AT&T Fellows Final Report: Glenda R. Westmoreland, MD, MPH

AT&T Fellows Final Reports

April 2002

Name	Glenda R. Westmoreland, MD, MPH
Title	Physician
Department	Medicine
Campus	IUPUI
Project Title	Web-based Geriatrics Modules for Resident Education: A Randomized Controlled Trial
Project Goal	The purpose of the project is to develop Web-based modules in geriatrics education. These modules will be designed for residents’ geriatric education in four content areas. Using Ameritech funding, the modules will be enhanced by adding video and audio components to increase stimulation and interactivity. Secondarily, a randomized controlled trial will be conducted to determine if the enhanced Web-based modules when compared with modules having largely textual, but similar content will improve resident satisfaction and improve knowledge, skills, and attitudes in geriatrics.
Type of Technology Used in the Project	Web-based technology

Executive Summary of Results

The four Web-based modules have been developed. They went through several modifications in content using input from nationally recognized medical educators. They have been coded into HTML with expectations to post them within a couple of weeks.

We will begin shooting the video clips to insert in the modules by the first week in June. The script has been written, resident doctors employed for the doctor roles in the video and the site of the shooting located.

Randomization of residents to interact with the Web-based materials versus traditional reading materials will begin in July 2002. These standardized patients will assess the residents’ knowledge, skills and attitudes after interacting with the Web modules or the traditional reading materials.

Need for the Project

Briefly explain why you believed there was a need for your project and what teaching approach was used to address this need.

Currently there is a disparity between the large numbers of resident learners who require training in geriatrics and the smaller number of qualified geriatrics trained teachers. Because of this disparity and mandates requiring resident training in geriatrics, innovative teaching approaches, such as computer-assisted instruction are needed. Toward this end, the Fellow submitted a proposal to the Robert Wood Johnson Foundation for the Generalist Physician Faculty Scholars Program entitled “The Effect of Web-based Training and Activated Standardized Patients on Residents’ Practice Patterns with Older Patients.”

The study is a randomized controlled trial with the following study aims: (1) to develop and assess the effect of a primary care geriatrics Web-based education intervention on internal medicine residents’ knowledge, skills and attitudes and (2) to employ standardized patients (SPs) to simulate older patients to further evaluate residents’ application of geriatric-focused health care in residents exposed to different educational interventions.

Although the modules will be evidence-based, interactive, and use the concepts of adult learning theory they were initially planned to be largely textual. Funding from the Ameritech Fellows Program will be used to enhance the textual content by adding multi-media presentations within the modules.

Use of Technology

Briefly explain how your project used instructional technology in a new or different way.

Funding from the Ameritech Fellows Program will be used to augment largely textual content material for resident education. Audio and video content will enhance the text. For example, one of the modules is on dementia. Video will be added to this module to demonstrate a doctor evaluating the cognition of a patient who has dementia. The resident will then be asked to comment on the evaluation.

Instructional Design Plan

Describe how the use of technology used supported your teaching approach:

What student learning outcomes were expected?
How did your teaching plan encourage active learning, provide feedback, address respective learning styles, and build collaboration?
What resources were used? (campus technology support services, etc.)
Would your project be easily understood and executed by other faculty?

Residents who are randomized to the Web-base modules are expected to have higher knowledge and better skills and attitudes as assessed by the standardized patients (SPs). SPs are actors who have been trained to portray real patients and to assess learners’ knowledge, skills and attitudes.

Residents will receive the Web-based instruction or traditional teaching materials covering the same content during a required rotation. Additional key readings will be provided for both groups.

Local information technology experts have been employed for the project.

A faculty member has already sought my help in developing Web-based educational materials that are interactive. The faculty member is applying for a grant and has sited my materials as evidence of local development of Web-based instruction.

Potential to Impact Student Learning

Clearly define how your project improved student learning - include specific examples of how your project:

Fostered depth of learning
Supported efforts to improve retention
Fostered the learning of large numbers of students
Has broader applications that will affect learning K-12 or community environments?

The project requires internal medicine and medicine-pediatrics residents to review geriatrics content in two formats: Web-based versus traditional reading. Additionally, both groups will receive literature citations for self-directed learning opportunities.

The use of adult learning theory in the development of the content and the use of audio and video materials to augment the textual content will promote understanding and retention. The audio and video streams will allow the learner to interact with the content and will enhance mastery of the material.

Because of the Web-based format, large numbers of learners will interact with the content. The learner audience will be expanded to medical students so that each of the 280 medical students will be required to interact with the modules as well. Additional modules will be developed for the students using the same concepts.

Assessment Plan

Briefly explain the effectiveness of your assessment plan:

What measure of assessment was used?
How did your approach obtain measures of performance?
Did you feel your measurement was accurate and effective?

Residents will be evaluated formatively as they answer questions while progressively moving through the modules. Residents will be evaluated summatively by completing questions at the end of the modules and all residents (Web-based modules and conventional reading materials) will complete a written questionnaire at the end of the ambulatory month that assesses their knowledge, skills and attitudes. They will be evaluated using the same questionnaire at six and twelve months after the educational intervention.

Learner outcomes measuring application of educational content is the most powerful form of assessment. This assessment of application may be accomplished using real patients which has been difficult to do in previous studies. We will use simulated patients also known as standardized patients (SPs) as proxies for real patients. These SPs will measure sophisticated learner outcomes by assessing residents’ application to patients. The SPs will be introduced unannounced (the resident is blinded to the fact that the SP is not a “real” patient) into the residents’ continuity clinic practice. Six unannounced SPs will be introduced into each resident’s practice beginning one month after the exposure to the geriatrics education and for the next 12 months. These SPs will evaluate each resident’s knowledge, skills, and attitudes about dementia, depression, falls, and urinary incontinence using a standardized evaluation form. It is hypothesized that residents who received the Web-based training will have higher performances on the standardized evaluations by SPs when compared with residents who receive geriatrics education using conventional reading materials.

We are in the process of writing the cases for the SPs and developing their assessment instruments.

Plan for Colleague Development

Describe your role and activities as a mentor:

What mentoring activities were implemented to assist colleagues?
How did you help to develop colleague's instructional technology skills?
How do you think your contributions to the Knowledge Base will help colleagues planning similar projects?
Is your project approach potentially applicable to other contexts or disciplines?
What tips would you offer?

The use of Web-based technology is very exportable to other contexts and disciplines. As noted above, another faculty member has sought my input on development of their Web modules. I have shared my content with him and provided myself as a consultant.

Additionally, I plan to present the findings of the study and the Web-based materials at regional and national meetings for education workshops.

Final Comments on Project Results

Do you think you met the goals of your project?
What, if anything,would you do differently?
Did you have any unexpected outcomes? (positive or negative)
Would you recommend this teaching approach to colleagues?
What other comments or suggestions would you offer to complete this report?

The Web based portion of the project will be done by the end of June for implementation at the beginning of July. The goals of the project will be met by the end of June.

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