John A. McNulty, Baltazar Espiritu, James R. Halama,
Arcot J. Chandrasekhar, Ronald Price
Loyola University Stritch School of Medicine
Maywood, IL 60153
Loyola University Medical Education Network (LUMEN)
ABSTRACT
The World Wide Web (WWW) and browsers such as NCSA Mosaic and Netscape provide multimedia, hypertext linking and cross-platform capabilities while the Internet provides rapid access and networking. Together, these resources provide the basic requirements for developing and disseminating computer-aided instructional materials. With these tools, we have undertaken to develop an educational network for the health sciences, the Loyola University Medical Education Network (LUMEN). Our aims are to emphasize important concepts in the health sciences through multimedia lessons and to provide a mechanism for integrating this information in a manner that best accommodates the future needs of students and practicing physicians. By achieving these aims LUMEN will provide several positive outcomes. First, it will help eliminate disparity of access by many medical and nursing schools that do not have the resources to develop multimedia computer-assisted learning technologies. Second, it will enhance access of practicing physicians to information they need to remain cognizant of the most recent advances in medicine. These educational materials designed for Continuing Medical Education (CME) would complement information available through other webs such as the Virtual Hospital.
PAPER
Description of the Project
There are increasingly significant annual advances in the acquisition of knowledge important to medical education, especially in such disciplines as molecular biology and new technological procedures (e.g., medical imaging). Moreover, the national mandate for enhanced primary care will increasingly isolate practicing physicians from university medical research centers and, subsequently, minimize their exposure to "cutting-edge" technologies and research findings. With these trends in mind we have developed a network for health care education. This network would consolidate and integrate relevant information and, equally important, make that information instantly available to users. Our specific goals are to: 1) integrate health sciences curricular content; 2) enhance access to the explosive increase in medical information worldwide; 3) encourage self-directed learning; 4) nourish intellectual interactions; 5) prepare students for future technological advances; and 6) promote the development of hypermedia educational projects (lessons).
The model we have developed is called the Loyola University Medical Education Network (LUMEN) (URL http://www.meddean.luc.edu/lumen/). The acronym further emphasizes our goal to "illuminate" and provide a "passageway" to educational materials. LUMEN is designed to incorporate important concepts in the health sciences and, most importantly, to provide a mechanism for integrating this information in a manner that best accommodates the future needs of students and practicing physicians.
Additionally, LUMEN will serve as a resource of medically-related information that end-users can access quickly and efficiently. LUMEN is not intended to replace texts and other printed material. In fact, contributors are encouraged to minimize the amount of text presented and to maximize the use of multimedia to illustrate their concepts. By emphasizing the use of multimedia, we hope to reduce the fatigue that commonly occurs after 20-30 minutes of reading off computer monitors. Multimedia, by its nature, can easily replace text and encourages interactivity with the end-user. Our model contains specific examples illustrating how multimedia can be incorporated into HTML documents to encourage end-user interactivity and integration of health science concepts.
The development of WWW browsers (NCSA Mosaic and Netscape) has provided the opportunity for end-users to navigate and access information around the world intuitively on a "need-to-know" basis. It is the most powerful communication medium yet developed because everything is represented to the user as a hypertext object. The flexibility of hypertext modeling, provided through its linking capabilities, is essential to our goals of integrating the medical curriculum. Each document (text, image, movie, and audio) can be accessed by multiple links. For example, users browsing neurosciences can easily access information related to pharmacology, anatomy, or specific clinical cases through simple links, thereby achieving the integration we feel is important to medical education.
LUMEN is intended to serve as an educational tool for the health science community; specifically for students to use to integrate important concepts of basic and clinical sciences as described above. In addition, we are developing LUMEN as an important resource for Continuing Medical Education (CME) activities with the obvious advantage that practicing physicians can easily access the information they need to remain cognizant of the most recent advances in medicine. Other services provided through LUMEN include:
- Library Services and the Internet: This service is self-explanatory. It allows end-users access to Loyola Library services as well as additional services available through the Internet (e.g., National Library of Medicine).
- Departmental Webs, Graduate Education and Research Services: This service will provide end-users access to Web servers on the Internet and information which is not available elsewhere on LUMEN or is specific to a particular course or discipline. Examples might include announcements about exams, tutorials, remediation, etc. A Web server for the Department of Cell Biology, Neurobiology and Anatomy has been included in LUMEN as a model for development of other similar servers. For research services, outside links to funding agencies and specific databases could provide grant and research-related information.
- Curriculum Text Base: The Curriculum Text Base will allow faculty, students and administrators access to information about specific subjects (curricular content). Secondarily, this text base would provide valuable data on curricular content required for administrative reports related to annual evaluations and accreditationÕs. The text base will be designed using a hierarchical classification to access information about the curriculum at different levels on a keyword basis.
