Computer Use in Pediatric Education

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67:924-926

8. Lucey JF, Dangman B: A reexamination ofthe role of oxygen in retrolental fibroplasia. Pediatrics 1984;73:82-96

9. Tasman W: The natural history of active retinopathy of prematurity. Ophthalmology 1984;91:1499-1503

10. Brann AW, Cefalo RC (eds): Guidelines for Perinatal Care.

Evanston, IL, American Academy of Pediatrics, 1983, 216 11. Reisner SH, Amir J, Shohat M, et al: Retinopathy of

pre-maturity: Incidence and treatment. Arch Dis Child 1985;60:698-701

Computer

Use in Pediatric

Education

During the past two decades, there has been an increasing awareness among educators of the po-tential use of the computer in medical education.’ Its use in research studies and in creating such educational instruments as unit lessons, patient simulations, lecture aides and testing and evalua-tion materials has been discussed in the hitera-ture.’9 The computer thus has been noted to be a beneficial educational tool. Much has been written predicting the inevitable and continued expansion of the computer in medical education as well as the implications of its future use for medical students, residents, and faculty’#{176} To date, however, there is little documentation regarding the actual use of computers in pediatric education. The purpose of this study was to examine the use of computers and to assess the attitudes of physicians regarding its application in pediatric education.

METHODS

A two-page questionnaire was sent to directors of all 233 pediatric residency programs listed in the i986/i987 Directory of Residency Training Pro-grams. The questionnaire was designed to deter-mine the frequency and pattern of use of computers in education in their programs. Those respondents whose programs were not using computers (nonu-sers) were asked to indicate the reason this was so and whether or not they planned to use computers in education in the near future. Those who were using computers (users) were asked to indicate the type of computer they used and the frequency of computer use in various educational areas. Other information obtained were the number of programs having faculty members involved in creating corn-puter-based educational programs, the kinds of

pro-Received for publication Jan 18, 1988; accepted April 19, 1988. Reprint requests to (V.J.G.) Department of Pediatrics, Texas

Tech University Health Sciences Center, School of Medicine, Lubbock, TX 7943.

grams that were being developed, the incentives offered to encourage computer program develop-ment, the ways the computer had proved to be a beneficial educational tool, and the trend in corn-puter use in their programs in the past 5 years.

Each question was coded and entered into a DBASE file. To determine whether the size of the residency program was related to computer usage, each program was coded as either small, medium, or large according to the number of residents cur-rently enrolled in the program. The three categories were determined by ranking all 233 programs ac-cording to the number of approved resident posi-tions for each program and dividing the list into thirds. Programs in the lower third (small) had less than iS residents, those in the middle third (me-dium) had between i6 and 32 residents, and those in the upper third (large) had more than 32 resi-dents. Cross-tabulations and frequency distribu-tions were calculated using the ABSTAT software program.

RESULTS

Completed responses were received from i56

(67.0%) of the 233 programs surveyed. A greater percentage of the large and medium programs

(53.2% and 52.0%) used computers compared with

small programs (3i.8%). More than half of the respondents (53.2%) indicated that they were not using computers in their programs (Table i). The reasons cited by respondents for nonuse are given in Table 2. The most common reason was the expense of hardware and software (54.2%). Overall, 5i.8% of those not presently using computers in-dicated that they plan to use them in the near future. The majority of the users (83.6%) used only microcomputers; the rest used both micro- and mainframe computers.

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PEDIATRICS

Vol. 83 No. 3 March 1989

TABLE

1. Computer Use in Pediatric Education Versus Program Size (N = 156)

Size of Program % of Programs % of Programs Not Using Computers Using Computers

Small 31.8 68.2

Medium 52.0 48.0

Large 53.2 46.8

Al! programs 46.8 53.2

TABLE 2.

Reasons for Nonuse of Computers

Reason % of Nonusers

(n= 83) Expense of hardware/software 54.2 Lack of familiarity with computers among 42.4

faculty

Paucity of well-written computer programs 32.5 Lack of faculty interest 22.9 Lack of resident/student interest 14.5

Belief that computer is an ineffective 4.8 teaching tool

Other reasons 14.5

pressed by respondents from small programs than those from large programs (85.7 v 66.7%). The users believed the educational benefits to be that it facil-itated research data analysis, allowed residents! students to learn at ther own pace, enhanced resi-dent/student effectiveness, and decreased instruc-tors’ teaching load (Table 4). Also among the users, 58.9% reported that faculty members were involved in developing computer-based educational pro-grams. Of these, 72.1% were creating case material for simulations, 55.8% multiple-choice questions, and 27.9% other kinds of programs. Faculty in-volvement was reported in a greater percentage of large programs (78.8%) than in small programs

(28.6%).

