Teaching Scholar ProgramTeaching Scholar ProgramFebruary 15February 15thth, 2007, 2007

Evaluation of a Web-Based Clinical Pathology Evaluation of a Web-Based Clinical Pathology Module in the Teaching of Medical StudentsModule in the Teaching of Medical Students

Francisco G La Rosa *Francisco G La Rosa *Kathleen Torkko, Gretchen Guilton, M. Scott LuciaKathleen Torkko, Gretchen Guilton, M. Scott Lucia

Department of Pathology, University of Colorado at Denver, HSCDepartment of Pathology, University of Colorado at Denver, HSCCenter, Aurora, CO 80015Center, Aurora, CO 80015

* Francisco G. La Rosa, MDFrancisco.LaRosa@uchsc.eduAssistant Professor, Department of Pathology

University of Colorado at Denver Health Science Center, Denver, Colorado

HYPOTHESISHYPOTHESIS

The use of A Web-based clinical pathology module The use of A Web-based clinical pathology module in the teaching of medical students will provide a in the teaching of medical students will provide a dynamic and motivational learning tool to facilitate dynamic and motivational learning tool to facilitate the rational understanding of the mechanisms of the rational understanding of the mechanisms of diseases and their corresponding prophylactic and diseases and their corresponding prophylactic and therapeutic approaches.therapeutic approaches.

Competing or rival hypothesis:Competing or rival hypothesis:

Web-based learning tools will not improve the Web-based learning tools will not improve the learning provided by traditional educational tools learning provided by traditional educational tools such as printed material and classroom teaching.such as printed material and classroom teaching.

CONTROL GROUP: Printed MaterialCONTROL GROUP: Printed Material

Web Based ModuleWeb Based Module

WEB CNT

Control GroupControl Group

Web GroupWeb Group

GretchenGretchen

Scores Test 1

WEB CNT0

2

4

6

8

10

12

14

Tes

t S

core

p=0.102

WEB CNT0

2

4

6

8

10

12

14

16

18

Scores Tests 2

Tes

t S

core

p=0.162

CONTROLDifference in Score

Test 1 Test 202468

101214161820

p=0.0008

Te

st

Sc

ore

Test 1 Test 20

2

4

6

8

10

12

14

16

18

p=0.002619

20

WEBDifference in Score

Te

st

Sc

ore

Difference in Test ScoresFrom Test 1 to Test 2

WEB CNT-5

0

5

10

Tes

t S

core

Dif

fere

nce

p=0.81

Test 1 Test 20

5

10

15

20

25

p<0.0001

Min

ute

s

CONTROLTime to Take the Tests

Test 1 Test 20

5

10

15

20

25

Min

ute

s

p<0.0001

WEBTime to Take the Tests

Difference in Times to take the TestsFrom Test 1 to Test 2

WEB CNT-12

-10

-8

-6

-4

-2

0C

han

ge

in M

inu

tes

p=0.64

1.1. In both WEB and CNT groups there was a significant increase in In both WEB and CNT groups there was a significant increase in scores and a significant decrease in time to take the test from Test 1 scores and a significant decrease in time to take the test from Test 1 to Test 2to Test 2

2.2. There were no significant differences between the two groups in There were no significant differences between the two groups in scores or times. Therefore, WEB was no better (or worse) than CNT.scores or times. Therefore, WEB was no better (or worse) than CNT.

……

CONCLUSIONSCONCLUSIONS

Are the scores for the two groups different for Test 1?Are the scores for the two groups different for Test 1?No (p=0.1016)No (p=0.1016)

Are the scores for the two groups different at Test 2?Are the scores for the two groups different at Test 2?No (p=0.1617)No (p=0.1617)

Are the differences in scores for the two groups different?Are the differences in scores for the two groups different?No (p=0.8115)No (p=0.8115)

Are the times to take the test for the two groups different at Test 1?Are the times to take the test for the two groups different at Test 1?No (p=0.7342)No (p=0.7342)

Are the times to take the test for the two groups different at Test 2?Are the times to take the test for the two groups different at Test 2?No (p=0.6171)No (p=0.6171)

Are the differences in times to take the test for the two groups different?Are the differences in times to take the test for the two groups different?No (p=0.6405)No (p=0.6405)

… … CONCLUSIONSCONCLUSIONS

In a scale from 1 to 5 (strongly disagree to strongly agree)In a scale from 1 to 5 (strongly disagree to strongly agree) CONTROLCONTROL WEBWEB

- I prefer self study sessions to instructor oriented sessions:- I prefer self study sessions to instructor oriented sessions: 2.242.24 2.482.48

- Descriptions and images adequately prepared me to understand - Descriptions and images adequately prepared me to understand this unit:this unit:

2.552.55 2.382.38

- The Web-based cases were easy to use and an effective tool:- The Web-based cases were easy to use and an effective tool: NANA 3.383.38

- The printed cases were easy to use and an effective tool:- The printed cases were easy to use and an effective tool: 3.483.48 NANA

