Acad Psychiatry 30:444-450, November-December 2006
doi: 10.1176/appi.ap.30.6.444
© 2006 Academic Psychiatry
APA Summit on Medical Student Education Task Force on Informatics and Technology: Steps to Enhance the Use of Technology in Education Through Faculty Development, Funding and Change Management
Donald M. Hilty, M.D.,
Sheldon Benjamin, M.D.,
Gregory Briscoe, M.D.,
Deborah J. Hales, M.D.,
Robert J. Boland, M.D.,
John S. Luo, M.D.,
Carlyle H. Chan, M.D.,
Robert S. Kennedy, M.D.,
Harry Karlinsky, M.D.,
Daniel B. Gordon, M.D.,
Peter M. Yellowlees, M.D. and
Joel Yager, M.D.
Received February 1, 2006; revised July 27, 2006; accepted August 1, 2006. Drs. Hilty and Yellowlees are affiliated with the University of California, Davis, Sacramento, California. Dr. Benjamin is affiliated with University of Massachusetts Medical School, Worcester, Massachusetts. Dr. Briscoe is affiliated with Eastern Virginia Medical School, Norfolk, Virginia. Dr. Hales is affiliated with the American Psychiatric Association, Arlington, Virginia. Dr. Boland is affiliated with Brown Medical School, Providence, Rhode Island. Dr. Luo is affiliated with the University of California, Los Angeles, California. Drs. Chan and Kennedy are affiliated with the Medical College of Wisconsin, Milwaukee, Wisconsin. Dr. Karlinsky is affiliated with the University of British Columbia, Canada. Mr. Gordan is affiliated with Valhalla Partners, Vienna, Virginia. Dr. Yager is affiliated with the University of New Mexico, Albuquerque, New Mexico. Address correspondence to Dr. Hilty, University of California, Davis, 2230 Stockton Boulevard, Sacramento, CA 95817; dmhilty{at}ucdavis.edu (e-mail).
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ABSTRACT
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OBJECTIVE: This article provides an overview of how trainees, faculty, and institutions use technology for acquiring knowledge, skills, and attitudes for practicing modern medicine. METHOD: The authors reviewed the literature on medical education, technology, and change, and identify the key themes and make recommendations for implementing technology in medical education. RESULTS: Administrators and faculty should initially assess their own competencies with technology and then develop a variety of teaching methods that use technology to improve their curricula. Programs should decrease the general knowledge-based content of curricula and increase the use of technology for learning skills. For programs to be successful, they must address faculty development, change management, and funding. CONCLUSIONS: Willingness for change, collaboration, and leadership at all levels are essential factors for successfully implementing technology.
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INTRODUCTION
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Learning through computers and applying technology to clinical care will increase over time (1), particularly through the infusion of medical informatics (2, 3). Portable devices and software reduce the need for memorization and facilitate the process of decision-making by putting the knowledge that can reduce errors at one’s fingertips (4). This is important because medical students worldwide spend 33% to 50% of their total time learning basic science and then report the information is soon forgotten. Physicians also note they often do not use much of their previous knowledge in practice (5). Portable devices and software improve quality of care, safety, and documentation (6).
"Which technology should be used?" and "How should it be used?" are key questions for medical educators and administrators. The right context is needed for technology to succeed. Faculty and administration must examine mission(s), needs, attitudes, and technology infrastructure to best use technology in health care. Like other educational endeavors, trainee, faculty, and institutional goals must be aligned. Substantial change to the current methods of medical education is needed, though, and change is not easy to effect (7). Faculty development in the use of technology is needed to integrate technology into the curriculum. Financing new technologies and managing the change that technology will bring to medical education are serious challenges.
This article will provide a brief overview of key issues for educators and administrators related to the use of technology in medical education. It will discuss how to assess students', faculty's, and administrators’ knowledge, skills, attitudes, and experience with technology. Suggestions are provided to integrate technology into the curriculum by developing competencies in faculty (8) and managing change. Technology can help integrate education and administrative tasks. These issues will be explored in more depth in subsequent articles in this edition.
