- Email: [email protected]
CAI at the Ohio State University College of Medicine (1973)
Comput. Biol. Med.
Pergamon Press 1973. Vol. 3, pp. 299-305.
Printed in Great Britain.
CA1 at the Ohio State University College of Medicine (1973) ARMIN Project
Administrator-CAIREN,
D. WEINBERG
1645 Neil
Avenue,
Columbus,
Ohio
43210,
U.S.A.
(Received 3 May 1973 and in revised form 9 May 1973) Abstract-The organization and activities related to The Ohio State University College of Medicine CA1 efforts are presented in this paper. Typical production methodolgy is discussed as it relates to the various developmental and continuing applications of CAL Ongoing CA1 projects in medical, nursing and allied health curricula, the use of CA1 in independent study, and the use of CA1 in continuing health professional education are discussed. The central organization and staffing has resulted in a viable system through the sharing of project personnel, materials and programs. Therefore, it has been possible to distribute and lower the cost of using CAI, through increased system efficiency and utilization, and eliminating duplication of efforts. Independent study Computer assisted instruction Network Program development programmers
Continuing medical education Medical education
Instructional
OHIO State University College of Medicine has been involved with the application and evaluation of computer-assisted instruction (CAI) for several years. During this period of time, a functional organization has evolved permitting shared resources and benefits from basic research and development. Programs utilizing CA1 ranged from those incorporated into medical, nursing and allied health curricula to those for continuing education. This paper will present a basic description of the organization and system structure, the process of program development, the ongoing application of CAI, and the current research and development efforts. THE
ORGANIZATIONAL
STRUCTURE
All CA1 activities are coordinated at the administrative level through the Assistant Dean for Medical Education in the College of Medicine. This central leadership facilitates overall coordination and future planning. Responding to the assistant dean are the Divisions of Research and Evaluation in Medical Education, and the Division of Computing Services for Medical Education and Research. Although both of these divisions are responsible for other activities, each has an important role in the development, maintenance and utilization of CAL The Division of Computing Services for Medical Education and Research, has the responsibility of supporting and developing instructional uses of computer-assisted instruction. In addition, the staff assists in the planning and design of special programs and functions related to those specific needs exhibited through the various applications and maintenance of CAL 299
300
ARMIND.
WEINBERG
The Division of Research and Evaluation in Medical Education has the responsibility of assisting authors in planning, evaluation and design, as well as the implementation of techniques which will aid the users of CA1 in evaluating its effectiveness. A component of the Division of Research and Evaluation in Medical Education is the CA1 Course Development staff, which is responsible for the instructional programming through which assistance is provided to those faculty interested in becoming CA1 authors. The College has formed a CA1 Advisory Committee which is composed of project directors, administrators and faculty representatives. It meets specifically for the purpose of providing coordination, direction and guidance of CA1 for the College of Medicine, as well as the special research and operational projects within the College. PROGRAM
DEVELOPMENT
In program development four divisions of personnel should participate in the formation of the final product-CAI, these are: (1) the author or author teams; (2) the instructional programmer; (3) the author consultant; and (4) the evaluation team. The Author is responsible for the actual content of the program. His goal is to develop a functional program using CAT. The Instructional Programmers are experts in the use of the computer language for their CA1 system. Their function is to assist the author by properly coding the material and to provide input into the computer. They are also responsible for the CA1 design, editing and debugging of the program. Along with their other duties, they are available to assist the author in developing other essential learning resources such as audiovisuals which may accompany the CA1 program. The Author Consultant serves as a pivot point for the Author, Instructional Programmer and Evaluation Team. He works closely with the author in developing program content. The author consultant handles any unusual problems the author encounters in reaching a workable CA1 program. The author consultant is also available to the instructional programmers and author team for consultation. The Evaluation Team is composed of experts in Educational Evaluation and the author. Their responsibility is to properly evaluate the students as they progress through the program. Also, their function is to consider the overall objectives and evaluation of the project. The general method of CA1 program production is identified through user suggestions, questionnaires and evaluations of current programs. Additionally, as new concepts are introduced, programs are authored if the topics are congruent with the CA1 medium. When a need is identified, the availability of related materials is investigated and a decision made and verified on the applicability of the CA1 program. Based on the identified need, a content expert with educational experience is selected to author the program and is provided an orientation to CA1 capabilities and the use of this media. As with any other instructional methodology, the next step in CA1 program development is for the author to construct outcome objectives for the learner. Criterion tests can be developed to evaluate whether or not the learner has in fact, achieved the program objectives. Criterion tests may appear as pre- and post-tests, quizzes or embedded evaluative questions within, or apart from, the program. Once decisions on program goals have been made, the author provides a content outline to orient the CA1 staff to the core material. One of the most important facets of program production is the strategy meeting. The author brings content expertise to this meeting, while the CA1 staff contributes expertise in the application of the CAI medium. The instructional programmer who will work closely
