"Library Learning Resources Center Support for Pathology CAI in a Medical School Curriculum"
David Izzo
Dartmouth College BioMedical Libraries
Learning Resource Center
Dana Biomedical Library
Hanover, NH 03755
David.J.Izzo@Dartmouth.edu

PAPER

In the Fall of 1993 the course directors of the Dartmouth Medical School (DMS) second year course "The Scientific Basis of Medicine" (SBM) approached the Biomedical Library with a proposal intended to explore the feasibility of integrating computer based learning into the curriculum. The Learning Resources Center (LRC) of the Biomedical Library has been providing and supporting computer applications for the medical school students since 1985 when the computer lab was first installed. In particular a highly successful program named PlanAlyzer has been used for several years by courses in cardiology and hematology. [1] Dr. Harold Lyon, Associate Professor in the pathology department, who is a member of the PlanAlyzer team, began working with the SBM faculty during the summer to identify programs for the course.

The strategy was to use the pathology sections of SBM course as a test to see if CAI could be used as a vehicle to provide more opportunities for self paced learning to medical students and to reduce the number of hours students and faculty spend in the passive learning environment of the large lecture hall.
The "Slice of Life" videodisk and several pathology review programs that use the videodisk images were selected as the software for this venture. In total for the academic year there are over 120 learning modules in 6 different applications covering the pathology material from 13 sections of the SBM curriculum.

The Role of the Library

In this venture the Library provided a setting; hardware, software and staff support that would serve as a centralized resource available to all of the medical students. We participated as a partner in the evaluation process. The Library is also viewed as a "neutral" department in seeking budgetary support for this activity.

Implementation
Hardware
Identify hardware requirements and specifications. Place orders and install equipment.
5 Pioneer videodisk 2400, 5 Sony Video monitors, 2 Macintosh Centris 610 computers, used 2 MacII and Mac IIsi computers already in the lab. Had to add 170 meg hard drives and Ram to 8 megs.
Software
Purchase 5 copies of Slice of Life. Dr. Lyon provided the rest of the software.
The LRC staff was asked to create a vehicle to keep use statistics and to collect evaluation data from the students.
Because of the large number of files [figure 1] involved in the course we felt it would be easier for the students to chose from a list rather than navigate the folders and directories of the hard drives. The computers in the LRC already employ a "front end" [figure 2] to collect usage statistics and it was relatively easy to add another screen with buttons and a scrolling list of the files for each course section. [figure 3] [figure 4]
A simple evaluation form was also built into the "front end" so students could comment on the programs immediately after using them.

Maintenance
Collect and summarize evaluation and use data.
Trouble shoot the use of the programs: modify HyperCard stacks to work with our "front end", maintain directory order, update applications, remove files copied to drives by users, replace damaged files.
Clean screens, keyboards, mice, etc.

Evaluation
The simple on-line evaluation form provided data on the use of the applications and the reactions of the students. [figure 5]
The questions surveyed the following issues:
1. Did students prefer to do CAI individually or in groups?
2. What is the general level of computer experience?
3. Did the students like these particular programs?
4. Is computer based presentation of the material preferred over lecture based presentations?
5. Were the programs difficult to use?
6. Was the content of the materials difficult?
7. Are there enough workstations in the library for this material?

Preliminary results from the first 3 sections based on 242 evaluations [figure 6]

Concerns and questions
* These programs need centralized and strong support from the Dean and the administration to provide fiscal support and to avoid inefficiency due to redundant programming.
* The Library LRC staff should work closely with faculty to understand capabilities, directions, and expectations.
* Earlier involvement of the Library in the process, more consultation, more communication, more support both financially and with program expertise.
* Training of the LRC staff in use of software.
* PAPER of students to the LRC environment by the LRC staff. Students then know what to expect, how the facilities are organized, how they can best use the lab. They get to know the staff and are less reluctant to ask for help.
* Staffing levels, and hours of support. The installation, maintenance and support of a large collection of programs takes a large commitment of staff time.
* Budget implications of hardware upgrades and continuing investment in future technologies.
* Supplemental vs. required course material - implications for the number of workstations, staffing, hours etc.
* The impact of dedicated stations on the use of the rest of the lab - and use by other courses.
* Faculty attitudes - fear of losing authority because of a lack of computer expertise and reluctance to use programs from other institutions.
* Printing, networking, file serving,

1 Lyon H. C. Jr., et al , "PlanAlyzer, an interactive computer-assisted program to teach clinical problem solving in diagnosing anemia and coronary artery disease", Academic medicine 1992 Dec;67(12):821-8.
Figure1 - folder with a confusing array of 68 files
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Figure2: User Information
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Figure3 - SBM Path Programs
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Figure 4-: list of lessons
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Figure 5 : Evaluation Form
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Figure 6: Number of Students Click here for Picture