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Intelligent physiologic modeling: an application of knowledge based systems technology to medical education.

This article describes the design and implementation of a knowledge-based physiologic modeling system (KPBMS) and a preliminary evaluation of its use as a learning resource within the context of an experimental medical curriculum--the Harvard New Pathway. KBPMS possesses combined numeric and qualitative simulation capabilities and can provide explanations of its knowledge and behavior. It has been implemented on a microcomputer with a user interface incorporating interactive graphics. The preliminary evaluation of KBPMS is based on anecdotal data which suggests that the system might have pedagogic potential. Much work remains to be done in enhancing and further evaluating KBPMS.

Artificial Intelligence↗

Parasitology tutoring system: a hypermedia computer-based application.

The teaching of parasitology is a basic course in all life sciences curricula, and up to now no computer-assisted tutoring system has been developed for this purpose. By using Knowledge Pro, an object-oriented software development tool, a hypermedia tutoring system for teaching parasitology to college students was developed. Generally, a tutoring system contains a domain expert, a student model, a pedagogical expert and the user interface. In this project, particular emphasis was given to the user interface design and the expert knowledge representation. The system allows access to the educational material through hypermedia and indexing at the pace of the student. The hypermedia access is facilitated through key words defined as hypertext and objects in pictures defined as hyper-areas. The indexing access is based on a list of parameters that refers to various characteristics of the parasites, e.g. taxonomy, host, organ, etc. In addition, this indexing access can be used for testing the student's level of understanding. The advantages of this system are its user-friendliness, graphical interface and ability to incorporate new educational material in the area of parasitology.

Artificial Intelligence↗

Nurse Education Tomorrow Conference 1990. Reforming nurse education. 2--Implications for teachers and students.

The development of Project 2000 will lead to the reorganisation of nursing knowledge as nurse education enters higher education. This paper explores the implications of these changes for the future of role of nurse teachers and the new choices for professional development as teachers evolve into nursing theorists, lecturer practitioners and educational managers. The paper also explores changing pedagogic relationships with students, changing assessment strategies, their new supernumerary position in clinical environments, and reference groups likely to be selected by students. Finally it examines the ways in which links with higher education and the contributions of non-nurse academics may lead to the reorganisation of course management structures.

Education, Nursing↗

Computer-assisted sequencing, interval graphs, and molecular evolution.

In 1945, Fox developed the strategy for sequencing long proteins by using overlapping fragments. We show how the formal mathematical technique for the construction of interval graphs (Gilmore and Hoffman, 1964) is useful both pedagogically for understanding the underlying logic of sequencing linear molecules and is more amenable to automation because of its algorithmic nature. We also present a computer program, that employs the interval graph algorithm, which can be used to sequence proteins when given digest data. An example is given to illustrate all the steps involved in the algorithmic processing of the data. The need for such developments with respect to molecular evolution is discussed.

Amino Acid Sequence↗

The effect of patient-practitioner interaction on compliance: a review of the literature and application in rheumatoid arthritis.

Persons with rheumatoid arthritis, like those with other chronic illnesses, often demonstrate poor compliance with their treatment regimens. Numerous factors have been identified as influencing compliances, including various features of diseases and therapeutic regimens, and demographic and sociobehavioral features of patients. Perhaps the most significant factor is the physician-patient relationship. Because of the relatively high prevalence of rheumatoid arthritis and the numerous characteristics of the disease and its treatment which adversely affect compliance, this literature review deals with the effects of the patient-practitioner interaction on compliance with treatment programs for rheumatoid arthritis. Specifically, this review examined the reported effects of four components of the patient-practitioner interaction--pedagogical techniques, sharing of expectations, the patient's assumption of responsibility and affective tone. Based on this literature review, several suggestions are provided for the health professional regarding ways to enhance compliance through the interaction with the patient, and specific areas for further research are identified.

Arthritis, Rheumatoid↗

Effects of video based training on spoken and signed language acquisition by students with mental retardation.

The purpose of this study was to assess the effects of video presentations on the acquisition of both spoken and manually signed lexical items by students with mental retardation. A 10-lesson curriculum in which lexical items were introduced and reviewed by one of three pedagogical methods (therapist only, therapist plus video, or video only) was implemented over a four week period. Pretest and posttest measures of expressive and receptive vocabulary of 35 students with mental retardation revealed that all three methods resulted in significant increases in both spoken and manual sign production of the targeted lexical items compared to control items which were not taught. The therapist only and therapist plus video methods yielded significantly higher sign production scores than the video only method. Receptive vocabulary was not significantly improved by the intervention.

