Administering a Gross Anatomy Exam Using Mobile Technology

By Alireza Jalali, Daniel Trottier, Mariane Tremblay, and Maxwell Hincke


Mobile technology has infiltrated medical school education. Students now bring tablet PCs, rather than notebooks, into the classroom. They can access Web-based curriculum during lectures and add notes directly to their files. At the Faculty of Medicine University of Ottawa the curriculum for the first two years is online, and PDAs have largely replaced reference books for students in clerkship programs. And more telling, employees at Ottawa Hospital Medical have been encouraged to replace pen and paper notes with iPads. Thus, transitioning from written to digital examinations seemed to be a reasonable next step. To assess the benefits and drawbacks of this approach, we developed a mock anatomy examination using the Questionmark software and compared its administration and evaluation on two electronic devices.

At the Faculty of Medicine of the University of Ottawa, gross anatomy is taught during the first two years of medical school. The course is divided into four units: musculoskeletal anatomy; the thorax, head and neck; the abdominal and pelvic cavity; and neuroanatomy. Students attend anatomy lectures and laboratories almost every week. After each unit students take a final laboratory examination, they also take a timed midterm examination. During each examination, students rotate through 20 (midterm exam) or 40 (final exam) stations in the laboratory covering anatomy, pathology, radiology, and a few other disciplines. Students spend two minutes at each station and answer two to four multiple-choice questions (MCQs). MCQs are frequently used in medical schools because they are reliable and allow for rapid marking and prompt feedback to learners (Fowell and Bligh, 1998); also MCQs can be used to examine higher levels of learning (Collins, 2006).

Our goal was to eliminate these paper examinations and move to an online version. As instructors we use guidelines from the National Board of Medical Examiners and the Medical Council of Canada to aid us in constructing our examination questions (Case and Swanson, 2002; Touchie, 2005). Since the students are taught using cadaveric specimens, their examination should also include such specimens. However there are disadvantages: Voluminous amounts of paperwork need to be organized. In proctoring seven examinations a year to 150 students, we use approximately 35,000 pieces of paper. It takes time to prepare the printed examinations, organize the examination stations, and then to carry all of the papers to the laboratory before the examination. It is also time consuming to correct the examinations and communicate results. Besides the issue of sustainability, online evaluation would save administrative time and money in addition to helping us to provide faster feedback to students.

Experimental Procedures


To move from a paper-based examination to an online version, we researched available hardware and software. We decided to use a portable device, which would allow us to continue to use the timed examination, the students would also be able to move easily from one station to another. After a discussion with our medical technology team, we chose two tablets for this study that were light weight and had fast screen reaction time and long battery life: the Lenovo S10-3t running Windows 7 Enterprise and the Apple iPad Wi-Fi 64GB running the iPhone 3.2 OS.

With all the available options, we tested numerous learning applications. Students were already comfortable Questionmark Perception and it was compatible with existing technologies being used at the school. The tool allows the creation of a question bank in different languages, which is very useful for our bilingual university. Also the ability to create 12 types of reports was useful, specifically the coaching report. The student can see detailed information, including the answers and scores for each question, which is used to help coach individuals through their learning curves. Furthermore, Questionmark Perception makes it possible to return to and continue a previously started examination via an auto-save feature. This feature is not Wi-Fi dependent and, therefore, lends itself well to a potentially unstable Internet connection environment and provides confidence for use during a live examination. For all of these reasons, our university purchased a license for Questionmark; eventually all of our written examinations at Faculty of Medicine will be created using the software.

Our data collection method was straight forward; we set up a mock anatomy examination using four stations, each having two MCQs. A student, an IT staff member, and a faculty member, who were all familiar with the paper-based examination, completed the examination first using the iPad, and then using the Lenovo tablet. The volunteers had two minutes at each station. Afterward they were individually questioned about their general impressions of the online examination and their preferences regarding the devices used.

Results

We identified numerous benefits and challenges related to the method. All of the participants liked the idea of an online anatomy examination to replace the paper version. Ease of use and immediate feedback were among the advantages they identified. The two main disadvantages identified were the stress related to not having an examination paper in hand and dependence on a potentially unreliable Internet connection. The participants found that an online examination added to the stress of taking the examination. The participants worried that their responses would not be recorded by the machines and that their answers might not be submitted.

