William E. Erkonen

Evaluation of a computer-based program for teaching cardiac anatomy.

RATIONALE AND OBJECTIVESThe authors determined to what extent a computer-based program could enhance or substitute for cadaver dissection in teaching cardiac anatomy to first-year medical students. METHODSFirst-year medical students (n = 175) were randomized into four groups. Group 1 (control) received no instruction, group 2 participated in cardiac dissection, group 3 viewed the computer application, and group 4 performed cardiac dissection and then viewed the computer application. Each group was tested with 10 ultrafast computed tomographic static images and 8 cardiac cadaver specimens. RESULTSThe computer program plus dissection was superior to either the computer program alone or dissection alone; however, the results varied according to the subtest used to assess the outcomes. CONCLUSIONSCardiac computer instruction after dissection resulted in dramatically improved image testing performance. However, computer instruction should not replace dissection for teaching cardiac anatomy.

Effectiveness of teaching radiologic image interpretation in gross anatomy: A long-term follow-up

This prospective study was designed to gauge the effectiveness of teaching radiologic interpretation during a gross anatomy course for first-year medical students by measuring short- and long-term ability to identify normal anatomic structures on radiologic diagnostic images. The evaluation required students to identify normal anatomic structures on radiographs, computed tomographs, ultrasonograms, and magnetic resonance images (MRIs). The assessments were made before (pre-test) and during (post-test) the experimental radiology portion of the gross anatomy course. The students were then retested 14 to 17 months later (long term). The pre-test correct response rate of 17% improved to 88% on the post-tests. After 14 to 17 months, the students had a 74% correct response rate on the same images and anatomic structures. This high level of long-term retention documents the effectiveness of integrating diagnostic radiologic imaging into normal gross anatomy instruction.

THE INFLUENCE OF CLINICAL HISTORY ON VISUAL SEARCH WITH SINGLE AND MULTIPLE ABNORMALITIES

RATIONALE AND OBJECTIVESFacilitation of detection by clinical history generally has been found with a single abnormality per image but not with multiple abnormalities. Multiple abnormalities per image can occasion a “satisfaction-of-search” effect in which detection of one lesion is reduced in the presence of other distant lesions. Our experiment studied the combined effect of multiple abnormalities and clinical history on accuracy. METHODSDetection of native lesions was measured 1) with histories suggestive of the native abnormality; 2) with these histories and added simulated pulmonary nodules; and 3) with the same added nodules and histories suggestive of metastatic disease. These conditions also were compared with those of a previous experiment that were similar but included no history. RESULTSDetection was substantially improved for appropriately prompted abnormalities even in the presence of a pulmonary nodule. In fact, satisfaction of search vas not found in the presence of an appropriate history. Detection of unprompted abnormalities was unchanged when prompts indicated other abnormalities actually present. Prompted abnormalities were detected earlier in search. CONCLUSIONSHistory appears to direct perceptual resources to the prompted abnormalities, thereby alleviating satisfaction of search. The presence of nodules yielded a small but consistent reduction in total search time for searches involving false responses, suggesting that satisfaction of search may depend more on reduction in search time than had been indicated by previous research.

Longitudinal comparison of multimedia textbook instruction with a lecture in radiology education.

RATIONALE AND OBJECTIVES The purpose of this prospective randomized study was to compare the long-term instructional effectiveness of a computer-based radiology multimedia textbook (MMTB) with that of a traditional lecture. METHODS Volunteer faculty/fellows and residents were randomly assigned to either a computer-based MMTB group or to a lecture group. The course content for each instructional group was the same. Pretests, posttests, and 1-year long-term retention tests were administered to both groups. The same 10 questions were on all tests. The resulting data were analyzed using analysis of variance procedures available on the Statistical Analysis System. RESULTS A comparison of the long-term instructional effectiveness of an MMTB versus a lecture showed that the MMTB computer instructional method was at least comparable in spite of the initial short-term appearance of lecture superiority. CONCLUSION These results suggest a promising future for MMTB and other forms of computer-based education in radiologic instruction for medical students and radiologists.

Interinstitutional study to compare the effectiveness of a radiology-anatomy module of instruction

RATIONALE AND OBJECTIVES The purpose of this study was to validate the effectiveness of a proven radiology-anatomy instructional module during I st-year gross anatomy courses at Emory University College of Medicine and the University of Iowa College of Medicine. MATERIALS AND METHODS This prospective study involved 108 Emory students and 177 Iowa students. The instructional content was the same at both institutions. Each student was randomly assigned into one of three groups at each institution, and each group received a unique, randomized, five-item pretest. All students were posttested as part of their gross anatomy laboratory examination, and the posttests consisted of all 15 items used in the three five-item pretests. RESULTS No statistically significant pretest effects were demonstrated by t tests. Posttest performances across items ranged from 73% to 96% correct for Emory students and 67% to 98% for Iowa students. Performance levels on the posttests were significantly higher than on pretests, and few significant differences were found in the performance of the two populations. CONCLUSION The radiology-anatomy instructional module integrated into the gross anatomy courses for 1st-year Emory University and University of Iowa students was not instructor or institution dependent.

The virtual hospital. Providing multimedia decision support tools via the Internet.

Physicians in the clinical setting remain isolated from important sources of medical information. The authors have created a multimedia database known as The Virtual Hospital that improves access to current medical data, which is used to improve patient care decisions. The Virtual Hospital is a digital health sciences library stored on a server (computer) at The University of Iowa and delivered via the Internet to inexpensive personal computers in the workplace. The emerging standard of the World Wide Web is used to provide cross-platform distribution.

