APPLICATIONS AND BENEFITS OF COMPUTER BASED EDUCATION FOR MEDICAL AND ALLIED HEALTH EDUCATION
by Robert M. Caldwell, Ph.D. Department of Allied Health Education
The University of Texas Health Science Center at Dallas
Dallas,
Texas 75235ABSTRACT 1. BENEFITS FOR INSTRUCTION
Advances in computer technology have pro-vided unique opportunities to apply computer sys-tems to a wide variety of medical and health care functions. One area which holds great potential for using computer systems is medical and health science education. The following paper focuses on
1. The benefits which can be derived from using computers to deliver many forms of medical education but particularly continuing medical education.
2. The applications of computer technology to medical and health science training.
3. The future applications of computers to medical and health science education.
The paper cites numerous examples of how computers are currently being used in health care training and what new developments might be used in the very near future.
It is difficult to determine exactly when computers were first used to deliver instructional programs, but by the late 1960's computer systems had already proved themselves to be extremely
powerful
tools for deliveringhigh-quality,
inter-active instruction in avariety
ofsubjects
and locations. As we enter a new decade,improvements
in computer technology and the introduction of inexpensive microcomputers adds considerablepotential
for promoting learning, formanaging
instruction and data, and for interfacing labora-tory and diagnostic equipment. Given this potential, then, we must turn now tofinding
the applications of computer technology which are most appropriate to the needs of the medical and allied health care professions.The purpose of this paper is to
1).
detail within a limited scope some of the benefits which can be derived fromapplying
computers to medical and allied health education,2).
citeexamples
of unique applications currently available in the health professions, and
3).
discuss futurepossibilities
for computer-based education in the medical and health sciences.The potential of computers for delivering medical and allied health education to hospitals, clinics, medical schools and inservice training environments is almost unlimited. The following are but a few of the many ways in which the computer can be used to offer alternative forms of instruction:
1.1
Continui_ng
Medical EducationEvidence of participation in continuing medical education programs
(CME)
has become a requirement of relicensure in fifteen states in the United States as of August 1976 and is planned as a part of specialty recertification by all twenty-two certifying boards. As medical, scientific and technological advances applicable to patient care accelerate, groups such as con-sumers, malpractice insurers, third party car-riers, and governmental agencies supportingpatient
care advocate an increase in the availa-bility of new information and procedures to physicians and health careprofessionals1.
Fulfilling this requirement for an increase in continuing medical education is difficult at present for a number of reasons:A. Many medical schools neither have adequate facilities or available staff to handle the heavy instructional
requirements
of extensivecontinuing
education. The University of Texas Southwestern Medical School in Dallas, for example, conducts inservice education for over 30,000 physicians a year. Much of this instruc-tion is done in hotels,public
buildings
orwherever space can be found. Also, it is often difficult to find
qualified
professionals
who candevote time to continuing education.
B. Physicians in rural areas or in remote locations have a difficult time
attending
continuing education
seminars withoutlarge
expenditures
of time and money.Many
find it difficult toleave
large
patient loads for the several days required to travel to a largecity
for seminars.C. Increased case loads in many urban areas prevent physicians from participating in contin-uing education classes. Many cannot find the time necessary to spend at inservice training.
D. At present most continuing medical education carries no accountability. Physicians who attend are not required to demonstrate any new knowledge or skill from the seminars they attend. They are granted AMA Category One credit simply on the basis of their attendance.
Large computer networks can help to provide a partial solution to these problems. One such system is capable of supporting instruction on over 7,000 terminals simultaneously in over 100 cities in the United States and Canada. This same system is also now available in five
countries
in Europe and Africa. A vast net-working system of this type is capable of delivering interactive instruction to wherever it is needed whenever it is needed immediately. Unfortunately, courseware of sufficientquantities is still not available but instruc-tional developers working with health care professionals are closing the gap
quickly.
