Attending in the Third Year Clerkship in Medicine, Acting Internship in Medicine

In our project, we attempted to integrate the use of tablet technology into several courses in the Georgetown University School of Medicine. The courses occurred in either pre-clinical years (Evidence-Based Medicine (EBM) and Lab Medicine), the first and second years spent largely in classroom-based learning, or the clinical third and fourth years (Third Year Clinical Clerkship in Medicine and Acting Internship in Medicine), these courses being based in the hospital or clinics when students are involved in experiential learning. Our aim was to create a tablet-enabled, digital collaboration between pre-clinical and clinical students which would afford the pre-clinical students a uniquely compelling clinical context to the curricular content covered in these pre-clinical courses. The digital collaboration was to foster a deeper engagement of students in classroom-based learning via a more concrete appreciation of the relevance of pre-clinical courses to their future clinical rotations.

The core of the digital collaboration consisted of the tablet based video capture of clinical students presenting actual cases on the wards. These videos would then be edited and annotated with relevant teaching points by supervising faculty on the tablet itself and then posted for student review to the relevant course’s Blackboard site. The digital capture occurred in three main teaching settings: a formal student report setting which occurred in a fixed conference location; bedside ward teaching rounds, and on the fly student presentations not occurring as part of teaching rounds. We captured five student report case presentations, two bedside teaching rounds case presentations, and two on the fly student presentations. It should be noted that as initially envisioned, students themselves were to carry out the video capture. But, in implementing the project it became clear that clinical students were not able or willing to video capture their peers citing competing clerkship duties. As a result supervising faculty carried out the above described video capture.

After video capture, the content was edited and annotated prior to posting on Blackboard. IMovie was utilized to edit down the size of the captured video to the relevant portions. Subsequently, the tablet teaching app “Explain Everything” was utilized to annotate the videos with relevant teaching points. The videos intended for the Lab Medicine course focused teaching points on differential diagnosis skills including the use of the tablet-based, differential diagnosis checklist generator called Isabel Healthcare. The videos intended for the EBM course focused teaching points on tablet-based searching skills. After editing and annotation, selected videos were either posted to the Blackboard site for Lab Medicine or presented to EBM students in small group settings.

The intention of the intervention was to not only create a more comprehensive experience of classroom learning which involved real patients but to also expose them to skills needed for work in the hospital much earlier in the curriculum.

There were several areas of interest we wanted to investigate with the development of this project. First, would using technology in video presentations be a more engaging experience for the preclinical students? For example, would hearing about an actual patient in the hospital with back pain, and seeing how the residents and students approached the problem in a conference create a more salient experience that would allow the groups exposed to this material retain it more effectively? Would having third and fourth year students record their patient encounters on video for their classmates be a motivating factor to refine the way they are able to construct the information and improve their presentation skills? In a broader sense, we were wondering if the institutional culture in both the hospital and the medical school would be receptive to the integration of technology in teaching concepts or would it prove cumbersome and distracting?

The data collection phase of our project is ongoing but some preliminary data relating to feasibility is available. In regards to the clinical students, as mentioned above in the project description, we were able to successfully tablet video capture five student report case presentations, two bedside teaching rounds case presentations, and two on-the-fly case presentations. These video captures ranged in size from 5 – 8 minutes for the bedside teaching rounds/on-the-fly presentations to 45-50 minutes for the more formal student report presentations.

In regards to pre-clinical students, as our implementation of the project evolved, we realized the need to narrow our focus to selected topics for specific teaching events in the Lab Medicine and EBM courses. Also, it became clear that this narrowed focus would make division of students into exposed and non-exposed groups untenable. Hence, our survey of impact is undergoing revision and will be administered to all pre-clinical students who were asked to review our annotated video of a case of low back pain. Currently, viewcount data indicates that at least 64 of approximately 110 second year students in the Lab Medicine course did access the low back pain video. Qualitative, unsolicited feedback from involved students suggests that the video enhanced their learning of low back pain material but formal evaluation of this awaits the administration and analysis of our survey.

In regards to future teaching, we plan on utilizing the same tablet platform to enhance existing medical school curricula in both pre-clinical courses and clinical clerkships. In regards to clinical clerkships, members of our Cohort group have agreed to take the lead in a multidisciplinary medical school faculty working group in the creation of a virtual, longitudinal nutrition lecture series spanning all six of the core 3rd Year clinical clerkships (Internal Medicine/ Family Medicine/ Pediatrics/ Obstetrics and Gynecology/ General Surgery/Psychiatry). We plan on employing tablet technology to create interactive, annotated videos which incorporate video capture of patients discussing nutrition related problems and medical students presenting patients under their care who suffer from nutrition related health conditions into all of the lecture videos. In regards to pre-clinical courses, we plan on expanding the scope and number of annotated videos created for the Lab Medicine course in the coming academic year. The goal will be to produce an annotated video for each of the clinical topics presented in that course.

In regards to spreading our experience to peer faculty, our group feels strongly that many of our teaching faculty colleagues would be willing to incorporate tablet-based teaching methods into their teaching. Informal feedback from our colleagues in Hospital Medicine and General Medicine suggest that interest is high among those who were aware of our involvement in the ITEL Cohort.

Our feeling is that interested faculty would need significant support to successfully incorporate tablet based teaching methods into their teaching repertoire. Mentoring in project design by faculty who completed our ITEL Tablet Cohort would be essential. Additionally, technical support for learning the relevant tablet based software (i.e. Explain Everything) would be helpful from either mentoring faculty or Gelardin New Media resources (or both sources). A final component would take the form of an academic incentive to incorporate these methods into existing teaching settings. This could be explicit acknowledgement from medical school leadership that incorporation of these teaching methods into a faculty member’s teaching portfolio is to be encouraged and would be expected to have positive impact on academic promotion for clinician-educator track faculty.

In regards to formal scholarship, our work in this Cohort is felt to be preliminary. If our planned future projects come to fruition (expansion of the annotated videos for the pre-clinical Lab Medicine course and the creation of a virtual nutrition lecture series for the clinical clerkships), we believe we would have enough student exposure to gather more meaningful impact data. We plan on keeping ITEL updated on these projects and would welcome ITEL collaboration on any academic scholarship that might result from this work.