Conclusion


Although the online examinations may help faculty administratively, it will present challenges. Students may be stressed by undergoing a new method of examination and will require suitable orientation. The choice of hardware and software also needs to be considered carefully, as the examination might render differently depending on the selected technology. During our study we discovered depending on the selected online examination tool, an online exam will render differently on the iPad compared with conventional laptops and tablet PCs. This is mostly do to the fact that iPad uses Safari as browser instead of the more widely used Internet Explorer. Consequently achieving the desired look and user experience required modifications to digital files; even our method for organizing the examination was affected. However our preliminary trials established that an iPad and the Questionmark software was a suitable combination to use for a timed, online anatomy examination. This recommendation is in line with the Ottawa Teaching Hospital's decision to use the iPad at the patient bedside for clinical purposes. Our hope is the transition from paper examinations to an online version will save faculty members time, but also improve the evaluation process for students. An electronic exam will also translate into cost savings for the university. Moreover the final licensing examination administered by the Medical Council of Canada is taken on a computer, adopting an online anatomy examination will offer students much needed practice and, it is hoped, better preparation for such professional examinations.

Acknowledgments

The authors appreciate the continued and enthusiastic support from the University of Ottawa's Faculty of Medicine and Bureau des Affaires Francophones (BAF) with this project.

About the Authors


Alireza Jalali, M.D., is a Francophone professor of anatomy at the Division of Clinical and Functional Anatomy, at the Faculty of Medicine, University of Ottawa, Ottawa, Canada. His research explores the use of technology and more particularly the Web 2.0 tools in medical education.

Daniel Trottier is the manager of the Web, multimedia, learning technologies and IT Systems at the Medical Technology Office at the Faculty of Medicine, University of Ottawa, Ottawa, Canada. His research interest includes the use of new technological tools in medicine.

Mariane Tremblay is a multimedia and learning technologies designer at the Medical Technology Office at the Faculty of Medicine, University of Ottawa, Ottawa, Canada. She is fascinated with the use of new technology in medical education.

Maxwell Hincke, Ph.D., is the Head of the Division of Clinical and Functional Anatomy at Faculty of Medicine, University of Ottawa, Ottawa, Canada. He is very interested in the use of novel technology for teaching anatomy in the medical curriculum.


References

Case, S.M. and Swanson, D.B. (2002). Constructing Written Test Questions for the Basic and Clinical Sciences. Third Ed. Philadelphia, PA. National Board of Medical Examiners, http://www.nbme.org/PDF/ItemWriting_2003/2003IWGwhole.pdf

Collins, J. (2006). Education techniques for lifelong learning: Writing multiple-choice questions for continuing medical education activities and self-assessment modules. Radiographics 26 (2): 543-551.

Fowell, S.L and Bligh, J.G. (1998). Recent developments in assessing medical students. Postgrad Medical Journal 74 (867):18-24.

Touchie, C. (2005). Guidelines for the Development of Multiple-Choice Questions. First Ed. The Medical Council of Canada, Ottawa, ON, http://www.mcc.ca/pdf/MCQ_Guidelines_e.pdf.pdf

This article was originally posted at http://www.elearnmag.org/subpage.cfm?section=articles&article=152-1

Online learning is making education more efficient and more effective

In his State of the Union address, President Obama urged the United States to out-innovate the rest of the world in order to to remain competitive. And when it comes to innovation, there’s no better place to start than education.

Fortunately, we're already moving in the right direction. Online learning is already being integrated into American education, with more than 3 million K-12 students enrolled in an online course in 2009. And the phenomenon is no longer confined to distance learning. Most of its growth has occurred in blended-learning environments, in which students learn online with adult-supervision.

This trend will continue. The troubled budget picture, coupled with the demand for better results, is forcing school operators to rethink the structure and delivery of education. This, in turn, is accelerating adoption of the blended learning model.

Blended learning has the potential to upend today’s standardized, factory-model school system by enabling personalized learning approaches for all students. Many experts agree that targeting students’ different needs at different times will in turn result in higher achievement.

One example is Carpe Diem, which began as a traditional, state charter school serving 280 students in grades 6 to 12 in Yuma, Arizona. When it lost its building lease eight years ago, the school had to slash its budget and question every assumption about what a “school” should look like.

Today, students at Carpe Diem are using online learning as teachers roam, looking over shoulders and offering instant help whenever a student struggles. Students only progress to the next level or unit once they have demonstrated mastery of the unit on which they are working. The software provides frequent feedback.

Students also spend time in traditional classrooms where teachers re-teach concepts as needed, and enhance and apply the material introduced online.

So far, the personalized learning approach has created a far more productive and affordable school model. Its student population—60 percent of which is on free or reduced-price lunch and 48 percent of which are minorities—is excelling. In 2010, the school ranked first in its county in student performance in math and reading and among the top 10 percent of all Arizona charter schools.

