July 9-13, 2004 
Tulane University School of Medicine 
New Orleans, Louisiana U.S.A.
 

Abstracts on Innovation and Technology

The following abstracts have been accepted for presentation at this meeting in Poster format in the category of Innovation and Technology.  Those selected for Oral Poster Presentations are so designated in the far right column.
 
 

IT1	DISTRIBUTED IMMERSIVE VIRTUAL REALITY SIMULATION DEVELOPMENT FOR MEDICAL EDUCATION Dale C. Alverson, M.D.1*, Stanley M. Saiki Jr, M.D.4, Thomas P. Caudell, Ph.D.2, Kenneth Summers, Ph.D.2, Timothy Goldsmith, Ph.D.3, Diane S. Wax, MPA, MBA1, Mark Bowyer, M.D.5, Alan Liu, Ph.D.5, David Wilks, M.D.1 1School of Medicine, 2School of Engineering, and 3Department of Psychology, University of New Mexico, Albuquerque, NM 87131 U.S.A., 4John A. Burns School of Medicine University of Hawaii, Honolulu, HI 96822 U.S.A., 5National Capital Area Simulation Center, Uniformed Services University of the Health Sciences, Silver Springs, MD 20910 U.S.A. Training professionals for real-world application of required knowledge and skills and assessing competence are major challenges. Simulations are being used in education and training to enhance understanding, improve performance, and assess competence. Validated virtual reality (VR) simulations provide a means of making experiential learning reproducible and reusable. Advanced communication networks, such as Internet2 Access Grid, allow dissemination of these simulations and collaborative learning independent of distance. The prior experiences of our three universities led to an interdisciplinary collaboration to further develop and evaluate an integrated, fully immersive, interactive VR based system. This environment employs simulations that are visually 3-dimensional and are driven dynamically by a rules-based artificial intelligence engine within Flatland, a virtual environments development software tool, and associated commodity hardware. Studies include usability and validation, deployment for distributed testing over Internet2, and evaluation of impact on training and performance using concept mapping and knowledge structure methods. Subject matter experts found face and content validity in our closed head injury simulation. Seven pairs of medical students participated collaboratively in problem solving and managing of the simulated patient in VR. Students stated that opportunities to make mistakes and repeat actions in VR were extremely helpful in learning specific principles and they felt more engaged than in standard text-based scenarios. This research cuts across the integration of computing, networking, human-computer interfaces, learning, and knowledge acquisition. VR creates a safe environment to make mistakes and could allow rapid deployment for just-in-time training or performance assessment.	ORAL
IT2	THE LANGUAGE OF ANATOMY: HELPING STUDENTS TO LEARN RATHER THAN SIMPLY TO RECOGNIZE NEW TERMINOLOGY Jacqueline Carnegie, Ph.D.*, Department of Cellular & Molecular Medicine, Patrick O’Byrne, School of Nursing, and Anne Patry, M.A. Ed. Tech., Centre for e-Learning, University of Ottawa, Ottawa ON K1H 8M5 CANADA  The increased need for healthcare professionals and the resultant large class sizes associated with undergraduate Faculties of Health Science and Medicine courses has necessitated that emphasis be placed on the multiple-choice question as the preferred method of student assessment. In such exams, students are asked to select the correct answer from a list of four or five possibilities. However, this exam format does not determine the student’s ability to provide the correct answer if it had not been presented as a candidate in a short list of choices, or in the case of new terminology, if the student would have been able to spell, or even pronounce, the word in question. The study of physiology and especially of anatomy is filled with new terminology with which students need to become comfortable in order to understand body structure and function and to be able to work productively in the healthcare field after graduation. In an effort to promote student familiarity with anatomical terminology, a content expert and a former student collaborated with an instructional designer to develop online interactive exercises for Faculty of Health Sciences anatomy and physiology courses. These online activities (crossword puzzles, anatomical images to be labeled by typing in the name of the anatomical structure) were designed to require students to come up with the correct word to match a definition or a particular anatomical structure and to correctly spell the word by fitting the letters into the required spaces. Students were given three tries to get the correct answer; if they were not successful, then the correct answer was provided. Students were able to try these activities as often as they liked throughout the duration of the course. The online self-testing activities were reinforced by five-minute mini-reviews of anatomical definitions at the beginning of class and midterm and final anatomy exam questions that required structure names to be written on the exam page rather than selected from a list of four or five choices. Data will be presented showing levels of student use of and satisfaction with these learning tools as well as improvement in overall course achievement for those students who tended to struggle with these courses.
