Feature

Computerising Medical Learning

Computer-assisted learning is teaching medical students
and their mentors.

Rita L. Teele, David W. Teele
Andrew M. Bryant

Clone the caring consultant and propagate the patient professor. That's the philosophy behind the computer-assisted learning programs that we are developing for medical students and postgraduates at Christchurch School of Medicine. We want each program to simulate a private tutorial with the ideal teacher -- a teacher who is well-informed, non-judgmental, interesting, untiring, and enthusiastic!

Three and a half years ago we took the initial step with our first program, "Upper Airway Obstruction in Children." We were helped by a fourth-year medical student who was supported by the National Child Health Research Foundation.

Since then, five other students have been involved in the production of programs, earning primary or co-authorship in the process. The students' involvement is crucial to the success of programs designed for medical students. They know and understand their peer group. They have grown up in a computerized world and are fully acquainted with such technologies as video recorders, remote controls, and modern operating systems (unlike some of their teachers!) They challenge our assumptions, tackle our sacred cows and by the end of any project are experts in the subject matter. They also learn something about teaching in the process.

The Medical Education Trust provided enough support for us to acquire equipment and begin work in earnest on paediatric postgraduate programs. The University of Otago provided summer studentships and a teaching and learning grant which partially supports the production of programs in imaging for medical students, such as "Essential Ultrasonography" and "Essential CT Scanning".

All programs have been created on Apple Macintosh computers using Allegiant SuperCard as the authoring tool and various media manipulation tools such as Adobe Photoshop, Adobe Illustrator and Media Cleaner Pro. This year we hope to convert the programs to MetaCard so that they can also be run on PCs.

What are the considerations for creating an educational tool? Students and teachers use textbooks, journal articles and magazines for information. The printed page is an accessible, comfortable, non-threatening standard. How can we simulate the familiar feel of a textbook on a computer screen but do more than just recreate the textbook?

• by beginning with the familiar

We provide a book cover, a list of authors and acknowledgements.

• by providing an idea of the size of the program as soon as it is opened

When you pick up a textbook, you know how much reading is required by its weight, the size of the print, and the number of illustrations. Programs should give the same indication. We do it by providing an index and noting the number of screens (pages) per section. We allow people to skip between sections with ease.

• by giving the program a simple consistent interface

The navigation buttons are present and in the same place on the screen throughout the program. Each of the different styles of interaction that we use have been extensively tested on students to make sure they are enjoyable and intuitive. Instructions are not needed, as they may discourage the neophyte from beginning a computer program. We don't want the users to be confused or frustrated by the mechanics of the program. We would rather have them concentrate on the content. However, sometimes help is needed, and in such situations we make "help" instantly available from any page in the program.

• by following the same design principles that produce a good quality book, journal or magazine using type face, fonts and layouts which lend themselves to easy readability.

Important Principles

There are four principles (the Four P's) that guide the design of our programs.

First the programs must be patient-oriented. Medical students want to learn how to take care of patients; postgraduates see continuing education as relevant when it relates to patients. Therefore, we put the patient in a central teaching role.

Thanks to the help of parents and children in Christchurch and Auckland, we have been able to include video footage of babies and children in our paediatric programs. Adult patients, medical physicists, radiologists, technologists and nursing staff in Christchurch have consented to be included in our series on imaging.

Secondly, programs are generally problem-based. For example, the program on immunisation focuses on answering questions that parents pose regarding immunisation of their children. Another program is directed at identifying common and uncommon signs of paediatric infectious diseases.

Programs are participatory. Reading text from a screen results in much less retention of information than reading from a printed page. If the reader has to interact with the screen, the text becomes more important and the learning is active rather than passive. We use at least 10 different modes of interaction in our programs, from labelling diagrams to solving crossword puzzles.

Active participation is a major difference between computer-assisted learning and a standard textbook. Other differences include the use of colour graphics, diagrams and photographs (expensive to reproduce in a book) and video. Particularly in certain forms of imaging such as ultrasonography, or in procedural work such as the endotracheal intubation of a baby, the video is worth a thousand still pictures.

The fourth "P" is pay-off. Rewards are given throughout the program for appropriate responses. We provide a tangible record of the student's work by concluding with a reward in the form of a take-away handout which can be printed by the students. The information in the handout parallels each section; the student can be selective in what they choose to print. We let each student create something which is very familiar and comfortable -- his or her own abbreviated textbook.

In Christchurch, we are fortunate to have a group of people in Paediatrics, Paediatric Radiology and Paediatric Surgery who are all working together to foster a collaborative approach to paediatric problems. The same group is involved in the creation and the development of computer assisted learning programs. If the students learn half as much as we have learned in creating them, we have accomplished our goals.

Andrew M. Bryant is currently a software developer at the Christchurch School of Medicine.
Rita L. Teele is Professor of Radiology at Christchurch School of Medicine, University of Otago.
David W. Teele is Professor of Paediatrics at the Christchurch School of Medicine, University of Otago.