If high quality materials can be developed by qualified
medical
educators and knowledgeable instructional designers, a large computer network could have the following advantages for conducting continuing medical education:A. Instruction
could
be delivered wherever it was needed regardless of thelocation
of the physician and without extensive requirements for physical space.B. Instruction could be accessed at the physician's convenience on an individual basis.
C. Medical schools could grant AMA Category
oie
credit based on achievement. This achieve-ment score could beeasily
accessed from the computer records file. A system of this type would enable medical educators tocertify
physicians
on the basis of competency rather than attendance, a feature whichmight
have its advantages inmalpractice
cases.D. The computer courseware delivered on the network could provide a more common
learning
experience
for allphysicians
andprovide
moreopportunities
forsharing
information withphysicians
who rarely have anopportunity
togain
access to the latest medical research. This information could be constantlyupdated
and accessed any time.E. More
planning
and research into the development of courses and seminars would be possible since computer-deliveryrequires
exact-ing statements of objectives and performance points. Inaddition,
information can beeasily
added or updated in a relatively shortperiod
of time.F. Physicians would save much time travel-ing to meetings and seminars.
The ultimate benefit in CME delivered in a computer-based format, as one might hope, is improved patient care. However, computer-based delivery can also offer the additional benefits of availability of large data bases, patient
profiles
and case studies, and inter-terminalinformation
exchange. In short, using a large networking system can allow health care profes-sionals at many levels to access a wide variety ofinformation
and data quickly and accurately. 1.2 Improved InstructionalDelivery
At present the most common mode of instruc-tion which is found in medical schools and continuing medical education is lecture. This traditional form of instruction is
adequate
for mostall
situations except when it is difficult to locate well qualified experts who are both extremely knowledgeable and proficient at lectur-ing. Where such a shortfall exists the computer can provide self-paced instruction which is highly interactive and which provides learners with a variety of applications of the knowledge they want to acquire. The computer can alsoprovide
a wide range of advantages over the lecture mode byA. Presenting simulations and case studies which
require
problem-solving, decision-making and general applications of the concepts under study.B. Offering detailed graphics, some anima-tion capability, and, more recently, color presentations. Computer-generated graphics, charts, scatter plots, and
illustrations
are currently adding significantly tocomputer-based
presentations
of course material.C. Interfacing with other delivery systems such as slide projectors, audio
equipment,
video tape and video disk.D. Interfacing with various types of labora-tory
equipment
for instruction indiagnosis,
monitoring, and data base management.E. Generating testing and
practice
materials from on-line item pools which can aiddrilling
or testing one'sunderstanding
of material.When computers can be interfaced with a variety of equipment and be made to use a wide range of
teaching
strategies,
the result isusually
increasedunderstanding
and very often savings in both the time of instruction and its overall cost.Section
2 of this paper will deal more specifically with some of theunique
applica-tions of computer
technology
to situations which use many of the features listed above.A further feature of the computer which im-proves the instructional process is its
ability
to measure and monitor learner achievement. By specifying periodic performance points within each instructional sequence, the computer can diagnose each learner's level of competency and monitor his/her progress toward content mastery.
In this way, each learner is guided along an instructional route appropriate to his or her level of understanding. In addition, mastery can almost be assured because of review sequences, variable path branching, and performance checks. In medical school education this is not a trivial feature. In many classes mean scores on exam-inations often range from 50-70 per cent mastery. Individualized instruction on an interactive, self-paced computer system can improve these mean scores considerably.
1.3 Increased Efficiency and Cost-effectiveness It is only fair to recognize that sophisti-cated computer systems capable of delivering the type of instruction cited thus far are expensive. Complex networking systems can cost well over
$1,000
per terminal per month. These costs, however, must be put in their proper perspective and factored into the amount of use they receive, how many individuals they serve, savings in personnel or travel time and a host of other considerations before they are dis-missed as costly fads.To date, few people have been able to calculate exact cost-benefit data when using computers as an instructional delivery system even though numerous studies have shown im-proved achievement, savings in time at instruc-tion, and cost reductions in personnel utili-zation . The reason for this is that many of the savings to be found in computer-based instruction are difficult to quantify and measure accurately. For example, how much does it cost to take individuals away from their jobs for hospital inservice? How much time is required for a technician to learn how to use a new
piece
of laboratoryequipment?