IT3	CYBERBODIES: BUILDING ONLINE – DEVELOPING INTERACTIVE EDUCATIONAL STRUCTURES.  Patrick O’Byrne, School of Nursing and Jacqueline Carnegie, Ph.D.*, Department of Cellular & Molecular Medicine, University of Ottawa, ON K1H8M5 CANADA The study of three-dimensional structures using two-dimensional images is challenging, and even more so when the structure moves or has movable parts. The movements of the eye are difficult for lecturers to explain and for students to understand. Using web-based animations, however, lecturers can enhance two-dimensional images, while learners can interact with the eye to highlight structures, learn names, cause muscle contractions to illustrate action, and view the effect of such contractions from numerous angles. The eye animation is designed with one forward-looking, central eye and four smaller, surrounding eyes that demonstrate the medial lateral, posterior and anterior views. The four smaller eyes mimic the actions of the larger eye, showing its movements from multiple angles. This synchronized, multi-angle view proves to be extremely helpful in demonstrating the actions of the oblique eye muscles. While certain pedagogical tools have limited availability, web-based learning activities are available simultaneously to multiple lecturers and learners, and can be accessed from anywhere at any time. In addition to being reusable, multi-lingual, and universally available, these animations provide learning activities for non-auditory (or non-lecture-based) learners: the interactive image enhances the visual learner’s experience and provides a pedagogical tool for the tactile learner. The efficacy of such learning tools has been demonstrated at the University of Ottawa where web-based interactive images have been used to improve comprehension of course content and, in some instances, subsequent examination performance for Faculty of Health Science students studying anatomy and physiology .
IT4	DEVELOPMENT OF A PROBLEM-BASED LEARNING VIDEOTAPE CASE PRESENTATION Sheila Crow, M.A.*; Chris Candler, M.D., University of Oklahoma College of Medicine, P.O. Box 26901, Oklahoma City, OK 73190 U.S.A. This poster will illustrate the process used at The University of Oklahoma College of Medicine to develop a video-based Problem-Based Learning Case for first year medical students. Generally, a PBL case is a paper-based case that unfolds over a period of time, allowing for the opportunity of greater retention and integration of new knowledge. New technologies however have given us the chance for more innovative educational methods of creating self-directed, life-long learners. As part of our fall PBL session this year at The University of Oklahoma College of Medicine, the Office of Educational Development and Support, in conjunction with basic science faculty, clinical faculty, and simulated patients, developed a clinically relevant combined gross anatomy and embryology PBL video case for freshman medical students. There are a number of advantages to using video-based PBL cases. First, video cases provide medical students with the opportunity to enhance their visual and auditory cues to patient evaluation. As clinicians know, the development of such skills is essential to good medical practice. Second, video cases provide a medium for studying the actions of the physician, thereby increasing the likelihood that students will model appropriate professional behavior in the clinic. Third, video cases provide a more "real" format than traditional paper cases, which in turn provides relevance and motivation to the instruction. Finally, video cases can be replicated at will for use by multiple groups. Student comments regarding the video-based PBL format were very positive.	ORAL
IT5	MEDICINE AND HUMANISTIC UNDERSTANDING: THE SIGNIFICANCE OF LITERATURE IN MEDICAL PRACTICE Sheila Crow, M.A.*; Jerry B. Vannatta, M.D.; Ronald Schleifer, Ph.D., The University of Oklahoma College of Medicine, PO Box 26901, Oklahoma City, OK 73190 U.S.A. This poster aims to introduce an important educational tool recently developed for the training of medical students and practicing physicians in the humanities. Medicine And Humanistic Understanding: The Significance Of Literature In Medical Practice is a DVD-ROM, to be published by the University of Pennsylvania Press in fall 2004. The DVD proposes to offer an important supplement for the training of physicians--asynchronous learning to supplement the rigorous training of scientific biomedicine--so that its first audience will be medical students. It will also be of important interest in relation to the ongoing training of practicing physicians, both in private study and also in workshops and symposia that are often part of continuing medical education. The DVD will present video discussions, enactments, and text presentations of the role of literature in medical education and practice. It is organized in the following chapters: The Patient-Physician Relationship The Patient's Story Doctors Listening to Patients Narrative and Medicine Narrative and Ethical Practices in Medicine The Death of Ivan Ilych The poster will exhibit pages from various DVD chapters so that participants will have an overall view of the content of the DVD, the technical functions, and an understanding of the ways in which it can be used in educating students and practicing physicians. Participants will be able to see how short stories (including Arthur Conan Doyle, Anton Chekhov, Richard Selzer, Jean Stafford, William Carlos Williams), novels (Dorthy Allison, Roddy Doyle, Scott Fitzgerald, Ferrol Sams, Toni Morrison), non-fiction (Robert Coles, Anne Fadiman, David Hilfiker, Oliver Sacks), and poetry (Rafael Campo, John Stone, William Carlos Williams) are used in the DVD to discuss issues related to the various "chapters". Contact: sheila-crow@ouhsc.edu or (405) 271-8001, ext. 48569