What is keeping America back from having many more Carpe Diems? Mostly ourselves. A host of policies and funding streams dictate to schools their inputs and processes, thwarting creative and innovative arrangements for student learning in the process. Others either restrict the online courses students may access, or tie them to an arbitrary calendar year. These policies should be reformed, and students should advance based on mastery; not the amount of time spent in a classroom.

Other countries are already moving in this direction. America, with its abundant technological resources and entrepreneurs on hand, ought to lead rather than follow.

Michael Horn is Executive Director of Education at Innosight Institute, a nonprofit think tank focused on education and innovation, which released a January 2011 report titled “The rise of K-12 blended learning” in conjunction with the Charter School Growth Fund and Public Impact.


This article was originally posted at  http://ideas.economist.com/blog/blended-model

Learning where you are

I shared this concept video a few months ago to illustrate just one broad aspect of mobile learning. But it has been misinterpreted by at least one administrator that I know.




The point of the video is not about knowing where you are. The point is is learning where you are and using what you (and your students) already have.

This article was originally posted at http://ashleytan.wordpress.com/2011/01/19/learning-where-you-are/

Online learning in 2011

As the new year takes off with a flying start, this is a great time to look forward to what's in store for online learning and learners in 2011.

2010 saw the North Carolina Virtual Public School (NCVPS) become the second largest in the country, second only to Florida's Virtual Public School program. Many North Carolina school districts are finding it more economical and efficient to pay the NCVPS rate of $600/per student per class rather than hiring teachers for courses that fall outside the standard curriculum but remain crucial to providing NC students with a quality, well-rounded education.

NCVPS will continue to grow in 2011 as NC school districts deal with a new round of budget cuts, and a increasingly diverse and demanding student population that expects all schools to offer high quality courses in a variety of subjects.

Educational applications for smartphones like the BlackBerry and Apple's iPhone (and associated products) will continue to grow in number and variety. Look for more foreign language apps, more apps aimed at all ages (especially younger users), and more apps aimed at learning specific skills "in time". Learning available when you need it.

Beware though of "in app purchases" which can cost substantial amounts of real world money. See: Smurf app fees leave parents steaming. While children become more and more tech savvy, parents still need to be aware of exactly what their children are doing online. A lapse in a attention can cost parents a lot of money.

Free or low cost online learning options will continue to increase. In October iTunes U started offering e-books to support lectures  and other resources from Oxford, Rice and the Open University. The Khan Academy continues to bring subjects as diverse as molecular biology and high finance to online learners for free. Khan Academy tutorials run the gamut from elementary school math topics to graduate level economics. Making it a great resource for parents and students.

Perhaps, most important for online learners and online learning providers, consumers will continue to become more knowledgable about accreditation and diploma mills . Information is power and in this case it will empower learners to make informed educational choices, which will improve consumer satisfaction with online education and the quality of online higher education offerings.

The future of online learning is bright and 2011 is sure to bring the changes listed here and many more. Find an online learning option that intrigues you and meets your needs and give it a try.

This article was originally posted at  http://www.examiner.com/online-learning-in-raleigh/online-learning-2011

THE TOP 3 EDUCATION TRENDS OF 2010

This a guest post By TeachStreet. Teachstreet is a website that provides online and local classes, including SAT Prep Classes.
2010 was a year of experimentation, change and flux, as educators scrambled to lay a foundation for a 21st century style of learning. Among the top trends in education were:

1. Mobile Devices in the Classroom

This year, Notre Dame set up an experimental classroom where every student was given an iPad. While some critics said that introducing mobile devices would be a distraction to students (as they can play games on the devices), others pointed out that iPads in the classroom may help the teacher make the classroom experience more interactive and engaging. The verdict is still out on whether or not mobile devices are a help or a hindrance, but this trend shows no sign of slowing down.



2. Emphasis on Teacher Evaluation

The “Race to the Top” program announced by the Obama administration last year had a big effect on how teachers were evaluated. Each state that competed for the $4.35 billion in funding had to make serious reforms in order to qualify for the program. A big part of meeting those qualifications were to create more merit based incentives for teachers who did well. The Bill and Melinda Gates Foundation jumped on the teacher evaluation bandwagon and provided over $335 million dollars in funding to place webcams in classrooms to better understand just what “star teachers” did in order to create a great learning experience.

3. Remote Learning

Although remote learning has been around for a while, many more universities are offering remote learning courses, including prestigious Universities like Stanford and Columbia. As webinars and other streaming video technologies become more reliable and ubiquitous, it only seems natural for this trend to continue. This is going to be especially handy for working students who will be able to fit their coursework around and between shifts.