CA1 at the Ohio State University
301
with the author is an important component of this team. It is the programmer who will convert the author’s program material using language commands into a CA1 program. During the strategy meeting the most appropriate methods of presentation of the content are identified, while audiovisual compliments are selected. Each author receives individualized assistance, depending on their educational background and experience with CAI. Ongoing with authorship is the preparation of audiovisuals. If illustrations are taken directly from texts or journals, permission for duplication and distribution should be secured. Authors are provided a manual entitled “The Author’s Guide to CAI” which explains what CA1 is all about, how he might utilize it, and how to write a CA1 program. Authoring for the beginner can be facilitated through the use of color coded forms which are explained in the manual. These encourage the author to be flexible and permit variety in program design. Furthermore, they remove the necessity for knowing about CA1 programming and its language. Program material is usually being programmed as it is written. Thus, the author can see completed sections at the terminal during production to assist in visualizing it as his users will. When the material is totally programmed, the author critiques his program at the terminal for edits, transitions and rewording which may be needed since CA1 is not static as a textbook, but dynamic so that revisions can be easily accomplished. A field test is conducted by students and programmers for the purpose of “debugging” the course of misspellings, punctuation errors and to identify unclear questions or explanations. In addition, programming is checked to determine that the sequence of question flow is as the author intended. The material is now ready for a content review by author designated consultants. Suggestions for additions, deletions and revisions may be given to the author but it is the author who has the designated control to decide which suggestions to initiate and follow. Evaluation is the final step in program development, and one of the most crucial. Reports will be used by authors to examine the validity of test questions and improve the feedback to unanticipated responses. Learner progress records will also indicate to the author whether the CA1 program is fulfilling instructional expectations. As a need arises for updating or major course revision, an author will be obtained for this purpose. As CA1 demands an active role on the part of the learner, the chances of learning are much increased over inactive learning modes such as lectures or movies. The conversational inquiry method of material presentation makes learning a pleasant, interactive experience. The additional feature of the hard copy printout permits the tracking of the assigned responsibilities, quality of performance and given group discussion. Typical CA1 items may be constructed response, true-false, multiple choice, matching or ranking questions. The computer encounters the student with a question and then immediately evaluates his response. Correct answers receive a positive reinforcing type of feedback, while wrong answers trigger corrective feedback and perhaps an additional opportunity to respond to the question. The computer will also respond to unanticipated answers and attempt to coach the student through a series of statements, clues or additional questions to the correct answer. Of particular note are the different types of computer feedback provided by the author for the student’s answers. The computer programs have also been designed to express the personalities of each author. When a student is not doing well on the program
302
ARMIN D. WEINBERG
the computer will alert him to his deficiencies and may issue a study prescription. Study prescriptions may appear as an additional study assignment, a review of previously suggested material or a simple statement suggesting a faculty conference. COMPUTER
FACILITIES
The typical CA1 installation consists of a typewriter terminal and carousel slide projector. Each terminal is linked to the computer center through a data set and telephone line. To facilitate usage and to permit economy, a telephone rotary is utilized saving in the number of computer ports necessary, yet accomodating peak usage. At present the system is composed of: (1) IBM package program COURSEWRITER III, v. 2.1 under OS/MFT; (2) core storage requirement 80 K; (3) IBM 360/50-31 ports; (4) system performance available 20-22 hr a day; and (5) average response time 1.6-l .7 sec. CA1 APPLICATIONS Through proper utilization of the capabilities of the various divisions and the computer hardware and software, operational and research projects related to CA1 can effectively develop and maintain CA1 usage and applications. The following are currently ongoing operational CA1 projects. Curricular applications Since 1964, the Ohio State University College of Medicine has been continuously evaluating and revising its medical education curriculum. Experience with independent study was acquired through the use of a two-track curriculum in anatomy and independent study groups in biochemistry. (l) Computer Assisted Instruction has been utilized in segments of its curriculum since 1967, when programs in anatomy and biochemistry were used to facilitate this early independent study. These early programs were used by students for selfevaluation. In histology, a simulated laboratory experience has replaced actual laboratory experience in organ identification. In the intervening years programs have been developed to accompany many areas of