TY - JOUR
AU1 - Hartmann, Aubrey C.
AU2 - Cruz, Jr, Ponciano D.
AB - ObjectivesTo develop interactive teaching mechanisms for an "Introduction to Dermatology" course for medical students and to compare the effectiveness and impact of these mechanisms on learning.DesignSurvey and before-after trial.SettingMedical school.ParticipantsSecond-year medical students (approximately 200 per year).Main Outcome MeasuresThe teaching mechanisms were evaluated through responses to questionnaire-based course evaluations (survey). The impact of the CD-ROM program was assessed by performance in Kodachrome slide–based multiple choice examinations (before-after trial).ResultsOverall the course was highly rated and among its components, the live-patient sessions, the CD-ROM program, and the poster exhibit were rated most effective. There was no difference in the examination performance of students who took the course before and after inclusion of the CD-ROM program. High-scoring students attended a significantly greater number of lectures in comparison with low-scoring students.ConclusionsThe 3 teaching mechanisms judged by students to be most effective were also the most visual and interactive, suggesting that these attributes are critical to learning dermatology. On the other hand, addition of the CD-ROM program failed to produce differential improvement in short-term cognitive skills.A CHALLENGE in medical education is effective teaching of highly visual specialties like dermatology within restricted time frames available in medical school curricula.At The University of Texas Southwestern Medical Center in Dallas we have developed an introductory course for second-year medical students (200 per year) that integrates clinical dermatology and dermatopathology, and combines didactic lectures and a syllabus with interactive components, including preceptor-led live-patient sessions and a poster exhibit and contest. Recently a CD-ROM program was added, allowing a before-after evaluation of its impact on acquisition of cognitive skills.METHODSThe didactic lectures consisted of 12 topics (Table 1). Faculty members were instructed to emphasize an approach to the differential diagnosis, using common or important skin diseases depicted by representative cases on Kodachrome slides.Table 1. Topics Covered in LecturesSee table graphicA syllabus consisting of 100 pages of text and diagrams provided 3 to 5 learning objectives per topic and an outline of the lectures.Preceptor-led live-patient sessions provided hands-on exposure to patients with skin diseases. These sessions were conducted in small groups consisting of a faculty member or senior resident and 6 to 8 students who spent 2 hours per session examining 5 to 6 patients with common or important skin diseases that exemplified the major differential categories (eg, psoriasis for scaling disorders, pemphigus for blistering disorders, vitiligo for pigmentary disorders, basal cell carcinoma for skin cancer, or alopecia areata for hair disorders). Visual recognition, terminology, and differential diagnosis were emphasized. The same set of patients were presented to the different groups.The poster exhibit and contest consisted of 35 cases, each composed of paired clinical and histological images with corresponding descriptions that underscored important terminology (ie, buzz words). The exhibit was available to the students for the entire duration of the course, typically 2 weeks. Students were required to supply the diagnoses through a contest that permitted collaboration among students and interaction with faculty and residents. The cases were discussed during the final lecture. A book award was given to the student(s) who submitted the most number of correct diagnoses.The CD-ROM program was composed of digital reproductions of the Kodachrome slide images presented in the lectures accompanied by selected text from the syllabus. We took advantage of the computer program's ability to incorporate interactive labels to refine, highlight, or magnify parts of the images. The program contained 3 templates (main menu, table of contents, and image template) that were created using Supercard software (Allegiant Technologies, San Diego, Calif) (Figure 1). The main menu template displayed the lecture topics, allowing the user to make selections and to move in and out of topics. Within each topic, a table of contents template provided a list of subtopics, each containing various screen entrees organized into image templates with corresponding images, text, and labels.Figure 1.A stepwise illustration of usage of the CD-ROM program, with blistering disorders and pemphigus serving as examples of the topic and subtopic templates, respectively.We employed a commercial company (The Color Place, Dallas) to convert images on Kodachrome slides into digital format ($1.25 per slide). Prior to inclusion into the templates, the digital images were edited using Adobe Photoshop 3.0 software (Adobe, San Jose, Calif). Text and interactive labels were added to their respective fields using SuperEdit 1.7 software (Binari Sonori, Milan, Italy). The CD-ROM program currently runs exclusively on a Macintosh system (4 MB RAM/16MB virtual, 256 color monitor, Apple Computer, Cupertino, Calif) and contains 700 images (maximum size, 250 × 350 pixels; resolution, 72 pixels/in). Efforts are underway to also run the program on a personal computer.A 30-item Kodachrome slide and multiple choice examination served as the objective outcome measure for information acquired from the course. The examination tested the ability to (1) recognize common or important skin diseases, (2) use appropriate terminology, and (3) identify the appropriate initial step in management. A feedback session was held immediately following the examination to discuss preferred responses.Finally, students completed a questionnaire-based course evaluation at the end of the Kodachrome slide examination, the results of which served as subjective outcome measures for the different teaching mechanisms.Statistical analyses were performed using the Student ttest. Differences were considered significant when P<.05.RESULTS AND COMMENTSRecognizing the importance of pattern recognitionas