College Of Medicine
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Thirteenth Round of Grants Announced - COMCEC Grant VI. Titles of grant proposals that have been approved and funded:
FINAL REPORTS COMCEC GRANTSProject Title: (1) ELECTRONIC LECTURES IN MICROSCOPIC ANATOMY DESCRIPTION Abstract: The specific aim of this project was to establish a series of electronic lectures in Microscopic Anatomy with the ultimate aim of completely replacing the traditional lecture. The electronic lectures were presented first in a traditional lecture hall with a projector. Once perfected, the electronic lecture was made available to students via a custom CD-ROM and via the Internet. Delivery via CD-ROM and the Internet allowed total elimination of the traditional lectures from the Microscopic Anatomy course. The overall goal of this grant was to create four to six electronic lectures that could be available for review or actual use in the 1999-2000 academic year. Five lectures were completed. These lectures can be viewed at the Dental Histology home page, (http://www.medinfo.ufl.edu/dental/denhisto/index.html /). Click on 'Laboratories and Lectures' to access the lectures. When prompted, enter the user name 'student' and the password 'toothbrush'. This brings up a list of lectures. Lectures 5, 6, 7, 8, and 9 are complete and ready to use. A couple more lectures are well underway. Click on the word audio in the right hand column and a list of individual slides for the lecture will appear. Slides are viewed by clicking the slide name with the mouse. The audio is selected by clicking on the little RealPlayer icon located to the left of the slide name (between the slide number and name). PI Name: HOLLINGER, THOMAS G., MD Project Start: 01-JULY-98 Project Title: (2) DOES ALTERING LECTURE FORMAT AND PROVIDING MORE FREQUENT TESTING AFFECT INTERN/RESIDENT AND MEDICAL STUDENT LEARNING BEHAVIOR? Abstract: The specific aims of this project were: to enhance medical education at the intern/resident and the medical student level through an interactive teaching format and written testing, to assess individual strengths and weaknesses prior to formal nationwide testing, to stimulate self-motivational learning by increasing outside reading, to encourage reading and questioning to a level that may inspire research, and to use this experimental data as a foundation to develop future educational curricula. It appeared that neither the didactic nor interactive teaching format was superior, but rather the attainment of knowledge both subjectively and objectively was dependent upon an individual's own "import processing unit" - i.e., THE BRAIN. The inference from the subjective data collected was that all "units" appeared to require constant stimulation. This was implicated by the fact that most participants despite their preferred mode of teaching felt they paid attention longer during the question and answer lectures. A further implication was made in that most "units" need constant probing (i.e. reminders) regarding what information has truly been acquired and made into memory vs. that which was heard and yet subconsciously discarded. This was where the human software was found to be lacking. A large majority of learning-time was spent reviewing over and over to identify that knowledge which had been processed into memory vs. that which had been discarded and required further review. This was implicated by the fact that most all the participants felt the question and answers before and after the lectures were helpful in recalling items of knowledge that were not made into memory. Some efficient "units" made this a conscious awareness verses a subconscious awareness and these fortunate individuals could divert their extra time into other areas. The reference to the brain as our "import processing unit" was done intentionally. The computer is the only modality that can be made to adapt to each individuals learning style. The key was to identify the various forms of learning that enhanced in the most efficient way an individuals own learning style. The earlier this style of learning was identified in an individual, the sooner a truly personalized computer system could be devised as the best learning tool for this individual. PI Name: PAULY, REBECCA R., MD Project Start: 01-JULY-98 Project Title: (3) DEVELOPMENT OF INTERACTIVE & ON-LINE HISTOLOGY COURSE FOR FIRST YEAR MEDICAL STUDENTS Abstract: Due to increasing student demand for computer-based assistance in Medical Cell and Tissue Biology (MCTB), a novel, multi-purpose program was designed and produced for use on the Internet during July 1995. This program ("Histology Review" - http://www.medinfo.ufl.edu/year1/histo/) was initially released with only a "quiz module" which incorporated fundamental histological topics and specific laboratory/lessons from the course into a practical examination format. Students utilized the program as a pre-test review tool complete with feedback for identification of approximately 300 original photomicrographs. Development of the "Review Module" that was based on a prototype developed prior to the grant has enabled students to preview each chapter of the course on line. Development of the On-line "Syllabus Module" offered the student immediate resources to the course syllabus and review module that have been carefully integrated. Students could submit questions, comments, or messages to a central "Message Board" where the course director and other faculty offered explanations and answers. Since the modifications to the computer-based coursework for the MHA course, students have offered excellent reviews. The Histology Review appeared to be a successful study aid and on-line resource. PI Name: PAWLINA, WOJCIECH, MD Project Start: 01-JULY-98 Project Title: (4) MEDICAL ECONOMICS CURRICULUM DEVELOPMENT PROJECT Abstract: Twenty years ago, physicians could practice with very little knowledge about the role of business in medicine. Times have changed. In order to prepare future physicians for the ever-changing medical marketplace, we believed it necessary to begin educating physicians in medical school and continue their education throughout residency and beyond. The Medical Economics Curriculum Development Project sought to understand the depth and level of education needed throughout the medical educational process. Our goals included developing an entirely new economics curriculum by initially incorporating this curriculum into existing programs with the long term goal of a freestanding course, researching other medical schools' approaches to this process and lessons learned, establishing appropriate joint degree programs campus wide, and organizing and facilitating faculty and student ownership and involvement in the creation and realization of such a curriculum. It was learned that it is imperative to integrate managed care education into our existing curriculum in order to keep abreast of other highly competitive medical schools. At the University of Florida, our current curriculum contains many of the elements vital to managed care education. However, certain key elements are lacking and are not tailored to specifically meet the needs of practicing in a managed care environment: a firm foundation in healthcare economics, medical jurisprudence, biostatistics, managed care ethics, quality controls and risk assessment, insurance concepts including and introduction to Medicare/Medicaid. Segments can easily be added to the first and/or second year curriculum. This timing would