study, i.e. musculoskeletal system, physiology, neuroanatomy, neuromuscular morphology, etc. A survey of the current uses of the CA1 materials reveals several instructional curricula incorporating CA1 courses on syllabi, reference lists and as required reading materials. The CA1 staff provides assistance to interested faculty in adapting this mode of learning to their particular instructional situations. Examination and task analysis of a topic area combined with scrutiny of the CA1 course material are recommended. The flexibility of the CA1 course flow permits varied access to the specific sections relevant to various situations. Available programming functions permit users to select many segments at the instructor’s direction. The hard copy printout from the typewriter terminal adds the extra advantage of resource material that the student may retain for further review and study. Instructors often utilize printouts for review with their students. Evaluation of learning is provided in many of the courses via pre- and post-tests. In addition, some courses provide statements which allow the instructor to determine his own criterion for successful completion, although he was not the author. Nursing, radiologic technology, medical technology, and constant and emergency care technician schools have found application of CA1 programs within their curricula. Basic medical science programs, the common denominator of health education are utilized by
CA1 at the Ohio State University
303
many. In addition, the basic patient education programs often appear as resource or required reading material for those areas oft neglected for lack of time in many training programs. CA1 has been utilized as a tool for facilitating the independent study concept at the curriculum level in the teaching of basic medical science concepts to the medical student. Work in this area has come under the auspices of the Independent Study Program (BP), formerly known as the Pilot Medical School (PMS). The Ohio State University Pilot MedicaV2) was a research project charged with investigating the effectiveness and efficiency of utilizing selected concepts of independent study in medical education. The Pilot Medical School was to design, implement and evaluate a preclerkship curriculum that would incorporate as its foundation, certain educational principles and tenets of independent study. The PMS was formed as a result of a 3 yr grant from the U.S. Public Health Service, Division of Physician Manpower. This grant provided for program development in the 1st yr, followed by 2 yr of operation and evaluation. The first class of 32 students began their medical studies under this independent study curriculum in July of 1970, the second class of 59 students began in July of 1971 and a third class of 58 students began in July of 1972. The class of students is operating through College support since the ISP was incorporated as a curriculum option. The “regular” Ohio State Medical curriculum known as the Lecture-Discussion Program, is a four-phase, 3 yr (35 month) curriculum. Students from the “regular” curriculum can take advantage of the ISP materials for restudy and review. It is worth noting that the ISP option has also allowed some slower students to recycle and move at their own rate in their medical studies. The concept of independent study means different things to different people and can encompass a wide spectrum of individual interpretation, as well as operational structures. The ISP does not employ CA1 in a primary instructional role. The student’s use of the computer is for tutorial self-evaluation, hence, the self-evaluation exercises were designed to provide the student an opportunity to gauge his progress and determine his success in satisfying the objectives. Continuing
education
In 1967 a group of medical educators from The Ohio State University College of Medicine established a pilot study to assess the feasibility of applying computer technology to the continuing education needs of Ohio physicians. Four hospitals were selected during the following year (1968) to participate in the initial phase of the study. These community hospitals were chosen as being representatives of various geographic and sociological factors. The expressed needs by other audiences for programs necessitated broadening of the original project scope to include nursing and allied health personnel. The receipt of a 3 yr grant from the Ohio State Regional Medical Program facilitated expansion of this network, which was enlarged to 10 hospitals, and the program offerings were increased. Core staff was expanded, and authors were solicited from the College of Medicine to develop programs. During the following years, subsidies to network hospitals were gradually decreased, allowing more funds for increasing the network and producing more programs of instruction including those for patient education. A reorganization, establishing the CA1 Regional Education Network (CAIREN) occurred in mid-1972. Mechanisms for soliciting comments on individual programs, maintaining close communication with each network member, and establishing production priorities to meet the needs of the members have been developed. To date, CAIREN has 18 terminals
ARMIN D. WEINBERG
304
