Education Informatics

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Education Informatics

• Christopher Cimino, M.D.
• Office of Computer Based Education
• Albert Einstein College of Medicine

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How does education occur?

• How do we teach?
• What do we teach?
• What is the educational environment?

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How do we teach?
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How does teaching occur?

• Who is the student?
• Who is the teacher?
• What is the role of discovery?

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Where does teaching occur?

• Lecture vs. small group vs. one-on-one
• Self study vs. tutoring
• Examinations as learning tools

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What passes between teacher student

• Communicating knowledge
• Assessing understanding and aptitude
• Changing the student's behavior
• Training skills
• Student as teacher (Dialogue)

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Benefits of Integrated Education

• Benefits to students
• Benefits to faculty
• Benefits to the institution

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Obstacles to Integrated Education

• Assigning "credit"
• Logistical problems
• Faculty development

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Results
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Logistic Obstacles
Pathology
Neurology
Pharmacology
Nervous System Human Behavior
Neuroscience
Psychiatry
Radiology
Informatics
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Where does technology fit in?

• Rely on analogies between old technology and new
• Books, VCR, Slide projectors
• Examine the points of failure of the analogies
  and leverage strengths
• Computer Aided Instruction, WWW, Distance
  Learning, Courseware

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Educational Technologies

• CD-ROM or Web Books
• Palm Computing
• Portals
• Courseware
• Meta-courseware (WebCT, Blackboard)
• Multimedia projectors
• E-mail, Newsgroups, Chat-rooms

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Example Computer as a fancy book

• Strengths Assessment, Graphics, Simulations,
  Item banks
• Weaknesses Role-modeling, Dialogue, One-on-one
  economics
• Emphasis on "self" study and "self" assessment

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Example WWW as a communication tool

• Strengths Communication, Assessment, Work Flow
• Weaknesses Role-modeling, Dialogue
• Group collaboration exercises, group feedback,
  asynchronous communication

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Where does technology fit in?

• Identify the teaching strategy first
• Match the technology to the teaching strategy

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Example Problem-based teachingTechnology
Strengths

• Asynchronous communication
• Work Flow
• Graphics
• Reference sources

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Example Systems approach ThemesTechnology
Strengths

• Asynchronous learning
• Curriculum management
• Individualized views

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What do we teach?
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Curriculum Content

• Mission
• Needs
• Goals
• Objectives
• Solutions
• Evaluation

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Needs and Objectives
Need
Goal
Objective
Method
Deficiency
Evaluation
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Curriculum Content

• Mission
• Needs
• Goals
• Objectives
• Solutions
• Evaluation

• Skills
• Knowledge
• Attitudes

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Medical Informatics Objectives

• AAMC MSOP Project
• Nursing Informatics Objectives
• IMIA WG 1
• Other sources of Informatics Objectives

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IMIA Informatics Objectives

• Domain
• Medicine, Nursing, Comp. Sci., etc.
• Specialty
• IT User vs. IT specialist
• Career Progression
• Bachelor, Master, Doctorate

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IMIA Informatics Objectives

• Methodology
• Knowledge -
• Organization
• Informatics

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IMIA Informatics Objectives

• Methodology
• Knowledge - Need, efficient use, HIS
  characteristics, etc.
• Skill - Communication, literacy, coding
• Medicine, Biology, and Organization
• Knowledge - Normal/abnormal processes, Health
  delivery
• Skill - Diagnostic and therapeutic choices
• Informatics
• Knowledge - Terminologies
• Skills - Spreadsheet, word processing,
  communication

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IMIA Informatics Objectives

• Knowledge and Skill topics are described across
  all disciplines
• Depth of knowledge is described based on
  Specialty
• Number of course hours is described based on
  career progression

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Institutional Problem Solving
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Teaching and assessing knowledge

• Intellectual property law as an example
• Putting teaching into practice
• Putting assessment into practice

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Teaching and assessing skills

• Doing a MEDLINE search as an example
• Putting teaching into practice
• Putting assessment into practice

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Teaching and assessing attitudes

• Regard for patient privacy as an example
• Putting teaching into practice
• Putting assessment into practice

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Educational technology revisited

• Intellectual property law " as an example
• Doing a MEDLINE search" as an example
• Regard for patient privacy" as an example

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Education Informatics

• Technology as a teaching tool
• Infrastructure needed to teach skills
• Role models needed for teaching attitude
• Integration into work-flow needed to develop role
  models
• Is knowledge necessary?

