Title: Transforming the Computers & Medical Information Elective Speaker: Gale G. Hannigan, PhD,MPH,MLS,AHIP, Texas A&M Medical Sciences Library, College Station, TX, USA Author: Gale G. Hannigan Abstract: Objective: The Computers & Medical Information Elective is a 1, 2, or 3-week elective with the goals to: 1) demonstrate use of computer technology, systems, and electronic resources for medical information management; 2) assess and improve personal computer skills in preparation for residency; and 3) have fun exploring new technologies. The objective of this presentation is to describe the evolution of a popular 4 th -year elective from a teacher-directed, onsite experience to a student-directed learning experience delivered and managed online. Methods: The course management system, Blackboard Vista and earlier versions, became an efficient method for delivering those modules that were formatted as guided exercises. Over time, it was apparent that students selected these modules in preference to those that required being on campus and/or meeting with a faculty member. As of 2007, most modules were available in the Blackboard Vista system. As of 2008, all students work is submitted electronically as well. Results: Approximately 75% of fourth-year students enroll in the elective. It has the reputation of being flexible and useful and can be completed anywhere there is an Internet connection. Allowing students to submit their work electronically reduces paperwork and improves the instructor s ability to manage the course. The formatted, modular organization of the course allows for consistency in format and makes it easy to remove outdated modules and add new ones. Conclusion: An elective begun in 1992 continues to evolve in content, delivery, and management. Introduction Fourth-year medical students at Texas A&M Health Science Center College of Medicine (COM) complete a minimum of 32 weeks of electives, 24 of which must comply with recommended electives for their career goal.(1) The Internal Medicine Special Topics - Computers & Medical Information elective, offered since 1992, routinely enrolls most fourth-year students who complete one, two, or three-week versions. The elective s content and format continue to evolve, but the basic educational objectives remain the same. They are that students will: 1. demonstrate use of computer technology, systems, and electronic resources for medical information management 2. assess and improve personal computer skills in preparation for residency 3. have fun exploring new technologies The purpose of this paper is to describe the continuing evolution of the elective and identify those features that have contributed to its success over the years.
Information about the elective has appeared in the literature previously, in 1996 and 2005 (2,3); this paper updates those publications. Methods Fourth-year medical students spend considerable time away from campus interviewing for residency programs and completing electives at other institutions. The Computers & Medical Information elective evolved from a conversation with the Dean of Student Affairs who saw the need for an elective course that students could take around the time they were required to be back on campus for another activity. He expected that the course would attract a large group of students all at the same time of the year. Instead, after approval by the College of Medicine Curriculum Committee, the two-week elective was selected by several students at different times throughout the year. Instead of one large class, the elective, from its inception, has been available to one or more students whenever they choose to schedule it. During the initial years, students met with the elective s faculty to learn about and explore a computer or information resource or skill. Each session covered a module, with topics such as Electronic Textbooks and MEDLINE. The student worked at a computer in the Learning Resources Center, with the faculty member there to provide navigational assistance. A medical librarian was and continues to be the primary faculty contact and teacher for the elective, although other College of Medicine faculty would meet with students for modules in Diagnostic Computing, Drug Information Resources, and Medical Information on the Internet. As systems became easier to navigate and students were more computer savvy, most modules could be completed by students on their own. By 2000, students accessed all of the elective s module information online using the course management product WebCT. Several modules were written as guided exercises and did not require meeting with anyone. Soon it became obvious that students preferred that format and most modules were redesigned as guided exercises. The original two-week course consisted of ten modules. Six were required and the other four could be selected from a choice of eight. As of 2009, there were four required modules (Course Overview, Essential Computer Skills, Databases, Information Ethics) and 32 others to choose from. Students are required to completed 24 modules total. In addition to the two-week version, students can now enroll for one week and complete 14 modules, including the four that are required, or add a third week and complete an approved project related to information management. Students needn t schedule the weeks in sequence and often add the elective or additional weeks during the year. This fexibility is appreciated by students and the Student Affairs Office because the fourth year includes many unexpected scheduling changes as students respond to opportunities for interviews, away rotations, or changes in career choices. The course is now entirely online except for a required module Course Overview during which the faculty member reviews course logistics and, more importantly, guides students to modules that might be of most relevance to them. For example, early in the year when students are still taking the licensing exam, modules such as Clinical Cases Online and Computer-Based Assessment can be useful in their