in two schools of nursing and 15 hospitals throughout Ohio providing CA1 access to approximately 20 000 health professionals and students, with over 170 hr of instructional and service programs. The success of this pilot program has provided a strong base for the state-wide expansion of CAIREN operations-both in terms of membership and program offerings. Such an expansion will result not only in greater educational opportunities for health care professionals in the State of Ohio, but could serve as a model for similar programs throughout the country. The project has worked on the premise that “The quality of patient care and health care services is contingent on the knowledge and skills of health professionals; therefore, the maintenance of current knowledge and skills is of vital importance to health practitioners.” Participating hospitals select the topics for continuing education courses; some courses are authored by hospital staff members and reviewed by leaders in the field while others are developed by CA1 staff members. Many of the courses developed by CAIREN are used by the College and vice versa. Inservice education is a dual responsibility of the hospital and staff member. Myriad problems involving accreditation, liability and quality of care are compounded by the realities of the health institution setting, i.e. time schedules, shifts and under staffing. Inservice education departments have a need for efficient, available programs to meet their responsibilities without placing unrealistic strain on personnel or budgets. The CAIREN offers an answer to many needs of inservice and orientation programs. The availability of CA1 to all shifts, each day of the week is viewed as most advantageous by those responsible for providng such programs. As in any CA1 utilization, relevance of the particular courses is dependent on the institution and staff member receiving education. Guidance and direction in the form of content outlines and course objectives are provided by CAIREN core staff. Professional societies for all health fields are moving toward continuing education requirements for recertification. The CAIREN is currently providing programs accredited by the following: (1) The Ohio Council on Medical Technology; (2) The American Medical Association; (3) The American Dietetic Association; and (4) The Ohio Osteopathic Association. RESEARCH
AND
DEVELOPMENT
In addition to the utilization of CA1 described previously, the College is currently involved in several experimental and developmental efforts. Under a grant from The Bureau of Health Manpower Education (BHME) the College of Medicine is extending the Independent Study Program concept into the clinical years of medical education. This curricular approach will again incorporate the advantages of computer assisted instruction, coupled with computer managed instruction. Through a contract with the Lister Hill National Center for Biomedical Communications, the College has completed a link with a national telecommunications network (TYM: SHARE) in order to make the materials which have been developed here at Ohio State available to users across the country. At the present time, there are two operational users; Washington Medical School and the Fort Worth Osteopathic Hospital, which are using the material on a regular basis through this network. In addition, some 30 or 50 trial users will have access to numerous programs during the coming months. As a result of this contract, the College will have access to the University of Illinois Medical Center’s “CASE” CA1
CA1 at the Ohio State University
305
programs which simulate the clinical encounter and the Massachusetts General Hospital CA1 programs. This particular effort allows valuable input from users in other regions and educators throughout the country relating to the content and presentation of the College CA1 programs. Furthermore, it provides national distribution and recognition to those agencies and authors of these programs. Under another grant from BHME, the faculty and staff of the Independent Study Program are preparing the ISP materials through extensive revisions, documentation and packaging thus making them exportable for distribution to other medical schools for use and adaptation into their educational programs. In addition, the Division of Medical Dietetics has been awarded a grant to develop 66 case studies simulating patient encounters through CA1 which will alleviate a “bottleneck” in the medical dietetic curriculum which is caused by the absence of a sufficient number of real patient encounters possible by their students. CAIREN has been awarded a contract from Bolt Beranek & Newman to develop several patient education programs for use in their Computer Aids in the Physician’s Office Proiect. SUMMARY The investment made in time and money by the Federal Government, and the Ohio State University and College of Medicine, have been of great value to students, faculty and staff at Ohio State. The benefits of these efforts have been shared with other universities and medical schools throughout the United States. Currently, trial and operational users of the Lister Hill National Center for Biomedical Communication are accessing the College of Medicine CA1 materials. These user groups represent both College of Medicine and Hospital applications of CAI, from various regions of the United States. CA1 programs developed at the Ohio State University are being released for use at other sites. The philosophy of the College recognizes the difficulties and obstacles in implementing and beginning to utilize CAI, viz cost involved and the absence of good courseware. A functional course release policy has been developed and established to encourage and assist all those involved in medical education who are interested in implementing and evaluating the capabilities and flexibility which CA1 permits. The central organization and staffing has resulted in a viable system through which the following benefits have been derived: (1) overall CA1 coordination; (2) sharing of project personnel; (3) sharing of materials and programs; (4) increased system efficiency; (5) increased utilization; (6) elimination of duplicate efforts; and (7) sharing and distribution of cost. Therefore, the Ohio State University College of Medicine has established a functional CA1 system capable of supporting ongoing program usage, as well as being a viable system capable of attracting and supporting research in CAI. Furthermore, it is capable of disseminating this material to interested users in this application through its involvement in both a state and national network for health educators, students and professionals. REFERENCES 1. G. 0. GRAVES,L. medical education, 2. J. V. GRIESEN,R. medical education,
E. EVANS, R. W. INGERKJLLand J. CAMISCIONI,Need for a multiple-track system in J. Med. Educ. 44, 344 (1969). L. BERAN, R. L. FOLK and J. A. PRIOR, A pilot program for independent study in Self-lnsiruclion in Medical Education. University of Rochester, Rochester (1971).