enable students to experience managed care decision-making scenarios during the OSCE examinations. If this scenario doesn't work, many students have expressed interest in a fourth year course that could be easily integrated into the existing curriculum. PI Name: STRINGER, SCOTT, MD, F.A.C.S. Project Start: 01-JULY-98 Project Title: (5) TRAINING SIMULATED PATIENTS TO TEACH THE NEUROLOGICAL EXAMINATION Abstract: Studies have demonstrated that students learn the physical examination better from simulated patients than by standard teaching methods. The neurological examination is a long and complex aspect of the physical examination that is currently taught to students at the University of Florida mostly by non-neurologists, in the Physical Diagnosis course in the fall of the second year. Students learn the examination in small groups, mostly from faculty and residents in Medicine. Students have reported a very variable experience, depending upon the interest and skills of their instructors. Neurology faculty have also observed varied skills of students on the second-year OSCE, and when they reach the wards in the third year. Although small group discussions with faculty will remain valuable for discussing the role of the examination in patient assessment; the mechanics of performing an examination can probably be better taught using well trained standardized patient instructors. This study demonstrated the feasibility of training standardized patients to teach the neurological examination. The standardized patients recruited were intelligent, and learned the essentials of the examination rapidly and well. They were able to give fairly good feedback to students during the examination. The study demonstrated that students receive this kind of instruction well, as judged by a very favorable student response with no students regarding the sessions as ineffective. Other points in favor of continuing this practice was the uniformity with which the examination could be presented to the whole class and the cost-effectiveness of standardized patients versus medical faculty. PI Name: VALENSTEIN, EDWARD, MD Project Start: 01-JULY-98 Project Title: (6) DEVELOPMENT OF A WEBSITE FOR INTRODUCTION TO CLINICAL NEUROLOGY Abstract: The specific aims of this project were: to develop a website for the second year course, Introduction to Clinical Neurology, containing case vignettes with videotape excerpts of the neurological history and/or examination, as well as radiographic images of the specific patient, and (when applicable) illustrations of the gross and microscopic pathologic anatomy, to integrate this new site with the existing website on the Neurological Examination, to integrate the instruction of the course, Introduction to Clinical Neurology, with material on these websites and to assess student acceptance of the website as an instructional aide. The web-based presentation of key aspects of the course was definitely well received by students. Web-based teaching sites that were not tightly integrated into the course and that were incomplete tended not to be utilized by the students. The project was more important for what was learned about the process of integrating web-based material into the curriculum of a specific course. The students appreciated teaching innovations on the web that were well done and conversely avoided web sites that were incomplete. More effective teaching appeared to be the reward for developing an efficient and tightly integrated web site. PI Name: VALENSTEIN, EDWARD, MD Project Start: 01-JULY-98 Project Title: (7) IMPROVEMENTS TO THE BUGS COMPUTER PROGRAM Abstract: The BUGS computer program is a self-instructional, interactive program designed to teach medical students basic microbiology and pathogenesis in a clinical context. The program consists of 44 clinical case histories with interspersed multiple-choice questions (MCQ) which lead the student through the case to a diagnosis and an understanding of the pathogenesis of the disease. In addition, there is a data base containing information on 130 microbial pathogens catalogued as to the diseases they cause, symptoms, sources, sites and diagnosis, treatment and virulence factors. The database was updated so that each disease caused by an organism is listed with its symptoms. Previously there were lists of diseases and lists of symptoms but no way of knowing which symptom went with which disease. PI Name: DUCKWORTH, DONNA Ph.D. Project Start: 01-JULY-98 Project Title: (8) DEVELOPMENT AND TESTING OF A NUTRITION MODULE Abstract: The aim of this project was to expand and enhance the study of nutrition in a format compatible with the University of Florida College of Medicine's course curriculum. The result of this project is the production of a packet for use by medical students that is designed to complement Dr. Josef Neu's two lecture hours given on the biochemical basis of nutrition. In May of 2000, the packet was piloted as one of the ten clinical correlation sessions for the Class of 2003. The feedback from the facilitators and student presenters of this packet has been excellent. PI Name: KOROLY, MARY JO, Ph.D. Project Start: 01-FEBRUARY-99 Project Title: (9) A PILOT STUDY TO EXAMINE THE EFFECT OF AN OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE) ON IMPROVING THE ACQUISITION OF CLINICAL SKILLS IN THE THIRD YEAR SURGERY CLERKSHIP Abstract: The specific aim of this project was to ascertain how effective Objective Structured Clinical Examinations were on improving third year medical students' skills during their surgery rotation. These OSCE were developed to teach the students the five most important topics/clinical skills that they needed to acquire while in surgery. Five OSCE stations were developed. Abdominal Mass, Breast Mass, Suturing/Wound Management, Venipuncture, Foley Insertion. The pilot phase of the surgical OSCE was used for teaching rather than evaluation and there was ample time for formative feedback. The results of the feedback were highly complimentary and positive. The OSCE has identified some gaps in the surgical curriculum. Students need adequate exposure during their surgery rotation to the topics/skills that are part of the OSCE if the OSCE is to be part of the students' evaluation process. The OSCE has brought together faculty, residents and students in an educational environment that has had significant impact on all aspects of student learning. PI Name: LIND, D. SCOTT, M.D. Project Start: 01-FEBRUARY-99 Project Title: (10) FINAL REPORT ON HANDHELD COMPUTERS Abstract: The aim of this project was to determine whether handheld computers or personal digital assistants (PDAs) should become a required tool for third-year students. The study was run for three months during the time Dr. Andria Klioze was on the in-hospital ward service at the VA Medical Center. The students recorded times required to load patient data onto the palm verses writing the data on a note card and the time it took to create the final history and physical using both modalities. The times were collected and a paired T-test was run. The results showed both methods took the same amount of time suggesting that with continued use and more expertise the PDAs may be more efficient. Students appreciated the fact that it was less cumbersome to carry the palm with its software than it was to carry a number of reference books, calculator, organizer and patient note cards. Access to the medical database via the palm significantly assisted the students in their education. Learning