The virtual hospital

App1e Mac1nt05h mach1ne5 f0110w the 1n5truct10n5 a5 91ven a60ve 1n 2(a) MacWe6. F0r Un1x we rec0mmend that y0u refer t0 y0ur 5y5tem adm1n15trat0r wh0 5h0u1d 6e a61e t0 1et y0u kn0w a60ut the 10ca1 51tuat10n v15-a-v15 v1ewer5. 1ntr0duct10n A phy51ca1 0r9an12at10n 15 def1ned 6y 1t5 phy51ca1 p1ant, the pe0p1e wh0 w0rk w1th1n 1t, the kn0w1ed9e they c0nta1n and the 5erv1ce5 they 0ffer. A u614u1t0u5 0r9an12at10n 15 a d191ta1 repre5entat10n 0f the 1nf0rmat10n and 5erv1ce5 0f a phy51ca1 0r9an12at10n that 15 made ava11a61e t0 any0ne at any t1me 1n any p1ace. Creat1n9 a u614u1t0u5 0r9an12at10n amp11f1e5 the attr16ute5 0f the phy51ca1 0r9an12at10n 6y extend1n9 1t5 p0wer and reach. N0w, 1n5tead 0f pe0p1e hav1n9 t0 c0me t0 the phy51ca1 0r9an12at10n f0r 1nf0rmat10n and 5erv1ce5, the u614u1t0u5 0r9an12at10n c0me5 t0 them whenever they need 1t. U614u1t0u5 0r9an12at10n5 can 6e created f0r phy51ca1 0r9an12at10n5 5uch a5 90vernment5, 116rar1e5, 5ch0015, un1ver51t1e5, and h05p1ta15. We have created a u614u1t0u5 0r9an12at10n wh1ch we ca11 the V1rtua1 H05p1ta1 wh1ch 15 the d191ta1 repre5entat10n 0f the Un1ver51ty 0f 10wa Hea1th 5c1ence5 C011e9e5, L16rary, and H05p1ta15 and C11n1c5. 7he V1rtua1 H05p1ta1 c0nta1n5 d191ta1 repre5entat10n5 0f key med1ca1 center 5erv1ce5 wh1ch are c0nt1nu0u51y ava11a61e at a d15tance, there6y 5erv1n9 a5 an eff1c1ent med1ca1 center exten510n. (U1HC) t0 he1p pat1ent5 ch005e a hea1th care pr0v1der • H05p1ta1 D1rect10n5 f0r any0ne trave11n9 t0 the U1HC fr0m 1n 0r 0ut 0f 5tate • H05p1ta1 Map 0f the campu5 and 6u11d1n95 t0 5erve a5 a 9u1de t0 the U1HC • P05t-V151t F0110w-up and H0me Care 1n5truct10n5 5eptem6er 1994 4 516810 NEW5LE71 • ER

Cardiac Anatomy Instruction by Ultrafast Computed Tomography versus Cadaver Dissection

RATIONALE AND OBJECTIVES This prospective study was designed to determine to what extent an ultrafast computed tomography (UFCT) videotape of the heart could enhance or substitute for cadaver dissection in teaching anatomy to first-year medical students. METHODS A student population (n = 180) was randomized into four groups. Group 1 (control) received no instruction, group 2 viewed the videotape, group 3 participated in cardiac dissection, and group 4 performed cardiac dissection and viewed the videotape. After randomized instruction, each group was tested with 10 UFCT static cardiac images and 8 cardiac cadaver specimens. A different population consisting of nonrandomized fourth-year medical students also was tested. RESULTS The results point to an interaction between instruction and the manner in which it was assessed. There was more carryover from the videotape-acquired knowledge to specimens than from dissection-acquired knowledge to UFCT images. CONCLUSIONS Cardiac UFCT instruction resulted in dramatically improved image testing performance. This image-acquired knowledge was not sufficiently transferred to cardiac specimen identification; thus, videotape instruction should not replace dissection for teaching cardiac anatomy. Video provided instruction benefits beyond that gained through general clinical experience.

The virtual hospital: the future of information distribution in medicine

A key 60tt1eneck 1n the deve10pment 0f expert 5y5tem5 15 the ac4u151t10n 0f expert kn0w1ed9e. A key pr061em 1n the pr011ferat10n 0f hypermed1a 5y5tem5 15 the 105t-1n5pace exper1ence wh1ch u5er5 have when they try t0 acce55 1nf0rmat10n fr0m the 5y5tem. Expert 5y5tem5 0ffer t0 5upp0rt nav19at10n 1n hypermed1a 5y5tem5 and thu5 501ve the 105t-1n-5pace pr061em. 8y c0m61n1n9 expert 5y5tem5 and hypermed1a 5y5tem5, 0ne m19ht pr0duce a new hy6r1d, ca11ed •expertmed1a• wh1ch w0u1d have the advanta9e5 0f 60th (Rada, 1991 * ). D0cument 0ut11ne5 and the5aur1 are cr1t1ca1 1n d0cument data6a5e5 and can 6e exp101ted t0 5upp0rt 6r0w51n9 and 5earch1n9 1n expertmed1a, a5 ha5 6een dem0n5trated w1th e1ectr0n1c encyc10ped1a5 and text600k5 0n CD-R0M.

The Iowa Health Book: creating, organizing and distributing a digital medical library of multimedia consumer health information on the Internet to improve rural health care by increasing rural patient access to information

Patients need access to consumer health information in order to improve their health and well-being. Rural patients, by nature of their geographic location, have limited access to such information. A partnership has been formed between non-profit public health organizations, a health sciences library, a tertiary care medical center, a medical informatics laboratory, a state library system, and the citizens of Iowa. The purpose of the partnership is to create, organize and distribute a digital medical library of multimedia consumer health information on the Internet in order to improve rural patient access to consumer health information.