1. Family Medicine Online Penn State College of Medicine Shou Ling Leong, MD Department of Family and Community Medicine Penn State College of Medicine

2. Family Medicine Clerkship Community-based ambulatory clerkship with multiple sites Relies heavily on teaching at the bedside Sequential series of lectures are logistically impossible to deliver to students Great variation of educational experiences from student to student

3. Advantages of Web-based Computer Bases Help standardize clinical experiences across teaching sites –deliver educational materials to students across temporal and geographical barriers ; l earning can be provided anywhere, anytime Provide self-directed, independent study Learning can be individualized Content can be updated instantly to reflect current knowledge Have the potential to reduce the teaching load of community preceptors

4. Hypothesis Web-based interactive computer cases have the potential to fill gaps and address educational needs in ambulatory clerkships.

5. Goals Computer cases are effective educational tools that can be successfully integrated into an existing clerkship. Computer cases can help student gain knowledge Leong SL, Baldwin CD, Adelman AM. Integrating web-based computer cases into a required clerkship, Acad Med, 2003;78:295-301

6. Penn State COM Project started 1995 Web-based interactive computer cases were developed to teach common problems Students were offered option of completing computer cases or a written assignment

7. Computer cases Developed using Microsoft Front Page Self-guided tutorials simulate clinical encounters Unfold gradually allowing students to think through the problem A series of questions and answers interjected throughout the case Instant feedback given as “faculty comments” after the students had answered the question

10. Three-year Evaluation Two computer cases on low back pain/ kidney stone and pneumonia were developed. Sixteen questions on these cases were included in clerkship's final exam (100 questions). For the clerkship assignment, students could choose to complete the two computer cases or a written exercise on unrelated topics. The number of students choosing the computer cases was tracked. Students’ ratings of these cases were analyzed

11. Participant Groups Included all students in the family medicine clerkship over 3 years (n=325) Students assigned to groups for evaluation based on the assignment they turned in: –C1+C2: completed the 2 computer cases on low back pain and pneumonia –Other than C1+C2: completed other computer cases –No computer cases: prepared a written assignment on unrelated topics

12. Exam Questions 16 questions on pneumonia, low back pain, and kidney stones were included in a 100-question exam (CC=computer case related) 84 questions covered common medical problems in family practice (NCC= unrelated to the computer case) We expect the scores between groups on the CC questions to show the educational effect of the 2 computer cases on student performance on these questions

13. Comparison of Test Scores for Students Who Did or Did Not Complete Computer Cases 1997-2000

14. Comparison of Test Scores of Students Who Took Their Internal Medicine (IM) Clerkship First and Students Who Took Their Family and Community Medicine (FM) Clerkship First

15. CONCLUSIONS AND IMPLICATIONS Computer cases are effective educational tools that can be successfully integrated into an existing clerkship. Completing computer cases on common medical problems improved students’ performance on exam questions covering the same topics, implying that they are useful in imparting knowledge.

16. CONCLUSIONS AND IMPLICATIONS Web-based computer cases can deliver learning material to all students, adding consistency to a highly diverse educational experience of ambulatory clerkships. Working on computer cases requires students to learn and seek information on their own, fostering independent learning.

18. CONCLUSIONS AND IMPLICATIONS Web-based computer cases were well received by students, with 86% choosing it as their assignment and received an overall rating of 6 (scale of 1 to 7). 14 students went on to become case writers with faculty supervision. They reported that writing further expanded their knowledge of the subject area.

19. Would Students Use Cases? 325 students took the FM clerkship 154 completed C1+C2 computer cases 110 completed other computer cases 61 (18.8%) chose the written exercise The percentage of students who chose the computer cases increased steadily: –76% in 1998 –89% in 1999 –94% in 2000

20. How did students assess the cases as learning tools? 276 students answered the question “the computer cases were educational” (7=strongly agree) –92% gave a rating of 4 or higher, average=6 Online survey: –educational and appropriately challenging