the palm's graffiti was troublesome but improved with time. In summary, PDA can be of assistance in improving organization by enhancing data retrieval in a timely fashion thus promoting learning and by taking equal or potentially less time than the standard format. The PDA can be a useful educational resource and asset to the medical learning environment. PI Name: Richard J. Rathe, M.D. Project Start: February 1, 1999 Project Title: (11) INTERDISCIPLINARY TRAINING FOR ELDER CARE FOR THE 21ST CENTURY The aim of this project was to fund curriculum development and implementation of a pilot training program designed to encourage medical students to choose careers in eldercare in the 21st century. This model program included the following important training innovations: creating interdisciplinary student teams to work together in eldercare training; using community elders as co-teachers with the interdisciplinary faculty team; using home visits with community elders as a training mechanism; providing students with longitudinal experiences with community elders and with health professions students from other colleges. The pilot curriculum was developed over the summer of 1999, and the actual pilot program was launched and completed in the fall and spring of 1999-2000. The pilot program involved nine medical students, nine nursing students and nine pharmacy students. The pilot program was organized as three SAIGE discussion groups composed of nine students (3 from each school), each group led by two faculty members. Activities included: Five home visits completed by each student team (each team consisted of a medicine, nursing and pharmacology student); Five small group meetings of each discussion group to discuss aging topics, interviewing skills, and to debrief home visits; A pre- and post-pilot evaluation of students aging knowledge and attitudes. PI Name: BURG, MARY ANN, M.S.W., Ph.D. Project Start: 01-FEBRUARY-1999 Project Title: (12) BUGS PROGRAM MODIFICATIONS Abstract: The BUGS computer program is a self-instructional, interactive program designed to teach medical students basic microbiology and pathogenesis in a clinical context. The program consisted of 44 clinical case histories with interspersed multiple-choice questions (MCQ) which lead the student through the case to a diagnosis and an understanding of the pathogenesis of the disease. In addition, there is a data base containing information on 140 microbial pathogens catalogued as to to the diseases they cause, symptoms, sources, sites and diagnosis, treatment and virulence factors. The aims of the grant were to add a section on Major Clinical Presentations and also to add several new cases. The Major Clinical Presentation section details the infectious causes of the following clinical presentations: abdominal pain, bloody diarrhea, cough, dysuria, genital lesions, hoarseness, penile discharge, rash, rhinorrhea, skin lesions, sore throat, vaginal discharge, and watery diarrhea. The information is presented in two ways for each presentation, a didactic listing of all the major microbiological causes of the symptom or presentation and a quiz mode containing short clinical cases. In the latter mode the student reads the clinical case and can then click on "labs" and get real lab tests or other hints as to the causative organism before clicking on the answer. The section on the major clinical presentations can be seen at http://www.medinfo.ufl.edu/year2/mmid/bms5300/clinical/index.html. Three more cases on fungal diseases have also been incorporated into the original clinical case histories section of the computer program. All the cases contain interspersed multiple choice questions located at http://www.medinfo.ufl.edu/year2/mmid/bms/5300/cases/index.html that the students can use as a tool to understand the disease. PI Name: Donna H. Duckworth, Ph.D. Project Start: February 1, 1999 Project Title: (13) MRI BRAIN ATLAS The specific aim of this project was to develop an MRI atlas of the entire human brain in three orthogonal planes and to convert it to a form that is readily accessible and easily usable by instructors throughout the Health Science Center. The purpose of this atlas is to serve as a database for the development of image sets to be used in neuroscience and radiological education. A proton density MRI was obtained on a single subject on a 3 Tesla scanner. 512 x 512 pixel images were obtained in three orthogonal planes at 3 mm intervals. These images have now been placed on a web server, together with software that enables the user to systematically and conveniently access them (http://www.medinfo.ufl.edu/~mribrain/). Several access methods are available. Using a point and click method, the three orthogonal images intersecting at any particular point can be obtained. One can page, one slice at a time, left or right, up or down, or forward or backward, depending on the plane of the image. The x, y and z coordinates of a particular point in the image space can be entered to bring up the three corresponding images. Finally, specific axial, sagittal or coronal images can be addressed by number. All images can be downloaded as gif files, which can then be manipulated as desired using such proprietary software as Adobe Photoshop. PI Name: NADEAU, STEPHEN E., M.D. Project Start: 08-AUGUST-99 Project Title: (14) Improving Teaching Skills of Residents The goal of this project was to develop and implement a program to improve the teaching skills of residents at the University of Florida Health Science Center/Jacksonville. The program committee developed a curriculum that addressed six major areas: learning climate, role modeling, feedback, evaluation, increasing understanding/retention, and promoting self-directed learning. Three half-day sessions were presented during the 1999/2000 academic year, with two major topics covered at each session. These were offered to first year residents from all departments. Activities included large group presentations, as well as small group activities which were led by members of the faculty from a variety of departments (these faculty had undergone a training session prior to the first session). Participation: 49 residents at the first session, 36 at the second, and 43 at the third. By self-assessment, comfort and effectiveness in all six areas increased following the sessions. Nearly 80% of residents also indicated that the sessions would change how they interacted with students. The overall program was rated 3.1 on a 4 point Likert scale. We are continuing to collect data on this group of residents. Additionally, we have secured funding through the Office of Educational Affairs in Jacksonville to continue this program in subsequent academic years. PI Name: Genuardi, Frank J., M.D., M.P.H. Project Start: 08-AUGUST-99 Project Title: (15) NETWORKED RADIOLOGY TEACHING FILE Abstract: The specific aim of this project was to acquire the hardware and develop the software to implement a networked teaching file of radiology teaching cases. A ubiquitous and practical mechanism was sought for radiologists to add cases to the database as they encountered them in daily practice. A dedicated network server was installed and activated to house the teaching file database and images. This computer has over 50 Gigabytes of internal storage and a robust tape back up system. It is connected to the departmental network and through it to the entire Shands Hospital/COM networks. The software is fully functional and has been used to catalogue about 100 