Interactive Module for Pediatric Seminar

Evidence shows pediatricians that lack of confidence in discussing developmental delay and disability with families as one of the main barriers to perform recommended, regular screening of infants and young children for developmental delays and disability. Medical training programs, including the Georgetown University Medical School are grappling with how to provide this content in a meaningful way within their busy curricula. The GU School of Medicine Pediatric Clerkship (PEDS300), Activity Team Based Learning Seminar on Early Childhood Development was enhanced through this ITEL Cohort on Exploring the Use of Technologies to Educate the Whole Person. The seminar for this project is part of a six week clerkship for third year medical students in the specialty area of pediatrics. Groups of 6-12 students are either in the hospital setting or in the community based outpatient clinics working with physician mentors and participating in daily1 hour seminars on various topics in pediatrics. The Early Childhood Development seminar was the seminar of focus for this project. Typically the seminar format consists of the students been listening to a lecture with a Power Point presentation about the importance of detecting and identifying delays in development in infants and toddlers and where to get support and services for the children and their families if they are showing signs of delay or disability. The lecture was followed by a case discussion designed to get the students to apply the knowledge they just learned during the lecture. An hour was not enough time to get through the lecture material and spend time on the case to apply the knowledge learned. The student seminar evaluations indicated that they wanted to spend more time on the case discussion and less on the lecture material. When attempting to meet this need with a redesign of the seminar, the students were sent the lecture material via email in a Power Point format to review before the in-person seminar. The seminar was held and began with the case discussion but the students did not have enough knowledge to respond to the scenario questions, did not engage in the discussion unless asked questions and the lecture material had to be covered anyway. When asked, the majority of the students responded that they did not have enough time to view the PowerPoint and the length of the material was a barrier to using it.

This project was designed to provide the lecture material in a short interactive online module that could be easily accessed via tablet or mobile phone by the students anytime prior to the seminar so that the in-person one hour seminar could be used to primarily focus on the applied learning case scenario discussion. A short, interactive online module was created using Captivate and placed online available at the Georgetown University Early Childhood Intervention Professional Development Center (http://learningei.org/medical-school-pediatric-seminar.html). The link to the module was sent to the students by the Clerkship Coordinator prior to the Early Childhood Development seminar. When the seminar was then conducted with brief introductions, answering of questions and going through case discussions. I compared the perceived knowledge of developmental screening and family interaction with the seminar that provided the PowerPoint via email to the seminar with the interactive module to see if the latter produced a better understanding of screening early development and interaction with families around developmental concerns. A secondary purpose of the project was to provide information to community-based pediatricians and health providers about early childhood developmental screening who mentor medical students in best practices.

The pedagogical intention was to break down the information about developmental screening and interacting with families around developmental concerns in a format that was easy to remember and focused on the main points. The technological intention was to provide an interactive module that could be easily accessed with the devices medical students primarily use to get information (mobile phones or tablets).

Questions of inquiry:

Will the short interactive module format be easy to access?
Will more of the students review the material to prepare for the in person seminar?
Will the students be able to discuss a case scenario and answer questions without repeating lecture material after viewing the module (as compared to the version of the seminar using the PowerPoint)?
Will the students perceive they have the knowledge to screen young children and discuss results with the family as result of the module and seminar?

The data collected was a 15 question seminar feedback evaluation about their perceptions of how their knowledge and attitudes about developmental screening changed from before the seminar to after, the rating of the instructor, and if they used and liked the technology. The last five questions were optional demographic questions required for each of our trainings.

Seven students completed the pilot seminar. The data showed that the students (6/7 completed the evaluation) were highly satisfied or satisfied overall with the seminar. The questions and responses are provided in the table below to the specific questions on the feedback form.

| Question | Response | Comments | |----------|----------|----------| | How satisfied were you with the information presented in the training? | 4/6 very satisfied, 2/6 satisfied | | | Rate the presenter | 6/6 Excellent | | | Gained new knowledge | 6/6 Agree | | | Perceived knowledge change before to after | Changed from low to medium | | | Perceived attitude of the topic | Changed from neutral to positive (some were positive to positive) | | | How did the technology enhance your experience? | | 5/6 accessed the online module technology prior to the seminar and liked it. Comments on the classroom technology used during the in-person seminar were negative. The computer in the room did not work and the discussion was conducted without the visual of the module they reviewed | | What did you find most useful? | |

Discussion of cases (2)
Answering individual student questions
Screening is important but follow up is essential
Explanation of approaches
When to refer

| | What do think would improve this session? | |

More specific cases and faster pace
Better AV (2)
More time
Not have session during lunch
Talk more about milestones
More cases on the computer
Show examples of screening forms
Talk more about what early intervention does

Successes:

Based on the findings from the pilot seminar feedback (paper and conversations), the students were able to access the module; generally liked it; and compared to the emailed Power Point, were more likely to access it and retain the information to use in the case presentation discussions. They did ask more questions vs. the Power Point groups and gave specific examples from their hospital or community based experiences. More discussion occurred around the cases reviewed and level of discussion from my point of view was more sophisticated. For example, one of the students related a case she saw in the clinic the past week and the group discussed what her and the attending physician would have done differently with the knowledge they now had about developmental screening and referral to services and supports. These conversations did not occur in previous groups. No lecture material (or module material) had to be covered but I did refer them back to portions they were unsure or confused by. Compared with the other groups, the change in knowledge gained and change in attitude toward the topic was about the same.

Challenges:

The students really did not like that the technology (computer and projector) during the in-person seminar did not work and could not see the module and cases on the screen (they did have a summary handout). This has not happened before and will test the computer and projector before the in person session and get assistance if it is not working. Learning and creating the Captivate session took more time than expected. Some the interactive features such as quizzes, branched scenarios or drop and drag choice making were not included because of the time to learn and create. Also, the Captivate program is dependent on devices that use Flash. It is not very compatible with html formats (even when published in html) that tablet and mobile devices use. The help of a web developer was needed to put the content online. Captivate is useful for creating interactive features for learning, but may not be the best long-term solution to creating mobile ready accessible content for courses.

Recommendations:

Given this experience, the use of this type of self-paced interactive module is worth the gain in time and sophistication of discussion for more effectively using in-person class time to apply knowledge. However, there are technology and time issues for creating the module that were not within my ability to solve. As Flash ready technology is less accessible and mobile html format for mobile devices is more commonly used, personnel are needed to create this type of self-paced interactivity within in websites/in html format for teaching. This requires the expertise of a website developer and someone who can write the code. Since this is beyond most faculty’s ability, it is recommended the University invest in website development or coding personnel who would work with the faculty to create this type of content.

Presentations:

This experience was recently shared with the Maternal and Child Health Distance Learning Grantees (5/28/14). This group has an annual virtual meeting and my colleague, Toby Long, and our website developer with the Georgetown University Health Information Group, John Richards shared our experiences in creating interactive web-based content with other distance learning trainers and solicited their feedback about how they create the interactive features. We were directed to the CDC learning website for more information about creating quality online learning and interactivity.

Future Plans:

The online module will continue to be used prior to the in-person seminar and the feedback evaluation will continue to ask about their preferences. Will add a specific question about the online module and a separate one about the classroom technology so the students can specify what they liked about the module without confusing that with the classroom technology. We are looking at funding to enhance the module for use with community-based pediatricians and get a more professional production completed that is compatible with html/mobile/tablet devices.

In addition, we are creating more Captivate modules for early intervention providers to enhance their professional development experiences. The modules will be used prior to in-person trainings that will be more seminar and discussion or activity based experiences to practice application of the knowledge gained from the modules.