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Interactive Case-based Assessment Tool ( iCAT ) Bringing Together the “What” and “How of Learning:. Wendy Ham, Andrew Rosenfeld, Lukasz Babiarz, Sandy Mong, Chris Dede, Susan Pasquale, Robert Leffert,  and James Quattrochi

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Interactive Case-based Assessment Tool ( iCAT ) Bringing Together the “What” and “How of Learning:

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Interactive case based assessment tool icat bringing together the what and how of learning

Interactive Case-based Assessment Tool(iCAT)Bringing Together the “What” and “Howof Learning:

Wendy Ham, Andrew Rosenfeld, Lukasz Babiarz, Sandy Mong, Chris Dede, Susan Pasquale, Robert Leffert,  and James Quattrochi

Harvard University, ICON Program for Multidisciplinary Learning, Cambridge, MA

University of Massachusetts Medical School, Worcester, MA

Supported by the Harvard Provost Innovations in Instructional Technology Award


Background

Background

  • We have developed a case simulation method, called ICON (Interactive Case-based Online Network)

  • In ICON, students interact with case characters online

  • Case characters (patient, physicians, case consultants, family members) are assumed by faculty members

  • Events in ICON unfold in real time

  • Students learn to:

    • Integrate the theory and practice of medicine

    • Solve problems

    • Navigate resources

    • Make decisions

    • Develop teamwork skills

    • Be accountable to case characters and teammates

  • How do we measure the competencies listed above?


Interactive case based assessment tool icat bringing together the what and how of learning

Survey of Student Perception of ICON

Hypothesis 1 ICON facilitates a learning process that is more engaging

Hypothesis 2 ICON increases peer contribution in learning

Hypothesis 3 ICON increases active faculty participation in student learning

Hypothesis 4 ICON decreases learning dependence on faculty lecturer

due to increased contribution by peer and faculty mentor


Interactive case based assessment tool icat bringing together the what and how of learning

Yr 1 26 (81%)12 (38%)

Year of surveyEntrance Exit

Yr 2 14 (58%)17 (71%)

Survey Method

Comparison of entrance and exit surveys from two years of ICON implementation in the second-year Human Nervous Systems and Behavior course at Harvard Medical School:

# of Responses (% Response)

Total40 (71%)29 (52%)


Interactive case based assessment tool icat bringing together the what and how of learning

Student Perception of ICON: Survey Results

Hypothesis 1:

ICON facilitates a learning process that is more engaging

# hours spent discussing tutorial cases outside of tutorial session

P=0.004

Without ICONWith ICON


Interactive case based assessment tool icat bringing together the what and how of learning

Student Perception of ICON: Survey Results

Hypothesis 2:

ICON increases peer contribution in learning

Mean ranking of peer relative to faculty mentor and faculty lecturer in contribution to learning

P=0.02

Mean ranking

Min value= 1

Max value=3

Without ICON With ICON


Interactive case based assessment tool icat bringing together the what and how of learning

Student Perception of ICON: Survey Results

Hypothesis 3:

ICON increases active faculty participation in student learning

Mean agreement rating to the statement that

“faculty (as case characters) actively participate in student learning”

P=0.00003

1=completely disagree

2=somewhat disagree

3=somewhat agree

4=completely agree

Agreement rating

Min value= 1

Max value=4

Without ICON With ICON


Interactive case based assessment tool icat bringing together the what and how of learning

Min value= 1

Max value=3

Without ICON With ICON

Student Perception of ICON: Survey Results

Hypothesis 4:

ICON decreases learning dependence on faculty lecturer

due to increased contribution by peer and faculty mentor

Mean ranking of faculty lecturer relative to peer and faculty mentor in contribution to learning

P=0.009

Mean peer ranking

Mean ranking


Ok so students think icon

OK… so students think ICON:

  • is engaging

  • increases peer contribution

  • promotes active faculty participation

  • decreases relative role of lectures

But how does ICON really add value in their learning?