The majority of programs (83. 6%) provided no incentives, financial, promotional, or other, to fac-ulty members to encourage development of com-puter-based educational programs. Whereas 2i.2% of large programs and 15.4% of medium programs provided an incentive, only 7.1% of small programs did so (Table 5). Most programs (9i.8%) reported an increase in the use of computers in their pro-grams for educational purposes during the past 5 years.

DISCUSSION

More than 5 years ago, in an editorial, Lu-cey,”’21 observed that “We are in the midst of a revolution as important as the industrial revolution. Computers, microprocessors and word processors have appeared on the pediatric scene.” Although Lucey was mainly referring to computer’s

ubiqui-TABLE 3.

Frequency of Computer Use in Various Ed-ucational Areas Among Users

Educational Area % of Users (n = 73)

Never Occasional Often

Unit lessons 56.2 27.4 16.4 Patient simulations 49.3 42.5 8.2 Lecture aides 47.9 41.1 10.9

Testing/evaluation 47.9 38.4 13.7

Research/data processing 13.7 23.3 63.0

Other 76.7 9.6 13.7

TABLE

4. Educational Benefits Cited by Users

Benefits % of Users

(n=73)

Facilitates data analysis for research projects 64.4 Allows residents/students to learn at their 35.6

own pace

Enhances resident/student clinical effective- 34.2

ness

Decreases instructor’s teaching load 8.2

Other benefits* 15.1

* Includes increases administrative effectiveness and

efficiency, facilitates resident patient panel scheduling, allows residents to record and monitor clinical experi-ences.

tous presence in the medical care setting, its poten-tial use in medical education has been a subject of discussion among educators throughout the world for more than a decade.’4 The field of medical education has seen the introduction of a variety of computer-assisted instructional programs during this period. The scope of these programs has ranged from a question-database multiple-choice system to relatively complex patient management simula-tions.39 More and more innovative educational for-mats are being continuously introduced, and the advocates of computer-based education are making a solid claim for its use to promote “problem-based, student-centered, self-directed learning.”2 With the universal availability of computer terminals in practicing physicians’ offices, attention is also being focused on the computer’s utility in continu-ing medical education. Clinical simulation, in par-ticular, is being considered an effective format in this regard.”3’4’6

Where are we with computers in pediatric edu-cation? Our study data clearly suggest that com-puters have yet to play a big part in pediatric education. This is especially so in small training programs. The nonusers of computers outnumber the users at the present time. The prevailing belief among the users is that the computer is a beneficial educational tool. A majority has seen its utility increasing in their programs during the past several years. But the pattern of its use at the present time

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TABLE 5. Incentives Offered to Faculty Members to Promote Computer Program Development Among Users*

Size of Program Type of Incen tives Offered (n = 73)

Promotional Financial Promotional and Financial Othert None Small Medium Large All programs 0.0 7.6 6.1 5.5 0.0 7.6 3.0 4.1 7.1 0.0 0.0 1.4 0.0 0.0 12.1 5.5 92.8 84.6 78.8 83.6

* Results are percentages of users.

t

Includes equipment (hardware or software).

is heavily oriented toward research studies and

related data analysis. Not many users are exploiting its potential as a teaching tool in facilitating self-directed learning (eg, patient management simula-tions, lecture aides, unit lessons) Neither is it being used much in creating testing and evaluation ma-terial (eg, multiple- choice question database) which also lends itself as a vehicle for self-directed instruction.

The reasons for nonuse are many. Hardware and software expense, lack of faculty interest in and familiarity with computers and their potential util-ity in education, and paucity of well-written mate-rials are but a few major reasons identified in our study. Also, a lack of demonstration of their effec-tiveness was a concern among some. The literature regarding this subject has also identified similar and additional problems of educational application of computers.4

The declining trend in the cost of computers and the ability of educational institutions to buy them at a discounted price should make computers more affordable. However, the other roadblocks to their wider use in education are more difficult to over-come. Removal of these roadblocks requires that the faculty responsible for medical education (i) acquire a better understanding of the computer’s capabilities in education, (2) feel convinced that computers are a valid and useful educational tool, and (3) engage in the creation of appropriate edu-cational materials. Although a lack of faculty inter-est in and familiarity with computers is a major reason cited for nonuse in our survey, the study data nevertheless suggest that a majority of the nonusers are planning to introduce computers in pediatric education in the near future. With in-creasing use of computers in almost every aspect of medical care, we believe, in time, more and more of the faculty will turn their attention to the task of familiarizing themselves with educational apphica-tions of computers. Entry into the academic world of younger faculty, already familiar with computers, would hasten the process of familiarization.