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General Issues Related to Technology for Faculty and Institutions
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Most medical schools do not teach technology directly or assess its use, despite recommendations from the Association of American Medical Colleges (AAMC) Medical School Objectives Project (MSOP) and the General Professional Education of the Physician (GPEP) and College Preparation for Medicine report (9, 10). Schools instead focus on other important items future physicians "need" to know. They are also quick to determine whether a student will require summer training before school to satisfy prerequisites but do not formally consider fluency in technology a prerequisite. Some schools "add on" a technology course but do not integrate the technology into the curriculum.
Faculty, departments, and medical schools have a shared responsibility in the education of medical students, including the use of technology. This implies a potential shift in culture, from technology as an adjunct service to part of the primary mission. The first step is an assessment of knowledge, skills, attitudes and other experiences with technology. They also need to examine how technology affects the process of medical education, psychiatric education, and administration.
The integration of medical education and informatics programs can improve learning and clinical care (Appendix 1). Among the major changes on the horizon for programs, preferred or not, are the following:
- Massive cuts in noninteractive faculty time face-to-face with medical students and residents. One-third of the curriculum will be discontinued, particularly that which is focused on knowledge and carried out by lecture. Instead, technology will be used to teach this knowledge and some skills better than faculty. Then, faculty will reinvest that time to increase clinical revenue (1/6) and skills with technology (1/6), for example.
- Core trainee classes will occur on site and elective/selective courses at a distance. If another medical school at a distance can better teach a course by the Internet, the student will select it. This is similar to portable e-graduate business classes. Portable curricula and teaching portfolios will be used nationally, accordingly.
- Service delivery will be changed in a similar fashion, with consumers shopping for or "selecting" a physician at a distance, even across state lines (11).
- The "continuing medical education (CME)" model for faculty development, as it is currently known, will end. This model focuses too much on basic knowledge, does not measure practical skill-building, and provides no meaningful outcomes. Instead, longitudinal, skills-based tutoring by informaticians and others will be used to meet individual and group needs, including technology topics.
- A technology educator will be necessary in each department. This person will work with other representatives in education: 1) curricula experts from the American Directors of Medical Student Education in Psychiatry (ADMSEP) and American Association of Directors of Psychiatry Residency Training (AADPRT); 2) methods-focused experts from the Association of Academic Psychiatry (AAP) faculty; and 3) technology experts from the American Association of Technology in Psychiatry (AATP) and American Medical Informatics Association (AMIA).
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Faculty Assessment and Development
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Needs Assessment of Computer Literacy
A needs assessment is a starting place for setting priorities regarding technology. Systematic assessments are very limited to this point. An assessment generally measures participants’ knowledge, skills, behaviors, and attitudes related to technology (12). Faculty also need to assess their own learning and teaching styles and adapt them to technology (13, 14).
Faculty and trainees may have different needs. Faculty are less confident and have more anxiety than trainees when using handhelds or PDAs in their practice (15). The use of PDAs is on the rise, but only 26% to 50% of faculty use one on a regular basis (16–18). Faculty are able to see potential applications of virtual simulation exercises in medicine (19), but they have had negative experiences with technology (e.g., tedious computer systems). A lack of infrastructure, time, and skills contributes to faculty frustration. They do not "computerize" their teaching or practice without support (20).
Technology is most useful when it helps faculty "function" better or more efficiently (Appendix 2). Therefore, an assessment should focus on how the technology will help them perform and how they "collaborate" with it.
Learning How to Teach With Technology
Most medical schools need demonstrations, lectures, small-group tutorials, hands-on labs, and task-based assignments on technology for faculty, not just students. Rather than taking a CME course, faculty may learn better longitudinally with an informatician, librarian, or other computer staff. One way to address trainee and faculty needs is through a longitudinal seminar of evidence-based medicine, co-led by a faculty member and a technology expert, and through employing technology every step of the way. This format meets the MSOP’s plan, which suggests featuring lifelong learning through technology in health care management. The "technology educator," an expert in the department, can mentor these faculty and serve as a role model for students.
