Objective To determine the impact of adding audio-feed to an online lecture on screening given to medical students who were participating in an outpatient clerkship. Design Prospective, randomised, controlled study. Setting Vanderbilt University School of Medicine, Nashville and Wake Forest Medical School, Winston-Salem. Participants A total of 59 Years 3 and 4 medical students. Main outcome measures Students' use of time, satisfaction with the lecture experience, and knowledge. Educational intervention The online lecture was developed at Vanderbilt University. At Vanderbilt, 16 Year 4 medical students were randomised to the lecture on screening with audio and 17 Year 4 medical students were randomised to the same lecture without audio. At Wake Forest, 13 Year 3 medical students were randomised to the lecture on screening with audio and 13 Year 3 students were randomised to the same lecture without audio. Results The audio lecture required 20 more minutes to complete than the non-audio lecture. Students in the audio group were more satisfied with their experience than students in the non-audio group. Students in the audio-feed group achieved a trend for higher post-intervention knowledge scores, with the difference attributed to the students at Vanderbilt. Conclusion Audio narration is an important aspect of an online lecture. The distribution of online lectures to students at different sites and different training levels requires further study.

Traditional methods allowing medical students and residents to review their work and receive feedback are lacking. We developed a web-based portfolio system that collects all clinical documentation and allows teachers to give feedback electronically. In a randomized control trial, we found that this system significantly increased feedback, often exceeding clerkship expectations. Seventy-five percent of students found the system a valuable teaching tool. Students in control and portfolio groups agreed that the system increased feedback.

OBJECTIVE: To determine whether the integration of an automated electronic clinical portfolio into clinical clerkships can improve the quality of feedback given to students on their patient write-ups and the quality of students' write-ups. DESIGN: The authors conducted a single-blinded, randomized controlled study of an electronic clinical portfolio that automatically collects all students' clinical notes and notifies their teachers (attending and resident physicians) via e-mail. Third-year medical students were randomized to use the electronic portfolio or traditional paper means. Teachers in the portfolio group provided feedback directly on the student's write-up using a web-based application. Teachers in the control group provided feedback directly on the student's write-up by writing in the margins of the paper. Outcomes were teacher and student assessment of the frequency and quality of feedback on write-ups, expert assessment of the quality of student write-ups at the end of the clerkship, and participant assessment of the value of the electronic portfolio system. RESULTS: Teachers reported giving more frequent and detailed feedback using the portfolio system (p = 0.01). Seventy percent of students who used the portfolio system, versus 39% of students in the control group (p = 0.001), reported receiving feedback on more than half of their write-ups. Write-ups of portfolio students were rated of similar quality to write-ups of control students. Teachers and students agreed that the system was a valuable teaching tool and easy to use. CONCLUSIONS: An electronic clinical portfolio that automatically collects students' clinical notes is associated with improved teacher feedback on write-ups and similar quality of write-ups.

This study examined the effects of diagnosis (functional versus organic), physician practice orientation (biomedical versus biopsychosocial), and maternal trait anxiety (high versus low) on mothers' responses to a child's medical evaluation for chronic abdominal pain. Mothers selected for high (n=80) and low (n=80) trait anxiety imagined that they were the mother of a child with chronic abdominal pain described in a vignette. They completed questionnaires assessing their negative affect and pain catastrophizing. Next, mothers were randomly assigned to view one of four video vignettes of a physician-actor reporting results of the child's medical evaluation. Vignettes varied by diagnosis (functional versus organic) and physician practice orientation (biomedical versus biopsychosocial). Following presentation of the vignettes, baseline questionnaires were re-administered and mothers rated their satisfaction with the physician. Results indicated that mothers in all conditions reported reduced distress pre- to post-vignette; however, the degree of the reduction differed as a function of diagnosis, presentation, and anxiety. Mothers reported more post-vignette negative affect, pain catastrophizing, and dissatisfaction with the physician when the physician presented a functional rather than an organic diagnosis. These effects were significantly greater for mothers with high trait anxiety who received a functional diagnosis presented by a physician with a biomedical orientation than for mothers in any other condition. Anxious mothers of children evaluated for chronic abdominal pain may be less distressed and more satisfied when a functional diagnosis is delivered by a physician with a biopsychosocial rather than a biomedical orientation.

