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Academic Psychiatry, VOL. 23, No. 2
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EDUCATIONAL COMPUTING   |   June 01, 1999 
The Computerized Residency Director
Carlyle H. Chan, M.D.
Academic Psychiatry 1999;23:107-109.
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Educational ComputingComputers
Dr. Kramer is Assistant Director of Training, Arkansas Mental Health Research and Training Institute, Little Rock, AR; and Mr. Kennedy is Director of Fellowship Training and Director of Computing Services, Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY. Dr. Kramer's e-mail address is: tamkmd@aol.com. Mr. Kennedy's e-mail address is: kennedy@aecom.yu.edu.Copyright © 1999 Academic Psychiatry.
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Abstract
This issue, we have invited Carlyle H. Chan, M.D., to be a guest columnist for our "Educational Computing" column. Dr. Chan is Professor and Vice Chair for Education and Informatics in the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin, where he directs residency education and continuing medical education. We hope you enjoy his column. —Tom Kramer, M.D., and Robert Kennedy, M.A. (Academic Psychiatry 1999; 23:107—109)Abstract Teaser
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    Of the various administrative tasks a residency director must perform, several lend themselves to computerization. Computer hardware and pertinent software permit the storage, rapid access, and usage of large amounts of data. However, there are few, if any, turnkey operations that do everything or that automatically save time. Most software will require both a financial and a time investment before there can be dividends, but once operational, can eventually save time, effort, and money. I review some of the specific tasks a training director must perform and how different types of software and hardware can enhance an educational administrator's performance.
    Our residency is supported by four separate hospitals. Although there are several monthly block rotations at one location, during some training years, residents will spend varying percentages of full-time equivalent (FTE) time at two, three, or four affiliates. To be certain that each hospital’s allotment of stipends was not exceeded, I would construct a year-long clinical rotation schedule for each resident and record what percentage of FTE time was attributed to each hospital each month. It took several hours to tabulate the total stipend support per institution. The subtotals also had to be broken down by 6-month periods, because some hospitals operated on a fiscal year that differed from the calendar year. If there were any schedule changes, this laborious task then had to be repeated.
    Spreadsheets have greatly simplified this process. Spreadsheets are accounting software that were originally designed to handle numbers, and they allowed one to perform mathematical calculations on numeric data. Spreadsheets are divided into rows and columns in a grid or matrix format. Each location or cell on this grid can be identified (e.g., Column B, Row 2, or B-2) and each location may contain primary data or a formula (e.g., location B-13 may contain the formula: add all the entries from B-2 to B-12). Finally, a series of these matrices or grids can be linked together. Spreadsheets are traditionally used to keep track of budgets and expenses and, by substituting numbers, can retabulate "what if" scenarios.
    Once set up, spreadsheets permit the tabulations to be accomplished almost instantaneously. Any schedule changes are also immediately recalculated. Thus, up-to-date totals can be provided to any hospital administrator. Spreadsheets have additional benefits. The grid can also contain alphabetical, as well as numeric, data. When scheduling rotations for the year, monthly rotation blocks may be moved and rearranged as one adjusts rotation assignments to establish the final schedule. The final schedule may then be printed out.
    The Residency Review Committee (RRC) stipulates that applicants be provided individual program information as well as information on benefits and fringe benefits. A residency recruitment brochure can fulfill this requirement. Ten years ago, our department hired an outside graphic artist to design and produce a brochure, at a cost (including printing) of almost $8,000. In spite of replaceable inserts, within a couple years, several sections became outdated.
    With the advent of desktop publishing software (under $100) and a binding machine ($200), we have now been able to create a recruitment brochure that is updated yearly at a small fraction of the original cost. Embossing a gold leaf cover cost $800, but the quantity purchased has lasted 8 years. Heavier stock paper is only marginally more expensive. New photos may be inserted either by using a scanner or a digital camera. Investment in a quality color printer could produce a color brochure as well.
    The RRC also expects residents to keep a log of their clinical experience. Paper-and-pencil techniques more than satisfy this requirement. However, trying to use summary data from these records means examining each page of information and then tallying each relevant piece of information on that page.
    If the information is kept on a computer database software, reports could be constructed, for example, that could separate a resident's caseload by institution, gender, treatment modality, diagnosis, or whatever variable that is chosen to be recorded. Thus, resident logs could provide valuable training information rather than simply be a tedious exercise.
    A key issue is how to input the log information into a computer. Several techniques have been used. Written information could be keypunched at a computer terminal by an administrative assistant or by the resident themselves. The former approach can occupy a considerable amount of data entry time, whereas the latter approach would require access to a computer and training.
    Optical marker sheets or cards are often used to record answers to multiple-choice exams. Small circled areas that are coded to represent a specific answer are filled in using a number 2 pencil. These same sheets or cards can be used to record resident log data. The sheet or card is then fed into an optical marker scanner which then "reads" the mark and converts the location into specific information.
    Finally, clinical information can be entered into small handheld computers, also known as a personal digital assistant (PDA) and then downloaded via a special connection or an infrared coupling onto a computer. The cost of a PDA can vary from $200 to $500 or more. Special software must be purchased that facilitates construction of a form that would capture the log data on a PDA. Finally, someone must then spend time programming the database software to generate relevant reports.
    The myriad of letters, reports, and meeting summaries a residency director dictates for transcription can occupy a considerable portion of time for an administrative assistant who might be used for other tasks.
    The development of continuous speech-recognition and voice-recognition software, combined with a low price, now makes it feasible to skip the manual transcription process. There is, however, a considerable amount of time required to "train" the software to recognize your voice and vocabulary. Current versions still make a number of mistakes, but the error rate is decreasing. Highly technical dictation (e.g., DSM-IV terminology) will usually require a specialized vocabulary module at a greater expense.
    Constructing slides to augment a lecture can be an expensive proposition. Some commercial firms charge as much as $9 to $12 per slide if you start with a typed or written page. Several days lead time may also be required to prepare the slide.
    Presentation software provides the tools to make your own slides on a computer. The slides can then be saved to a floppy disk and then transported to a developer who can then convert the digital images on the disk to actual slides, usually at a cost of $4 to $6 a slide. Of course, if your department owns a LCD (liquid crystal diode) projection device and a connected computer, you can display your slides directly to a screen without the need to develop a 35-mm version. If you are prone to last-minute changes, this is the option of choice.
    The ability to access information, both clinically and educationally related, has been greatly enhanced by both CD-ROM and the Internet. Entire books and full text of journal articles can be found in both mediums. The APEL (American Psychiatric Electronic Library), produced by APPI, is but one example of a CD-ROM product.
    One can access from the office or the home, the library catalogues of most major universities, as well as conduct MEDLINE or "Psychlit" searches via the Internet. Intranet sites (that is, Web sites limited to a particular institution) can also be a source of institutional information, such as class schedules and phone directories, etc. E-mail has become an invaluable communication tool to exchange ideas and information. As faculty practice plans adopt computerized medical records linked to billing software, computer skills will be required of faculty and residents alike to document clinical tasks.
    The computerized residency director must also make decisions on what equipment is necessary. For example, a mobile director may prefer a notebook computer over a desktop version. Frequent desktop publishing or the need to digitalize text necessitates a scanner, plus optical character-recognition software. A digital camera (both still photos and movie) is another tool to capture images.
    Computers can be a valuable aid to completing administrative and teaching tasks by increasing efficiency and decreasing costs. +Table 1 is a nonexhaustive list of commercial software described in this column. However, there is a learning curve that limits the initial cost and time savings. But the long-term benefits are worth the time and effort.
     
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