Beyond the Blackboard:

Using Computers to Enhance Psychiatric Education

Sudha Prathikanti, MDLee Rawitscher, MDAmy Berlin, MD

Education Technologies

Search Tools & Electronic DatabasesHand-held Devices Presentation SoftwareInteractive Case ModulesVirtual ClassroomsTelepsychiatryOnline Evaluation ToolsCurriculum Management ToolsComputer-aided Decisionmaking Tools

Computer-aided Education:Possible Advantages

“Universal” AccessibilityRemoval of Time/Geography Barriers

Self-directed EducationHyperlink Capability

Standardization of ContentEase of Updating Content

Efficiency in Didactic InstructionEfficiency in Course CoordinationEfficiency in Content Distribution

Computer-Aided Education:Possible Disadvantages

Hardware/Software RequirementsBandwidth Requirements

Technical Maintenance & SupportTime-Intensive Course Development

Asynchronous CommunicationUni-dimensional Communication

Faculty Knowledge DeficitStudent Knowledge Deficit

Evaluation of Web-Based Learning

Still in infancyValuable Addition to EducationNo Clear Evidence of SuperiorityWell-designed Curriculum Best Indicator of Satisfaction, Web-based or NotConnection Speed/Bandwidth Critical Possible Increase in Learning Efficiency?Relative Costs Must be Better Examined

Computers and StudentsComputers and Students

Lee Rawitscher, M.D.Lee Rawitscher, M.D.

OverviewOverview

Ilios – UCSF designed databaseIlios – UCSF designed database

iRocket – Online curriculumiRocket – Online curriculum

Colorado University Case SoftwareColorado University Case Software

Evalue – Commercial evaluation softwareEvalue – Commercial evaluation software

IliosIlios

Developed entirely by UCSFDeveloped entirely by UCSF

Data storage programData storage program– Faculty, resident and student dataFaculty, resident and student data– Course schedulesCourse schedules– Search engineSearch engine

Primary method for module creationPrimary method for module creation

iRocketiRocket

Based on a commercial product called Based on a commercial product called Web CTWeb CT

Modified by UCSF to fit culture and needsModified by UCSF to fit culture and needs

Online CurriculumOnline Curriculum– Learning objectivesLearning objectives– Site informationSite information– Discussion forumDiscussion forum– Key linksKey links

Colorado University Case SoftwareColorado University Case Software

Developed by University of Colorado Developed by University of Colorado Department of PediatricsDepartment of Pediatrics

Offered free of chargeOffered free of charge

Self contained teaching unitsSelf contained teaching units– UCSF uses a CD Rom in conjunctionUCSF uses a CD Rom in conjunction– Video ClipsVideo Clips– QuizzesQuizzes

Allows for standardization of curriculumAllows for standardization of curriculum

E-ValueE-Value

Purely commercial (UCSF subscribes)Purely commercial (UCSF subscribes)

Online evaluationOnline evaluation– Attendings and residents evaluate studentsAttendings and residents evaluate students– Students evaluate all their teachersStudents evaluate all their teachers– Teachers can be rankedTeachers can be ranked– Evaluations reviewed by directorsEvaluations reviewed by directors

Increases number of evaluatorsIncreases number of evaluators

Simplifies reading your evaluationsSimplifies reading your evaluations

Areas of EvaluationAreas of Evaluation

Fund of KnowledgeFund of KnowledgeHistory TakingHistory TakingMental Status ExamMental Status ExamOral Case PresentationsOral Case PresentationsRecord KeepingRecord KeepingProblem SolvingProblem SolvingProfessional Attributes ResponsibilitiesProfessional Attributes ResponsibilitiesSelf ImprovementSelf ImprovementRelationships with Patients and FamilyRelationships with Patients and FamilyRelationships with Members of the Health Care TeamRelationships with Members of the Health Care TeamSummary CommentsSummary Comments

SummarySummary

Data Storage and Search EngineData Storage and Search Engine

Course Descriptions and Internet LinksCourse Descriptions and Internet Links

Standardized Teaching ModulesStandardized Teaching Modules

System for EvaluationSystem for Evaluation

Behavioral Medicine Behavioral Medicine Curriculum for Curriculum for

Primary Care Residents Primary Care Residents

Sudha Prathikanti, MDSudha Prathikanti, MD

Limitations ofLimitations ofMany Behavioral Health Many Behavioral Health

CurriculaCurricula

Often more emphasis on communication Often more emphasis on communication than on diagnosis and treatment.than on diagnosis and treatment.

Rarely incorporate significant audiovisual Rarely incorporate significant audiovisual components.components.

Often lack the algorithm-based teaching Often lack the algorithm-based teaching approach commonly used in other areas of approach commonly used in other areas of medicine.medicine.

Web-DVD Module: Clinical ScenarioWeb-DVD Module: Clinical Scenario

Video Clip of Clinical Encounter

QuickTime™ and aDV/DVCPRO - NTSC decompressor

are needed to see this picture.

Web-DVD Module: Decision TreeWeb-DVD Module: Decision Tree

OPTION A“You’re going thru a rough period, but you’ll be fine.”

OPTION B“You seem overwhelmed; do you ever think of ending your life?”

