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，使用国家的最先进的计算机辅助教学（CAI），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，确保新手医生在培训的临床能力。通常，基于计算机的模拟和教学模块的开发和实施到医疗培训没有充分重视有效的教学设计或有意义的评估教育成果。如果有效的话，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而造成的主要教育空白，而大多数医生培训都是在这种环境中进行的。对于距离学术医疗中心（AMC）有一定距离的学员来说，情况尤其如此。如果效果不佳，那么在进一步投资和推广这种技术之前，需要做一些基本工作，以提高这些学习工具的教育价值，特别是当风险与医生培训一样高的时候。沿着我的合作者在教育心理学，外科教育和计算机科学，并借鉴我们的经验，在多机构合作医学教育研究，我们将利用一个独特的机会，严格研究的有效性网络倡议在外科教育（WISE-MD），25个模块，基于案例，丰富的媒体，外科教育的核心课程，是由美国外科医生学会和外科教育协会认可。 WISE-MD课程的目标是加快新手医学生临床推理的发展。我们提出了一个严格的，2年，3臂随机对照试验，以评估的有效性，例如WISE-MD模块的认知和情感方面的学习临床推理，一个关键的和复杂的结构。通过这种设计，我们比较了2种CAI教学设计方法：1）有限交互性CAI和2）增强交互性CAI功能，这是昂贵的生产和实施（例如交互式体检）彼此和标准的临床实习经验。这一点很重要，因为尽管对现有的7个WISE-MD模块充满热情，（它们是22所医学院校的必修课程），这证明了模块的表面效度，我们还没有证据来确定什么是必要的CAI教学设计特征，以及CAI在医学生临床教育中的相对教育价值，与他们目前接受的传统课程相比。此外，在这个设计中，我们将能够评估一些CAI属性学生能力的相互作用，如对学生成绩的影响的性质的临床情况下（“案例效应”）和一些重要的变量，已知修改教学方法和成绩之间的关系，包括个人学习者变量，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解决不同的机构文化，信息技术基础设施，技术能力和资源，包括，特别是教师的时间所带来的标准化课程和医学教育研究的挑战。

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.