Teaching With Technology
Teachers have to decide how and when to use technology. It may be used as an organizing tool or as a supplement, but it must be integrated into curricular content (Appendix 3). Investment in computer-aided instruction with multimedia and simulators could pay off significantly. Computers can help skill acquisition in many fields, including novice and intermediate levels of instruction (21, 22). Psychiatric educators believe that such programs could demonstrate symptoms, teach diagnostic skills, and provide feedback on communication skills (23). A computer-assisted assessment program has been applied to teach communication skills in an objective structured video examination (OSVE), and for problem-based learning tasks, as well (24). This format is more reliable and valid than oral examinations and more reproducible than objective structured clinical examinations (OSCEs) (25). Quota systems are starting to guarantee that students have enough clinical encounters with patients of a given diagnosis, and computer simulations make this easier to accomplish (e.g., using virtual reality for a psychosis tutorial rather than sending students off-site to see patients with schizophrenia) (11).
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Clinical Uses
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PDA technology and other innovations are becoming commonplace in practice. PDA software has been evaluated on at least 40 clinical and 40 nonclinical parameters (26–29). It has also been used to enhance communication, house drug databases and guidelines (30–31), write prescriptions (e.g., iScribe) (28), and reduce documentation errors (32). Programs can specifically collect data on depression and anxiety (33) and assist with diagnosis (DSM-IV-TR software, DepressQ and ManiaQ, and DiagnosisPro).
Hospitals are now automating assessments of patients (e.g., telephone, Web, and other) and computerizing all medical records, prospectively. Difficulties include changing handwritten tasks to a technological format and integrating information between technologies. These obstacles are being overcome, however, and soon electronic medical records will become the standard (11, 34). In the business world, hard-copy newspapers had to make this shift or risk losing advertising revenue to e-newspapers and their Web resources.
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Institutional Issues Related to Technology: Complexity of Intervention, Resources, and Change
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Academic institutions have limited resources, change missions, and skew priorities toward revenue. Though schools have more faculty now than in the past, fewer are actually "available" to teach or practice medicine. Faculty report too many demands on their time and view technology as another "problem" or budgetary item rather than as help. A lack of computer literacy in leadership, changes in technology, and fear of technology itself are also barriers. Costs mount with each change.
An integrated approach with incentives for all parties is needed. A collaborative academic network based on technology is in place at several institutions (Figure 1). The overall framework uses technology to integrate materials, methods, and administration. The trainee is the centerpiece of a collaborative learning environment, assisted by the computer, faculty, and system.
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Costs and Funding
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Cost analyses used in other areas of medicine apply to technology. Economic assessment methods include cost description, cost comparison, cost minimization, cost-effectiveness, and cost-benefit analysis (35, 36). The results of such assessments vary for the institution, department, faculty or trainee. The bottom line is that there needs to be a return on investment. Cost analyses become less worrisome if users see high value in the use of technology. Similarly, if analyses seem more favorable when a "critical mass" is reached (e.g., number of computers purchased, high utilization of technology), which leads to integration of information, reducing requirements on less efficient procedures of the past. In some instances, e-integration could save a lot of money, though initial investments are often needed (6).
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Management of Change
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Institutional change occurs at multiple levels, ranging from the administration to trainees (7). Faculty, staff and trainee change requires a buy-in, rewards, defined leaders, and accountability. Institutions change based on their mission, funding, (re-)organization of leadership (e.g., assistant dean of informatics), and faculty. Opportunities may also come from changes in the curriculum, such as Liaison Committee on Medical Education (LCME) "suggestions" and AAMC recommendations. Too often, with all that is going on, administrators "depend" on these outside agencies to promote change, or are newly willing to "bend" when pressure is applied.
For a medical school, some technology interventions add quality control, automated decision-making, and other advantages. User-friendly computerized protocols, clinical pathways and guidelines can reduce resistance while improving the delivery of care, educating physicians and automatically providing administrators with data. Access to patient information from multiple points-of-service helps improve delivery of care. However, practice and feedback are needed, along with further incentives to learn the new technology and clearer definitions of exactly how that technology will benefit the faculty member (20, 37).
