and performance on each summative examination (r = 0.17 and r = 0.07). The frequency with which students accessed the practice quizzes was greatest the day before each examination. In both studies, there was a decline in the level of student utilization of practice quizzes over time. We conclude that practice quizzes provide some predictive value for performances on summative examinations. Second, making practice quizzes available for longer periods prior to summative examinations does not promote the use of the quizzes as a study strategy because students appear to use them mostly to assess knowledge one to two days prior to examinations.

Are online student evaluations of faculty influenced by the timing of evaluations?

Student evaluations of faculty are important components of the medical curriculum and faculty development. To improve the effectiveness and timeliness of student evaluations of faculty in the physiology course, we investigated whether evaluations submitted during the course differed from those submitted after completion of the course. A secure web-based system was developed to collect student evaluations that included numerical rankings (1-5) of faculty performance and a section for comments. The grades that students received in the course were added to the data, which were sorted according to the time of submission of the evaluations and analyzed by Pearson's correlation and Student's t-test. Only 26% of students elected to submit evaluations before completion of the course, and the average faculty ratings of these evaluations were highly correlated [r(14) = 0.91] with the evaluations submitted after completion of the course. Faculty evaluations were also significantly correlated with the previous year [r(14) = 0.88]. Concurrent evaluators provided more comments that were statistically longer and subjectively scored as more "substantive." Students who submitted their evaluations during the course and who included comments had significantly higher final grades in the course. In conclusion, the numeric ratings that faculty received were not influenced by the timing of student evaluations. However, students who submitted early evaluations tended to be more engaged as evidenced by their more substantive comments and their better performance on exams. The consistency of faculty evaluations from year to year and concurrent versus at the end of the course suggest that faculty tend not to make significant adjustments to student evaluations.

An audience response system may influence student performance on anatomy examination questions.

This study integrated an in-house audience response system (ARS) in the human anatomy course over two years to determine whether students performed better on high-stakes examinations following exposure to similar interactive questions in a large lecture format. Questions in an interactive ARS format were presented in lectures via PowerPoint presentations. Students who chose to participate in the anonymous ARS sessions submitted answers via their personal wireless devices (e.g., laptops, smartphones, PDAs, etc). Students were surveyed for feedback. Student participation in ARS activities was greatest (65-80%) in the first lecture. The number of students who actively participated in ARS activities decreased over the next four sessions, and then slightly increased in the last two sessions. This trend was the same for both years. Use of the ARS did not dramatically enhance overall student performance on examination questions that dealt with content similar to content presented in the ARS sessions. However, students who scored in the lower quartile of the examination performed better on the examination questions after the ARS was implemented. Accordingly, our findings suggest that the effect of ARS to improve student performance on examinations was not uniform. The overall benefit of an ARS to enhance the lecture experience was confirmed by student surveys.

Evaluation of computer-aided instruction in a gross anatomy course: a six-year study.

Web-based computer-aided instruction (CAI) has become increasingly important to medical curricula. This multi-year study investigated the effectiveness of CAI and the factors affecting level of individual use. Three CAI were tested that differed in specificity of applicability to the curriculum and in the level of student interaction with the CAI. Student personality preferences and learning styles were measured using the Meyers Briggs Type Indicator (MBTI) and Kolb's Learning Style Inventory (LSI). Information on "computer literacy" and use of CAI was collected from student surveys. Server logs were used to quantify individual use of respective CAI. There was considerable variability in the level of utilization of each CAI by individual students. Individual use of each CAI differed and was associated with gender, MBTI preferences and learning style, but not with "computer literacy." The majority of students found the CAI useful for learning and used the CAI by themselves. Students who accessed the CAI resources most frequently scored significantly higher on exams compared with students who never accessed the resources. Our results show that medical students do not uniformly use CAI developed for their curriculum and this variability is associated with various attributes of individual students. Our data also provide evidence of the importance of understanding student preferences and learning styles when implementing CAI into the curriculum.

An analysis of lecture video utilization in undergraduate medical education: associations with performance in the courses.