OPTION C“Hmm…I think some meds will make you feel better.”

Negative consequences seen on video clipExplanation & optional content module offeredRe-direct to Decision #1

Patient confirms severity of psych symptom on video clipTrainee congratulated & optional content module offeredProceed with case

Negative consequences seen on video clipExplanation & optional content module offeredRe-direct to Decision #1

Video Clip of Clinical Encounter

Decision #1: What will you do now?

OPTION C“Hmm…I think some meds will make you feel better.”

Negative consequences discussedOptional content module offeredRe-direct to Decision #1

QuickTime™ and aDV/DVCPRO - NTSC decompressor

are needed to see this picture.

Web-DVD ModuleWeb-DVD Module(continue Decision Tree)(continue Decision Tree)

Decision #2: What will you do now?

Decision #3: What will you do now?

OPTION AOverlooks medical etiologies:“This guy must have Major Depression!”

OPTION BConsiders wide differential:“Let’s review all the possible causes for these mood symptoms.”

OPTION COverlooks psych etiologies:“This is probably just steroid-induced.”

Negative consequences seen on video clipExplanation & optional content module offeredRe-direct to Decision #1

Patient elaborates upon symptom severity on video clipTrainee congratulated & optional content module offeredProceed with case

Negative consequences seen on video clipExplanation & optional content module offeredRe-direct to Decision #1

Web-DVD Modules asWeb-DVD Modules asTeaching ToolsTeaching Tools

In traditional classroom.In traditional classroom.

In web-based course for independent In web-based course for independent studystudy

In virtual classroomsIn virtual classrooms

Web-DVD Modules: Web-DVD Modules: Resource IntensiveResource Intensive

Authoring RequirementsAuthoring Requirements

Lots of Time!Lots of Time! Actors to Simulate Patients Actors to Simulate Patients Software Programmer/Web DesignerSoftware Programmer/Web Designer

Digital Video Camera & Filming AccessoriesDigital Video Camera & Filming Accessories Computer with Firewire, DVD Drive & Disk SpaceComputer with Firewire, DVD Drive & Disk Space DVD BurnerDVD Burner

Digital Video Editing ProgramDigital Video Editing Program HTML Editing ProgramHTML Editing Program (Custom) Web Application Program(Custom) Web Application Program

Web-DVD Modules: Web-DVD Modules: Resource IntensiveResource Intensive

Deployment RequirementsDeployment Requirements

InstructorInstructor Administrative access to large Web ServerAdministrative access to large Web Server Technical support to manage user problemsTechnical support to manage user problems

StudentStudent Computer with DVD DriveComputer with DVD Drive Internet Connection Internet Connection Recent Browser with JavascriptRecent Browser with Javascript

Web-DVD Modules: Web-DVD Modules: One Part of Overall One Part of Overall

CurriculumCurriculum Classroom DidacticsClassroom Didactics Classroom PBL with Movie ClipsClassroom PBL with Movie Clips Live Patient InterviewLive Patient Interview Clinic PreceptorshipClinic Preceptorship Downloadable Reading Assignments Downloadable Reading Assignments Web-based Discussion Group Web-based Discussion Group Web-based Multiple-choice ExamsWeb-based Multiple-choice Exams Web-DVD Interactive Case ModulesWeb-DVD Interactive Case Modules

COMPUTERS & MEDICINE: FANTASY vs. REALITY

Amy Berlin, MD

How does improving the technological sophistication

with which we deliver educational material affect

the quality of the educational experience?

CLINICAL DECISION SUPPORT SYSTEM =

CDSS

SCENARIO

YOU: YOUR CLINIC:

Electronic Medical Record

ONLINE • Problem list• Medication list• Allergies

AT EACH VISIT…

Patient completes questionnaire

Have you suffered from depressed mood more often than not over the past 4 weeks?

Do you have trouble sleeping?

Have you had any weight loss or weight gain?

Have you lost interest in activities which generally give you pleasure?

+ depression screen

Generates email

message

1

2

3

Three arms of the studyArm #1

Questionnaire with positive depression screen generates email

Arm #2

Depression reminder on encounter form

Arm #3

Patient-specific recommendations on encounter form

Which group of patients do we predict will have the lowest Hamilton Rating Scale for Depression

scores, at three and six months?

Patients identified as having a major depression flagged for return visit within four weeks

Patients identified as having a major depression flagged for return visit within four weeks AND paper-based encounter form includes reminder to address depression

Patients identified as having a major depression flagged for return visit within four weeks AND paper-based encounter form includes guideline-based, patient-specific recommendations

NO difference in outcome among all three 3 groups

• Mean Hamilton scores at time 0 ranged from 19.7-20.7, with no significant differences among groups

• Mean Hamilton scores at both 3 and 6 months ranged from 14-16, with no significant differences among groups

• PMDs with more intensive decision support saw their patients more frequently

• No difference in frequency of SSRI prescription among groups

Adding technology to a problem does not

necessarily generate its solution

When implementing computer-based

educational instruments, remember to evaluate your

system using objective measures

References

Rollman, Bruce et al. A Randomized Trial Using Computerized Decision Support to Improve Treatment of Major Depression in Primary Care. Journal of General Internal Medicine 2002; 17:493-503.