OBJECTIVE Clinical notes, typically written in natural language, often contain substructure that divides them into sections, such as "History of Present Illness" or "Family Medical History." Such structural organization provides important context for each segment of content in a note. We designed and evaluated an algorithm ("SecTag") to identify both labeled and unlabeled (implied) note section headers in "history and physical examination" documents ("H&P notes"). DESIGN The SecTag algorithm uses a combination of natural language processing techniques, word variant recognition with spelling correction, terminology-based rules, and naïve Bayesian scoring methods to identify note section headers. Eleven physicians evaluated SecTag's performance on 319 randomly chosen H&P notes. Physicians evaluated its ability to identify a predefined list of twenty-nine "major sections," which could be either labeled or unlabeled in the H&P note. Raters also evaluated all other document sections identified by SecTag. MEASUREMENTS The primary outcomes were the recall and precision of the SecTag algorithm in identifying all document sections and major sections. A secondary outcome was to evaluate the algorithm's ability to recognize the correct start and end boundaries of identified sections. RESULTS The SecTag algorithm identified a total of 16,036 sections in 319 notes. Of these, 7,858 (49%) were major sections. Physician evaluators classified 15,329 as true positives and identified 160 sections omitted by SecTag. The recall and precision of the SecTag algorithm were 99.0% and 95.6% for all sections, 98.6% and 96.2% for major sections, and 96.6% and 86.8% for unlabeled sections. The algorithm determined the correct starting and ending text boundaries for 94.8% of labeled sections and 85.9% of unlabeled sections. CONCLUSION The SecTag algorithm accurately identified both labeled and unlabeled sections in history and physical documents. This type of algorithm may assist in clinical note natural language processing applications, such as clinical decision support systems, clinical research, and competency assessment for medical trainees.

With the goals of delivering of just-in-time educational content during geriatric patient encounters and tracking curriculum development over time, we attempted to classify documents for the broad concept of geriatrics by comparing three approaches. The problem is made difficult by the lack of a well-defined expansion hierarchy for terms related to the concept geriatrics in the UMLS.

There were 65 third-year medical students and 59 pediatric residents who participated. The intervention was a 40-minute multimedia program that teaches how to counsel parents about childhood aggression. Comparing pre- and 2-month postintervention data, there was an increase in the proportion of medical students (11% pre vs 92% post; P <.001) and residents (3% pre vs 95% post; P <.001) who felt that their ability to counsel parents about hurtful behavior was high or very high. Compared with baseline, a higher proportion of trainees at the 2-month follow-up recommended redirecting (11% pre vs 69% post; P <.001), promoting empathy (13% pre vs 42% post; P <.001), and not using physical punishment (25% pre vs 50% post; P <.001). A brief, independently viewed curriculum addition expanded the repertoire of health care trainees related to counseling parents about childhood aggression. These findings have implications for violence prevention.

Background: The Liaison Committee on Medical Education (LCME) recently reinterpreted ED-2, their quantified patient criteria requirement. Purpose: The purpose is to describe pediatric clerkship directors' response to ED-2. Method: We used a survey of U.S. and Canadian pediatric clerkship directors. Results: Survey response rate was 76%(108/142). The most frequent categories that clerkship directors used to describe quantified patient criteria were age group (77%), organ systems (65%), or symptoms (61%). Computer simulations were the alternative patient experience in 83% of clerkships. Patient logs (90%) and checklists (31%) tracked student completion of ED-2. Thirty-two respondents had an LCME visit since ED-2 was reinterpreted, and 69% reported that LCME had concerns about their clerkships' fulfillment of ED-2. There was no difference in method of ED-2 implementation between schools who were cited by LCME and those who were not. Conclusions: Clerkship directors have used a variety of approaches to specify and monitor quantified patient criteria.

BACKGROUND: Often, medical educators and students do not know where important concepts are taught and learned in medical school. Manual efforts to identify and track concepts covered across the curriculum are inaccurate and resource intensive. OBJECTIVE: To test the ability of a web-based application called KnowledgeMap (KM) to automatically locate where broad biomedical concepts are covered in lecture documents in the Vanderbilt School of Medicine. METHODS: In 2003, the authors derived a gold standard set of curriculum documents by ranking 383 lecture documents as high, medium, or low relevance in their coverage of 4 broad biomedical concepts: genetics, women's health, dermatology, and radiology. We compared the gold standard rankings to KM, an automated tool that generates a variable number of subconcepts for each broad concept to calculate a relevance score for each document. Receiver operating characteristic (ROC) curves and area-under-the-curve were derived for each ranking using varying relevance score cutoffs. RESULTS: Receiver operating characteristic curve areas were acceptably high for each broad concept (range 0.74 to 0.98). At relevance scores that optimized sensitivity and specificity, 78% to 100% of highly relevant documents were identified. The best results were obtained with the application of 63 to 1437 subconcepts for a given broad concept. The search time was fast. CONCLUSIONS: The KM tool capably and automatically locates the detailed coverage of broad concepts across medical school documents in real time. Use of KM or similar tools may prove useful for other medical schools to identify broad concepts in their curricula.