a key process in effectively diagnosing skin diseases, we sought to maximize exposure to visual evidence. In negotiations prior to implementation of the course, we insisted that the majority of the allotted time be dedicated to viewing and discussing live cases in preceptor-led small group sessions (total, 12 hours). Faculty members were encouraged to include as many Kodachrome slides as was possible in their lectures (total, 9 hours). The poster exhibit and contest served an additional visual resource that was freestanding and an opportunity for interactive discussion. Finally, the 30-item multiple choice examination (1 hour) was based on visual evidence presented in Kodachrome slides.Although annual feedback from questionnaire-based evaluations consistently documented overall satisfaction with the course, there also had been a considerable number of requests for even greater access to visual images of skin diseases. To address this need, the CD-ROM program was developed and added to the course in the last 2 years. Computer-based programs offer several advantages over conventional teaching mechanisms. Such programs can incorporate high-quality images into a customized resource. They can be accessed conveniently through online networks on campus or through telephone service in students' homes, thereby allowing self-paced interactive instruction. They also can be modified readily to adapt to changes in the course.Finally, computer-based programs might even substitute for didactic lectures, allowing sessions presided by faculty to be more interactive (ie, question-and-answer sessions or panel discussions).In the most recent questionnaire evaluation, 70% of the students rated the course as very good to excellent. Among the teaching mechanisms, the 3 most interactive components, namely the live-patient sessions, the CD-ROM program, and the poster exhibit (in decreasing order) generated the highest ratings with respect to content and quality, enhancement of visual recognition of skin disease, and help in comprehending the material (Figure 2). The popularity of the live-patient sessions led us to request expansion of this venue from 1 to 2 sessions per student, the first to be held early in the course with a focus on proper use of terminology and the second to be scheduled as currently implemented toward the end of the course with a focus on making a diagnosis.Figure 2.Comparative ratings of the effectiveness of the different course components, as judged by responses to 3 stems expressed as percentages for each course component.We had feared that the CD-ROM program would reduce students' presence at lectures. This was proved baseless, since attendance remained high; close to 75% of students went to at least 60% of the lectures (Figure 3). Postulating that the CD-ROM program would increase students' cognitive skills, we compared the performance of successive classes in the Kodachrome slide examinations (Table 2). The computer program had little effect on this outcome measure, since there was no significant difference in the mean scores or in the range of scores of classes that took the course before and after inclusion of the program. Because this may reflect the course's high level of effectiveness even in the absence of the CD-ROM program, we wanted to compare performance of students taught by the CD-ROM program alone with that of a parallel group taught by lectures or live-patient sessions. Conducting this study on our medical students was not feasible because the CD-ROM program is accessible to everyone on the university network and because of keen competition for grades inherent in medical school. However, we have initiated such a study among physician assistant students. It is also possible that the impact of the CD-ROM program is exerted more decisively on long-term cognitive ability. To assess this issue, we will evaluate medical students' retention of information at more distal time points (eg, third- and fourth-year rotations in dermatology).Figure 3.Attendance at lectures by the entire class and by the highest- and lowest-scoring quartiles, expressed as percentages of the cohort population (n).Table 2. Performance in Kodachrome Slide-Based Multiple-Choice ExaminationsSee table graphicFinally, we compared the evaluation responses of high-scoring students (>75th percentile; n = 50) with those of low-scoring students (<25th percentile; n = 50). There were no significant differences between these 2 student groups (data not shown) except in the pattern of attendance at lectures (Figure 3): 62% of the former group attended at least 75% of the lectures, whereas only 33% of the latter group did so (P<.05). Although this difference most likely reflects the thoroughness in the study approach of the high-performing students, it also suggests that our current method of evaluating students may be biased toward learning dependent on conventional teaching mechanisms (ie, lectures). In this context, we are exploring the use of interactive and computer-based examinations in future courses.JHooperJO'ConnorRCheesmarLearning clinical biochemistry using multimedia interactive clinical cases.Clin Chim Acta.1996;248:119-123.GRegehrJClineGRNormanLBrooksEffect of processing strategy on diagnostic skill in dermatology.Acad Med.1994;69:S34-S36.ACLapeyreThe world-wide Web is already changing medical education.Acad Med.1997;72:563-564.Accepted for publication November 14, 1997.We are grateful to Herbert Hagler, PhD, for use of his computer facilities and for help in developing the CD-ROM program. We also thank the clinical faculty and the residency staff of the Department of Dermatology at The University of Texas Southwestern for implementing the course.Corresponding author: Ponciano D. Cruz, Jr, MD, Department of Dermatology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235-9069 (e-mail: pcruz@mednet.swmed.edu)
TI - Interactive Mechanisms for Teaching Dermatology to Medical Students
JF - JAMA Dermatology
DO - 10.1001/archderm.134.6.725
DA - 1998-06-01
UR - https://www.deepdyve.com/lp/american-medical-association/interactive-mechanisms-for-teaching-dermatology-to-medical-students-PLLVNv4DiS
SP - 725
EP - 728
VL - 134
IS - 6
DP - DeepDyve
ER -