Bmc Medical Education Evaluation of an Interactive Case Simulation System in Dermatology and Venereology for Medical Students

BackgroundMost of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning.MethodsThrough continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85) or conventional teaching plus NUDOV (n = 31) and comparing the results of the two groups in a final written examination.ResultsThe questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination.ConclusionWe created a computerised case simulation program allowing students to manage patients in a non-linear format supporting the clinical reasoning process. The student gets feedback through comparison with a specialist, eliminating the need for external scoring or correction. The model also permits discussion of case processing, since all transactions are stored in a log file. The program was highly appreciated by the students, but did not significantly improve their performance in the written final examination.

[1]  H. Schmidt,et al.  A cognitive perspective on medical expertise: theory and implication [published erratum appears in Acad Med 1992 Apr;67(4):287] , 1990, Academic medicine : journal of the Association of American Medical Colleges.

[2]  Nikos Mattheos,et al.  The effects of an interactive software application on the self-assessment ability of dental students. , 2004, European journal of dental education : official journal of the Association for Dental Education in Europe.

[3]  T L Diepgen,et al.  Web-based training modules in dermatology. , 1997, M.D. computing : computers in medical practice.

[4]  B. Lowell,et al.  Dermatology in primary care: Prevalence and patient disposition. , 2001, Journal of the American Academy of Dermatology.

[5]  H. Schmidt,et al.  A Cognitive Perspective on Medical Expertise: Theory and Implications , 1990 .

[6]  The Council for National Academic Awards , 1964, Nature.

[7]  A. Ortiz,et al.  [The epidemiology of dermatologic diseases in primary care]. , 1992, Revista de sanidad e higiene publica.

[8]  Kirsti Lonka,et al.  Individual Ways of Interacting with the Learning Environment--Are They Related to Study Success?. , 1998 .

[9]  D. Cook.  The Research We Still Are Not Doing: An Agenda for the Study of Computer-Based Learning , 2005, Academic medicine : journal of the Association of American Medical Colleges.

[10]  B. Beagan,et al.  The patient as text: a challenge for problem‐based learning , 2004, Medical education.

[11]  K. Lonka,et al.  Students' Perceptions of Assessment Practices in a Traditional Medical Curriculum , 2001, Advances in health sciences education : theory and practice.

[12]  Abd El-Rahman,et al.  Improving the quality of student learning , 2003 .

[13]  J. Hudson.  Computer‐aided learning in the real world of medical education: does the quality of interaction with the computer affect student learning? , 2004, Medical education.

[14]  J. Biggs.  Student Approaches to Learning and Studying , 1987 .

[15]  F. T. de Dombal,et al.  A computer-assisted system for learning clinical diagnosis. , 1969, Lancet.

[16]  C P Friedman,et al.  The research we should be doing , 1994, Academic medicine : journal of the Association of American Medical Colleges.

[17]  Linda Hutchinson,et al.  Evaluating and researching the effectiveness of educational interventions , 1999, BMJ.

[18]  Watts Gt.  Letter: Breast prostheses. , 1975 .

[19]  A Roesch,et al.  Computer assisted learning in medicine: a long-term evaluation of the ‘Practical Training Programme Dermatology 2000’ , 2003, Medical informatics and the Internet in medicine.

[20]  S. Wong,et al.  Procedures in primary care dermatology. , 2005, Australian family physician.