- The cases provided the feeling of a "real-life" situation:- The cases provided the feeling of a "real-life" situation: 3.433.43 3.193.19

- The instructions were complete/accurate and easy to follow:- The instructions were complete/accurate and easy to follow: * 4.38 ** 4.38 * * 4.29 ** 4.29 *

- I would like to have more of these teaching modules in other units:- I would like to have more of these teaching modules in other units: 3.573.57 3.053.05

- My overall rate for this module is (from very poor to excellent):- My overall rate for this module is (from very poor to excellent): 3.333.33 3.33.3

Additional QuestionsAdditional Questions

Comment on positive aspects: CONTROL GroupComment on positive aspects: CONTROL Group

Work at own paceWork at own pace

Clear instructions, I prefer paper basedClear instructions, I prefer paper based

Good quality picturesGood quality pictures

To allow each student to proceed at his own speedTo allow each student to proceed at his own speed

Good explanationsGood explanations

Like the setup and the individualized learning, however, it is Like the setup and the individualized learning, however, it is hard to learn/understand hard to learn/understand what is abnormal if we have never learned what is normalwhat is abnormal if we have never learned what is normal. Perhaps including in the . Perhaps including in the descriptions could be normals & arrows to directly point out abnormal findings. I never descriptions could be normals & arrows to directly point out abnormal findings. I never know what the description of the images are actually referring to.know what the description of the images are actually referring to.

It is good to have practice questions to focus on important aspectsIt is good to have practice questions to focus on important aspects

Test-like scenario and self-directed learningTest-like scenario and self-directed learning

I know I needed to study moreI know I needed to study more

Having pictures & answers help to learn/identifyHaving pictures & answers help to learn/identify

Allows me to move at my own pace!Allows me to move at my own pace!

Many cases: goodMany cases: good

We rarely see histologyWe rarely see histology so I am glad to see examples here so I am glad to see examples here

Reading explanationsReading explanations

Extra free to learnExtra free to learn

We saw cases and answers were immediately available. We saw cases and answers were immediately available. We need normals to compare toWe need normals to compare to..

Great to see images and descriptions.Great to see images and descriptions.

I like having explanations with clear photos.I like having explanations with clear photos.

The cases seem realisticThe cases seem realistic

The instructors are very focused on us learning and understandingThe instructors are very focused on us learning and understanding

It is good to see the images.It is good to see the images.

Easy to control paceEasy to control pace

I can do it on my own timeI can do it on my own time

Clear cases; clean, large picturesClear cases; clean, large pictures

It is nice to get to spend time with the cases & It is nice to get to spend time with the cases & process it at your own timeprocess it at your own time..

Factual info was goodFactual info was good

Great pix and easy aspects.Great pix and easy aspects.

I really I really enjoy self directed exercisesenjoy self directed exercises and thank you for putting them together! and thank you for putting them together!

I like having exposure to histology images I like having exposure to histology images on my own timeon my own time..

Able to test oneselfAble to test oneself..

Cases were straight forward.Cases were straight forward.

Nice correlation of cases & histology, good explanation of answers.Nice correlation of cases & histology, good explanation of answers.

Comment on positive aspects: WEB GroupComment on positive aspects: WEB Group

Highlighting & outlining cells on the image would be very nice to do. Highlighting & outlining cells on the image would be very nice to do.

Include in answers why something is wrong.Include in answers why something is wrong.

Arrows on photos pointing out specific cell types & more clear explanations would be Arrows on photos pointing out specific cell types & more clear explanations would be helpful.helpful.

I I would ratherwould rather have a pathologist explaining the imageshave a pathologist explaining the images to me. I do not get much out of to me. I do not get much out of just reading descriptions of the images. The just reading descriptions of the images. The histology is very foreign to mehistology is very foreign to me. .

I would like better descriptions with correlated pictures up front.I would like better descriptions with correlated pictures up front.

I learn much better from instructors/classrooms sessions. Staring at computer cases does I learn much better from instructors/classrooms sessions. Staring at computer cases does not fit my learning style well.not fit my learning style well.

Need normals to compare toNeed normals to compare to..

Images & Answers linked to same window, making learning aspect difficult. Answers Images & Answers linked to same window, making learning aspect difficult. Answers were sometimes not very descriptive or informative.were sometimes not very descriptive or informative.

I wonder if I'll do it adequately to learn the material or just learning from an exam.I wonder if I'll do it adequately to learn the material or just learning from an exam.

I like it, just fix the windows issue we chatted about I like it, just fix the windows issue we chatted about 

A lot of times the answers would say A lot of times the answers would say "You'll see a ___", but I do not know what"You'll see a ___", but I do not know what … looks … looks like, so it wouldn't help me at all. like, so it wouldn't help me at all. I felt lost & that I needed an instructorI felt lost & that I needed an instructor for help. for help.

I have no idea what I am looking atI have no idea what I am looking at!! I would greatly prefer if a person explained the !! I would greatly prefer if a person explained the pictures to me!.pictures to me!.

