Assessment of a computer-aided instructional program for the pediatric emergency department.

Assessment of a Computer-Aided Instructional Program for the Pediatric Emergency Department Mark D. Adler MD1,, Anne Duggan ScD 2 , C. Jean Ogborn MD3 , Kevin B. Johnson MD MS3 The Division of Pediatric Emergency Medicine1 , Feinberg School of Medicine, Northwestern University, Chicago, IL; the Divisions of Pediatric Emergency Medicine3 and General Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, and the Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN. ABSTRACT Computer aided instruction (CAI) software is becoming commonplace in medical education. Our experience with CAI programs in our pediatric ED raised concerns about the time commitment some of these programs require. We developed a just-in-time learning program, the Virtual Preceptor (VP) and evaluated this program for use in a busy clinical environment. Forty-three of 47 pediatric residents used the VP at least once. Interns used the program 2 ½ times more often than upper level residents. Of 321 topics available in 18 subject categories, 153 (48%) were selected at least once. Content was rated as appropriate by 72% of users. 95% of residents would use the program again. Although no resident felt the program itself took too long to use, 51% said they were too busy to use the VP. Time of use and level of training may be important factors in CAI use in the pediatric ED environment. area, the pediatric emergency department (PED), a limited amount of specific CAI has been produced. Yamamoto’s Radiology Cases in Pediatric Emergency Medicine appears to be the best known.10 Acute care settings (emergency departments, busy clinics, etc.) are difficult educational environments. Some specific learning challenges include: • High patient volumes • Serious, acute illnesses are infrequent. • Seasonality of disease may result in a resident not experiencing common illness Pusic and colleagues developed three CAI tutorials and evaluated residents’ use of these programs.11 The tutorials focused on infrequent, high-risk illnesses. In this study, only 34% of residents completed a tutorial; 37% interacted with the program for less than five minutes. This may reflect one limitation on the use of CAI in the PED. Our research question stems from this point: Does integrating CAI into the workflow of a busy clinical setting offer any advantages? INTRODUCTION Resident education is a primary responsibility of academic faculty practicing in busy clinical settings. While clinical demands have increased in recent years, these instructional responsibilities remain 1 . Complementary educational resources may help extend the learning opportunities for residents in these settings. Computer-aided instructional (CAI) software is one possible resource2 . CAI tools are becoming commonplace in medicine, as indicated by the expanding medical literature on this topic 3 . At least one study suggests that pediatric residents are interested in using CAI as a supplement to direct one-on-one instruction.4 Educational World Wide Web sites5,6 , electronic textbooks 7 , tutorials 8 , and simulations9 have been produced for both general audiences and specific subspecialties. In our practice To adapt CAI to our acute care environment, we used as a guide the just-in-time (JIT) learning model described by Chueh and Barnett12 . JIT instruction involves the provision of information in a concise, learner-specific form “just as the learner needs it”. This concept is borrowed from the JIT inventory model used in business. Just as a business is more efficient if the needed part arrives the day it is used, avoiding the cost of storage, learning is more efficient if the appropriate information is provided just as its use is required. As one might have guessed, the JIT model is not so much a novel concept as a formulation of what is already practiced – it is precisely the method used by academic medical faculty in settings like the PED. We simply call it precepting. (Of course, precepting encompasses other functions such as role modelling.) In a survey of PED faculty, precepting was the most commonly AMIA 2003 Symposium Proceedings − Page 6 employed educational strategy.13 To evaluate the value of this model of CAI design, we developed a CAI program called the Virtual Preceptor that: • Requires less than five minutes to use. • Provides a brief amount of information based on a user’s request. • Provides information in a timely fashion. In this paper, we describe the development of the Virtual Preceptor program and evaluate the resident use of and satisfaction with the program. METHODS Study Setting and Population This study was conducted at the Johns Hopkins Hospital Pediatric Emergency Department (Baltimore, MD), in which 26,000 children are seen annually. Residents provide the first line of care and are precepted by faculty or fellows in the Division of Pediatric Emergency Medicine. The number of residents working at any one time varies from one to seven. Pediatric residents (all years) rotate to the PED for month-long rotations one to two months per year. During any month, fourteen to seventeen residents are assigned to the PED for at least two weeks. database was limited to eighteen subject categories and a total of 321 topics. The content of the database was written by one of the authors (MA) with citations to source material as necessary. Total development time for this database was three months. Faculty members reviewed all topics for accuracy. The content was stored in a relational database created using Microsoft Access 97™. In this version of the Virtual Preceptor, the user was restricted in how the content could be queried. Restricting search options reduced the need for sophisticated searching software and a complex database structure. A user logs into the site from any Web connected computer using his/her hospital assigned doctor ID number. In our PED, there were two main computers used by residents. A second page was then displayed, allowing a user to choose from a list of subjects . (e.g. asthma). That choice, in turn, returned a new list of 12-20 topics pertaining to the subject chosen (e.g. asthma medications). The user could choose up to three subject/topic pairs, which were displayed on the results page (Figure 1). Development of the Virtual Preceptor Software Our goal in developing the Virtual Preceptor was to provide brief, focused educational content for use in the pediatric emergency department. To accomplish this goal, we designed the software with specific constraints. To address the time pressures of the PED, the program was designed to take less than 5 minutes per encounter. The content was broken down into paragraph-long segments for quick reading. The interface was streamlined to require only three Web pages in total. To increase initial acceptance, we avoided the introduction of new software. This was a second motivation for choosing a Web interface, as previous work at (...truncated)