Barry D. Mann

The development of an interactive game-based tool for learning surgical management algorithms via computer

BACKGROUNDnWe have previously demonstrated the potential efficacy of a computer-assisted board game as a tool for medical education. The next logical step was to transfer the entire game on to the computer, thus increasing accessibility to students and allowing for a richer and more accurate simulation of patient scenarios.nnnMETHODSnFirst, a general game model was developed using Microsoft Visual Basic. A breast module was then created using 3-D models, radiographs, and pathology and cytology images. The game was further improved by the addition of an animated facilitator, who directs the players via gestures and speech. Thirty-three students played the breast module in a variety of team configurations. After playing the game, the students completed surveys regarding its value as both an educational tool and as a form of entertainment. 10-question tests were also administered before and after playing the game, as a preliminary investigation into its impact on student learning.nnnRESULTSnAfter playing the game, mean test scores increased from 6.43 (SEM +/- 0.30) to 7.14 (SEM +/- 0.30; P = 0.006). The results of the five-question survey were extremely positive. Students generally agreed that the game concept has value in increasing general knowledge regarding the subject matter of breast disease and that the idea of following simultaneously the work-up of numerous patients with similar problems is a helpful way to learn a work-up algorithm.nnnCONCLUSIONSnPostgame surveys demonstrate the efficacy of our computer game model as a tool for surgical education. The game is an example of problem based learning because it provides students with an initial set of problems and requires them to collect information and reason on their own in order to solve the problems. Individual game modules can be developed to cover material from different diagnostic areas.

Teaching a multidisciplinary approach to cancer treatment during surgical clerkship via an interactive board Game

BACKGROUNDnAlthough educators agree that the approach to cancer management must be multidisciplinary, medical students usually observe cancer patients through the eyes of a single specialist at any given time.nnnMETHODSnIn order to teach third-year medical students that cancer management is multidisciplinary, we developed the Oncology Game, an interactive, computer-assisted board game built on the principles of self-directed learning and student-student interaction. Eight patients with different histologic types of cancer are distributed randomly to 4 students, who play in teams of 2. The object is for the team to obtain the best treatment for its patients by advancing them via a roll of dice through surgical, medical, and radiation oncology clinics in the order most logical for the patients particular cancer type. To test improvement in cognitive skills as a function of play, 16 students participated in a tournament taking parallel pretest and posttests before and after each round of play.nnnRESULTSnStudents demonstrated a statistically significant change in the total number of questions answered correctly each time they played the Oncology Game (F = 4.16, P = 0.018; Pretest Round 1: 8.88 +/- 0.58; Posttest Round 1: 9.63 +/- 0.42; Pretest Round 2: 10.75 +/- 0.62; Posttest Round 2: 11.5 +/- 0.85). Post hoc pairwise comparison revealed a significant improvement in student performance after playing two rounds of the Oncology Game. Based on the postgame survey, students felt they improved their understanding of oncologic principles (4.56 +/- 0.13), knowledge of malignancies (4.50 +/- 0.13), and appreciation for the multidisciplinary nature of cancer management (4.56 +/- 0.13).nnnCONCLUSIONSnImproved test scores and postgame survey results demonstrate that third-year medical student students can learn about basic oncology principles and gain an appreciation for oncology as a multidisciplinary field of medicine through an interactive, computer-assisted board game.

Teaching medical students by role playing: a model for integrating psychosocial issues with disease management.

BACKGROUNDnMedical students on third-year rotations seem to be focused more on the particulars of disease management than on patient management. They often pay too little attention to the psychological and social needs of the patient and to the importance of working in a multidisciplinary team. The authors postulated that a model for teaching breast cancer management that included role playing, self-study, and active student involvement would facilitate the integration of psychosocial and affective issues into scientific content and would demonstrate the importance of the team approach in managing patients with breast cancer.nnnMETHODSnOne month following a problem-oriented, case-based, interactive session focusing on clinical management of breast disease, each student was assigned the role of either patient or one of four specialists-1) a general surgeon, 2) a medical oncologist, 3) a radiation oncologist, or 4) a plastic surgeon. A packet of readings containing discipline-specific information was distributed to each specialist and a similar preparation packet was distributed to each patient. One week later students from each specialty met in multidisciplinary groups and five patients with written scenarios of recently diagnosed primary breast cancer rotated among them. Important decision-making choices were discussed in each consultation. Following their consultations in the multidisciplinary groups, the patients met with the entire group of 20-25 students and with physician faculty to discuss differences in the information obtained. They compared specialists styles of presentation and attitudes. Specific issues involving coordination of care among specialists were carefully highlighted.nnnRESULTSnAll students participated and the teaching sessions were well received.nnnCONCLUSIONSnRole playing facilitates the discussion of psychosocial issues and aptly demonstrates to students the need for a multidisciplinary approach to breast cancer treatment. This model is applicable to other types of cancer and to other groups of cancer educators.

Screening to the converted: an educational intervention in African American churches.

BACKGROUNDnAfrican American women have higher incidences of breast and cervical cancers and African American men present with more advanced stages of colon and prostate cancers than do their non-African American counterparts. Since the church is central to the organization of the African American community, the authors set out to determine whether a church-directed educational project could influence parishioners to obtain cancer screening.nnnMETHODSnThree African American churches having memberships of 250, 500, and 1,500, respectively, were selected for their different socioeconomic strata: one congregation was composed mostly of working poor, the second was more affluent, and the third consisted primarily of retirees. During a five-week summer period, appropriate literature, health fairs, testimonials by cancer survivors, and visits by representatives of the medical community were used to increase awareness of cancer screening. Surveys regarding cancer-screening behaviors were distributed at the end of church services. Using the guidelines established by the American Cancer Society, individual recommendations for screening examinations were developed and sent to parishioners based on their survey responses.nnnRESULTSnOf 437 parishioners surveyed (73% female, 27% male), 75% were 40 years old or older. Many reported up-to-date screening for breast (84%), cervical (78%), colon (62%), and prostate (89%) cancers. The results were remarkably similar in all three churches. Telephone follow-up seven months after the survey directed at the 120 parishioners identified as noncompliant for at least one cancer screening revealed that 49% had obtained the appropriate screenings.nnnCONCLUSIONSnThese African American churchgoers were well screened compared with estimated national averages, possibly due to previous efforts of the activist ministers in the churches selected. The message for cancer screening is heeded when delivered through the African American church.