BACKGROUND: Increasing numbers of medical schools are providing videos of lectures to their students. This study sought to analyze utilization of lecture videos by medical students in their basic science courses and to determine if student utilization was associated with performance on exams. METHODS: Streaming videos of lectures (n = 149) to first year and second year medical students (n = 284) were made available through a password-protected server. Server logs were analyzed over a 10-week period for both classes. For each lecture, the logs recorded time and location from which students accessed the file. A survey was administered at the end of the courses to obtain additional information about student use of the videos. RESULTS: There was a wide disparity in the level of use of lecture videos by medical students with the majority of students accessing the lecture videos sparingly (60% of the students viewed less than 10% of the available videos. The anonymous student survey revealed that students tended to view the videos by themselves from home during weekends and prior to exams. Students who accessed lecture videos more frequently had significantly (p < 0.002) lower exam scores. CONCLUSION: We conclude that videos of lectures are used by relatively few medical students and that individual use of videos is associated with the degree to which students are having difficulty with the subject matter.

Personality preference influences medical student use of specific computer-aided instruction (CAI).

BACKGROUND: The objective of this study was to test the hypothesis that personality preference, which can be related to learning style, influences individual utilization of CAI applications developed specifically for the undergraduate medical curriculum. METHODS: Personality preferences of students were obtained using the Myers-Briggs Type Indicator (MBTI) test. CAI utilization for individual students was collected from entry logs for two different web-based applications (a discussion forum and a tutorial) used in the basic science course on human anatomy. Individual login data were sorted by personality preference and the data statistically analyzed by 2-way mixed ANOVA and correlation. RESULTS: There was a wide discrepancy in the level and pattern of student use of both CAI. Although individual use of both CAI was positively correlated irrespective of MBTI preference, students with a "Sensing" preference tended to use both CAI applications more than the "iNtuitives". Differences in the level of use of these CAI applications (i.e., higher use of discussion forum vs. a tutorial) were also found for the "Perceiving/Judging" dimension. CONCLUSION: We conclude that personality/learning preferences of individual students influence their use of CAI in the medical curriculum.

Characterization of lymphocyte subsets over a 24-hour period in Pineal-Associated Lymphoid Tissue (PALT) in the chicken.

BACKGROUND: Homeostatic trafficking of lymphocytes in the brain has important relevance to the understanding of CNS disease processes. The pineal gland of the chicken contains large accumulations of lymphocytes that suggest an important role related to homeostatic circadian neuro-immune interactions. The purpose of this initial study was to characterize the lymphocyte subsets in the pineal gland and quantitate the distribution and frequency of lymphocyte phenotypes at two time points over the 24-hour light:dark cycle. RESULTS: PALT comprised approximately 10% of the total pineal area. Image analysis of immunocytochemically stained sections showed that the majority of lymphocytes were CD3+ (80%) with the remaining 20% comprising B-cells and monocytes (Bu-1+), which tended to distribute along the periphery of the PALT. T-cell subsets in PALT included CD4+ (75-80%), CD8+ (20-25%), TCRalphabeta/Vbeta1+ (60%), and TCRgammadelta+ (15%). All of the T-cell phenotypes were commonly found within the interfollicular septa and follicles of the pineal gland. However, the ratios of CD8+/CD4+ and TCRgammadelta+/TCRalphabeta/Vbeta1+ within the pineal tissue were each 1:1, in contrast to the PALT where the ratios of CD8+/CD4+ and TCRgammadelta+/TCRalphabeta/Vbeta1+ each approximated 1:4. Bu-1+ cells were only rarely seen in the pineal interstitial spaces, but ramified Bu-1+ microglia/macrophages were common in the pineal follicles. Effects of the 24-h light:dark cycle on these lymphocyte-pineal interactions were suggested by an increase in the area of PALT, a decline in the density of TCRalphabeta/Vbeta1+ cells, and a decline in the area density of Bu-1+ microglia at the light:dark interphase (1900 h) compared to the dark:light interphase (0700 h). CONCLUSION: The degree of lymphocyte infiltration in the pineal suggests novel mechanisms of neuro-immune interactions in this part of the brain. Our results further suggest that these interactions have a temporal component related to the 24-hour light:dark cycle and that CD8+ and TCRgammadelta+ T-cells are preferentially recruited to the pineal follicles. Pineal microglia/macrophages were common and represent an important candidate for mediating these lymphocyte-pineal interactions via secretion of cytokines and chemokines.