IT6	NEW APPROACH TO TEACHING HISTOLOGY Amos G. Gona, Ph.D.*, Peter B. Berendsen, Ph.D., and Elizabeth A. Alger, M.D., Department of Cell Biology and Molecular Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ 07103U.S.A. At UMDNJ-New Jersey Medical School, we have taken a new approach to teaching Histology with the chief objective of being able to make this basic science discipline as clinically relevant as possible, and at the same time reduce the lecture time. The core strategy of this approach is to make the laboratory sessions more efficient and effective in teaching and learning. We implemented two major changes in our program. First, we equipped the four histology laboratories (each accommodating about 45 students) with ‘Audiovisual Switching and Projection System’ (ASPS; Hacker Audio Video Communications, Hackensack, NJ). The ASPS technology enables us to project images from a) glass slides via Olympus BH-2 microscope equipped with Sony 3CCD camera, b) 2" x 2" slides with NAVITAR Videomate Slide-to-Video System, c) textbook figures or photomicrographs via ELMO EV-6000AF Visual Presenter, or d) videotape. From a studio adjacent to the labs, images are projected into each lab via an LCD projector and two-way audio system. Second, using the ASPS, we have been able to change from the old Lecture-Lab-Review sequence to Lab-Lecture-Conference sequence. Each topic starts with a live pre-lab presentation by the topic expert, who uses the ASPS to direct the students to observe the basic histological features of the tissues/organs to be studied in that laboratory session. After about 20 minutes of pre-lab presentation, students use simple written instructions, the lab atlas, and the assistance of lab instructors, to complete the lab. Lecture time is used primarily to emphasize structure-function relationships. The Conference, which replaces the old Review, is designed to use the structure-function relationship as the basis to meaningfully discuss selected topics of clinical relevance. With the new approach, we have been able to reduce the lecture time from about 43 hrs to 34 hrs, even as we significantly increased the clinically relevant topics. Perhaps the most satisfying benefit is that we have been able to steadily move away from the minutiae of histological detail to the more beneficial expansion of concepts of pathophysiology in the context of Histology. We believe that this approach will better prepare our students for subsequent coursework, and also help them remember the useful and clinically relevant aspects of basic science material they have learnt in Histology. Furthermore, it addresses the common criticism that Histology, like other basic sciences in general, is taught as a collection of details, which are largely irrelevant to clinical science and the practice of medicine. As for effects of this approach on students, a) attendance in the labs has markedly improved (perhaps because they were made to understand that descriptive histology was to be taught and learnt primarily in the labs), b) there was no detrimental effect on student performance in the exams, as compared with previous years, and c) students seem to be content and comfortable with this approach, and appreciate the shift in emphasis to clinical relevance. Finally, the degree of success in this approach largely depends on the willingness and ability of basic science faculty to acquire the competence required for introducing clinically relevant material appropriately and accurately.	ORAL
IT7	CREATING A COMMUNICATION SKILLS PROGRAM FOR FIRST YEAR MEDICAL STUDENTS George P. Kolo, D.O*, Cheryl Benge, Gautam J. Desai, D.O, Depts of Family Medicine/Academic Affairs, The University of Health Sciences, Kansas City, MO, 64106 U.S.A Physician-patient communication training at the University of Health Sciences (UHS) College of Osteopathic Medicine had not been taught prior to 1997. The majority of patient concerns about their physicians relate not to their medical management, but the inability of the physician to communicate well with their patient. Better communication skills have been shown to improve the ability of physicians to diagnose their patients’ ailments, thereby improving patient care, which decreases the chances of a lawsuit against the physician, and improves the doctor-patient relationship. Prior to the creation of this program, our students’ performance in this realm was historically poor, based on feedback of preceptors. Realizing the need to incorporate medical communication skills into our curriculum, we obtained, a grant in order to initiate the program as a pilot study in 1997 for first year medical students. Our goal was to improve the ability of medical students to achieve rapport with patients and to become comfortable with the patient encounter, and ultimately to become better practicing physicians. Improved performance on communication skills training will likely improve performance on clerkships as well as the recently implemented clinical skills portion of the national board examination. A new course, Introduction to Core Communication Skills, was created in 1997 to achieve an enhanced level of medical communication skills performance and to begin to prepare for the national boards performance examination, which we had begun hearing about at that time. Below are some challenges and solutions we realized during this process. Challenge/solution Large class size /repeat learning activities in small groups - Few full time faculty/use of community faculty/residents Objective evaluation /enhanced faculty training, checklists - Training of Standardized patients/obtaining local thespians Case creation /adapting cases from actual patients - Faculty involvement/staff realization of course’s importance The Introduction to Core Communication Skills course was successfully implemented as part of the curriculum. Feedback from learners, faculty and preceptors has been positive, and has served to increase interest in the Standardized Patient Program as well. Although the assessment tool for clerkships has changed, overall performance for the communication skills of our students has improved. Ongoing assessment of this program’s success includes evaluation of preceptor feedback following clerkships, and UHS student success on the first performance evaluation component of national boards this fall.
