Reinforcing outpatient medical student learning using brief computer tutorials: the Patient-Teacher-Tutorial sequence

• Published in: BMC medical education Vol. 12; no. 1; p. 70
• Main Authors: Pusic, Martin V, MacDonald, Wendy A, Eisman, Harley O, Black, John B
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08-08-2012; BioMed Central; BMC
• Subjects: Ambulatory medical care; Child, Preschool; Clinical Competence; Computer-Assisted Instruction; Curriculum; Diarrhea, Infantile - therapy; Education, Medical, Undergraduate - methods; Educational Measurement; Educational Resources; Educational Strategies; Emergency medical care; Emergency Medical Services; Emergency Medicine - education; Fever of Unknown Origin - etiology; Fever of Unknown Origin - therapy; Fluid Therapy; Hospitals; Humans; Infant; Intervention; Medical education; Medical students; Models, Educational; Pediatrics - education; Physician and patient; Physicians; Programmed Instruction as Topic; Reinforcement (Psychology); Studies; Study and teaching; Teachers; Teaching; Teaching Methods; Training; Vomiting - therapy
• ISSN: 1472-6920; 1472-6920
• DOI: 10.1186/1472-6920-12-70

At present, what students read after an outpatient encounter is largely left up to them. Our objective was to evaluate the education efficacy of a clinical education model in which the student moves through a sequence that includes immediately reinforcing their learning using a specifically designed computer tutorial.
Prior to a 14-day Pediatric Emergency rotation, medical students completed pre-tests for two common pediatric topics: Oral Rehydration Solutions (ORS) and Fever Without Source (FWS). After encountering a patient with either FWS or a patient needing ORS, the student logged into a computer that randomly assigned them to either a) completing a relevant computer tutorial (e.g. FWS patient + FWS tutorial = "in sequence") or b) completing the non-relevant tutorial (e.g. FWS patient + ORS tutorial = "out of sequence"). At the end of their rotation, they were tested again on both topics. Our main outcome was post-test scores on a given tutorial topic, contrasted by whether done in- or out-of-sequence.
Ninety-two students completed the study protocol with 41 in the 'in sequence' group. Pre-test scores did not differ significantly. Overall, doing a computer tutorial in sequence resulted in significantly greater post-test scores (z-score 1.1 (SD 0.70) in sequence vs. 0.52 (1.1) out-of-sequence; 95% CI for difference +0.16, +0.93). Students spent longer on the tutorials when they were done in sequence (12.1 min (SD 7.3) vs. 10.5 (6.5)) though the difference was not statistically significant (95% CI diff: -1.2 min, +4.5).
Outpatient learning frameworks could be structured to take best advantage of the heightened learning potential created by patient encounters. We propose the Patient-Teacher-Tutorial sequence as a framework for organizing learning in outpatient clinical settings.