Evaluation of computer-aided instruction in the medical gross anatomy curriculum.

A two-year study was conducted to provide summative evaluations of web-based computer-aided instruction (CAI) specifically designed to supplement the laboratory dissections in the medical human anatomy course. Utilization of CAI was analyzed using server statistics, student surveys and network login tables. There was a significant increase in server requests for CAI over the period of the course in both years of the study. In general, student surveys corresponded with the login data for individual students, although several discrepancies showed limitations of the respective methodologies. When course examination scores were compared to the number of CAI logins for individual students, there were statistically significant direct correlations between exam grades and frequency of CAI use. Our findings illustrate the value of combining server statistics with user surveys for evaluations of CAI as an effective supplement for student learning in the anatomy curriculum.

Brain activation of monocyte lineage cells: brain-derived soluble factors differentially regulate BV2 microglia and peripheral macrophage immune functions.

Brain injury and subsequent neurodegeneration are often associated with infiltrating leukocytes and the activation of microglia as well as other infiltrating cells. However, the characteristics of activation are poorly understood. The objective of this study was to further the understanding of brain regulation of microglial activation. We used an organotypic coculture paradigm to assess how brain-derived soluble factors modulate microglia and peripheral macrophage activation through microscopy and flow cytometry techniques. In the presence of brain-derived soluble factors, the BV2 microglia cell line increased MHC II and phagocytic receptor (Fcgamma II/III) expression. The increased expression correlated with a functional increase in phagocytic activity, but did not correlate with an increase in allostimulation ability. Furthermore, this interaction was selective to an interaction between brain-derived soluble factor(s) and BV2 microglia, since it was not observed in the ANA1 macrophage cell line or in primary peritoneal macrophages. The results indicated that brain-derived soluble factor(s) modulate microglial activation in a manner that is distinct from the effects on peripheral macrophages. Moreover, our results suggest that inflammatory events associated with some types of brain injury may be induced by the brain without dependence on infiltrating peripheral macrophages or T lymphocytes.

Brain activation of monocyte-lineage cells: involvement of interleukin-6.

Immune processes such as phagocytosis of debris and antigen presentation can be damaging to the function and survival of brain cells. Understanding what conditions and factors mediate immune processes in the brain is central to ameliorating the pathology associated with brain injury and disease. The elevation of secreted interleukin (IL)-6 is a common feature of brain injury and neurodegenerative pathology. Using organotypic brain slice coculture, the effects of brain-derived soluble factors on immune functions in the BV2 microglial cell line were studied. We have previously shown that brain-derived soluble factors upregulated phagocytic activity and class II major histocompatibility complex (MHC II) expression and altered BV2 morphology in a manner selective for microglia and not peripheral macrophages. The present study used IL-6-neutralizing antibody to show that brain-derived IL-6 was at least partially responsible for the brain coculture-induced upregulation of MHC II expression in the BV2 microglia. Additionally, IL-6 upregulated phagocytic activity and induced morphological changes in the BV2 cells similar to brain coculture. These effects were selective for microglia, as they were not observed in peripheral macrophage cell types. The ability of IL-6-neutralizing antibody to downregulate MHC II expression while maintaining enhanced phagocytic activity could potentially evade an antagonizing immune response associated with brain injury or disease.

The morphology of dermal chromatophores in the infrared-reflecting glass-frog Centrolenella fleischmanni.

The morphology and organization of chromatophores in the neotropical glass-frog, Centrolenella fleischmanni (family Centrolenidae), were studied with both light and electron microscopes. Four types of pigment cells are described in the dorsal skin. The fine structure of two chromatophores corresponds to the typical amphibian xanthophore and iridophore; one is similar to the unusual melanophore found in phyllomedusine hylids; the fourth cell type is unlike any chromatophore previously described. Pigment granules in the unusual chromatophore are moderately electron-dense and have an irregular shape, suggesting a fluid composition. This pigment appears to be laid down in organelles similar in appearance to pterinosomes. The organization of pigment cells in this species differs from that of other green, leaf-sitting frogs in that there are few discrete groups resembling "dermal chromatophore units." It is suggested that the unusual new pigment cell contributes significantly to the overall green color of C. fleischmanni.