cases. The main source for images will be our clinical PACS system. In cooperation with the PACS software vendor there is a completely automatic method for identifying, converting, transporting and importing images and demographic information into the teaching database. PI Name: SISTROM, CHRIS, M.D. Project Start: 01-AUGUST-99 Project Title: (16) A WEB SITE TO ENHANCE THE TEACHING OF NEWBORN MEDICINE TO MEDICAL STUDENTS. Abstract: Presently, 3rd year medical students at the University of Florida spend one-week in the newborn unit at Shands Hospital during their six-week rotation in Pediatrics. This is likely to be the only exposure they have to newborn medicine during Medical School. From a patient care perspective, the students have minimal exposure to sick infants unless the residents or attendings make a special effort to tour them through the NICU. This also only offers a brief snapshot of the wide variety of clinical problems encountered by neonates. They also receive a one-hour lecture on a variety of newborn problems during their six-week rotation through Pediatrics, which only provides them with a fraction of the problems encountered in newborn medicine. In order to improve the quality and consistency of neonatal teaching, a web page has been designed in which various neonatal problems are organized under organ systems. Students access this web page on the 3rd year UF-medinfo URL under Neonatal Pathology. The student clicks on an organ-system, i.e., musculoskeletal, dermatology, etc. A series of cases pertaining to this organ system can then be accessed in a question and answer format. Using this approach, the student may access this web page at their convenience and have the opportunity to learn about a wide variety of neonatal problems. PI Name: NEU, JOSEF MD Project Start: 01- AUGUST-1999 Project Title: (17) ELECTRONIC TEACHING CURRICULUM FOR ABDOMINAL IMAGING Abstract: The goal of this project was to develop computer-based tools which would provide medical students and residents with an overview of abdominal imaging procedures and terminology. A pilot website was developed entitled "Abdominal Imaging: A Self-Guided Tour". The website is accessible at www.medinfo.ufl.edu/~abdimg/. The site includes modules on radiography, intravenous urography, fluoroscopy, CT, ultrasound, MRI, and interventional procedures. Each module includes a basic description of the technology used, procedures and protocols and their indications, risks and patient requirements. Diagrams and digital images of equipment are provided as well as representative case examples. This website serves as an introduction for medical students and residents and a framework for further development. PI Name: BURTON, SHARON S., M.D. Project Start: 01-AUGUST-99 Project Title: (18) OCCUPATIONAL EXPOSURES AMONG MEDICAL STUDENTS Abstract: The aim of this project was to describe the epidemiology of occupational exposures sustained by third year medical students(MS3's) at a state university medical school , and to identify factors associated with occupational exposure that might be modified to protect medical students from unnecessary risk. Method: A cohort group consisting of all third year medical students after completion of each third year clerkship rotation. Demographic information , type of exposure, rotation, circumstances, compliance with CDC universal precaution recommendations, and post-exposure prophylaxis(PEP) was assessed. Descriptive statistics were used to describe the results. Results: 714 total surveys were distributed to 119 students at the end of each third year clinical rotation. 644 surveys ( 90.2%) were returned of which 60 (9.3%) reported an exposure to blood or body fluids. Taking into account multiple exposures, 54 students (45.4%) of the 119 experienced one or more type of exposure. The incidence of exposure varied with clerkship: 3 on Internal Medicine, 4 on Psychiatry, 23 on Surgery, 8 on Outpatient medicine, 18 on Obstetrics and Gynecology, and 4 on Pediatrics. 36 (60%) were skin or mucous membrane exposures to blood, body fluid, or respiratory secretions. 24 (40%) were percutaneous exposure by instrumentation. 10 (17%) of the exposures filed an official incident report of which 7 accepted recommended post exposure prophylaxis. Conclusions: At this institution, medical students are often exposed to some type of bodily fluid during their initial clerkship year, primarily occurring in their surgical rotations. Additional education on these rotations may be useful in reducing exposure risk. PI Name: BIRENBAUM, DALE SCOTT MD, FACEP Project Start: 01- AUGUST-1999 Abstract: The specific aim of this project was to develop an interface to allow users of the Radiology Department clinical picture archiving and communication system (PACS) to send selected images to the departmental teaching file. A second aim was to convert the teaching file interface from Microsoft Access to a web based one. Results: In cooperation with our PACS software vendor (Cedera, Inc, Montreal, Canada) we developed a completely automatic method for identifying, converting, transporting, and importing images and demographic information into the teaching database. Additionally, we designed a mechanism for users to export images from the database into commonly used file format (GIF) and to produce a Microsoft PowerPoint presentation containing all pertinent images from a series of cases in one step. Conclusions: We purchased a suitable dual monitor computer and appropriate software from Cedera to implement a PACS workstation dedicated to medical student and resident education. This was necessary because the PACS workstations intended for clinical reporting and review were not available for students and residents to use in developing teaching materials. Additional purchases included a tape back up system and a scanner with transparency adapter. PI Name: SISTROM, CHRIS, M.D. Project Start: July 1, 2000 Project Title: (24) Providing Medical Students with a Practical Community Involvement Experience as a New Curricular Component of the Jacksonville Family Medicine Interdisciplinary Generalist Clerkship Abstract:. In an attempt to develop physicians who are aware of the health care education needs of the community, a new component was added to the current primary care clerkship for third year medical students at the University of Florida Jacksonville campus. The new curriculum expanded the primary care clerkship, during the family practice portion of the rotation, by providing an opportunity for medical students to work in the community. The purpose of the new curriculum was to provide an opportunity for students to: 1) understand the role of physicians as community health educators, 2) expand views of medicine beyond the clinic walls, 3) develop and deliver culturally competent community education sessions, and 4) to strengthen student recognition of community health issues. Findings: To date, thirty-nine medical students (20 females and 19 males; mean age 26 years) have participated in the curriculum. Twenty-four students facilitated health talks, six performed health screenings, three have authored health notes for elementary school newsletters, and two have participated in house calls. Medical students, faculty, and the community evaluated the educational sessions highly (2.7 on a 3.0 scale; 1=below average and 3=above average). Thirty-four percent (12 out of 35) of the medical students responded to the post clerkship evaluation questionnaire. Approximately 92% reported they