Interactive case based assessment tool icat bringing together the what and how of learning

iCATInteractive Case-based Assessment Tool

  • Characterization of process, not only outcome

  • Case-based

  • Emphasis on problem solving in the context of:

    • Hypothesis formulation

    • Diagnosis and treatment plan

    • Risk management


Interactive case based assessment tool icat bringing together the what and how of learning

Case: Morning Trouble

(adapted from Risk Management Foundation case study, 2006)

A 42-year-old uninsured woman, who had not seen a doctor in 20 years, presented to the emergency department (ED) at 7:50 a.m., complaining of chest pain and trouble breathing. She was accompanied by her husband and her son, who helped interpret because English was her second language.

The husband reported that his wife had been experiencing chest pain since 11:00 the prior evening, which she treated with aspirin. In the morning, she had sudden onset of severe chest pain and fainted on her bed.

The patient was first seen by the ED attending and then by a resident. Her initial vital signs were: HR: 107, BP: 146/99, RR:29. Her chest pain was documented as “sudden onset, right-sided, sharp, under the right breast, started while the patient was lying in bed and worse with inspiration, movement, and palpation.” The patient’s medical history was documented by the resident as: “fainting spells, no family history of coronary artery disease or clots, father suffered a stroke.”

Toolbox

Background

H&P

Test

Consult

Notebook

Incurred cost: $0.00

Select a tool from the Toolbox

Time: 00:00:17


Interactive case based assessment tool icat bringing together the what and how of learning

English as a second language

Click on a keyword for more information:

Is there someone with a medical background who can reliably interpret for the patient?

Is English the son’s/husband’s first language?

Was the history documented with the presence of an interpreter other than family members?

Was there any ambiguity in taking the patient’s history?

A 42-year-olduninsured woman, who had not seen a doctor in 20 years, presented to the emergency department (ED) at 7:50 a.m., complaining of chest pain and trouble breathing. She was accompanied by her husband and her son, who helped interpret because English was her second language.

The husband reported that his wife had been experiencing chest pain since 11:00 the prior evening, which she treated with aspirin. In the morning, she had sudden onset of severe chest pain and fainted on her bed.

The patient was first seen by the ED attending and then by a resident. Her initial vital signs were: HR: 107, BP: 146/99, RR:29. Her chest pain was documented as “sudden onset, right-sided, sharp, under the right breast, started while the patient was lying in bed and worse with inspiration, movement, and palpation.” The patient’s medical history was documented by the resident as: “fainting spells, no family history of coronary artery disease or clots, father suffered a stroke.”

Toolbox

Background

H&P

Test

Consult

Notebook

Incurred cost: $0.00

Time: 00:01:35


Interactive case based assessment tool icat bringing together the what and how of learning

English as a second language

Click on a question for more information

A reliable interpreter with

a medical background is not available.

Is there someone with a medical background who can reliably interpret for the patient?

Is English the son’s/husband’s first language?

Was the history documented with the presence of an interpreter other than family members?

Was there any ambiguity in taking the patient’s history?

Save in Notebook

A 42-year-olduninsured woman, who had not seen a doctor in 20 years, presented to the emergency department (ED) at 7:50 a.m., complaining of chest pain and trouble breathing. She was accompanied by her husband and her son, who helped interpret because English was her second language.

The husband reported that his wife had been experiencing chest pain since 11:00 the prior evening, which she treated with aspirin. In the morning, she had sudden onset of severe chest pain and fainted on her bed.

The patient was first seen by the ED attending and then by a resident. Her initial vital signs were: HR: 107, BP: 146/99, RR:29. Her chest pain was documented as “sudden onset, right-sided, sharp, under the right breast, started while the patient was lying in bed and worse with inspiration, movement, and palpation.” The patient’s medical history was documented by the resident as: “fainting spells, no family history of coronary artery disease or clots, father suffered a stroke.”