studies. Those applying for residency programs should consider the Residency Decision Making module and the Personal Statement, CV, and Interviewing Skills modules, in which they will get advice and feedback regarding these important activities. Later in the year, when students know where they will be for their residency, the Time Management and Budgeting modules may be more relevant. There are two very self-directed modules: Underutilized Technology and Special Topics. Students may complete and count three activities/modules for each. Underutilized Technology requires that the student identify equipment or software that needs repair or replacement, or explore its features (usually by reading the accompanying manual); it can include gathering and evaluating information to decide about the purchase and installation of an item. Specialized Topics is broadly defined as anything that includes information management and life as a medical student. Students have organized course notes, compiled specialty web links, and taken the next step in a research project. These two modules give the student the time to solve a problem or resolve an issue related to their own information management activities. Other modules introduce resources and/or reinforce skills. Some modules have been part of the elective since its inception, such as MEDLINE and Computer-based Diagnosis, although the specific content has changed as systems have evolved or been replaced. For example, Essential Computer Skills is a basic, required module and probably always will be, but the content is updated each year. Orginally, setting up an e- mail account was an activity in this module; today it includes demonstrating the ability to edit a photo. Each year all of the modules are reviewed and some are retired (for example, MS PowerPoint) usually because most students already know the resource and have the skill. Practice using MS PowerPoint is still part of the Research module in which students use the software to create a poster describing a research report. New modules are added to reflect new technologies and resources. The Geographic Information Systems module, originally developed for public health students, was very popular when it was introduced because most medical students had not used systems that link health information with geographic location. Social Networking was added to make students aware of all the ways that medical, as well as social, information is being disseminated. Even the required in person Course Overview has changed over time. Because it is so important to the success of the elective, person-to-person contact is still mandatory, but in the past year that has sometimes been achieved by a regular phone call or a Skype desktop video phone call. Because the course is so flexible and students often enroll mid-year due to a schedule change and at the recommendation of Student Affairs personnel, some students admit that they start the course without knowing what to expect. All they know is that it meets their scheduling requirements. Based on observation, students comments, and students written evaluations, it is apparent that students come to realize and appreciate that the elective is designed to meet their needs and give them the time to get important skill building and organization done. During the Overview students are told that the elective is purposely decompressed, meaning that it provides unstructured time to explore beyond the guided exercises.
Many students, when asked what they want to get out of the elective, are unsure but they all seem to have a to do list with tasks that fit nicely into some modules. From an educator s perspective, it is more likely that students will go beyond doing the minimum amount of work if the effort leads to a desired outcome. The upfront 30 minutes spent reviewing the elective with the student is clearly motivational. Many students leave with noticeable enthusiasm and direction. It is an extra perk that one module, the Course Overview, has already been completed. Management of the course has changed as well. Until two years ago, students printed off the modules, completed the exercises and submitted all their work in a folder. The instructor read through the folder and graded the modules. Now, students retrieve learning modules from Blackboard Vista, copy, complete the exercises, and then submit them to the website. The instructor sees and grades submitted modules, and the grades are automatically posted to the website s Gradebook. All course management can be completed at a computer with an Internet connection. The standard clinical evaluation form is not appropriate for this elective, which is graded Pass/Not pass based on completion of the required number of electives. Appendix 1 is the evaluation form for the elective, listing each of the modules offered in 2008-2009. Results Four students enrolled the first year the elective was offered (1992-93); by the fifth year, 20 students enrolled (1996-97); in the tenth year, 47 students enrolled (2001-02); this past academic year (2008-09), 71 students completed the elective. In 2008-09, at least one student and as many as 13 were enrolled in the one, two, or three-week version during 39 of the 49 weeks of the curriculum. Students complete a 32-question evaluation form for each elective they take. The Computers & Medical Information elective consistently gets high marks (4.5-4.9 on a scale of 1 to 5, Strongly Disagree to Strongly Agree) for statements such as: Goals & objectives were met Faculty modeled and encouraged self-directed and career-long learning The workload was appropriate The overall scores for the past two years of evaluations were 4.6 and 4.7, each slightly higher than the departmental average. Students comments include: [Instructor] just cares that you learn Everyone should be required to take this I wish I knew some of this information earlier [I] enjoyed the orientation and gained great ideas for [completing] the learning modules