How much time is wasted searching for a qualified pro-fessional to deliver a lecture? How much is lost when the lecturer takes time to prepare and deliver that lecture? These are difficult questions but they imply numerous factors which can influence the true costs ofconducting
training.The costs of computer-based education, there-fore, cannot be based
entirely
on how much it costs to develop instructional materials or the cost of a terminal ormicrocomputer.
These costs must be amoritizedagainst
the real costs ofconducting training
in traditional ways. Certainly, more research is needed in this area before computer-based instruction is dismissed as an expensive adjunct to medical education.2. APPLICATIONS OF COMPUTER TECHNOLOGY TO
HEALTH
CARETRAINJING
The applications of computer technology to medical and allied health education are many and
varied. Obviously, in a paper of this
length
all of those applications cannot be cited. What follows, therefore, is several examples which represent some of the ways computers are being used in the field of health care training. These examples have been grouped to illustrate how the various capabilities of the computer are being used to improve instruction.2.1 Graphics
Because of the highly illustrative nature of much of what is presented in traditional medical and allied health education, the graphic capa-bilities of the computer offer enormous possi-bilities for instruction and research. The graphic, animation, and color features offered by many computers allow complex graphs to be drawn, detailed cross sections of organs and molecules to be displayed and even animated, and multicolored illustrations to be presented on a monitor. Learners can respond to questions presented about these graphics and watch the computer modify them as a result of those responses.
At the University of California, San Fran-cisco, for example, computers are being used to simulate various molecular fusions. By color-coding each molecule, researchers can study bonding thus saving valuable time in pharmaceuti-cal research. Computer color display is also playing an increasingly important role in research with tomography and variety of other photographic processes.
2.2 Utilization of Data Bases
At present the utilization of data bases is certainly one of the most common uses of compu-ters in medical education. At the University of Texas Health Science Center at Dallas, for example, data based instruction is a common element in the education of health care profes-sionals. The following serve as examples which are fairly typical of the way in which computers are used in many institutions:
A. SCARS
The Surgical Coding, Reporting and Retrieval System is a data base used in the Department of Surgery. It processes about 6,000 surgery cases annually for the purpose of establishing a record of the most common surgical procedures used in various types of operations. In prepar-ing for surgery, surgeons can consult this data base on procedures, anesthesia, recovery rates, and a variety of other factors.
Following
surgery, the surgeon can add to the data base so that others might share in theexperience
of that surgical operation.B. Biochemistry Item Pool
Over 5,000 test items in the area of bio-chemistry have been compiled and stored in the
University's DECsystem-10 for use in reviewing for biochemistry examinations. The DECsystem-10 supports over 125 terminals simultaneously; these are usually in full use prior to an examination. Students may review as many items as they wish and receive a hard-copy print out of the items they answer incorrectly. This data base has been extremely popular among students and is well used. A similar data base is currently being estab-lished by the Department of Nutrition and Dietet-ics.
2.3 Equipment Interface
Another common use of computers in health care has been to interface computer systems with various types of existing and new equipment. For instructional purposes computers are being used to control slide projectors, 16mm film projectors, video tape and video disk units. In most in-stances, the computer allows random access to these other media with the exception of the 16mm film projector. The range of possibilities for interfacing both media systems and medical equipment is almost endless:
A. A dental education program at the University of Iowa uses the plasma display PLATO terminal to rear-project slides on the terminal screen. Computer generated text can then be superimposed on these visuals. This allows random access of the slides as well as the presentation of textual material. This technique has also been used in a burn care simulation at
Iowa.
