Transcript Document 7273320

Beyond the Blackboard:
Using Computers
to Enhance
Psychiatric Education
Sudha Prathikanti, MD
Lee Rawitscher, MD
Amy Berlin, MD
Education Technologies
Search Tools & Electronic Databases
Hand-held Devices
Presentation Software
Interactive Case Modules
Virtual Classrooms
Telepsychiatry
Online Evaluation Tools
Curriculum Management Tools
Computer-aided Decisionmaking Tools
Computer-aided Education:
Possible Advantages
“Universal” Accessibility
Removal of Time/Geography Barriers
Self-directed Education
Hyperlink Capability
Standardization of Content
Ease of Updating Content
Efficiency in Didactic Instruction
Efficiency in Course Coordination
Efficiency in Content Distribution
Computer-Aided Education:
Possible Disadvantages
Hardware/Software Requirements
Bandwidth Requirements
Technical Maintenance & Support
Time-Intensive Course Development
Asynchronous Communication
Uni-dimensional Communication
Faculty Knowledge Deficit
Student Knowledge Deficit
Evaluation of Web-Based Learning
Still in infancy
Valuable Addition to Education
No Clear Evidence of Superiority
Well-designed Curriculum Best Indicator
of Satisfaction, Web-based or Not
Connection Speed/Bandwidth Critical
Possible Increase in Learning Efficiency?
Relative Costs Must be Better Examined
Computers and Students
Lee Rawitscher, M.D.
Overview
Ilios – UCSF designed database
iRocket – Online curriculum
Colorado University Case Software
Evalue – Commercial evaluation software
Ilios
Developed entirely by UCSF
Data storage program
– Faculty, resident and student data
– Course schedules
– Search engine
Primary method for module creation
iRocket
Based on a commercial product called
Web CT
Modified by UCSF to fit culture and needs
Online Curriculum
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Learning objectives
Site information
Discussion forum
Key links
Colorado University Case Software
Developed by University of Colorado
Department of Pediatrics
Offered free of charge
Self contained teaching units
– UCSF uses a CD Rom in conjunction
– Video Clips
– Quizzes
Allows for standardization of curriculum
E-Value
Purely commercial (UCSF subscribes)
Online evaluation
– Attendings and residents evaluate students
– Students evaluate all their teachers
– Teachers can be ranked
– Evaluations reviewed by directors
Increases number of evaluators
Simplifies reading your evaluations
Areas of Evaluation
Fund of Knowledge
History Taking
Mental Status Exam
Oral Case Presentations
Record Keeping
Problem Solving
Professional Attributes Responsibilities
Self Improvement
Relationships with Patients and Family
Relationships with Members of the Health Care Team
Summary Comments
Summary
Data Storage and Search Engine
Course Descriptions and Internet Links
Standardized Teaching Modules
System for Evaluation
Behavioral Medicine Curriculum
for
Primary Care Residents
Sudha Prathikanti, MD
Limitations of
Many Behavioral Health Curricula
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Often more emphasis on communication than on
diagnosis and treatment.
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Rarely incorporate significant audiovisual
components.
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Often lack the algorithm-based teaching
approach commonly used in other areas of
medicine.
Web-DVD Module: Clinical Scenario
Video Clip of
Clinical Encounter
QuickTime™ and a
DV/DVCPRO - NTSC decompressor
are needed to see this picture.
Web-DVD Module: Decision Tree
Video Clip of
Clinical Encounter
Decision #1: What will you do now?
OPTION A
“You’re going thru a rough
period, but you’ll be fine.”
Negative consequences
seen on video clip
Explanation & optional
content module offered
Re-direct to Decision #1
OPTION B
“You seem overwhelmed; do you
ever think of ending your life?”
Patient confirms severity of psych
symptom on video clip
Trainee congratulated & optional
content module offered
Proceed with case
OPTION C
“Hmm…I think some meds will
make you feel better.”
Negative consequences seen
on video clip
Explanation & optional
content module offered
Re-direct to Decision #1
OPTION C
“Hmm…I think some meds will make you feel better.”