Dem-onstration of the computer’s educational benefits has been and continues to be a difficult task. The academic world rightly demands that a proposed teaching modality is first thoroughly evaluated for its effectiveness before it is accepted as valid. Stud-ies designed to demonstrate the benefits of com-puter-based educational programs are beginning to appear in the hiterature.’3’5 But, larger studies with more persuasive objective data are clearly needed to sway more faculty into accepting the computer’s role in medical education.

Further progress in the integration of computers within the medical curriculum will then depend on the quantity and quality of educational software available for use. Here, a greater involvement of the faculty in creating appropriate educational material

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Received for publication Oct 29, 1987; accepted March 28, 1988. Reprint requests to (G.J.S.) P0 Box 3467, Salem, OR 97302.

428 PEDIATRICS

Vol. 83 No. 3 March 1989

In summary, the study data suggest that, despite a decade-long optimistic projection of computer application in medical education, its use in pediatric educational programs is still limited and largely confined to research studies, data collection, and analysis. Problems of educational applications of computers are many and some (eg, cost, computer literacy) even fundamental in nature.

ACKNOWLEDGMENT

This study was supported, in part, by Primary Care Residency Program Funds.

REFERENCES

VYMUTT J. GURURAJ, MD PATRICIA FIELDS ROGERS, MA

JENNY K. PATRICK, MD Department of Pediatrics Texas Tech University

Health Sciences Center School of Medicine

Lubbock

1. Abdulla MA, Watkins LO, Henke JS, et a!: Usefulness of

computer-assisted instruction for medical education. Am J Cardiol i984;54:905-907

2. Stolurow KAC: A perspective on instructional uses of

corn-puting in medicine. J Med Syst 1982;6:165-170

3. Nanson EM: The potential of an educational computer in medical education. Aust NZ J Surg 1977;47:545-547

4. Coggan PC, Hoppe M, Hadac R: Educational applications ofcomputers in medical education. J Fam Pract i984;19:66-7i

5. Michael JA: Computers in physiology teaching: How can

APS help? Physiologist 1983;26:323-325

6. Rosenblatt RA, Gaponoff M: The microcomputer as a ye-hide for continuing medical education. J Fam Pract 1984;

18:629-632

7. Asbury AJ: Computers in medical education. Br Med J

1983;287:887-890

8. Bidwel! CM, Col!ins-Nakai RL, Taylor WC, et a!:

Multidis-ciplinary team production of computer-based simulations to teach pediatrics. J Med Educ 1985;60:397-403

9. Gururaj VJ, Atkins ZS, Sewel! BJ: Computer assisted patient management simulations in pediatrics. J Comp-Based Instr 1984;11:i17-120

10. Francis K: Applications of the microcomputer in the health care environment. South Med J 1986;79:1137-1140

11. Lucey JF: New section on uses of computers in pediatrics.

Pediatrics 1982;69:121

12. Jonas 5: The case for change in medical education in the

United States. Lancet 1984;2:452-454

13. Paris RA: The efficacy of computer-assisted instruction

(CA!) in an outpatient pediatrics clinic. Clin Pediatr

1986;25:255-256

14. Nardone DA, Schriner CL, Guyer-Kelly P, et a!: Use of computer simulations to teach history-taking to first year medical students. J Med Educ 1987;62:191-193

15. Knapp RG, Miller MC, Wise C, et a!: Computer instruction as part of a course on analytic medicine for first year

students. J Med Educ 1987;62:771-774

Duration

of Pediatric

and

Internal

Medicine

Practice

in

Oregon

This study was prompted by the perception that there were few pediatricians older than 60 years of age in the state of Oregon who were practicing primary care pediatrics. The hypothesis that there was a high practice attrition rate of primary care pediatricians was suggested by this observation. This could be the result either of early retirement or career change.

Data concerning attrition rates in medical spe-cialties are sparse. Manpower studies of the medical profession have described the entry of students into medicine and the entry of young physicians into medical practice but have not offered information

regarding the exit from practice or the frequency of career changes.’ The future of pediatrics was the topic of a recent report by the American Medical Association’s Council on Long Range Planning and Development and the American Academy of Pedi-atrics.2 In this article, changes in the population of children are correlated with changing pediatric practice demographics. Pediatric practice attrition rates were not discussed, presumably for lack of valid data. For the purposes of discussion, a uniform duration of practice was assumed to exist among medical specialties.

Our initial inquiries to the state medical associ-ation and the state board of medical examiners yielded little information concerning the exit from practice or career changes among practitioners. Physicians may make career changes or retire corn-pletely while retaining professional society mem-berships and their medical licenses. A direct ap-proach in which information was sought from in-dividual physicians was necessary and a case study questionnaire was developed. Internists were se-lected as the comparison group. This choice was made because of the similarity in length of training, role as primary care practitioners, and comparable income.

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1989;83;425

Pediatrics

VYMUTT J. GURURAJ, PATRICIA FIELDS ROGERS and JENNY K. PATRICK