Pergamon Press 1973. Vol. 3, pp. 299-305.
Printed in Great Britain.
CA1 at the Ohio State University College of Medicine (1973) ARMIN Project
Administrator-CAIREN,
D. WEINBERG
1645 Neil
Avenue,
Columbus,
Ohio
43210,
U.S.A.
(Received 3 May 1973 and in revised form 9 May 1973) Abstract-The organization and activities related to The Ohio State University College of Medicine CA1 efforts are presented in this paper. Typical production methodolgy is discussed as it relates to the various developmental and continuing applications of CAL Ongoing CA1 projects in medical, nursing and allied health curricula, the use of CA1 in independent study, and the use of CA1 in continuing health professional education are discussed. The central organization and staffing has resulted in a viable system through the sharing of project personnel, materials and programs. Therefore, it has been possible to distribute and lower the cost of using CAI, through increased system efficiency and utilization, and eliminating duplication of efforts. Independent study Computer assisted instruction Network Program development programmers
Continuing medical education Medical education
Instructional
OHIO State University College of Medicine has been involved with the application and evaluation of computer-assisted instruction (CAI) for several years. During this period of time, a functional organization has evolved permitting shared resources and benefits from basic research and development. Programs utilizing CA1 ranged from those incorporated into medical, nursing and allied health curricula to those for continuing education. This paper will present a basic description of the organization and system structure, the process of program development, the ongoing application of CAI, and the current research and development efforts. THE
ORGANIZATIONAL
STRUCTURE
All CA1 activities are coordinated at the administrative level through the Assistant Dean for Medical Education in the College of Medicine. This central leadership facilitates overall coordination and future planning. Responding to the assistant dean are the Divisions of Research and Evaluation in Medical Education, and the Division of Computing Services for Medical Education and Research. Although both of these divisions are responsible for other activities, each has an important role in the development, maintenance and utilization of CAL The Division of Computing Services for Medical Education and Research, has the responsibility of supporting and developing instructional uses of computer-assisted instruction. In addition, the staff assists in the planning and design of special programs and functions related to those specific needs exhibited through the various applications and maintenance of CAL 299
300
ARMIND.
WEINBERG
The Division of Research and Evaluation in Medical Education has the responsibility of assisting authors in planning, evaluation and design, as well as the implementation of techniques which will aid the users of CA1 in evaluating its effectiveness. A component of the Division of Research and Evaluation in Medical Education is the CA1 Course Development staff, which is responsible for the instructional programming through which assistance is provided to those faculty interested in becoming CA1 authors. The College has formed a CA1 Advisory Committee which is composed of project directors, administrators and faculty representatives. It meets specifically for the purpose of providing coordination, direction and guidance of CA1 for the College of Medicine, as well as the special research and operational projects within the College. PROGRAM
DEVELOPMENT
In program development four divisions of personnel should participate in the formation of the final product-CAI, these are: (1) the author or author teams; (2) the instructional programmer; (3) the author consultant; and (4) the evaluation team. The Author is responsible for the actual content of the program. His goal is to develop a functional program using CAT. The Instructional Programmers are experts in the use of the computer language for their CA1 system. Their function is to assist the author by properly coding the material and to provide input into the computer. They are also responsible for the CA1 design, editing and debugging of the program. Along with their other duties, they are available to assist the author in developing other essential learning resources such as audiovisuals which may accompany the CA1 program. The Author Consultant serves as a pivot point for the Author, Instructional Programmer and Evaluation Team. He works closely with the author in developing program content. The author consultant handles any unusual problems the author encounters in reaching a workable CA1 program. The author consultant is also available to the instructional programmers and author team for consultation. The Evaluation Team is composed of experts in Educational Evaluation and the author. Their responsibility is to properly evaluate the students as they progress through the program. Also, their function is to consider the overall objectives and evaluation of the project. The general method of CA1 program production is identified through user suggestions, questionnaires and evaluations of current programs. Additionally, as new concepts are introduced, programs are authored if the topics are congruent with the CA1 medium. When a need is identified, the availability of related materials is investigated and a decision made and verified on the applicability of the CA1 program. Based on the identified need, a content expert with educational experience is selected to author the program and is provided an orientation to CA1 capabilities and the use of this media. As with any other instructional methodology, the next step in CA1 program development is for the author to construct outcome objectives for the learner. Criterion tests can be developed to evaluate whether or not the learner has in fact, achieved the program objectives. Criterion tests may appear as pre- and post-tests, quizzes or embedded evaluative questions within, or apart from, the program. Once decisions on program goals have been made, the author provides a content outline to orient the CA1 staff to the core material. One of the most important facets of program production is the strategy meeting. The author brings content expertise to this meeting, while the CA1 staff contributes expertise in the application of the CAI medium. The instructional programmer who will work closely