As usual, technology was a big driver for changes in education in 2010. It’s still unclear where these changes will lead us, but that many will point to 2010 as a key year of change.

This article was originally posted at http://www.eduinreview.com/blog/2010/12/the-top-3-education-trends-of-2010/

Mobile will become our gateway to the world

2010 marked the year in which infrastructure, technology and design finally intersected in the mobile space. For the first time, sales of smartphones outpaced sales of desktops and laptops, iPhone and iPad applications were downloaded more than 7 billion times and research shows e-mail access is now on the rise on the iPhone while declining on the computer.

With the foundation in place, in the coming year we will witness the scales tip: Mobile device users will interact with content, companies and the Web more on their phones and iPads than on their computers, and IT and service providers will create solutions that are defined by our mobile consumption and use behaviors. "The highway has been there but until now we needed a special car to get us to our destination, so the average pedestrian was not going to get there. Now that technology barriers have been lowered, mobile will become an extension of who we are," said Philippe Suchet, CEO of MyShopanion, and the recipient of the Web2.0' Summit 2010 award for most innovative startup in the mobile shopping category.

From social shopping on the go, to easy paperless transactions and check-ins, to watching (and creating) videos with friends abroad, to in-class learning and collaboration, to managing our health real-time - prepare for an explosion of connected experiences across all points of interactions between people and people, people and companies, and people and information in the cloud.

Source: edustange.posterous.com

After one semester, students and staff love iPads at St. Cat's

Students in a sixth grade science class in the middle school program at St. Catherine's High School use their iPad tablets rather than pens, pencils, and notebooks, Thursday December 9, 2010. / Mark Hertzberg mhertzberg@journaltimes.com Buy this photo at jtreprints.com

RACINE - Seated at his school desk Thursday, sixth-grader Nicholas Rodriguez placed his fingers on an Apple iPad touch-screen and began typing the findings of a group science experiment onto a slide for a class presentation.

At a desk across from Nicholas, fellow sixth-grader Sam Letsch used another iPad to search the Internet for photos to be included in the presentation. Upon finding them, he quickly e-mailed them to Nicholas who placed them in the presentation file.

Around Nicholas and Sam, 25 other sixth-graders in the Middle School Program at St. Catherine's High School did similar work on iPads, which are very thin, light and portable single-panel touch-screen computers.

Students in St. Catherine's Middle School Program, which started this fall with 54 sixth- and seventh-graders, have been using iPads all school year in place of textbooks, spirals and standard computers. Students and staff said after some adjustment at the start of school the iPads are now working well and they'd never go back to classes that use regular textbooks, paper and pencils.

"All our books are on (the iPads). We don't have to carry around our big books anymore. Instead of writing everything down you can type in notes, e-mail them to our teacher and they can grade it right at their computer," said Nicholas, 11, adding that means assignments are returned quicker so students know sooner if answers are right or wrong and if they need help. "The old way is slower."

The old way is also less engaging, said Diane Putra, middle school science and math teacher at St. Catherine's, 1200 Park Ave. Petra said the iPads keep her class lessons moving faster and keep students attentive because they allow for so many interactive activities that can involve each and every student.

"I couldn't go back to the other method," Petra said of teaching with regular books, paper and pencils. "This has so much to offer."

Using the iPads, students can access electronic versions of their textbooks that include online activities and video tutorials. The iPads also have a word-processor program, an electronic dictionary, a drawing program, school-appropriate Internet access, interactive learning games and a calendar for recording homework assignments, explained Sam, 11, clicking through the programs on the iPad Thursday.

St. Catherine's is the only school in Racine County and in much of the country to provide iPads for individual students, a decision made to expose students to the latest technology - for a per student technology fee of $400, which replaces a textbook fee.

St. Catherine's plans to increase iPad use among students to include eighth-graders next school year and high schoolers the following year.

So far no iPads have been stolen, damaged or lost and the new machines have caused only a few problems, including occasional screen glares and students sometimes getting distracted during lessons by all the iPad features. Petra said those problems have been largely fixed by closing blinds in classrooms, the wearing off of the iPads' novelty and rearranging student desks so teachers can see their screens.

Petra also said her students picked up the new technology fast. Watching them in class Thursday the students typed with ease on the iPads and quickly switched from program to program with no difficulty or confusion.

"It was hard at first," Sam said. But the iPads include a typing program that taught students to use the iPad keyboard and frequent iPad use has accustomed students to the machines. "It really does get a lot easier as the year goes."

Source: journaltimes.com