Since the tools and resources for information management continuously evolve, the elective must also undergo constant revision, too. Students comments and questions lead to navigational corrections as needed throughout the year. The instructor maintains a file of suggestions and additions. At year s end, the instructor reviews all modules, removes, revises and adds modules based on observations, comments, ideas, and what new technologies and resources are available. Special Topics is a good source for learning what students need and do with regard to information management. Learning Resources staff members complete revised and new modules to test out the instructions and the time it takes to complete them. Typically, more modules are added than deleted, resulting in more choice for students. A noticeable trend is emerging. Rather than just learn to use a resource or tool, more modules are being developed in which students reflect on the value of the resource or apply tools to their own information management projects. For example, the Virtual Surgery module instructs students to watch a surgical procedure online and then asks them if they would recommend that a patient scheduled to have that surgery watch it being performed beforehand. This reminds students that patients have access to these resources too and prepares these future physicians to provide advice and interpretation to their patients. The Time Management module has students identify a goal with a defined deadline (e.g., taking a licensing exam), reflect on the essential activities needed to be completed to meet that goal and the non-essential but important activities that would enhance preparing for that goal, and then use a scheduling tool of their choice (usually an online or smartphone calendar application) to develop a schedule for meeting that goal. Students demonstrate completion of the module by describing their goal and schedule, and responding to the question Is this a feasible plan? The tools are becoming less the focus than the thoughtful use of those tools. The availability of information is less an issue than the evaluation and appropriate application of that information. Conclusion There is increasing need for health professionals to use information management resources and tools effectively. National recommendations repeatedly point this out.(4,5) A 2006 revision to the Liaison Committee for Medical Education Accreditation Standards states: It is expected that the methods of instruction and evaluation used in courses and clerkships will provide students with the skills to support lifelong learning. These skills include self-assessment on learning needs and independent identification, analysis, and synthesis of relevant information, as well as the assessment of whether information sources are credible. Students should receive explicit experiences in using these skills, and evaluation of and feedback on their performance. (ANNOTATION TO ED-5-A) (5)
It can be difficult to find formal venues for teaching information management topics in the medical school curriculum. Fourth-year electives provide an opportunity to make available instruction in that topic to those students who are interested. The Computers & Medical Information Management course establishes a place in the curriculum for students to explore information resources and tools, and develop and practice related skills. Medical information management is a rapidly developing field that ranges in scope from the use of basic information resources and tools for medical decision making. Teaching the topic requires that the instructor continuously learn new tools and resources to keep the elective up to date and useful. Postive feedback from students who perceive the elective as a schedule saver and fundamentally useful, plus the prompt to learn enough about a topic to create a guided exercise, are among the benefits to the instructor who teaches this course. Using new technologies to deliver and manage the elective makes the management of an elective taken throughout the year by many students in different locations possible. This becomes even more important as the College of Medicine adds locations where students can complete their curriculum. References 1. Texas A&M Health Science Center College of Medicine Fourth Year Required Curriculum [Online]. 2008 [cited 2009 May 10]; Available from: http://medicine.tamhsc.edu/elective/fyrc.html 2. Hannigan GG, et al. Computers and Medical Information: an elective for fourthyear medical students. Med Ref Serv Q 1996 Winter;15:81-88. 3. Hannigan GG. Computers & Medical Information Elective at Texas A&M University. In: Connor E, editor. A Guide to Developing End User Education Programs in Medical Libraries. New York: Haworth Press; 2005. p. 1-14. 4. Association of American Medical Colleges. Contemporary issues in medicine: medical informatics and population health [Online]. 1998 June [cited 2009 May 10]; Available from: http://www.aamc.org/meded/msop/start.htm. 5. Liaison Committee on Medical Education. Accreditation Standards [Online]. 2008 [cited 2008 May 10]; Avaiable from: http://www.lcme.org/standard.htm.
Appendix 1. Evaluation Form Computers & Medical Information Elective (IMED989301) Evaluation 2008-2009 completed the elective on. The purpose of the elective is to improve students skills in finding and managing medical information. The standard evaluation form does not fit the nature of this elective; this is used in its place. Several people worked with this student during the elective. This student: 1. Met the content requirements of the elective by completing the following modules Course overview (required) Essential Computer Skills (required) Databases (required) Information Ethics (required) Active Epi Budget Spreadsheet Clinical Cases Online Comparative Health Computer-based Assessment Connectivity Software Consumer Health Information Healthy People Curriculum Project Diagnostic-assist Software Digital Photography and Image Management Drug Information Resources on Computer Toxicology Information Educational Technology Electronic Books Electronic Health & Medical Records Systems Evidence-Based Medicine Practice Geographic Information Systems (GIS) for Health Information Martha s Clinic Computer Resources Medical Jeopardy Database PDA Applications and Resources Presenting Research PubMed Assessment PubMed Tutorial Research Residency Decision Support Tool Personal Statement Interviewing Skills CV Social Networking Specialty Information Time Management Tools Underutilized Technology Virtual Surgery Web Search Engines Webpage Development Special Topics 3 rd Week Project 2. Demonstrated independent learning skills, e.g., scheduled own course of study, consulted mentors as needed 3. Worked effectively and professionally with various information specialists including computer experts, librarians, pharmacists, physicians Course Coordinator Date