CA1 at the Ohio State University
301
with the author is an important component of this team. It is the programmer who will convert the author’s program material using language commands into a CA1 program. During the strategy meeting the most appropriate methods of presentation of the content are identified, while audiovisual compliments are selected. Each author receives individualized assistance, depending on their educational background and experience with CAI. Ongoing with authorship is the preparation of audiovisuals. If illustrations are taken directly from texts or journals, permission for duplication and distribution should be secured. Authors are provided a manual entitled “The Author’s Guide to CAI” which explains what CA1 is all about, how he might utilize it, and how to write a CA1 program. Authoring for the beginner can be facilitated through the use of color coded forms which are explained in the manual. These encourage the author to be flexible and permit variety in program design. Furthermore, they remove the necessity for knowing about CA1 programming and its language. Program material is usually being programmed as it is written. Thus, the author can see completed sections at the terminal during production to assist in visualizing it as his users will. When the material is totally programmed, the author critiques his program at the terminal for edits, transitions and rewording which may be needed since CA1 is not static as a textbook, but dynamic so that revisions can be easily accomplished. A field test is conducted by students and programmers for the purpose of “debugging” the course of misspellings, punctuation errors and to identify unclear questions or explanations. In addition, programming is checked to determine that the sequence of question flow is as the author intended. The material is now ready for a content review by author designated consultants. Suggestions for additions, deletions and revisions may be given to the author but it is the author who has the designated control to decide which suggestions to initiate and follow. Evaluation is the final step in program development, and one of the most crucial. Reports will be used by authors to examine the validity of test questions and improve the feedback to unanticipated responses. Learner progress records will also indicate to the author whether the CA1 program is fulfilling instructional expectations. As a need arises for updating or major course revision, an author will be obtained for this purpose. As CA1 demands an active role on the part of the learner, the chances of learning are much increased over inactive learning modes such as lectures or movies. The conversational inquiry method of material presentation makes learning a pleasant, interactive experience. The additional feature of the hard copy printout permits the tracking of the assigned responsibilities, quality of performance and given group discussion. Typical CA1 items may be constructed response, true-false, multiple choice, matching or ranking questions. The computer encounters the student with a question and then immediately evaluates his response. Correct answers receive a positive reinforcing type of feedback, while wrong answers trigger corrective feedback and perhaps an additional opportunity to respond to the question. The computer will also respond to unanticipated answers and attempt to coach the student through a series of statements, clues or additional questions to the correct answer. Of particular note are the different types of computer feedback provided by the author for the student’s answers. The computer programs have also been designed to express the personalities of each author. When a student is not doing well on the program
302
ARMIN D. WEINBERG
the computer will alert him to his deficiencies and may issue a study prescription. Study prescriptions may appear as an additional study assignment, a review of previously suggested material or a simple statement suggesting a faculty conference. COMPUTER
FACILITIES
The typical CA1 installation consists of a typewriter terminal and carousel slide projector. Each terminal is linked to the computer center through a data set and telephone line. To facilitate usage and to permit economy, a telephone rotary is utilized saving in the number of computer ports necessary, yet accomodating peak usage. At present the system is composed of: (1) IBM package program COURSEWRITER III, v. 2.1 under OS/MFT; (2) core storage requirement 80 K; (3) IBM 360/50-31 ports; (4) system performance available 20-22 hr a day; and (5) average response time 1.6-l .7 sec. CA1 APPLICATIONS Through proper utilization of the capabilities of the various divisions and the computer hardware and software, operational and research projects related to CA1 can effectively develop and maintain CA1 usage and applications. The following are currently ongoing operational CA1 projects. Curricular applications Since 1964, the Ohio State University College of Medicine has been continuously evaluating and revising its medical education curriculum. Experience with independent study was acquired through the use of a two-track curriculum in anatomy and independent study groups in biochemistry. (l) Computer Assisted Instruction has been utilized in segments of its curriculum since 1967, when programs in anatomy and biochemistry were used to facilitate this early independent study. These early programs were used by students for selfevaluation. In histology, a simulated laboratory experience has replaced actual laboratory experience in organ identification. In the intervening years programs have been developed to accompany many areas of study, i.e. musculoskeletal system, physiology, neuroanatomy, neuromuscular morphology, etc. A