Toolbox

Background

H&P

Test

Consult

Notebook

Incurred cost: $0.00

Time: 00:02:09


Interactive case based assessment tool icat bringing together the what and how of learning

Test

ECG

Chest X-Ray

ECG

Lab Tests: $650

Blood gassesAcetoneArteritis (ANA)CO2EKGGlucosePotassiumSodiumLiver (SGOT)Liver (SGPT)StoolType & cross blood

Studies/Tests: $1,000

Angiogram

Audiometry

Biopsy

Bone Scan

Cardiac Eval

Cisternogram

CSF Studies

CT

EEG

ECG

EMG/NCS

ENG

Evoked Potentials

Genetic Tests

Ischemic Exercise Test

MRA

MRI

Muscle Biochem

Myelogram

Neuropsych Testing

Pap Smear

Pulmonary Function

Schilling Test

SPECT Scan

Tensilon Test

Visual Fields

X-rays

Click to enlarge

Save in Notebook

Toolbox

Background

H&P

Test

Consult

Notebook

Incurred cost: $1,650.00

Time: 00:07:42


Interactive case based assessment tool icat bringing together the what and how of learning

Test

ECG

Chest X-Ray

ECG

Lab Tests: $650

Blood gassesAcetoneArteritis (ANA)CO2EKGGlucosePotassiumSodiumLiver (SGOT)Liver (SGPT)StoolType & cross blood

Studies/Tests: $1,000

Angiogram

Audiometry

Biopsy

Bone Scan

Cardiac Eval

Cisternogram

CSF Studies

CT

EEG

ECG

EMG/NCS

ENG

Evoked Potentials

Genetic Tests

Ischemic Exercise Test

MRA

MRI

Muscle Biochem

Myelogram

Neuropsych Testing

Pap Smear

Pulmonary Function

Schilling Test

SPECT Scan

Tensilon Test

Visual Fields

X-rays

Click to enlarge

Save in Notebook

Toolbox

Background

H&P

Also notice the timer and cost counter

Test

Consult

Notebook

Incurred cost: $1,650.00

Time: 00:07:42


Interactive case based assessment tool icat bringing together the what and how of learning

Notebook

Chest pain

Shortness of breath

Stroke in family history

Absence of trained interpreter

Age

Aspirin

Gender

Background

Final vital signs

Initial vital signs

H&P

ECG

No cardiac enzymes results

Elevated glucose

X-Rays

Blood gases

Test

Absence of cardiology consult

Consult


Interactive case based assessment tool icat bringing together the what and how of learning

Notebook

Key Student

Chest pain

Shortness of breath

Stroke in family history

Absence of trained interpreter

Age

Aspirin

Gender

Background

Why does the student not consider these high risk?

Final vital signs

Initial vital signs

H&P

ECG

No cardiac enzymes results

Elevated glucose

X-Rays

Blood gases

Test

Absence of cardiology consult

Consult


Interactive case based assessment tool icat bringing together the what and how of learning

Model of Student’s Rating Profile during Case Progression

Profile of Student’s Rating during Case Progression

Cumulative value of information accessed (Scale 1-5)

(High) 5

4

Student X

(Moderate) 3

2

What causes the profile to shift?

Baseline

(Low) 1

0

(Start)

Time (seconds)

(End)


Interactive case based assessment tool icat bringing together the what and how of learning

iCAT beta


Instructional technology impacts the process of learning which impacts the outcome of learning

Instructional technology impacts the process of learning, which impacts the outcome of learning

Design, Development, and Implementation

of Instructional Technology

Outcome of Learning

Process of Learning

Impact

Inform


Interactive case based assessment tool icat bringing together the what and how of learning

Impact is tightly coupled with information, allowing progress in educational development to be driven by hypothesis

Design, Development, and Implementation

of Instructional Technology

Outcome of Learning

Process of Learning

Impact

Inform


Contact information

Contact Information

  • http://icon.fas.harvard.edu

  • [email protected]


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