Adolescent↗

Competing risk analysis of life table data: application to lifetime risk computation.

In this pedagogic note we propose to assess the safety of treatment in a clinical trial, or the effect of risk exposure in a chronic animal study, in terms of two lifetime risks. These risks are computable from life table type data and take into account the effects of competing risks. We first describe their computational procedures in detail to demonstrate the need for their implementation in a computer program. We then illustrate their practical application through use of the data obtained from an actual clinical study.

Health Status Indicators↗

Faculty perceptions of teaching on television: one school's experience.

Videoteleconferencing (or teaching on television) represents a means of growing importance for distant learners to gain greater access to nursing education. Research has identified a number of key issues for nurse educators to consider related to videoteleconferencing: teaching/evaluation strategies, faculty workload, rewards and incentives, and support structures. The authors conducted an evaluation survey using a case study approach aimed at describing the perceptions of a convenience sample of faculty members (n = 17) regarding their recent television experiences. The survey, conducted by means of a mailed questionnaire, examined perceptions centering on sources of support, reception site logistics, rewards teaching strategies, and future directions. Key findings included: overall, respondents perceived television teaching positively; reception site, administrative support, and peer support were important to faculty; additional preparation time was required for television teaching; teaching on television required changes in style and pedagogical strategies; and student-teacher interactions were affected by the medium. Findings have implications for the implementation of videoteleconferencing operations, recruitment of faculty for television teaching, and evaluation of videoteleconferencing operations.

Attitude of Health Personnel↗

[What education means in surgery? A surgery among chirurgical residents in university hospital in Strasbourg].

OBJECTIVE: Numerous tools for surgical education are available. The objective of the study is to know how future surgeons do feel about these different possibilities to learn and what do they think about the place of e-learning, or virtual universities and on-line training and learning in their formation. METHODS: A questionnaire has been sent to each surgical student of Strasbourg University. Learning and training methods were evaluated: observation, fellowship, Internet, reading videos, reading books or scientific journals, discovery of pathology by oneself or performing surgical procedures by oneself, sharing meetings, playing pedagogic games. RESULTS: Fellowship is voted by plebiscite, as using Internet which grows the usual book contents thanks to interactivity, videos, quickenings and actuality of the inquiries. The difficulties to approach this tool is emphasized : the cost, availability, time consuming, lack of any tutor, ability with a computer. Dissection of corpses or live animals is wished by the majority of young surgeons. Using simulators or robots remains something for the future and must be evaluated. CONCLUSION: Fellowship is voted by plebiscite for learning surgery. The interest for new technologies of communication is more out of curiosity than necessity.

Adult↗

An intelligent tutoring system for visual classification problem solving.

OBJECTIVE: This manuscript describes the development of a general intelligent tutoring system for teaching visual classification problem solving. MATERIALS AND METHODS: The approach is informed by cognitive theory, previous empirical work on expertise in diagnostic problem-solving, and our own prior work describing the development of expertise in pathology. The architecture incorporates aspects of cognitive tutoring system and knowledge-based system design within the framework of the unified problem-solving method description language component model. Based on the domain ontology, domain task ontology and case data, the abstract problem-solving methods of the expert model create a dynamic solution graph. Student interaction with the solution graph is filtered through an instructional layer, which is created by a second set of abstract problem-solving methods and pedagogic ontologies, in response to the current state of the student model. RESULTS: In this paper, we outline the empirically derived requirements and design principles, describe the knowledge representation and dynamic solution graph, detail the functioning of the instructional layer, and demonstrate two implemented interfaces to the system. CONCLUSION: Using the general visual classification tutor, we have created SlideTutor, a tutoring system for microscopic diagnosis of inflammatory diseases of skin.

Artificial Intelligence↗

Rapid application design of an electronic clinical skills portfolio for undergraduate medical students.