The The lack of normal histology to comparelack of normal histology to compare the pathologic specimen to. the pathologic specimen to.

Comment on negative aspects: WEB GroupComment on negative aspects: WEB Group

It would be great if the answers could appear below the questions or images, rather than It would be great if the answers could appear below the questions or images, rather than in a separate window. They would be easier to view.in a separate window. They would be easier to view.

Not enough information provided in the answers to fully understand the topic.Not enough information provided in the answers to fully understand the topic.

It would be great if there were arrows pointing to structures that are identified - It would be great if there were arrows pointing to structures that are identified - I forget I forget what nerve tissue looked likewhat nerve tissue looked like so in the answers maybe structures should be labeled. I so in the answers maybe structures should be labeled. I also like seeing question, answer and image all at once. I connect facts better than if I also like seeing question, answer and image all at once. I connect facts better than if I have to switch back and forth. Also, having multiple questions with only one answer to have to switch back and forth. Also, having multiple questions with only one answer to put was confusing and slowed me down.put was confusing and slowed me down.

Do not like computer based stuff. Like paper, even though more expensive.Do not like computer based stuff. Like paper, even though more expensive.

II would like to see labels on the slides so I know what I am looking atwould like to see labels on the slides so I know what I am looking at..

Difficult since Difficult since we do not have much exposure to histologywe do not have much exposure to histology of normal prostate, testes or of normal prostate, testes or placenta.placenta.

Comment on negative aspects: WEB GroupComment on negative aspects: WEB Group

(continued)(continued)

I is nice to have someone who is in the room and easily accessible to ask questions to I is nice to have someone who is in the room and easily accessible to ask questions to and clarify, explain and help with understanding.and clarify, explain and help with understanding.

Seems out of order or as though Seems out of order or as though directors thinkdirectors think we've already learned the normal phys we've already learned the normal phys & anatomy & that & anatomy & that we can instantly recognize histo imageswe can instantly recognize histo images..

The problem is, The problem is, I do not feel I have an adequate knowledge of normal histologyI do not feel I have an adequate knowledge of normal histology to to understand pathological histology. Even with the descriptions, I am not sure I am understand pathological histology. Even with the descriptions, I am not sure I am seeing what I suppose to see.seeing what I suppose to see.

It just needed more explanation of the pictures (arrows) It just needed more explanation of the pictures (arrows) 

Sometimes it was unclear what was being described. Arrows would be nice. Also, Sometimes it was unclear what was being described. Arrows would be nice. Also, slides slides of normal tissue are neededof normal tissue are needed..

Sometimes Sometimes I am not sure what the description is referring to on the imageI am not sure what the description is referring to on the image..

We have too little path exposure& We have too little path exposure& explanations from pathologists to know what we are explanations from pathologists to know what we are looking atlooking at. . 

Arrows pointing to relevant structures would be helpful. I think in general Arrows pointing to relevant structures would be helpful. I think in general my histology my histology is pooris poor because most of the time I have no idea what I am looking at or for. because most of the time I have no idea what I am looking at or for.

Comment on negative aspects: CONTROL GroupComment on negative aspects: CONTROL Group

I am extremely I am extremely confused about normal histological appearanceconfused about normal histological appearance. I need someone to . I need someone to identify various cells in the picture. I do not know what they are. An online study module identify various cells in the picture. I do not know what they are. An online study module with more specifics would be very helpful. Begin by telling us about the various types of with more specifics would be very helpful. Begin by telling us about the various types of tumors, their behaviors & their defing features. Include many pictures of normal and tumors, their behaviors & their defing features. Include many pictures of normal and abnormal for comparison. Then, include cases such as these to help us test ourselves & abnormal for comparison. Then, include cases such as these to help us test ourselves & reinforce our understanding. Include arrows to specific cells.reinforce our understanding. Include arrows to specific cells.

Not enough detailNot enough detail

I am not very strong in histological analysisI am not very strong in histological analysis..

Not being able to ask questions - not enough information.Not being able to ask questions - not enough information.

I can't focus with people getting up & down to take the different parts of the test. It makes I can't focus with people getting up & down to take the different parts of the test. It makes me nervous.me nervous.

Comment on negative aspects: CONTROL GroupComment on negative aspects: CONTROL Group

(continued)(continued)

ADDITIONAL CONCLUSIONSADDITIONAL CONCLUSIONS

• Students need a better histology background to understand Students need a better histology background to understand pathologypathology

• Web-based cases allow students to study at their own paceWeb-based cases allow students to study at their own pace

• Students need more detailed instruction and many prefer a “live” Students need more detailed instruction and many prefer a “live” instructor.instructor.

• Need to improve presentation of cases using arrows, simplified Need to improve presentation of cases using arrows, simplified answer windows, etc.answer windows, etc.

ACKNOWLEDGMENTSACKNOWLEDGMENTS

• Dr. Robert Shikes, MDDr. Robert Shikes, MD

• Susan PethSusan Peth

• The Class 2009 medical students The Class 2009 medical students