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Curriculum Content

• Mission
• Needs
• Goals
• Objectives
• Solutions
• Evaluation

• Skills
• Knowledge
• Attitudes
• Student Evaluation
• Program Evaluation

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Evaluation of educational technology

• Education success as measured by science
• Why success is harder to measure in medical
  education
• Alternate measures of success

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Cost

• Intellectual property law as an example
• Doing a MEDLINE search as an example
• Regard for patient privacy as an example

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Cost of educational technology

• Why cost data is difficult to pin down
• Silly accounting tricks
• Real cost saving tricks

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Evaluation Problems

• Conventional vs unconventional interventions
• Unequal vs. limited interventions
• Control group contamination
• Unequal baseline of groups over time
• Unmotivated students

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Evaluation Alternatives

• Compare different technology alternatives to each
  other
• Evaluate how students interact with the
  technology
• Focus on evaluating behavior outcomes

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Looking at the environment
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What kind of institution are you at?

• School owns the clinical site
• Clinical site owns the school
• School and Clinical site are 50/50
• School is independent
• To a lesser degree, research relation creates
  similar tensions

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Setting determines stakeholders

• Who determines educational approach?
• Who determines educational content?
• Who supports technology?

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Instigating Change

• Innovation
• Splash and publicity, attracts support
• Spark enthusiasm but protect resources
• Long term growth
• Mundane interventions have long lives
• Invisible, ubiquitous
• Incremental interventions
• Invest heavily in those willing but cautious

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Instigating Change

• Make use of power of iteration
• One mundane success times many courses
• A simple tool times many faculty
• Conserve support effort
• Adequate commercial software is better than great
  home grown software (for the long hall)

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Instigating Change

• Shape user expectations to be reasonable
• Early failure is inevitable
• Prepare the willing but cautious
• Leverage unreasonable expectations
• Overload failure is inevitable after success
• Build dependency then ask for support
• Let users fight the support battles

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Instigating Change

• Technology is only a tool for teaching
• Technology is only a tool for winning support for
  teaching
• Ties between promotion and computer based
  education
• Internal grants for innovations in education
• Computer support (e-mail, equipment, help-line)
  for educators

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Instigating Change

• Change ultimately follows the lead of the leaders
  (i.e. Dean, Chairman)
• Change is nurtured by consensus of the faculty
  (progress by committee!)
• Those dragging their heals will bow to peer,
  student pressure, and applicant pressure or they
  will eventually move on

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Institutional Problem Solving
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Problems

• Need seed money
• Need leadership
• Need support staff
• Need faculty development
• Need more money

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Technology and Education

• Technology is a means, not an end
• But teaching about technology IS an end
• People change is harder than technology changing
• Institution change is harder than people change

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Selected References

• Freidman, C. P. (1994). The Research We Should Be
  Doing. Academic Medicine, 69(6), 455-456.
• Eriksson, H. (1992). Quality assessment of
  medical research and education. International
  Journal of Technology Assessment in Health Care,
  8(3), 479-489.
• Seidel, R. J., Perez, R. S. (1994). An
  Evaluation Model for Investigating the Impact of
  Innovative Educational Technology. In H. F.
  O'Neil, Jr. E. L. Baker (Eds.), Technology
  Assesment In Software Applications (pp. 177-212).
  Hillsdale, NJ Lawernce Erlbaum Associates.
• IMIA Working Group 1 Objectives
  http//www.imia.org/ OR http//www.rzuser.uni-hei
  delberg.de/d16/rec.htm
• Medical Informatics and Population Health Report
  II of the Medical School Objectives Project. Acad
  Med 1999 Feb74(2)130-41 or http//www.aamc.org/m
  eded/msop/informat.htm
• Weiner BJ, Culbertson R, Jones RF, and Dickler R.
  Organizational Models for Medical SchoolClinical
  Enterprise Relationships. Acad Med 2001 76
  113-124.
• Kneebone R. Evaluating clinical simulations for
  learning procedural skills a theory-based
  approach. Academic Medicine. 80(6)549-53, 2005.