IT9	"DRUG BUDDY": A WEB-BASED EDUCATIONAL RESOURCE PROVIDING SOUND FILES AS A GUIDE TO DRUG PRONUNCIATION Chris J. Van Dyke, B.S., Karen A. Woodfork, Ph.D. and David J. Smith, Ph.D.*, Department of Biochemistry and Molecular Pharmacology, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506-9142 U.S.A. Because students at our institution were requesting advice on the pronunciation of drug names, we developed, Drug Buddy, a web-based resource to assist them in their study of pharmacology. Drug Buddy contains a compilation of sound files of the generic names of common drugs. Currently, the resource consists of about 500 drugs, but more are to be added on a routine basis. Drugs covered in our courses were used as the basis for Drug Buddy's content. In addition, all drugs from Rx List's (RxList.com) "Top 200 Drugs of 2002", and many of those on the "Pharmacology Drug List" complied by University of Texas at Houston were included. The sounds are monophonic files (.WAV) sampled at 22 kHz with a median file size of 24 kB. Guidance for articulating the sounds was from the text presentation of the pronunciation of the drugs from USP DI® Advice for the Patient® produced by US Pharmacopeia, and MedMaster™ produced by the American Society of Health System Pharmacists. The audio portion of Drug Buddy and a text pronunciation of each drug can be copied to a CD for distribution. However, we routinely use it as a WEB-based resource, which provides links to other pharmaceutical information available through the Internet. For example, as selected drugs are accessed, the student finds a link to Medline-PlusÒ , and within our institution's secure, password protected, web-based internet site, students may also link to Clinical PharmacologyÒ , which is provided through Gold Standard Multimedia, Inc. Students find a link to Drug Buddy as they access on-line study materials used in each of our separate courses for medical, pharmacy, dental and undergraduate students. Additionally, our on-line course for undergraduate students provides links to individual sound files of drugs as they are initially encountered in the on-line text. Students report that Drug Buddy is useful, and that links to other reference material is helpful.
IT10	CASE TOOL: DEVELOPMENT, IMPLEMENTATION AND EVALUATION OF AN INTERACTIVE WEB-BASED APPLICATION Jim Stewart, M.D.*, Stephen Welch, B.B.A., and C. Darrell Jennings, M.D., Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY 40536 U.S.A. The University of Kentucky pathology department uses small groups in our sophomore pathology course similar to most pathology programs in the country. Enhancing the benefit of these experiences for students via technology is desirable, but can be problematic. We also have been challenged by the Accreditation Council for Graduate Medical Education with the need to provide pathology resident assessments of medical knowledge along with appropriate documentation. It was felt that some of these challenges could be met with a web-based case tool that provides interaction, expandability, feedback, and documentation for resident, small group medical student, and continuing medical education. We subsequently developed a tool to allow students to view images and textual information about a case scenario, and answer questions in an interactive manner with individual instructors. The tool is a website developed in asp that utilizes a SQL Server database to allow image uploading and case creation by faculty. In order for any educational application to be successful, faculty interface time must be minimized. The submitter needs only to provide a brief summary and upload images. Interactivity is accomplished by notifying the case creator (instructor) when answers are made to his/her case questions. The instructor can then submit personalized instruction to the student via email, thereby teaching to specific problems of students. The case tool has been initially evaluated by 16/19 (84%) of pathology house staff, who used it routinely. Using a Likert scale (1=strongly agree, 5=strongly disagree), it was found to be overall valuable (M=1.19) with specific benefit seen in its interactivity (M=1.13) and value for national board study (M=1.00). Also, more quizzes for individual study were desired (M=1.19). Overall, the case tool was strongly assessed as valuable by the responding residents and fellows. In particular, the interactivity was seen as a benefit as well as its use for licensing exam study. In the small group setting, this tool can be easily utilized for medical student teaching, allowing the group leader to see and correct some of the weakness of his/her students. Our experience shows that dynamic web-based tools can be developed that allow for personalized learning experiences.