Physician response to technology also depends on personal styles, attitudes, and familiarity with technology, to name a few. Most learners (80%) have some anxiety trying something new, but will do it if there is a good reason to do it. The definition of "good" is obviously important. About 10% of learners will avoid technology at about any cost and 10% are enthusiastic early adopters. Those who enjoy learning to use a new technology generally report excitement, see opportunities of what it can do, feel "better" for doing it, and link it with past positive experiences (7). Naturally, learners gauge others’ responses, with negative attitudes reducing the likelihood of progress (38).
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Conclusions
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Medical schools, departments, and faculty have little choice but to examine how technology can be integrated into education and clinical, administration and research activities. An assessment of knowledge, skill needs, interests, and experience is critical to identify barriers and solutions to technology implementation. The use of technology should also "fit" participants’ needs. Faculty development programs should try to embrace technology as much as possible. Change is difficult, but it is necessary to keep up with discovery and improve health care delivery. Institutions must also reassess their mission, priorities, existing resources, and funding to increase the use of technology in medical training and education.
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REFERENCES
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- Peterson M: Library service delivery via hand-held computers—the right information at the point of care. Health Inform Libr J 2004; 21:52–56
- Hilty DM, Hales DJ, Briscoe G, et al: APA Summit on Medical Student Education Task Force on Informatics and Technology: learning about computers and applying computer technology to education and practice. Acad Psychiatry 2006; 30:29–35[Abstract/Free Full Text]
- Council on Graduate Medical Education Resource Paper: Preparing learners for practice in a managed care environment. Washington, DC, Department of Health and Human Services, HRSA, 1997
- Grasso BJ, Genest R: Use of a personal digital assistant in reducing medication error rates. Psychiatr Serv 2001; 52:883–886[Free Full Text]
- Cruess RL, Patel VL, Groen GJ: Basic science studies. J Med Educ 1985; 60:208[Medline]
- Luo JS, Hilty DM, Worley LL, et al: Considerations in change management. Acad Psychiatry 2006; 30: 465-469
- Martich GD, Waldmann CS, Imhoff M: Clinical informatics in critical care. J Intensive Care Med 2004; 19:154–163[Abstract/Free Full Text]
- Srinivasan M, Keenan C, Yager J: Visualizing the future: technology competency development in clinical medicine, and implications for medical education. Acad Psychiatry 2006; 30:480–490[Abstract/Free Full Text]
- Gjerde CL, Pipas CF, Russell M: Teaching of medical informatics in UME-21 medical schools: best practices and useful resources. Fam Med 2004; 36:S68-S73
- Kirby RL: The GPEP report on undergraduate medical education: implications for rehabilitation medicine: Association of American Medical Colleges Panel on the General Professional Education of the Physician. Am J Phys Med 1987; 66:184–191[Medline]
- Yellowlees PM, Hogarth M, Hilty DM: The importance of distributed broadband networks to academic biomedical research and educational programs. Acad Psychiatry 2006; 30:451–455[Abstract/Free Full Text]
- Seago BL, Schlesinger JB, Hampton CL: Using a decade of data on medical student computer literacy for strategic planning. J Med Libr Assoc 2002; 90:202–209[Medline]
- Kolb DA: Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs, NJ, Prentice-Hall, 1984
- Jerant AF, Lloyd AJ: Applied medical informatics and computing skills of students, residents, and faculty. Fam Med 2000; 32:267–272[Medline]
- Bergman LG, Fors UG: Computer-aided DSM-IV-diagnostics—acceptance, use and perceived usefulness in relation to users’ learning styles. BMC Med Inform Decis Mak 2005; 5:1[CrossRef][Medline]