Abstract Introduction Most medical teaching is still delivered by traditional face to face interaction. E-learning has the potential benefit of instilling deeper learning of topics by virtue of repeated and convenient access to content presented in a range of media. We aimed to evaluate objectively the benefit of educating medical students on a common surgical topic (haemorrhoids), through a web site and podcast package versus a traditional lecture. Methods Baseline knowledge was established by a questionnaire given to two different groups of year three medical students starting their first clinical attachment. Group A (n=73) were given a lecture and group B (n=75) were asked to use a web site containing text and pictures augmented by a podcast. Students were re-assessed with the same pre-intervention questionnaire and satisfaction was acquired from a feedback form. Results There was no difference in knowledge between the two groups at baseline. Both groups demonstrated significant gains in knowledge after intervention (p<0.0001). Group B (web/podcast) showed a significantly greater increase in knowledge (p<0.05) than group A (lecture). Pre intervention subjective assessment of knowledge rated by the students showed no difference between the groups. Both groups of students were equally satisfied with the educational method. Conclusion E-learning supplemented with podcast results in greater knowledge acquisition when compared with a traditional lecture without a loss of satisfaction with teaching. Using augmented web-based educational tools reduces demands on teaching time with no decrease in quality for selected parts of the curriculum.

The purpose of this descriptive survey study was to determine the comfort of nurse practitioner (NP) students with webcam invigilation of online examinations and the effectiveness of webcam invigilation in preventing students from cheating. An online questionnaire was developed for NP students currently enrolled in Ontario's Primary Health Care Nurse Practitioner program, in which online examinations are invigilated through a webcam. All students were contacted via e-mail and invited to participate in the online questionnaire. The response rate was 77%. Data were collected and analyzed. Results demonstrated that webcam invigilation can be an uncomfortable experience and that cheating on webcam-invigilated examinations is possible. The results will contribute to the scarce literature available on webcam invigilation of online examinations, but research with a larger sample is needed if results are to be generalized to the webcam invigilation process.

Background Self-determination theory posits that informational versus controlling interpretations of intra-personal events have positive and negative implications, respectively, for well-being. Self-talk represents an intra-personal event that could be interpreted as informational or controlling and may attenuate or exacerbate the negative effects of a stressful experience. Aims The present study investigated relationships between students' informational and controlling interpretations of self-talk, and their post-lecture affective state. An interactive hypothesis, whereby self-talk would be more strongly associated with well-being when students reported experiencing the lecture as stressful, was also tested. Sample Participants were 146 male and female undergraduate students (M age=19.25, SD=2.57) enrolled on research methods/statistics modules. Methods Immediately post-lecture, participants completed a measure of informational and controlling self-talk, short forms of the State-Trait Anxiety Inventory and the Positive and Negative Affect Scale, and self-report measures of their experience and understanding of the lecture. Results Findings from moderated hierarchical regression analyses indicated that informational self-talk was positively associated with positive affect regardless of students' experience or understanding of a lecture. Significant interactions were found between controlling self-talk and experience and understanding, in that a negative experience or poor understanding predicted higher state anxiety and negative affect when students used high, but not low, levels of controlling self-talk. Conclusions The functional significance of students' self-talk may have implications for affect in higher education, suggesting that providers should promote the use of self-talk that emphasizses students' autonomy and competence.