felt comfortable to very comfortable in participating in the activities. One hundred percent of the medical students (12) reported that the experience was valuable, and, that they were likely to provide community health education once they become a physician. Conclusions: Formal exposure in providing community health education is an underutilized curricular component in medical schools during the clinical training years. Incorporating this experience into the third year of medical school allowed students an opportunity to learn more about the role of the physician as a community health educator, and enabled students to develop and provide culturally competent health education. Participating in this type of program allowed medical students to expand views of medicine beyond the clinic walls (home visits, health talks) and allowed them intimate exposure to health care beliefs, needs, and issues of the community. Further inquiry into the longitudinal effects of this program is warranted since 100% of medical students responding said they would provide community health education after graduation. This experience will continue to be a part of the family practice rotation for medical students on the Jacksonville campus. P.I. Name: WRIGHT, ANNA M., M.D. Project Start Date: July 1, 2000 Abstract: Using the clinical presentation model in Essentials of Patient Care III will improve students' ability to evaluate patients as evidenced by the performance of an accurate history and physical examination. This approach will facilitate vertical integration of basic sciences into the clinical sciences. This approach will encourage students to generate differential diagnoses appropriate for patients' presenting complaints. Integrating the clinical presentation model into the structure of this course will improve students' interaction with patients and help them cultivate an empathetic bedside manner. Conclusion: Integrating the clinical presentation model into EPC III will provide a more realistic approach to clinical encounters earlier on in the educational process. If students learn about clinical encounters as a whole rather than in pieces, the progression is more natural. Using the adult learning techniques to vertically integrate basic science into clinical medicine will solidify this information. The SP sessions and the Problem Solving Exercise provide avenues to cultivate the development of a differential diagnosis, which is essential in the clinical years. This innovative format will avoid problems with synthesis during third and fourth year. In addition, both focused and comprehensive patient encounters will be resources for students' professional development. P.I. Name: ROSSI, MICHELLE L., M.D. Project Start: August 20, 2001 Abstract: Airway evaluation and basic management are essential skills of all physicians. The ability to identify patients for whom mask ventilation endotracheal intuabtion will be difficult to impossible is vital for patient safety. Despite this, training in airway evaluation is minimal in the curricula of most medical schools. At this institution the airway examination is introduced during a brief Fourth Year exposure to Anesthesiology. to ensure a thorough understanding of airway anatomy and evaluation techniques, and exposure to various abnormal findings, an Internet-Based module including interactive graphics, animation, video and a self-assessment tool is proposed. Current Internet resources related to this topic are merely text documents with an occasional diagram. the interactivity and review of basic science in this proposal are novel and a significant improvement to current teaching methods. Once developed, application of this template to other teaching objectives is planned for the near future. Conclusion: We developed an Internet-based airway evaluation program (currently located at http://www.anest.ufl.edu/at) for medical students with the following learning objectives: Following completion of this module the student will be able to: 1) name all significant airway-related structures in the pharynx and neck 2) list the innervation of the pharynx 3) perform a thorough airway examination 4) identify and recognize the presence of risk factors for difficult endotracheal intubation 5) describe the airway management of a high-risk patient (e.g., a trauma patient with possible cervical spine injury) P.I. Name: EULIANO, TAMMY, M.D. Project Start: August 20, 2001 Abstract: In the last cycle we enhanced the teaching file system to provide a seamless interface with our clinical picture archiving and communication system (PACS). This allows users to identify pertinent images and send them to the teaching image database in a matter of seconds. We also acquired a dedicated PACS workstation for use by medical students and residents to produce and review teaching cases. Also, we obtained hardware to perform tap backup of the database. We were not able to convert the teaching file interface to web based one due to time and funding considerations. We plan on performing this conversion during the current cycle. P.I. Name: SISTROM, CHRIS, M.D. Project Start: August 20, 2001 Project Title: (34) Development and Assessment of a Pediatric Instructional Web Site Based on Pediatric Morning Report at the University of Florida Abstract: Currently, pediatric morning report at the University of Florida is a half hour review and discussion of a recently admitted pediatric patient. this discussion format is a well-recognized part of the pediatric resident educational experience and is perceived as an effective modality for teaching clinical evidence based medicine. It is active, but synchronous and therefore has some built in limitations. a presentation of case histories and outcomes in the form of education. We will attempt to integrate the active morning report experience with asynchronous web learning to create an interactive educational forum for pediatric learners and teachers of North Florida. Elements of the morning report will be posted on an interactive web site and presented to pediatric residents and staff at the Gainesville, Pensacola and Jacksonville programs as well as the private practitioners in the area. The site will be introduced in different manners to subgroups and the success of the web site will be measured by satisfaction surveys and participant use of the site over months. Summary: The course has added another education perspective to pediatric training for medical students, residents and pediatricians. It is hoped that for some, it will be the foundation for life long learning and connection to the University of Florida pediatric program. A course has also been developed for pediatricians. The system was presented and favorable received at several conferences. It received the Oral Presentation Award at this years University of Florida Medical Education week . It is being used to foster medical education international collaboration and is already been funded by the Irish Pediatric Group for presentation. P.I. Name: ZORI, ROBERT, M.D. Project Start: August 20, 2001 Project Title: (35) Does Teaching Type 2 DM Using Evidence Based Medicine to Family Practice Residents will Improve Patient Care? Abstract: Diabetes has become a global epidemic in the 21st century
with approximately 15 million americans suffering from this chronic
disease. With its associated conditions and complications, diabetes
produces significant morbidity and mortality; this places enormous
financial burden on the nation's health care system and causes devastation