IT11	the use of a Human Patient Simulator in PROBLEM-BASED LEARNING AND MEDICAL STUDENTS’ RESPONSES TO ITS USE.  Ian Winston, m.b.b.s., b.sc.* and John L. Szarek, Ph.D., Department of Introduction to Clinical Medicine and Department of Pharmacology, Ross University School of Medicine, Portsmouth, Commonwealth of Dominica, WEST INDIES Human patient simulators, high-fidelity computer-controlled mannequins, are becoming increasingly common in the education and training of physicians in the clinical portions of their curriculum, however, their use in the pre-clinical portion of their training is only beginning. The purpose of this study was to compare the typical problem-based learning (PBL) session to a PBL session using a human patient simulator (HPS) and to assess medical students’ satisfaction with the use of the HPS during their fourth semester. The use of the HPS at our school evolved from the process used in our PBL program during the students’ first three semesters. Our HPS sessions were conducted in a manner which paralleled that which we used in our paper-based PBL sessions. Rather than presenting the problem on paper over three sessions in a two week period, as is done in our typical PBL sessions, the students encountered the problem as a lifelike patient in three sessions over a 2-3 day period. There were three significant differences between the HPS sessions and our typical PBL sessions. The first was that the students used their communication and physical examination skills to generate the patient data. Second, there was an added dimension of stress which was evidenced by a comment from a student during a debriefing session who stated that at the beginning of the first session, while he was just observing, "I saw people frozen. I saw people sweating bullets." Third, students were able to develop a plan of treatment, administer their plan, and then observe the effects of their intervention. There was unanimous agreement among the students that the HPS sessions were a good use of their time. The most frequent comments by the students regarding the usefulness of the sessions can be summarized by two students who commented that the sessions "Build student interpersonal skills in a professional setting" and "I found the experience useful because it allowed the integration of material in a clinical setting." Pertaining to how the sessions can be improved, the most frequent comments were those suggesting smaller group sizes and more sessions. We conclude that the enjoyment and motivation that the students exhibited during their HPS session contributed to their learning and provided an opportunity to integrate the sciences basic to medicine.
IT12	DEVELOPMENT AND PILOTING OF PDA-BASED PATIENT ENCOUNTER / DATA COLLECTION APPLICATIONS FOR MEDICAL STUDENTS Lynn C. Yeoman, Ph.D.*, Anne S. Gill, M.S., R.N., Dodie T. Hall, M.S., Dan P. Hunt, M.D., Larry E. Laufman, Ed.D., Cathy C. Montoya, M.L.S. and Wayne J. Riley, M.D., M.B.A., Office of the Dean of Medical Education, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 U.S.A. Students at Baylor College of Medicine are required to document their clinical encounters in several courses by keeping a "Passport" where selected history and physical examination information is recorded. The course passport is reviewed by their faculty preceptor and audited by course coordinators. We have developed two Palm OS personal digital assistant (PDA) e-Passports that are digital equivalents to the paper-based passports required for two of our clinical courses. These applications collect clinical encounter data, reinforce proper clinical data collection and uniformity in performing history and physical examinations, feed a patient encounter database, reduce the use of paper, and document the completion of required patient encounters. Mobile applications were designed using HanDBase® and HanDForm® to achieve form-based data entry and portable database architecture that is similar in look and feel from application to application and from course to course. Applications were specifically designed to fit each course director’s specifications. Applications designed in HanDBase® offer the advantage of interfacing with Microsoft Access, as well as, other ODBC compliant databases. In addition, HanDBase® is sufficiently scalable to accommodate multiple users and can be adapted to run on either the Palm or Pocket PC operating systems. Our applications have been designed and tested in 4 groups and represent data and experience gained from a total of 43 medical student volunteers. We have conducted focus groups with student volunteers to determine features they like, problems they encountered and suggestions for improving the usability and value of these applications. As a result we have learned that students report: (a) ease of use, (b) greater use of PDA programs and features, and (c) a general appreciation for our effort to enhance their knowledge and skill in mobile medical computing. Students want these applications to require minimal text entry, to accommodate patient progress notes, to generate printable output for submission with case write ups, and to permit later annotation on the PDA or on their personal computer. Course directors appreciate the manageable acquisition and review of patient encounter data and the ability to accommodate query-based review of program data for research projects, documentation of requirements met, and tracking of course development issues.	ORAL