Randomized Trial Comparing Digital and Live Lecture Formats--论文代写范文精选

51Due论文代写网精选essay代写范文：“ Randomized Trial Comparing Digital and Live Lecture Formats” 医学教育开展越来越多，以社区为基础的教学网站，对于以外的传统学术医疗设置，与此同时,卫生保健要求的经济学方面更富有成效。这篇医学essay代写范文讲述了这一问题。这些趋势在学术医学上，使它更加难以为学生和居民提供一致的高质量的教学。尽管说教的演讲在医学教育作用有限。人类医学学院(CHM)在密歇根州立大学(MSU)社区集成结构,医学生在临床部分的培训在全国蔓延。虽然社区集成结构有许多优点,它是具有挑战性的，为学生们提供了一个一致的教育体验。

Abstract
Medical education is increasingly being conducted in community-based teaching sites outside of the traditional academic medical setting [1] At the same time, the economics of health care are requiring academic physicians to be more productive.[2] These trends in academic medicine are making it ever more difficult to provide students and residents with consistent high quality instruction. Although didactic presentations have a limited role in medical education, they currently form an important component of both predoctoral and graduate medical education. 2 The College of Human Medicine (CHM) at Michigan State University (MSU) has a community integrated structure where medical students spend the clinical portion of their training in one of six community campuses spread throughout the State of Michigan. 

While CHM’s community integrated structure has many advantages, it is challenging to provide a consistent educational experience for the students. To help address this challenge we implemented an all-day lecture series held at one of the community campuses the week before the end of the internal medicine clerkship. The lecture series titled “Crush the Boards” was designed to prepare the students for the National Board of Medical Examiners (NBME) subject examination in internal medicine which is used as the final written examination for the clerkship. The students and faculty presenters from other campuses travel from their home campus to the campus hosting the lecture series. While the lecture series has been successful, coinciding with a marked increase in subject exam performance, traveling to the host community is inconvenient and time consuming for both the students and the faculty presenters. In addition, it is not practical for students at CHM’s rural medicine campus at Marquette to attend due to the distance, approximately 400 miles, from the other CHM campuses.

Methods 
Students taking the third-year required internal medicine clerkship at CHM during the 2003-2004 academic year* were offered the opportunity to participate in the study. Those agreeing to participate were randomized into to one of two arms of the study. The control group traveled to one of the CHM community campuses (Lansing) and attended the Crush the Boards lectures with their colleagues who chose not to participate in the study. The experimental group stayed at their home campus on the day other students attended the Crush the Boards lectures and completed a parallel set of CD-ROM-based multimedia modules made from digital recordings of the previous year’s Crush the Boards lectures. The lecture series included six lectures covering asthma, coronary artery disease, renal failure, liver disease, thyroid disease, and antibiotic pharmacology.

Discussion 
Although approximately 100 students completed the internal medicine clerkship during the academic year the study was conducted, only 29 participated in the study. This occurred for several reasons. During the first rotation, the study was not well advertised and there were technical problems in a demonstration of the digital lectures. The net result was that very few students chose to participate during that rotation. During the second and third rotations, approximately two thirds of the students agreed to participate. There were also approximately 20 students who were ineligible to participate. 

These included students from the rural medicine program at Marquette who do not participate in the live lecture series due to the distance from the other communities. Additionally, some of the communities conducted a fourth rotation of the 6 internal medicine clerkship due to space limitations in the three regular rotations and a live version of the lecture series was not given for the fourth rotation. The statistical power of the study was limited do to the small sample sizes in each group. This is an issue for this study since the goal was to prove the “null hypothesis”, i.e., students completing the digital lectures would perform as well as those attending live lectures on a written test of the material contained in the lectures. 

Given the students who viewed the digital lectures actually performed slightly better than the students who attended the live lectures, we are fairly confident the digital lectures can provide an adequate replacement for the live lectures from a learning perspective although further research data confirming this would be helpful. Despite the fact that almost all of the students experienced some technical difficulties using the modules, they had a very positive view of delivering the lectures using this format. All the students either agreed or strongly agreed the modules could serve as an adequate replacement for live lectures. They were particularly appreciative of not having to travel to another community to attend didactic presentations and having the flexibility of viewing the modules at their convenience. Of the three potential disadvantages of the format that were listed on the feedback form, they felt their inability to ask a question of the presenter was the most important. 

In the future we are considering using a web-based bulletin board system as a means of allowing students to ask questions of the presenter. As noted virtually all the students had some technical difficulty using the modules. We were surprised as we had tested the modules on a variety of different computers with very few problems. In some cases, the CD-ROMs we distributed apparently had not been copy correctly. Additionally we switched the video editing software we used for creating the modules from Pinnacle’s Studio 8 to Microsoft’s Movie Maker which is distributed with Windows XP. We 7 assumed there would be less compatibility problems with the Window’s media files created via Movie Maker than the MPEG files created by Studio 8. Unfortunately, we later found out the Window’s media files created by Movie Maker require a codec for translation that was not shipped with earlier versions of Windows. We expect this was a significant cause of the technical problems the students experienced. 

We have since abandoned the format we used for creating the digital lectures and are now using Impatica’s OnCue for creating digital lectures. OnCue simplifies the process of creating the digital lectures and allows them to be distributed over the Web as well as via CD-ROM. It requires no special software other than a Java enabled browser and we expect it will solve the majority of the technical problems encountered with the original format. Although the data collected in this study were fairly limited, it provides evidence that digital lectures are both well received by students and can provide a satisfactory substitute for live lectures from a performance standpoint. To complement these modules we have developed a web-based testing system for providing students with immediate feedback on their mastery of the material contained in the digital lectures. Such combined Web and CD-ROM distance learning formats have been shown to be effective in a number of educational settings. [5-6]

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