An Undergraduate Nurse Employment Demonstration Project (UNDP) was implemented in four Health Service Areas in British Columbia with a concurrent evaluation study. This demonstration project comprised the development and implementation of a new position in the BC healthcare system. The position enabled third- and fourth-year nursing students to be employed at their level of education. The purposes of the evaluation were to explore the feasibility and outcomes of this type of paid undergraduate student nurse employment. The three-year project and evaluation included both implementation and outcome analysis. The implementation evaluation design was descriptive and prospective, involving multiple data sources. The outcome evaluation design was quasi-experimental, with intervention and comparison groups. Learning outcomes for undergraduate nurses were increased confidence, organizational ability, competency and ability to work with a team. Workplace outcomes were increased unit morale, help with workload and improved patient care. New graduates with undergraduate nurse experience reported less time required for orientation and transition than other graduates who did not have this experience, and workplace nurses viewed these new graduates as more job-ready than other new graduates. After 21 months, new graduates with undergraduate nurse experience were less likely to move to other employment than other new graduates. Results from the four Health Service Areas indicated that the paid undergraduate nurse position was feasible and that outcomes benefited students, new graduates and workplaces. The undergraduate nurse position is now being implemented throughout all Health Service Areas in British Columbia.By 2000, concerns in British Columbia about the nursing workforce, workplace and patient safety had escalated to the point where diverse stakeholder groups were prepared to work together in new ways to prepare nursing graduates to be more job-ready, to recruit and retain new graduates and to retain existing nurses. Stakeholder groups were administrators, labour organizations, professional associations, educators and government. One idea to support job readiness and retention focussed on the feasibility of implementing cooperative education for nursing students. The effort was unsuccessful owing to lack of funding, but resulted in a review of the literature on cooperative education and other work-study programs. Cooperative education connects classroom learning with paid work experience for the purpose of enhancing students' education (Fitt and Heverly 1990; Heinemann and De Falco 1992; Ryder 1987). Reported benefits for students were improved job preparation and graduate retention (Ishida et al. 1998), additional staffing and reduction in orientation time (Cusack 1990; Ishida et al. 1998), increased practice judgment (Cusack 1990; Siedenberg 1989) and better workload management (Ross and Marriner 1985). A work-study model reported in the literature offered benefits similar to those of cooperative education, with greater flexibility in design. An example was the University of Texas Health Science Center at Houston's collaborative work-study scholarship program with local hospitals (Kee and Ryser 2001). Students in second clinical semesters were employed as unlicensed personnel by hospitals. The students, as unlicensed personnel, worked to the level of their nursing preparation. Reported benefits for students were academic credit, financial assistance, interaction with multidisciplinary teams, opportunity to refine clinical skills, understanding of nurses' roles and guaranteed interview for positions on graduation (Kee and Ryser 2001). Benefits for practice organizations were skilled help, the opportunity to recruit new nurses and increased interaction with a university nursing program. While nurse education stakeholders in British Columbia were exploring options, the concept of undergraduate student nurse employment was initiated by a group of fourth-year students at the University of Victoria who were completing the course "Nurses Influencing Change." The students were concerned about having enough practice experience to meet increasing nursing competency requirements and their survival as new graduates given workplace realities. Debt load also was a concern because extensive student practicum time limited opportunities for paid employment during the nursing education program. Students found that the idea of paid undergraduate nurse positions, based on the student employment model in Alberta, was supported by nurse leaders, many practising nurses and nursing faculty who also were concerned about meeting patient care standards and adequately preparing nursing students. In 2000, the BC Ministry of Health Services funded an Undergraduate Nurse Demonstration Project (UNDP)- one type of paid employment for undergraduate student nurses - in four Health Service Areas linked with four schools of nursing. A concurrent three-year evaluation study examined the feasibility and outcomes of the UNDP (Gamroth et al. 2004). This paper summarizes the findings of the evaluation. Evaluation Research An Undergraduate Nurse Employment Demonstration Project (UNDP) was implemented in four Health Service Areas in British Columbia with a concurrent evaluation study. This demonstration project comprised the development and implementation of a new position in the BC healthcare system. The position enabled third- and fourth-year nursing students to be employed at their level of education. The purposes of the evaluation were to explore the feasibility and outcomes of this type of paid undergraduate student nurse employment. The three-year project and evaluation included both implementation and outcome analysis. The implementation evaluation design was descriptive and prospective, involving multiple data sources. The outcome evaluation design was quasi-experimental, with intervention and comparison groups. Learning outcomes for undergraduate nurses were increased confidence, organizational ability, competency and ability to work with a team. Workplace outcomes were increased unit morale, help with workload and improved patient care. New graduates with undergraduate nurse experience reported less time required for orientation and transition than other graduates who did not have this experience, and workplace nurses viewed these new graduates as more job-ready than other new graduates. After 21 months, new graduates with undergraduate nurse experience were less likely to move to other employment than other new graduates. Results from the four Health Service Areas indicated that the paid undergraduate nurse position was feasible and that outcomes benefited students, new graduates and workplaces. The undergraduate nurse position is now being implemented throughout all Health Service Areas in British Columbia. By 2000, concerns in British Columbia about the nursing workforce, workplace and patient safety had escalated to the point where diverse stakeholder groups were prepared to work together in new ways to prepare nursing graduates to be more job-ready, to recruit and retain new graduates and to retain existing nurses. Stakeholder groups were administrators, labour organizations, professional associations, educators and government. One idea to support job readiness and retention focussed on the feasibility of implementing cooperative education for nursing students. The effort was unsuccessful owing to lack of funding, but resulted in a review of the literature on cooperative education and other work-study programs. Cooperative education connects classroom learning with paid work experience for the purpose of enhancing students' education (Fitt and Heverly 1990; Heinemann and De Falco 1992; Ryder 1987). Reported benefits for students were improved job preparation and graduate retention (Ishida et al. 1998), additional staffing and reduction in orientation time (Cusack 1990; Ishida et al. 1998), increased practice judgment (Cusack 1990; Siedenberg 1989) and better workload management (Ross and Marriner 1985). A work-study model reported in the literature offered benefits similar to those of cooperative education, with greater flexibility in design. An example was the University of Texas Health Science Center at Houston's collaborative work-study scholarship program with local hospitals (Kee and Ryser 2001). Students in second clinical semesters were employed as unlicensed personnel by hospitals. The students, as unlicensed personnel, worked to the level of their nursing preparation. Reported benefits for students were academic credit, financial assistance, interaction with multidisciplinary teams, opportunity to refine clinical skills, understanding of nurses' roles and guaranteed interview for positions on graduation (Kee and Ryser 2001). Benefits for practice organizations were skilled help, the opportunity to recruit new nurses and increased interaction with a university nursing program. While nurse education stakeholders in British Columbia were exploring options, the concept of undergraduate student nurse employment was initiated by a group of fourth-year students at the University of Victoria who were completing the course "Nurses Influencing Change." The students were concerned about having enough practice experience to meet increasing nursing competency requirements and their survival as new graduates given workplace realities. Debt load also was a concern because extensive student practicum time limited opportunities for paid employment during the nursing education program. Students found that the idea of paid undergraduate nurse positions, based on the student employment model in Alberta, was supported by nurse leaders, many practising nurses and nursing faculty who also were concerned about meeting patient care standards and adequately preparing nursing students.