- Gillingham W, Holt A, Gillies J: Hand-held computers in health care: what software programs are available? N Z Med J 2002; 115:U180
- Jwayyed S, Park TK, Blanda M, et al: Assessment of emergency medicine residents’ computer knowledge and computer skills. Acad Emerg Med 2002; 9:138–145[CrossRef][Medline]
- Barrett JR, Strayer SM, Schubart JR: Assessing medical residents’ usage and perceived needs for personal digital assistants. Int J Med Inform 2004; 73:25–34[CrossRef][Medline]
- Weller JM: Simulation in undergraduate medical education: bridging the gap between theory and practice. Med Educ 2004; 38:32–38[CrossRef][Medline]
- Lai TYY, Leung GM, Wong IOL, et al: Do doctors act on their self-reported intention to computerize? a follow-up population-based survey in Hong Kong. Int J Med Inform 2004; 73:415–431[CrossRef][Medline]
- Mars M, McLean M: Students’ perceptions of a multimedia computer-aided instruction course in histology. S Afr Med J 1996; 86:1098–1102[Medline]
- Uribe JI, Ralph WM Jr, Glaser AY, et al: Learning curves, acquisition, and retention of skills trained with the endoscopic sinus surgery simulator. Am J Rhinol 2004; 18:87–92[Medline]
- Hulsman RL, Mollema ED, Hoos AM, et al: Assessment of medical communication. Med Educ 2004; 38:813[CrossRef][Medline]
- McLean M, Murrell K: Web CT: Integrating computer-mediated communication and resource delivery into a new problem-based curriculum. J Audiov Media Med 2002; 25:8–15[CrossRef][Medline]
- Srinivasan M, Hwang J, West D, et al: Assessment of clinical skills using simulator technologies. Acad Psychiatry 2006; 30:508–518
- Barron R: An evaluation of personal digital assistant software for drug interactions. Am J Health Syst Pharm 2004; 61:380–385[Abstract/Free Full Text]
- Dobrousin A, Wilderman I: Which hand-held computer is better for doctors? part 2: comparing models with Microsoft operating systems. Can Fam Physician 2004; 50:595–598[Free Full Text]
- Luo JS: Portable computing in psychiatry. Can J Psychiatry 2004; 49:24–30[Medline]
- Luo JS, Ton H: Personal digital assistants in psychiatric education. Acad Psychiatry 2006; 30:516–521[Abstract/Free Full Text]
- Brilla R, Wartenberg KE: Introducing new technology: handheld computers and drug databases: a comparison between two residency programs. J Med Syst 2004; 28:57–61[CrossRef][Medline]
- Adatia FA, Bedard P: Palm reading 1: handheld hardware and operating systems. Can Med Assoc J 2002; 167:775–780[Free Full Text]
- Carroll AE, Tarczy-Hornoch P, O’Reilly E, et al: The effect of point-of-care personal digital assistant use on resident documentation discrepancies. Pediatrics 2004; 113:450–454[Abstract/Free Full Text]
- Tseng HM, Tiplady B, Macleod HA, et al: Computer anxiety: a comparison of pen-based personal digital assistants, conventional computer and paper assessment of mood and performance. Br J Psychol 1998; 89:599–610[Medline]
- Keenan CR, Nguyen HH, Srinivasan M: Electronic medical records and their impact on resident and medical student education. Acad Psychiatry 2006; 30:522–527[Abstract/Free Full Text]
- Hailey D, Roine R, Ohinmaa A: Systematic review of evidence for the benefits of telemedicine. J Telemed Telecare 2002; 8(suppl 1):1-30
- Weinstein MC, Stason WB: Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med 1977; 296:716–721[Abstract]
- Majeed A: Ten ways to improve information technology in the NHS. BMJ 2003; 326:202–206[Free Full Text]
- Fielding N, Lee RM: New patterns in the adoption and use of qualitative software. Field Methods 2002; 14:197–216[Abstract/Free Full Text]
- Liaw ST, Marty JJ: Learning to consult with computers. Med Educ 2001; 35:645–651[CrossRef][Medline]
- Hilty DM, Marks SL, Urness D, et al: Clinical and educational applications of telepsychiatry: a review. Can J Psychiatry 2004; 49:12–23[Medline]
- Pluye P, Grad RM: How information retrieval technology may impact on physician practice: an organizational case study in family medicine. J Eval Clin Pract 2004; 10:413–430[CrossRef][Medline]
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ABSTRACT
INTRODUCTION