to the patient and family. Following the guidelines P.I. Name: SAMRAJ, GEORGE P. N., M.D Project Start: August 20, 2001 Abstract: Educational portfolios have been rarely used in the setting of medical education. One of their strengths is the ability to evaluate performance using multiple modalities that can be tailored to specific competencies. Additionally, they require more active engagement by the students in their educational development. For this reason, one would hypothesize that they would promote more self-directed (life-long) learning behaviors. Beginning July 2002, the Medicine Clerkship will move to educational portfolios as the primary means of student assessment. It will be important to determine whether this promotes more self-directed learning behaviors when compared to a more traditional clerkship, like Pediatrics. This will also be an excellent opportunity to involve a medical student in the development of the assessment tool to be used and IRB protocols with the aim towards presentation at a regional meeting (SGEA) and hopefully publication. P.I. Name: HARRELL, HEATHER E., M.D. Project Start: July 1, 2002 Abstract: Simulation training allows instructors to create learning scenarios that teach students such invaluable tools as critical thinking, team management, and procedural skills without risk to a patient. We intend to develop a series of critical actions using a rapid sequence intubation scenario by which medical students and residents can be assessed and graded on both their performance and competency. Initially, an evaluation tool will be developed using a series predetermined scenario critical actions. Attending board certified emergency physicians will then be tested on the scenario to create a benchmark standard of competency. Next, Emergency Medicine residents and Medical students will be evaluated and assessed on the simulator. Videotaping will be performed to ensure that all the critical actions are captured. In addition, all participants will be debriefed in an educational session utilizing the videotapes following each simulation encounter. P.I. Name: GODWIN, STEVEN A., M.D. Project Start: July 1, 2002 Project Title: (38) Graduated Competency Assessment: An Internet-Based Tool for Measuring Surgical Resident Competency Abstract: Surgical residents obtain increased clinical and operative responsibilities during successive training years. However, surgical educators have not developed and implemented consistent methodologies for assessing competency at each training level. With imminent and inevitable changes in the conduct of surgical resident education dictated by accreditation and regulatory bodies, we perceive an urgent need to develop and implement consistent tools to assess clinical and technical competencies for our residents. This project describes development of: 1) Graduated Competency Assessments (GCA) for each PGY level; 2) Internet-based tools for faculty assessment and "sign-off" of resident GCA proficiencies; and 3) Models for comparing resident perception of their competency with faculty GCA assessments. P.I. Name: SCHELL, SCOTT R., M.D., Ph.D. Project Start: July 1, 2002 Project Title: (39) Interpersonal/Communication Skills and Patient Care Skills Evaluations: Assessment in the Clinic Abstract: The purpose of this project is to provide and develop the means by which resident may be evaluated in a reproducible fashion for certain skills or competencies. Many areas are evaluated in resident education. It is very difficult to evaluate certain of these reproducibly. The ACGME has provided methods for evaluating resident competencies in six areas. Two areas requiring infrastructure for specific patient related interactions include 1. compassionate, appropriate, effective patient care that is compassionate, appropriate, and effective and 2. interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and other health professionals. We propose the use of simulated patients in the out-patient neurology clinics in order to use specific assessment tools in the evaluation of our residents. P.I. Name: GILMORE, ROBIN L., M.D. Project Start: July 1, 2002 Abstract: The goal of this project is to incorporate the clinical presentation model in the teaching of first-year and fourth-year medical students at the University of Florida College of Medicine. During the 2002/2003 academic year, cases will be developed that address four areas of the adopted clinical presentation list: shortness of breath, hypoxia, neonatal respiratory distress, and muscle weakness. Digital images of relevant anatomic structures also will be collected to provide detailed information about correlation between the phrenic nerve and internal thoracic/or mammary artery and adjacent structures for the developed cases. A minimum 6 cases of the clinical presentation based on the literature will be created. Digital images will be taken at the level of the thoracic outlet after dissecting phrenic nerve and internal mammary artery of 15 cadavers. In addition, an open-heart dissection will be performed on one cadaver, using standard surgical techniques. For each specimen the images of the phrenic nerve and internal mammary artery and their anatomical correlation's will be analyzed. The clinical cases with associated images will provide, first-year and fourth-year medical students a means to learn more about clinical-anatomical relationships between phrenic nerve and internal mammary artery. P.I. Name: MALAKHOVA, OLGA E, M.D, Ph.D. Project Start: July 1, 2002 Project Title: (41) Does a Web-Based Lecture Archive Improve Learning for Post Night Shift Fatigued Medical Students in Emergency Medicine Abstract: Scheduling didactic and other educational events in Emergency Medicine is problematic. Some students are on duty, or coming off night shift and the teaching moment will either be missed or a sub-optimal experience because of disturbed circadian rhythms. With a web-based archive of lectures and hand-out material, students can access material whenever it suits them and can review as often as needed. We developed a web-based curriculum for student rotation in Emergency Medicine. Student feedback has been positive and they frequently accessed material during "off" hours. We would like to expand and upgrade the course and we are adding self assessment exams, procedural demonstrations and streamed video lectures. In addition, we want the ability to record selected teleconference lectures held during the daytime to create an archive for night shift or on duty students to use when their schedule and circadian rhythms permit. P.I. Name: FERGUSON, KEVIN L., M.D. Project Start: July 1, 2002 Abstract: A high-volume, urban residency training environment presents a unique educational environment that causes some residents to thrive, and other s to have overwhelming difficulties. The Learning Style Inventory (LSI-3) is a validated tool to assess learning styles. We hypothesize that there are learning styles that flourish in this environment, and that they can be identified in medical students, prior to the start of their residency, with the LSI-3. P.I. Name: CARO, DAVID A., M.D. Project Start: July 1, 2002 Project Title: (43) Development of a Web-Based Program ot Enhance Allergy for Otolaryngology Residents Abstract: Web-based educational tools have emerged as power as powerful resources to disseminate medical information. Traditional medical education for residents is predominantly based on didactic lectures and participation