OBJECTIVES: Since 2001, an e-learning tool has been developed for dentistry. To compare online self study with traditional lectures, a module about instrumental occlusal analysis was offered by oral lecture and by a unit in the virtual library of the e-learning tool. METHODS: 85 pre-clinical dental students were randomly divided into two groups: the computer assisted learning (CAL) group (n = 48) and the lecture group (n = 37). A pre-test was made to assess the students' basic knowledge. The first post-test and the scoring of the teaching methods were performed immediately after the lecture or the self studying by the online tool and a second post-test six weeks later. RESULTS: The oral lecture got better educational and enjoyment values. The students prefer CAL in addition to traditional lectures. The results of the pre-tests were not different between the two groups (p = 0.706). The lecture group significantly improved their scores in the first post-test (p = 0.011), but the scores of the second post-test did not differ significantly (p = 0.157). CONCLUSIONS: In the short term, knowledge acquisition seems to be better in oral lectures but in the long term there is no difference in knowledge retention between the two learning scenarios.

OBJECTIVE: To assess the effectiveness of online instruction in a cardiology pharmacotherapy elective. DESIGN: Eight drug-focused lectures and 6 introductory presentations were added to a cardiology pharmacotherapy course. Students completed an online quiz after each online drug-focused lecture and scores were compared to quizzes taken at the beginning and end of the course, as well as on a cardiology advanced pharmacy practice experience (APPE). For online introductory presentations, students completed a quiz at the beginning of the next face-to-face session. A survey was conducted at the end of the course to obtain student feedback. ASSESSMENT: Compared to baseline scores, student learning was demonstrated after online drug-focused lectures by higher quiz scores attained immediately after completing the lecture, at the end of the course, and at the beginning of the APPE. Furthermore, students performed better on quizzes at the beginning of face-to-face sessions if they first completed an online introductory presentation. Students expressed strong support for the online components of the course. CONCLUSIONS: A blended learning environment with online and face-to-face instruction is an effective way to teach a cardiology pharmacotherapy elective. The online component of this course was well received by students, improved student preparation before attending class, and appeared to enhance long-term cardiovascular drug knowledge.