Randomized trial of educational outcomes of Web Initiative in Surgical Education

描述(由申请人提供)： 在这项拟议的工作中，使用最先进的计算机辅助教学(计算机辅助教学)，我们将解决国际公认的困难，提供一致的，高质量的学习环境，以确保新手医生在培训中的临床能力。通常，基于计算机的模拟和教学模块被开发并实施到医学培训中，而没有充分关注有效的教学设计或对教育结果的有意义的评估。如果有效，这些工具有可能填补由于快速变化或资源匮乏的医疗保健提供环境造成的重大教育缺口，大多数医生培训都是在这些环境中进行的。对于距离学术医学中心(AMC)一段距离的实习生来说，情况尤其如此。如果不是有效的，那么在进一步投资和推广这些技术之前，需要做基本的工作来提高这些学习工具的教育价值，特别是在风险与医生培训一样高的情况下。与我在教育心理学、外科教育和计算机科学方面的合作者们一起，并利用我们在多机构协作医学教育研究方面的经验，我们将利用一个独特的机会，严格研究外科教育中的网络倡议(WISE-MD)的有效性，这是一个由美国外科医学院和外科教育协会认可的25个模块、基于案例的富媒体核心外科教育课程。 WISE-MD课程的目标是快速推进新手医学生的临床推理发展。我们提出了一项严格的、为期2年的3臂随机对照试验，以评估范例WISE-MD模块在学习临床推理的认知和情感方面的有效性，这是一个关键而复杂的结构。通过这个设计，我们比较了两种用于计算机辅助教学的教学设计方法：1)有限的互动性计算机辅助教学和2)增强的互动性计算机辅助教学功能，它们彼此之间以及与标准的临床见习经验相比都是昂贵的制作和实施(例如交互式体检)。这一点很重要，因为尽管人们对现有的7个WISE-MD模块(它们是22所医学院的必修课程)充满热情，这证明了这些模块的表面有效性，但我们还没有证据来确定与他们目前接受的传统课程相比，计算机辅助教学的必要教学设计特征以及计算机辅助教学在医学生临床教育中的相对教育价值。此外，在这个设计中，我们将能够评估一些计算机辅助教学属性-学生能力倾向的交互作用，例如临床病例的性质对学生成绩的影响(“案例效应”)，以及一些已知的改变教学方法和成绩之间关系的重要变量，包括学习者个人变量，以及课程结构和内容。最后，在这个重大项目上的合作使我们能够应对不同的机构文化、信息技术基础设施、技术能力和资源，包括教师时间在内的不同机构文化、信息技术基础设施、技术能力和资源对标准化课程和医学教育研究带来的挑战。

DESCRIPTION (provided by applicant): In this proposed work, using state-of-the art computer assisted instruction (CAI), we will address internationally recognized difficulties in providing consistent, high quality learning environments that ensure clinical competence for novice physicians-in-training. Frequently, computer-based simulations and instructional modules are developed and implemented into medical training without adequate attention to effective instructional design or meaningful assessment of educational outcomes. If effective, these tools have the potential to fill major educational gaps caused by rapidly changing or resource poor health care delivery environments in which most physician training occurs. This would be especially the case for trainees at some distance from an Academic Medical Center (AMC). If not effective, then fundamental work needs to be done to improve the educational value of these learning tools before further investment in and diffusion of such technology, especially when the stakes are as high as in the training of physicians. Along with my collaborators in educational psychology, surgical education and computer science, and drawing on our experience in multi-institutional collaborative medical education research, we will capitalize on a unique opportunity to rigorously study the effectiveness of the Web Initiative in Surgical Education (WISE-MD), a 25 module, case based, rich media, core curriculum in surgical education that is endorsed by the American College of Surgeons and the Association of Surgical Education. The goal of the WISE-MD curriculum is to fast-forward the development of clinical reasoning in novice medical students. We propose a rigorous, 2 year, 3-armed randomized controlled trial to assess the effectiveness of example WISE-MD modules on both cognitive and affective aspects of learning clinical reasoning, a critical and complex construct. With this design we compare 2 instructional design approaches to CAI: 1) limited interactivity CAI and 2) enhanced interactivity CAI features, which are costly to produce and implement (e.g. interactive physical exams) with each other and to the standard clinical clerkship experience. This is important to do because, despite enthusiasm for the 7 existing WISE-MD modules (they are required curriculum in 22 medical schools), which attests to the face validity of the modules, we do not yet have the evidence to determine what are necessary instructional design features of CAI and what the relative educational value of CAI in the clinical education of medical students, compared to the traditional curriculum they currently receive. In addition, in this design we will be able to assess a number of CAI attribute-student aptitude interactions such as the impact on student achievement of the nature of the clinical case ("case effect") and a number of important variables known to modify the relationship between instructional method and achievement including individual learner variables, and curriculum structure and content. Finally, collaboration on this substantial project allows us to address challenges to standardizing curriculum and medical education research posed by differing institutional cultures, information technology infrastructures, technical capabilities and resources including, and especially, faculty time.