survey of the current uses of the CA1 materials reveals several instructional curricula incorporating CA1 courses on syllabi, reference lists and as required reading materials. The CA1 staff provides assistance to interested faculty in adapting this mode of learning to their particular instructional situations. Examination and task analysis of a topic area combined with scrutiny of the CA1 course material are recommended. The flexibility of the CA1 course flow permits varied access to the specific sections relevant to various situations. Available programming functions permit users to select many segments at the instructor’s direction. The hard copy printout from the typewriter terminal adds the extra advantage of resource material that the student may retain for further review and study. Instructors often utilize printouts for review with their students. Evaluation of learning is provided in many of the courses via pre- and post-tests. In addition, some courses provide statements which allow the instructor to determine his own criterion for successful completion, although he was not the author. Nursing, radiologic technology, medical technology, and constant and emergency care technician schools have found application of CA1 programs within their curricula. Basic medical science programs, the common denominator of health education are utilized by
CA1 at the Ohio State University
303
many. In addition, the basic patient education programs often appear as resource or required reading material for those areas oft neglected for lack of time in many training programs. CA1 has been utilized as a tool for facilitating the independent study concept at the curriculum level in the teaching of basic medical science concepts to the medical student. Work in this area has come under the auspices of the Independent Study Program (BP), formerly known as the Pilot Medical School (PMS). The Ohio State University Pilot MedicaV2) was a research project charged with investigating the effectiveness and efficiency of utilizing selected concepts of independent study in medical education. The Pilot Medical School was to design, implement and evaluate a preclerkship curriculum that would incorporate as its foundation, certain educational principles and tenets of independent study. The PMS was formed as a result of a 3 yr grant from the U.S. Public Health Service, Division of Physician Manpower. This grant provided for program development in the 1st yr, followed by 2 yr of operation and evaluation. The first class of 32 students began their medical studies under this independent study curriculum in July of 1970, the second class of 59 students began in July of 1971 and a third class of 58 students began in July of 1972. The class of students is operating through College support since the ISP was incorporated as a curriculum option. The “regular” Ohio State Medical curriculum known as the Lecture-Discussion Program, is a four-phase, 3 yr (35 month) curriculum. Students from the “regular” curriculum can take advantage of the ISP materials for restudy and review. It is worth noting that the ISP option has also allowed some slower students to recycle and move at their own rate in their medical studies. The concept of independent study means different things to different people and can encompass a wide spectrum of individual interpretation, as well as operational structures. The ISP does not employ CA1 in a primary instructional role. The student’s use of the computer is for tutorial self-evaluation, hence, the self-evaluation exercises were designed to provide the student an opportunity to gauge his progress and determine his success in satisfying the objectives. Continuing
education
In 1967 a group of medical educators from The Ohio State University College of Medicine established a pilot study to assess the feasibility of applying computer technology to the continuing education needs of Ohio physicians. Four hospitals were selected during the following year (1968) to participate in the initial phase of the study. These community hospitals were chosen as being representatives of various geographic and sociological factors. The expressed needs by other audiences for programs necessitated broadening of the original project scope to include nursing and allied health personnel. The receipt of a 3 yr grant from the Ohio State Regional Medical Program facilitated expansion of this network, which was enlarged to 10 hospitals, and the program offerings were increased. Core staff was expanded, and authors were solicited from the College of Medicine to develop programs. During the following years, subsidies to network hospitals were gradually decreased, allowing more funds for increasing the network and producing more programs of instruction including those for patient education. A reorganization, establishing the CA1 Regional Education Network (CAIREN) occurred in mid-1972. Mechanisms for soliciting comments on individual programs, maintaining close communication with each network member, and establishing production priorities to meet the needs of the members have been developed. To date, CAIREN has 18 terminals
ARMIN D. WEINBERG
304
in two schools of nursing and 15 hospitals throughout Ohio providing CA1 access to approximately 20 000 health professionals and students, with over 170 hr of instructional and service programs. The success of this pilot program has provided a strong base for the state-wide expansion of CAIREN operations-both in terms of membership and program offerings. Such an expansion will result not only in greater educational opportunities for health care professionals in the State of Ohio, but could serve as a model for similar programs throughout the country. The project has worked on the premise that “The quality of patient care and health care services is contingent on the knowledge and skills of health professionals; therefore, the maintenance of current knowledge and skills is of vital importance to health practitioners.” Participating hospitals select the topics for continuing education courses; some courses are authored by hospital staff members and reviewed by