QuickTime™ and a
DV/DVCPRO - NTSC decompressor
are needed to see this picture.
Negative consequences discussed
Optional content module offered
Re-direct to Decision #1
Web-DVD Module
(continue Decision Tree)
Decision #2: What will you do now?
OPTION A
Overlooks medical etiologies:
“This guy must have Major
Depression!”
Negative consequences
seen on video clip
Explanation & optional
content module offered
Re-direct to Decision #1
OPTION B
Considers wide differential:
“Let’s review all the possible
causes for these mood symptoms.”
Patient elaborates upon symptom
severity on video clip
Trainee congratulated & optional
content module offered
Proceed with case
OPTION C
Overlooks psych etiologies:
“This is probably just steroidinduced.”
Negative consequences seen
on video clip
Explanation & optional content
module offered
Re-direct to Decision #1
Decision #3: What will you do now?
Web-DVD Modules as
Teaching Tools
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In traditional classroom.
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In web-based course for independent study
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In virtual classrooms
Web-DVD Modules:
Resource Intensive
Authoring Requirements
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Lots of Time!
Actors to Simulate Patients
Software Programmer/Web Designer
Digital Video Camera & Filming Accessories
Computer with Firewire, DVD Drive & Disk Space
DVD Burner
Digital Video Editing Program
HTML Editing Program
(Custom) Web Application Program
Web-DVD Modules:
Resource Intensive
Deployment Requirements

Instructor
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Administrative access to large Web Server
Technical support to manage user problems
Student
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Computer with DVD Drive
Internet Connection
Recent Browser with Javascript
Web-DVD Modules:
One Part of Overall Curriculum
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Classroom Didactics
Classroom PBL with Movie Clips
Live Patient Interview
Clinic Preceptorship
Downloadable Reading Assignments
Web-based Discussion Group
Web-based Multiple-choice Exams
Web-DVD Interactive Case Modules
COMPUTERS & MEDICINE:
FANTASY vs. REALITY
Amy Berlin, MD
How does improving the
technological sophistication
with which we deliver
educational material affect
the quality of the
educational experience?
CLINICAL DECISION
SUPPORT SYSTEM =
CDSS
SCENARIO
YOU:
YOUR CLINIC:
Electronic Medical Record
ONLINE
• Problem list
• Medication list
• Allergies
AT EACH VISIT…
1
3
Patient completes
questionnaire
2
Have you suffered from
depressed mood more often
than not over the past 4
weeks?
Do you have trouble sleeping?
Have you had any weight loss
or weight gain?
Have you lost interest in
activities which generally give
you pleasure?
+ depression
screen
Generates
email
message
Three arms of the study
Arm #1
Questionnaire with positive depression
screen generates email
Arm #2
Depression reminder on encounter form
Arm #3
Patient-specific recommendations on
encounter form
Which group of patients do
we predict will have the
lowest Hamilton Rating
Scale for Depression
scores, at three and six
months?
 Patients identified as having a major depression flagged
for return visit within four weeks
 Patients identified as having a major depression flagged
for return visit within four weeks AND paper-based
encounter form includes reminder to address depression
 Patients identified as having a major depression flagged
for return visit within four weeks AND paper-based
encounter form includes guideline-based, patient-specific
recommendations
NO difference in outcome
among all three 3 groups
• Mean Hamilton scores at time 0 ranged from
19.7-20.7, with no significant differences among
groups
• Mean Hamilton scores at both 3 and 6 months
ranged from 14-16, with no significant
differences among groups
• PMDs with more intensive decision support saw
their patients more frequently
• No difference in frequency of SSRI prescription
among groups
Adding technology to a
problem does not
necessarily generate its
solution
When implementing
computer-based
educational instruments,
remember to evaluate your
system using objective
measures
References
Rollman, Bruce et al. A Randomized Trial
Using Computerized Decision Support to
Improve Treatment of Major Depression in
Primary Care. Journal of General Internal
Medicine 2002; 17:493-503.