in clinical activities. We performed a prior study which showed that a web-based module resulted in equivalent short and long term retention of material when compared to didactic lecture. The Residency Review committee has added a formal requirement for Otolaryngology Residency programs to include an otolaryngologic allergy curriculum. The first aim of this project is to develop a Web-based module with a standardized curriculum for educating otolaryngology residents about Allergic Upper Respiratory Disorders. The Web module will be used to perform a prospective, randomized study involving otolaryngology residents. Resident satisfaction and the impact of case illustrations and interval question and answer sections on short and long term retention of content will be tested. P.I. Name: COLLINS, SAVITA P., M.D. Project Start: September 1, 2003 Project End: May 30, 2004 Project Title: (44) Evaluating the Tools: Are They Equivalent in Assessing Resident Communication Competency? Abstract: Post-graduate training programs must require their residents to demonstrate competency in several areas. One of these areas involves communication skills. The purpose of this study is to assess the evaluation process for this competency, to compare the OSCE with a 360 degree global rating. Surgical residents will undergo a specialized training program focused on discussing with families of critically ill patients issues surrounding end of life decision-making. They will subsequently be evaluated by an OSCE as well as undergo a 360 degree global rating during a real clinical situation. Correlation between the two evaluation tools will be tested. I hypothesize that the latter evaluation tool will prove equivalent to the more cumbersome OSCE. P.I. Name: SCHINCO, MIREN A., M.D. Project Start: September 1, 2003 Project End: May 30, 2004 Project Title: (45) A Web-Based Educational. Program for Medical Students About Eating Disorders and Obesity Abstract: Eating disorders and obesity are important societal health problems. Studies suggest that 50 to 66% of all Americans are overweight or obese. Up to 9% of women could be diagnosed with an eating disorder, such as anorexia, bulimia, or binge eating disorder throughout their lifetime. While education regarding these subjects is included in parts of the medical student curriculum, the amount and depth seems insufficient to tackle these disorders. The specific aim of this project is to develop a web-based course on the diagnosis and treatment of Eating Disorders and Obesity to be included in the third year medical student Psychiatry rotation. Clinical vignettes, video clips, and text and picture will be used to help students learn more about these diseases. Additionally, a standardized patient will be created with possible utilization during OSCE examination. This would allow objective information on the efficacy of information delivery. P.I. Name: STAR, JODI E., M.D. Project Start: September 1, 2003 Project End: May 30, 2004
Project Title: (51) Virtual Suture Point Selection Exercise for Students and Residents Learning to Create Wound Closures and Anastomoses. Abstract: The eventual aim of this project is the development of computer-based exercises of linear wound closure and anastomoses, and determining if computer-based simulations enhance the performance of medical students and residents making wound and circular anastomoses in “real” tissue. We developed two 3D interactive programming models:
a) The Linear Closure Model (e.g. a linear laceration) requires proper approximation of two opposing tissue planes in perpendicular and longitudinal directions, such as 1) even spacing along the wound, 2) even spacing away from the edge of the wound and 3) even depth approximation. b) The Circular Wound Closure (e.g. an Anastomoses) Model needs the same requirements as above (linear laceration): 1) even spacing along the wound, 2) even spacing away from the edge of the wound, 3) even depth approximation and additionally - 4) radial orientation to prevent alignment between the two structures being secured. Both models (Linear and Circular Wound closures) were presented at The College of Medicine Annual Research Day and at the Department of Surgery Research Day. Both programs were tested by a number of experienced surgeons from the Department of Surgery. They gave a high score of realism to the Linear Closure exercise and the only suggestion was to create exercise for both hands with surgical instruments. We were not able to test groups of students in real lab environments due to time and funding considerations. We plan on performing this testing during the next cycle. These models will be tested in a study where one group of students is exposed to traditional laboratory training and another is exposed to the simulator. Finally, all the participants will be asked to close an actual wound and an impartial party will judge the results. Conclusion and Future Directions: In order to improve realism of Linear laceration exercise the second hand model of surgical instrument (forceps) should be implemented. This requires the second force feedback (haptic) device. Acknowledgements. The authors are grateful for the constructive comments, discussions and suggestions made by surgeons from the College of Medicine, University of Florida. We thank Professor William Cance for contributing his inspiring comments, support and stimulation discussions. The authors thank Professor Paul Fishwick from the Computer and Information Science and Engineering department for useful programming discussions. We thank Kevin Lloyd and Brett Baskovich for their programming help. P.I. Name: Kurenov, Sergei N., MS, Project End: May 30, 2005 Project Title: (57) The Utility of the Family Health Survey For Interdisciplinary Health Assessment - Dissertation Abstract: Assessment is the key to identification of appropriate support and intervention in family health care. Current reviews of assessment tools and practice are being utilized in health prevention and intervention programs. The family, its function, structure, rules, and beliefs are known to have a significant relationship to the health behaviors and illness outcomes of family members (Gillis & Knafl, 1999; and Marmot & Wilkinson, 1999). The entire family affects the interpretation of and response to health information, by individuals and the family as a whole. The research literature suggests that failure to provide care in the family context using an interdisciplinary team approach can affect the influence of interventions recommended by health professionals. P.I. Name: Rhondda Waddell Project Start: August 1, 2005 Project Title: (58) Computer Based Exercise For Students And Residents Learning To Create Wound Closures And Anastomosis – Development And Evaluation. Abstract: We have developed and demonstrated a virtual computer environment employing two Omni force feedback devices that simulate surgical instruments in a visually driven wound-closure task. In this exercise the student is able to simultaneously manipulate two major surgical instruments: a needle holder and forceps in 3D scenario. We also developed a new measurement and scoring interface which automatically calculates the score based on the following metrics: elapsed time, even needle placement spacing along the wound in both directions, even spacing away from the edge of the virtual wound and quantity of stitches placed for completing closure. The score displays in real time on the screen and can also be reviewed after the procedure.