The aim was to find how to use information and communication technology to present the clinical skills content of an undergraduate medical curriculum. Rapid application design was used to develop the product, and technical action research was used to evaluate the development process. A clinician-educator, two medical students, two computing science masters students, two other project workers, and a hospital education informatics lead, formed a design team. A sample of stakeholders took part in requirements planning workshops and continued to advise the team throughout the project. A university hospital had many features that favoured fast, inexpensive, and successful system development: a clearly defined and readily accessible user group; location of the development process close to end-users; fast, informal communication; leadership by highly motivated and senior end-users; devolved authority and lack of any rigidly imposed management structure; cooperation of clinicians because the project drew on their clinical expertise to achieve scholastic goals; a culture of learning and involvement of highly motivated students. A detailed specification was developed through storyboarding, use case diagramming, and evolutionary prototyping. A very usable working product was developed within weeks. "SkillsBase" is a database web application using Microsoft Active Server Pages, served from a Microsoft Windows 2000 Server operating system running Internet Information Server 5.0. Graphing functionality is provided by the KavaChart applet. It presents the skills curriculum, provides a password-protected portfolio function, and offers training materials. The curriculum can be presented in several different ways to help students reflect on their objectives and progress towards achieving them. The reflective portfolio function is entirely private to each student user and allows them to document their progress in attaining skills, as judged by self, peer and tutor assessment, and examinations. Training materials include web links and materials developed locally using pedagogic principles developed by the SkillsBase team. Although the usability of SkillsBase has been proven, uptake of software that has arisen 'bottom-up' from within the curriculum has proved slow. We plan to incorporate the SkillsBase services into a more comprehensive virtual managed learning environment, anticipating that presenting the functionality in an environment that is routinely used by students and teachers will increase uptake and use.

Clinical Competence↗

Laparoscopic surgery in adult cattle.

Laparoscopy in cattle is a promising tool for clinical diagnosis and treatment. The lower cost of the materials available in addition to the possibility of an intervention on an animal that is sedated does not entail more costs than an exploratory laparotomy. The application of this tool during abdominal explorations and biopsies allows the avoidance of invasive and often useless surgical interventions and even with the diagnosis and prognosis of certain conditions. Surgical techniques currently are limited to abomasopexies; however, never-ceasing progress and improvements in human surgery are expected to affect the future of bovine surgery. With the advancements in the multimedia technology used by universities, the use of laparoscopy as a pedagogic tool definitely has a promising future. Endoscopic exploration of the thorax is possible using the same material as for laparoscopy. In addition, diagnostic and biopsy applications are useful. The use of the laparoscope in different body cavities and for different applications would make the purchase of the required materials more cost-effective.

Abomasum↗

Perceptions of work in humanitarian assistance: interviews with returning Swedish health professionals.

Health personnel volunteering for humanitarian assistance assignments work in increasingly dangerous situations and increasingly complex roles. A qualitative analysis of interviews with returning Swedish aid workers, who collectively had been on 74 missions in 32 different countries, revealed that they felt positive about their contribution, but experienced high levels of stress and frustration. They were also surprised and inadequately prepared for tasks that fell outside their professional health care training, including ones demanding pedagogic and management skills. The volunteers perceived their success on humanitarian assistance assignments as being affected not only by their own professional competence and special preparatory training, but also by many other factors. In particular, recruiting organizations could improve volunteer performance by accepting only experienced professionals, requiring special preparatory training, clarifying the exact nature of the work, and providing better support during the assignment. Further analysis of humanitarian assistance as a complex and dynamic system involving multiple 'actors' could lead to improved understanding and better performance.

Adult↗

Transdisciplinary training in reproductive health through online multidisciplinary problem-solving: a proof of concept.

OBJECTIVE: The problem of iatrogenic multiple pregnancies has been addressed through an online multidisciplinary discussion forum with the primary aim of developing a transdisciplinary research and training tool. STUDY DESIGN: The pedagogical approach was divided in three phases, unidisciplinary, multidisciplinary and multi/transdisciplinary. Evaluation of the level of transdisciplinarity reached by each of the students was based on their capacity to translate disciplinary knowledge, to establish a frank dialogue, to cross disciplinary barriers, to detach from their initial opinion, and to develop curiosity for others' perspectives and concerns. RESULTS: Translation of disciplinary knowledge and frank dialogue were easily performed by all. Most students showed curiosity towards the others' point of view and started to be preoccupied with the concerns of other students. CONCLUSION: Online discussion forum is a particularly well-adapted tool for transdisciplinary research and training.

Education, Medical, Graduate↗

Training medical students to manage a chronic pain patient: both knowledge and communication skills are needed.