leaders in the field while others are developed by CA1 staff members. Many of the courses developed by CAIREN are used by the College and vice versa. Inservice education is a dual responsibility of the hospital and staff member. Myriad problems involving accreditation, liability and quality of care are compounded by the realities of the health institution setting, i.e. time schedules, shifts and under staffing. Inservice education departments have a need for efficient, available programs to meet their responsibilities without placing unrealistic strain on personnel or budgets. The CAIREN offers an answer to many needs of inservice and orientation programs. The availability of CA1 to all shifts, each day of the week is viewed as most advantageous by those responsible for providng such programs. As in any CA1 utilization, relevance of the particular courses is dependent on the institution and staff member receiving education. Guidance and direction in the form of content outlines and course objectives are provided by CAIREN core staff. Professional societies for all health fields are moving toward continuing education requirements for recertification. The CAIREN is currently providing programs accredited by the following: (1) The Ohio Council on Medical Technology; (2) The American Medical Association; (3) The American Dietetic Association; and (4) The Ohio Osteopathic Association. RESEARCH
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DEVELOPMENT
In addition to the utilization of CA1 described previously, the College is currently involved in several experimental and developmental efforts. Under a grant from The Bureau of Health Manpower Education (BHME) the College of Medicine is extending the Independent Study Program concept into the clinical years of medical education. This curricular approach will again incorporate the advantages of computer assisted instruction, coupled with computer managed instruction. Through a contract with the Lister Hill National Center for Biomedical Communications, the College has completed a link with a national telecommunications network (TYM: SHARE) in order to make the materials which have been developed here at Ohio State available to users across the country. At the present time, there are two operational users; Washington Medical School and the Fort Worth Osteopathic Hospital, which are using the material on a regular basis through this network. In addition, some 30 or 50 trial users will have access to numerous programs during the coming months. As a result of this contract, the College will have access to the University of Illinois Medical Center’s “CASE” CA1
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programs which simulate the clinical encounter and the Massachusetts General Hospital CA1 programs. This particular effort allows valuable input from users in other regions and educators throughout the country relating to the content and presentation of the College CA1 programs. Furthermore, it provides national distribution and recognition to those agencies and authors of these programs. Under another grant from BHME, the faculty and staff of the Independent Study Program are preparing the ISP materials through extensive revisions, documentation and packaging thus making them exportable for distribution to other medical schools for use and adaptation into their educational programs. In addition, the Division of Medical Dietetics has been awarded a grant to develop 66 case studies simulating patient encounters through CA1 which will alleviate a “bottleneck” in the medical dietetic curriculum which is caused by the absence of a sufficient number of real patient encounters possible by their students. CAIREN has been awarded a contract from Bolt Beranek & Newman to develop several patient education programs for use in their Computer Aids in the Physician’s Office Proiect. SUMMARY The investment made in time and money by the Federal Government, and the Ohio State University and College of Medicine, have been of great value to students, faculty and staff at Ohio State. The benefits of these efforts have been shared with other universities and medical schools throughout the United States. Currently, trial and operational users of the Lister Hill National Center for Biomedical Communication are accessing the College of Medicine CA1 materials. These user groups represent both College of Medicine and Hospital applications of CAI, from various regions of the United States. CA1 programs developed at the Ohio State University are being released for use at other sites. The philosophy of the College recognizes the difficulties and obstacles in implementing and beginning to utilize CAI, viz cost involved and the absence of good courseware. A functional course release policy has been developed and established to encourage and assist all those involved in medical education who are interested in implementing and evaluating the capabilities and flexibility which CA1 permits. The central organization and staffing has resulted in a viable system through which the following benefits have been derived: (1) overall CA1 coordination; (2) sharing of project personnel; (3) sharing of materials and programs; (4) increased system efficiency; (5) increased utilization; (6) elimination of duplicate efforts; and (7) sharing and distribution of cost. Therefore, the Ohio State University College of Medicine has established a functional CA1 system capable of supporting ongoing program usage, as well as being a viable system capable of attracting and supporting research in CAI. Furthermore, it is capable of disseminating this material to interested users in this application through its involvement in both a state and national network for health educators, students and professionals. REFERENCES 1. G. 0. GRAVES,L. medical education, 2. J. V. GRIESEN,R. medical education,
E. EVANS, R. W. INGERKJLLand J. CAMISCIONI,Need for a multiple-track system in J. Med. Educ. 44, 344 (1969). L. BERAN, R. L. FOLK and J. A. PRIOR, A pilot program for independent study in Self-lnsiruclion in Medical Education. University of Rochester, Rochester (1971).