To validate the environment, surgeons from the Department of Surgery at UF and medical students participated in trials involving a linear incision. Four surgeons and four medical clerks participated in the exercise; all were enthusiastic, and understood clearly the force needed for closing the wound. However, difficulties in handling virtual instruments (requiring the pushing and holding of switch buttons on the original Omni styluses, rather than holding and manipulating real instruments) was noted. Also, the medical students found difficulties in determining depth in the virtual environment due to the nature of flat screen monitors. P.I. Name: Kurenov, Sergei N., MS, Cendan, Juan C., MD Project Start: August 1, 2005 Project Title: (65) ”Hands-on” Surgical teaching. Abstract: Medical illustrations and more recently, videos have become the standard for the dissemination, documentation and teaching of surgical procedures. Presently, the hurdles for taking descriptive text to illustration demand long hours involving a trained medical illustrator and the physician developing the presentation. The illustrator generates images, which generally required revision before results are satisfactory. These paperbound reproductions are generally limited in the ability to illustrate the nuances of relative size, texture or position. In cases where an accurate depiction is rendered, 3D or multiple views may be required to provide satisfactory transfer of information. The illustration process is only partly in the surgeon’s control, and can take years for a textbook to reach the user. P.I. Name: Cendan, Juan C., MD,
Peters, Jorg, PhD,
Kurenov, Sergei N., MS Project Start: August 1, 2005 Project title: (66) Development of a Web-Based Program to Teach Anesthesia Residents during Pediatric Rotation Abstract: Anesthesia residents spend usually one month on pediatric rotation during second year of residency, providing anesthesia to a wide variety of pediatric patients from newborns to teenagers. Resident teaching is performed between cases in the OR, during daily 30-minute morning lectures, and during Friday morning case presentation conferences. Only small fraction of these lectures cover pediatric anesthesia topics. A pediatric patient is very different from an adult patient, and the initial experience learned during pediatric rotation is not enough. There is a simulator course available at the Anesthesia Department at UF but it mainly covers airway problems. To provide a better teaching mechanism, to help residents prepare for written and oral board exams, and to help ensure better understanding of pediatric anesthesia during pediatric rotation, an Internet-Based module including interactive graphics and self-assessment tools was proposed. We been planning to use the Pediatric Anesthesia Manual for this module which is already available at the Department of Anesthesiology. We believe that such a module will significantly help residents perform in OR during pediatric cases and improve their scores on written and oral examinations. The students may access the web page at their convenience. For further information gathering, a Likert survey is utilized for feedback and program evolution. Conclusion: We developed an Internet-Based program to teach anesthesia residents during pediatric rotation. It is available at Anesthesiology Department web page and consists of about 67 slides and 30 questions. This program will be utilized for data collection from anesthesiology residents at the PGY-3 and PGY-4 level who are engaged in mandatory or elective blocks of pediatric anesthesiology, results will be ongoing and cumulative. Application of this template to other areas of anesthesia is possible and planned for the near future. P.I. Name: Matveevskii Alexander, MD, PhD Project Start: August 1, 2005
Project Title: (69) Online Physical Exam Teaching Assistant: A Pediatric Companion http://opeta.medinfo.ufl.edu/pediatric/ Abstract: This program is designed to teach medical students the proper components and technique of examining pediatric patients. A narrated video is coupled with text checklists to walk the students step by step through sample examinations of an infant, toddler, child, and adolescent. Specific components and tips for challenges unique to each age group are addressed. A segment in each video is devoted to suggesting techniques that foster good interpersonal relations and communication with young patients such as comfortable positioning, respecting patient modesty, and relating to the child at an appropriate level. Students have the option of watching each video in its entirely or selecting a video clip of developmental milestone assessment, growth charting, physical exam, or special tests in each age group for quick review. This tutorial is intended as a companion teaching tool to introduce pediatric examination and review examination techniques. Students are encouraged to practice the skills presented with real or standardized patients and receive feedback from supervising faculty. At the University of Florida, we have implemented this teaching tool in the second year clinical skills course when students have their first pediatric encounter. Over 100 students have used the tutorial as an introduction to the pediatric assessment. Traditionally, we have found the pediatric exam to be an intimidating examination for medical students given that medical education focuses on adult medicine and most students have less experience with children. After using the Pediatric Companion tutorial, students feel they are better prepared and more confident when practicing their first pediatric assessment under attending supervision. Students are also encouraged to review the videos prior to their third year pediatric and family medicine clerkships. This program has also been peer reviewed and published through AAMC’s MedEdPORTAL, ID=593. Project
Start: September 1, 2006 Project Title: (70) The Development of an Emergency Radiology Course and Simulating the Resident On-Call Experience Abstract: The purpose was to develop and implement an emergency radiology resident course which included medical simulation, and to assess resident learning. This course was developed to help prepare first year residents for call. PI name: Lori Deitte, M.D. These results were presented at the April 2007 annual meeting of the Association of University Radiologists (AUR).
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