3-22-01

The remainder of the meeting was devoted to Dr. Tom Nosek’s update on Bioinformatics Initiatives in Medical Education.  Dr. Nosek provided online demonstrations throughout his entire presentation in the E401 lecture hall.  Due to the extensive nature of the presentation, there was not sufficient time to cover all the material.  Dr. Nosek will conclude his update at the April 12 CME meeting.

Delphi study’s prediction for the future of health care and medical education by 2010:

• A highly integrated national core curriculum will be available through the Internet and in use at accredited medical schools.

• All procedural skills will be taught first on a digital simulator.

• All schools will tailor the mix of online and in-person instruction to suit the individual student’s psychological and intellectual predispositions to learning.

• Academic Informatics will be integrated in teaching, research, and medical practice.

Vision of the integrated electronic curriculum:  As the first step, the learning objectives (what the student is expected to be able to do) direct students to the electronic syllabus, which prepares students for faculty/student interaction, which is assessed via evaluations and exams, and, hopefully, culminates in student mastery of the material.

Dr. Nosek accessed the electronic curriculum home page.

Electronic resources are on the WWW for students and faculty.  Faculty are encouraged to use links to their teaching.  Dr. Nosek used specific electronic sites for two professors, pointing out learning objectives and resources to be used to achieve them (such as original text, multiple color illustrations, and specific electronic articles to be reviewed along with lectures prior to small group meetings).  Faced with numerous copyright abuses of print material by many faculty, Dr. Nosek encourages using the material we have access to on the Internet.

Enhancements are available for faculty to use in their teaching.  The School of Medicine collaborates with the Cleveland Institute of Art-sponsored program run by David Aldrich.  David Aldrich matches up one of his students with a CWRU faculty member for the purpose of enhancing the electronic curriculum with multimedia resources.  Dr. Nosek showed examples of video, slide collections (putting all slides together and making them available online at anytime), PowerPoint presentations (able to be customized at the last minute, PowerPoint presentations can be linked up to the appropriate lecture in the electronic curriculum once the faculty member gives the Office of Biomedical Information Technologies his/her file), animations, three-D reconstructions, and sound files.  Dr. Nosek reiterated that the technology is there; the only limitation is the faculty.

Dr. Nosek’s BIT office has spent three years developing the electronic exam system.  Ms. Irene Medvedev created the system.  The exam has been administered over 800 times with only 4 failures.  Dr. Nosek feels confident that at present it is operating well.  We are not yet ready to expand it to the entire class.  The main problem/financial drain is making sure that exams taken on the student’s computer are secure.  Dr. Nosek is targeting fall 2001 as the time to initiate whole-class electronic exams for both Years I and II.  He felt that Dr. Hopfer’s succession of whole-class online quizzes, which were not secure and thereby eliminated the security problem, afforded a good test of the system.  Online interims are currently offered as an option.  From two to 11 (allowing for a maximum of 20) students currently use the online option via the computers in room E324.

Dr. Nosek demonstrated the streamlining advantages of online exams through the following steps:  Begin with the Question Database, which combines all the questions from many files, proceed to the Exam Delivery, which allows for both paper and online versions, which at this point are identical, continue to Grading (which allows for immediate flagging of questions, analysis, and distribution of grades) that allows for both Question Database Update and Student Database Update, and end with Student Notification.

Brief discussion of online examinations followed.  Caution was advised in notification of student identification.  If faculty are present for an exam, they should look at the analysis before they leave.  One discussant suggested a means of further streamlining—have the subject committee chair—not the author of the question—determine its validity.  Faculty can delete the questions they want themselves; they just have to learn how to use the technology.

The new grading system has been tested successfully for the last five online interim exams.  It will be ready for implementation in fall 2001.  While it ensures quick grading, it allows you to decide when you want to report grades to the students.

Dr. Nosek walked us through a mock exam.  Students boot off a floppy disk and CD-ROM.  Students cannot “screen capture” or send the exam anywhere, because their machine will lock.  Two passwords are required:  the first, so that only our registered students can log in, and the second, a unique password tailored to each exam.  On the left of the screen is a navigation menu.  On the right is the question with any color illustration or desired multimedia feature.  Students can indicate where they are unsure of an answer and wish to return to specific questions before completing the exam.  The option to view the time is left to the student’s discretion.  The student’s answers are saved in three places:  1) on the SQL server, 2) on the hard drive, and 3) on the floppy disk backup that students hand in.

Discussion on appropriateness of the fall implementation date of the online exam system followed.  Dr. Nosek’s rationale for the fall implementation target date follows:  1) The capability is there. 2) The one glitch—security—has been fixed. 3) All the students have computers. 4) There are 23 backup computers in the computer classroom (E324) if needed.  Dr. LaManna asked whether it was the sense of the CME to see a specific report on the performance of the online test exams before going ahead with the mandatory whole-class implementation.  The CME consensus was that was not necessary.  Dr. Nosek proposed, sometime halfway through next year, that we add the multimedia electronic features.

Dr. Nosek briefly highlighted the increased interest in the electronic curriculum by tracking screen hits per month.  In 1997, there were approximately 1,500 hits per month on digitized texts.  Upon implementation of the electronic curriculum in 1998, usage increased, peaking for the Biological Basis of Disease committee, when hits on this multimedia format reached 120,000 per month.  In 1999, hits averaged about 50,000 per month.  The BIT office is making the electronic curriculum available in a portable format on CD-ROM.  Popularity of Dr. Kaiserman-Abramof’s Histology CD-ROM subsequently reduces the number of hits, so that interest in using digitized materials may not be adequately measured by just looking at the number of hits to the Web-based electronic curriculum.

Time constraints allowed only brief mention of the following topics that will be discussed at the next CME meeting (see April 12, 2001 Curriculum Revision Update.):  faculty development, updating of facilities, alumni’s interest in the electronic curriculum, Dr. Philip Hall’s online conversion of P4 packs (Portable Patient Problem Pack) used in second semester Year II CPDP’s problem-based learning case format, the wireless project, and providing PalmPilots for all third year students.

Dr. Nosek stated that we have more hits to the Gold Standard materials than any other medical school.  However, by fall, these sites will no longer be free.  They will be available via subscription.  It will cost approximately $24,000 to buy a site license, or, as another option, each student can pay approximately $100 for access.

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