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Beyond the Blackboard: Using Computers to Enhance Psychiatric Education Sudha Prathikanti, MD Lee Rawitscher, MD Amy Berlin, MD. Education Technologies. Search Tools & Electronic Databases Hand-held Devices Presentation Software Interactive Case Modules Virtual Classrooms Telepsychiatry

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slide1

Beyond the Blackboard:Using Computers to Enhance Psychiatric EducationSudha Prathikanti, MDLee Rawitscher, MDAmy Berlin, MD

education technologies
Education Technologies
  • Search Tools & Electronic Databases
  • Hand-held Devices
  • Presentation Software
  • Interactive Case Modules
  • Virtual Classrooms
  • Telepsychiatry
  • Online Evaluation Tools
  • Curriculum Management Tools
  • Computer-aided Decisionmaking Tools
computer aided education possible advantages
Computer-aided Education:Possible Advantages
  • “Universal” Accessibility
  • Removal of Time/Geography Barriers
  • Self-directed Education
  • Hyperlink Capability
  • Standardization of Content
  • Ease of Updating Content
  • Efficiency in Didactic Instruction
  • Efficiency in Course Coordination
  • Efficiency in Content Distribution
computer aided education possible disadvantages
Computer-Aided Education:Possible Disadvantages
  • Hardware/Software Requirements
  • Bandwidth Requirements
  • Technical Maintenance & Support
  • Time-Intensive Course Development
  • Asynchronous Communication
  • Uni-dimensional Communication
  • Faculty Knowledge Deficit
  • Student Knowledge Deficit
evaluation of web based learning
Evaluation of Web-Based Learning
  • Still in infancy
  • Valuable Addition to Education
  • No Clear Evidence of Superiority
  • Well-designed Curriculum Best Indicator of Satisfaction, Web-based or Not
  • Connection Speed/Bandwidth Critical
  • Possible Increase in Learning Efficiency?
  • Relative Costs Must be Better Examined
computers and students

Computers and Students

Lee Rawitscher, M.D.

overview
Overview
  • Ilios – UCSF designed database
  • iRocket – Online curriculum
  • Colorado University Case Software
  • Evalue – Commercial evaluation software
ilios
Ilios
  • Developed entirely by UCSF
  • Data storage program
    • Faculty, resident and student data
    • Course schedules
    • Search engine
  • Primary method for module creation
irocket
iRocket
  • Based on a commercial product called Web CT
  • Modified by UCSF to fit culture and needs
  • Online Curriculum
    • Learning objectives
    • Site information
    • Discussion forum
    • Key links
colorado university case software
Colorado University Case Software
  • Developed by University of Colorado Department of Pediatrics
  • Offered free of charge
  • Self contained teaching units
    • UCSF uses a CD Rom in conjunction
    • Video Clips
    • Quizzes
  • Allows for standardization of curriculum
e value
E-Value
  • Purely commercial (UCSF subscribes)
  • Online evaluation
    • Attendings and residents evaluate students
    • Students evaluate all their teachers
    • Teachers can be ranked
    • Evaluations reviewed by directors
  • Increases number of evaluators
  • Simplifies reading your evaluations
areas of evaluation
Areas of Evaluation
  • Fund of Knowledge
  • History Taking
  • Mental Status Exam
  • Oral Case Presentations
  • Record Keeping
  • Problem Solving
  • Professional Attributes Responsibilities
  • Self Improvement
  • Relationships with Patients and Family
  • Relationships with Members of the Health Care Team
  • Summary Comments
summary
Summary
  • Data Storage and Search Engine
  • Course Descriptions and Internet Links
  • Standardized Teaching Modules
  • System for Evaluation
limitations of many behavioral health curricula
Limitations ofMany Behavioral Health Curricula

Often more emphasis on communication than on diagnosis and treatment.

Rarely incorporate significant audiovisual components.

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

web dvd module clinical scenario
Web-DVD Module: Clinical Scenario

Video Clip of Clinical Encounter

web dvd module decision tree
Web-DVD Module: Decision Tree

Video Clip of Clinical Encounter

Decision #1: What will you do now?

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 clip

Explanation & optional content module offered

Re-direct to Decision #1

Patient confirms severity of psych symptom on video clip

Trainee congratulated & optional content module offered

Proceed with case

Negative consequences seen on video clip

Explanation & optional content module offered

Re-direct to Decision #1

slide40
OPTION C

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

Negative consequences discussed

Optional content module offered

Re-direct to Decision #1

web dvd module continue decision tree
Web-DVD Module(continue Decision Tree)

Decision #2: What will you do now?

OPTION A

Overlooks medical etiologies:

“This guy must have Major Depression!”

OPTION B

Considers wide differential:

“Let’s review all the possible causes for these mood symptoms.”

OPTION C

Overlooks psych etiologies:

“This is probably just steroid-induced.”

Negative consequences seen on video clip

Explanation & optional content module offered

Re-direct to Decision #1

Patient elaborates upon symptom

severity on video clip

Trainee congratulated & optional content module offered

Proceed with case

Negative consequences seen

on video clip

Explanation & optional content module offered

Re-direct to Decision #1

Decision #3: What will you do now?

web dvd modules as teaching tools
Web-DVD Modules asTeaching Tools
  • In traditional classroom.
  • In web-based course for independent study
  • In virtual classrooms
web dvd modules resource intensive
Web-DVD Modules: Resource Intensive

Authoring Requirements

  • Lots of Time!
  • Actors to Simulate Patients
  • Software Programmer/Web Designer
  • Digital Video Camera & Filming Accessories
  • Computer with Firewire, DVD Drive & Disk Space
  • DVD Burner
  • Digital Video Editing Program
  • HTML Editing Program
  • (Custom) Web Application Program
web dvd modules resource intensive1
Web-DVD Modules: Resource Intensive

Deployment Requirements

  • Instructor
    • Administrative access to large Web Server
    • Technical support to manage user problems
  • Student
    • Computer with DVD Drive
    • Internet Connection
    • Recent Browser with Javascript
web dvd modules one part of overall curriculum
Web-DVD Modules: One Part of Overall Curriculum
  • Classroom Didactics
  • Classroom PBL with Movie Clips
  • Live Patient Interview
  • Clinic Preceptorship
  • Downloadable Reading Assignments
  • Web-based Discussion Group
  • Web-based Multiple-choice Exams
  • Web-DVD Interactive Case Modules
slide47
How does improving the technological sophistication with which we deliver educational material affect the quality of the educational experience?
scenario
SCENARIO

YOU:

YOUR CLINIC:

electronic medical record
Electronic Medical Record

ONLINE

  • Problem list
  • Medication list
  • Allergies
at each visit
AT EACH VISIT…

1

3

Patient completes questionnaire

Generates email message

2

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

three arms of the study
Three arms of the study

Arm #1

Questionnaire with positive depression screen generates email

Arm #2

Depression reminder on encounter form

Arm #3

Patient-specific recommendations on encounter form

slide53

Which group of patients do we predict will have the lowest Hamilton Rating Scale for Depression scores, at three and six months?

slide54
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
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
slide57
When implementing computer-based educational instruments, remember to evaluate your system using objective measures
references
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.

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