B. Successful experiments in the use of video tape and video disk under computer control are being tried at a number of medical schools. Video disk particularly adds a new dimension to
individualizing
instruction in a computer-based mode. Learners may access taped or filmed segments immediately or they can bepresented
over and over for review
instantaneously.
Students may view surgicalprocedures
from a variety ofangles
if they are recorded on the disk. In short, thepotential
of this medium interfaced with the computer is almost unlimited.C. Computers linked to various
diagnostic
and laboratoryequipment
is now commonplace in most hospitals. Therapid
development of many new fields such as nuclear medicine would be severelyhandicapped
without the use of computer-controlledequipment.
Some researchers are also trying to link somecommonplace equipment
with microcomputers. A researcher in Montana, for example, hasdeveloped
an interface that will allow anApple
computer to monitor aspirometer.
The computer compares parameters to formulas for
predicted
means,prints
the actual and per cent predicted results and stores them in a data base for later use.As computer systems become less
expensive
and morecomplex
and as healthprofessionals
become moresophisticated
in their use, theapplications
of computers to a variety of equipment will burgeon.
2.4 Computer Based Education
Computers have been used to deliver health care education since the medium was first used for instruction. It has not been until recently, however, that courses have been developed for use in
large-scale
networking systems. The Control Data Corporation is one company that has invested hundreds of thousands of dollars in educational materials for delivery over their PLATO system. These materials cover a broad range of topics and are intended for continuing medical education. TheMiliken
Publishing Company also offers limited medical courseware for delivery on the Apply II microcomputer. Milliken calls their courseware computer-based "seminars" and can be used for Category One credit. Seminars are offered in surgery, medicine, psychiatry, and urology.Most of the courseware used to deliver computer-based medical education is currently offered "in-house," that is, it was developed at the institution at which it is used and gets little use outside of that environment. Research is needed to identify these various courses and catalog them for use by other professionals.
3. FUTURE APPLICATIONS
The future applications of computers to medicine and health care depends heavily on fur-thur developments in computer technology. How-ever, current
applications
and research promises many new and exciting developments in the very near future. The following are some recent pro-jects which give some indication of the direction computerapplications will
take:A. "Spectracs" Programmable Pacemaker - This
device, as the name implies, is a pacemaker which can be
programmed,
but it is done after the pace-maker has been implanted. The obvious advantage in this device is that constant adjustment can be made in the pacemaker without surgery. This is ofparticular
benefit to small children who must havepacemakers
replaced asthey
grow older.B. Interactive Television - Interactive
television operates from a video disk unit that is under microcomputer control. An event is recorded on the video disk
by
many different camerasmaking
itpossible
to later view the event at the angle of the viewers choice. The viewer then hasoptions
ofseeing
aprocedure
or event from the top, side back or from whicheverangle
has been recorded.EC.
Digicasting
-Digicasting
is a newtechnique for
actually
broadcasting
digitized
data over airways in the same manner that tele-visionsignals
are transmitted. This eliminates expensive terminalcharges,
phone
lineconnections
and delays. Thesesignals
can also be trans-mitted via satellite to most parts of the world.In sunmmary, the applications of computer technology to all phases of medicine and health care are unlimited. We must, however, continue research into the most advantageous use
of these new technologies and begin to train health care professionals in the operation and use of computer systems of all types. The result can only be improved medical and health care in the future.
REFERENCES
1. Greenburg, A. G., Bruegel, R. and Peskin, G. W. "Surgical Continuing Medical Education: Format and Impact,"
Surgery, Vol. 81, No. 6, June 1977, 708. 2. Caldwell, R. M. "Evaluation of a program of
Computer-assisted Reading Instruction for Semi-literate Adults." Paper presented at the American Educational Research Association Annual Meeting. Chicago, March 1974.
3. Levin, S. "Inter.active Movies," paper presented at the American Educational Research Association Annual Meeting, Boston, 1980.