Most studies concerning pain education of undergraduate medical students focus on knowledge, but little is known about the interviewing skills and pain evaluation. At the end of the fifth study year and at the beginning of the sixth year the students were asked to answer an electronical questionnaire to evaluate how the IASP curriculum on pain had been covered during the studies. In addition, the interviewing skills of the fifth year medical students were assessed using an objective structured clinical examination (OSCE). The students met a standardized patient suffering from postherpetic neuralgia, who was instructed to express depressive and exhausted feelings. A total of 97 students received the questionnaire and 35% responded with identification. All students answering the IASP questionnaire evaluated teaching of postherpetic pain and antidepressant treatment as sufficient. OSCE appeared as a feasible instrument in the assessment of chronic pain education. Eighty-eight percent of the students made the correct diagnosis. However, only 35% asked about sleep disturbances and 16% about depression. When developing a curriculum on pain education, attention should be paid to pedagogic methods about helping the students to implement the learned knowledge in their practice. Formative assessment of both knowledge and skills is essential for the development of a functional pain curriculum.

Acute Disease↗

Nicephor[e]: a web-based solution for teaching forensic and scientific photography.

Nicephor[e] is a project funded by "Swiss Virtual Campus" and aims at creating a distant or mixed web-based learning system in forensic and scientific photography and microscopy. The practical goal is to organize series of on-line modular courses corresponding to the educational requirements of undergraduate academic programs. Additionally, this program could be used in the context of continuing educational programs. The architecture of the project is designed to guarantee a high level of knowledge in forensic and scientific photographic techniques, and to have an easy content production and the ability to create a number of different courses sharing the same content. The e-learning system Nicephor[e] consists of three different parts. The first one is a repository of learning objects that gathers all theoretical subject matter of the project such as texts, animations, images, and films. This repository is a web content management system (Typo3) that permits creating, publishing, and administrating dynamic content via a web browser as well as storing it into a database. The flexibility of the system's architecture allows for an easy updating of the content to follow the development of photographic technology. The instructor of a course can decide which modular contents need to be included in the course, and in which order they will be accessed by students. All the modular courses are developed in a learning management system (WebCT or Moodle) that can deal with complex learning scenarios, content distribution, students, tests, and interaction with instructor. Each course has its own learning scenario based on the goals of the course and the student's profile. The content of each course is taken from the content management system. It is then structured in the learning management system according to the pedagogical goals defined by the instructor. The modular courses are created in a highly interactive setting and offer autoevaluating tests to the students. The last part of the system is a digital assets management system (Extensis Portfolio). The practical portion of each course is to produce images of different marks or objects. The collection of all this material produced, indexed by the students and corrected by the instructor is essential to the development of a knowledge base of photographic techniques applied to a specific forensic subject. It represents also an extensible collection of different marks from known sources obtained under various conditions. It allows to reuse these images for creating image-based case files.

Computer-Assisted Instruction↗

[Obstetrical forceps: yesterday, today and tomorrow. Toward a new classification of obstetrical forceps].

OBJECTIVE: Obstetrical forceps are used worldwide since more than 400 years. In 2003 forceps deliveries accounted for 6.3% of all deliveries of the AURORE Grand-Lyon perinatal network. Although more than 400 different forceps have been described, obstetrics handbooks neither describe experimental forceps nor provide any chapter dedicated to instrumental delivery training. Our aim was to provide junior obstetricians with information that will allow them to select the best instrument and to let them know about experimental as well as pedagogic forceps. PATIENTS AND METHODS: International literature review using the terms "forceps" and "delivery" and a four year experimental work involving a close collaboration between obstetricians and biomechanics of the INSA engineering school. RESULTS: Two instruments are presented as well as a new forceps classification. DISCUSSION AND CONCLUSION: This classification distinguishes between three types of forceps: operational forceps designed to delivers neonates, experimental forceps designed to study biomechanics and training forceps designed for resident training. For the first time the classic blind forceps procedure is transformed in a full screen real time procedure.

Equipment Design↗

The SIMRI project: a versatile and interactive MRI simulator.

This paper gives an overview of SIMRI, a new 3D MRI simulator based on the Bloch equation. This simulator proposes an efficient management of the T2* effect, and in a unique simulator integrates most of the simulation features that are offered in different simulators. It takes into account the main static field value and enables realistic simulations of the chemical shift artifact, including off-resonance phenomena. It also simulates the artifacts linked to the static field inhomogeneity like those induced by susceptibility variation within an object. It is implemented in the C language and the MRI sequence programming is done using high level C functions with a simple programming interface. To manage large simulations, the magnetization kernel is implemented in a parallelized way that enables simulation on PC grid architecture. Furthermore, this simulator includes a 1D interactive interface for pedagogic purpose illustrating the magnetization vector motion as well as the MRI contrasts.

Algorithms↗