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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 75235

ABSTRACT 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 delivering

high-quality,

inter-active instruction in a

variety

of

subjects

and locations. As we enter a new decade,

improvements

in computer technology and the introduction of inexpensive microcomputers adds considerable

potential

for promoting learning, for

managing

instruction and data, and for interfacing labora-tory and diagnostic equipment. Given this potential, then, we must turn now to

finding

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 from

applying

computers to medical and allied health education,

2).

cite

examples

of unique applications currently available in the health professions, and

3).

discuss future

possibilities

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 Education

Evidence 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 supporting

patient

care advocate an increase in the availa-bility of new information and procedures to physicians and health care

professionals1.

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 extensive

continuing

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

or

wherever space can be found. Also, it is often difficult to find

qualified

professionals

who can

devote time to continuing education.

B. Physicians in rural areas or in remote locations have a difficult time

attending

continuing education

seminars without

large

expenditures

of time and money.

Many

find it difficult to

leave

large

patient loads for the several days required to travel to a large

city

for seminars.

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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 sufficient

quantities 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 the

location

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 be

easily

accessed from the computer records file. A system of this type would enable medical educators to

certify

physicians

on the basis of competency rather than attendance, a feature which

might

have its advantages in

malpractice

cases.

D. The computer courseware delivered on the network could provide a more common

learning

experience

for all

physicians

and

provide

more

opportunities

for

sharing

information with

physicians

who rarely have an

opportunity

to

gain

access to the latest medical research. This information could be constantly

updated

and accessed any time.

E. More

planning

and research into the development of courses and seminars would be possible since computer-delivery

requires

exact-ing statements of objectives and performance points. In

addition,

information can be

easily

added or updated in a relatively short

period

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-terminal

information

exchange. In short, using a large networking system can allow health care profes-sionals at many levels to access a wide variety of

information

and data quickly and accurately. 1.2 Improved Instructional

Delivery

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 most

all

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 also

provide

a wide range of advantages over the lecture mode by

A. 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 to

computer-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 in

diagnosis,

monitoring, and data base management.

E. Generating testing and

practice

materials from on-line item pools which can aid

drilling

or testing one's

understanding

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 is

usually

increased

understanding

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 the

unique

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

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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 laboratory

equipment?

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 of

conducting

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 or

microcomputer.

These costs must be amoritized

against

the real costs of

conducting 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

CARE

TRAINJING

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 the

experience

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

(4)

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 be

presented

over and over for review

instantaneously.

Students may view surgical

procedures

from a variety of

angles

if they are recorded on the disk. In short, the

potential

of this medium interfaced with the computer is almost unlimited.

C. Computers linked to various

diagnostic

and laboratory

equipment

is now commonplace in most hospitals. The

rapid

development of many new fields such as nuclear medicine would be severely

handicapped

without the use of

computer-controlled

equipment.

Some researchers are also trying to link some

commonplace equipment

with microcomputers. A researcher in Montana, for example, has

developed

an interface that will allow an

Apple

computer to monitor a

spirometer.

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 more

complex

and as health

professionals

become more

sophisticated

in their use, the

applications

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. The

Miliken

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 computer

applications 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 of

particular

benefit to small children who must have

pacemakers

replaced as

they

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 cameras

making

it

possible

to later view the event at the angle of the viewers choice. The viewer then has

options

of

seeing

a

procedure

or event from the top, side back or from whichever

angle

has been recorded.E

C.

Digicasting

-

Digicasting

is a new

technique for

actually

broadcasting

digitized

data over airways in the same manner that tele-vision

signals

are transmitted. This eliminates expensive terminal

charges,

phone

line

connections

and delays. These

signals

can also be trans-mitted via satellite to most parts of the world.

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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.

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