The uppermost level will include general information about the school and each academic period; the lowermost level will have detailed information about each instructional unit.
- LUNIS (Loyola University Nuclear Information System): This is an established electronic mail and bulletin board service providing interactive opportunities to physicians and scientists, in particular those who are outside major metropolitan and medical center arenas. Access to LUNIS is through dial-up modems as well as through the Internet. LUNIS offers CME credit to physicians who use the educational components. LUMEN will provide a platform for development of a bulletin board interface employing the "asynchronous communication" feature of Mosaic, permitting users to return comments, replies and send new material back to LUNIS. It is expected that this interface will become a model for future bulletin board systems.
- Student Life: This service is designed for students at Stritch School of Medicine and will be password restricted. The options will include: 1) Information on Student Organizations; 2) Information on Health Services and Policies; 3) Academic Policies; 4) Volunteer Opportunities; 5) Minority Student Affairs; 6) University Ministry; and 7) Calendar of events.
Implementation
The project is located at the Stritch School of Medicine, Loyola University of Chicago. A new Computer-Aided Learning Laboratory (CALL) has 27 networked computers; 15 Apple Power Macintoshes, and 12 Gateway 2000 (Pentium) computers. A Novell netware server (ALR VQ/66 Pentium) is also available. All computers are connected to ethernet hubs and LAN. For printing, the lab has 2 HP Laserjet SI printers. These computers allow students access to LUMEN through the network and provide facilities and personnel for development and testing of documents for inclusion in LUMEN.
At the core of LUMEN is a dedicated workstation made up of a Sun Sparcstation 20 that sends HTML documents across the Internet to computing clients utilizing Mosaic. For dial-up access to LUMEN, three 28,800 bits/sec (v.fast) modems are attached to a 16 port Cisco 500 CS terminal server that provides terminal, SLIP, and PPP services. The Loyola University Nuclear Information System(LUNIS) is an electronic bulletin board system used by practitioners of Nuclear Medicine throughout the world. It is run on two Nuclear Medicine MicroVAX computers with 6 dial-up modems and an Internet connection. Four years of accumulated data have been converted to documents viewable by Mosaic clients. A Sun SPARCstation 1, located in Nuclear Medicine, is the HTTP server for this project. The servers are high-performance UNIX systems running the HyperText Transfer Protocol (HTTP), a TCP/IP network protocol developed at CERN (Switzerland) as part of the World Wide Web hypermedia project to provide a distributed hypertext-based information system.
The choice of UNIX, TCP/IP, HTTP, and Mosaic for this project encompass standards and protocols extensively adopted by the Internet. More importantly, the Mosaic software and the TCP/IP network protocols, which are freely available from the NCSA, operate on Apple Macintosh, Microsoft Windows, and X-windows platforms. To ensure interoperability, all three platforms are represented in developmental workstation requests.
The Loyola University computer network backbone is an ethernet network with fiber optic cabling within its campuses and multiple T1 Ameritech links between the campuses . The Internet service to Loyola is contracted with CICNet and is brought through a T1 (1.544 Mbits/sec) Ameritech feed. A second fractional-T1 link (56 Kbits/sec) is maintained with the University of Illinois, Chicago. CICNet provides a Cisco MGS router for the Internet feed at Loyola.
Students can access LUMEN either through computers (PowerMacs and Pentiums) in the Computer-Assisted Learning Lab or through SLIP dial-in from home. The medical school is undergoing an extensive curricular reform with a shift towards problem-based, self directed learning strategies. The use of computer-aided instructions that offers interactive tutorial teaching and simulations will enhance these goals. Loyola is well positioned to enhance the educational information offered on the Internet through its faculty (content experts) and existing facilities for creating documents. Equipment to convert X-ray film, pictures, drawings, audio, and video to digital format already exist. Libraries of case studies stored on technologically older computer and video-disk systems are being converted.
The broad scope of the project will require participation of faculty spanning all disciplines in the health sciences. A program of workshops to develop HTML documents was initiated to encourage faculty, staff, and student participation in LUMEN. Faculty participation is also encouraged through a grant program to purchase hardware necessary for development of html documents and through formal recognition of their contributions toward decisions of tenure and promotion, as well as merit salary increases. Important to the design of LUMEN is the considerable flexibility faculty will have in terms of the complexity and specificity of their contributions. The unique feature of the project will be the potential for world-wide collaboration by faculty on important educational concepts. While we consider this global project to be innovative, it is not without some risk because recruitment and coordination of faculty participation has never been attempted on such a scale. However, we have received very positive responses from faculty to date. Student participation is encouraged through several mechanisms including summer work/study internships and an elective entitled, "Computers in Medical Education". The addition of documents to LUMEN has shown a steady increase since its inception (Fig. 1). Utilization of documents provided through LUMEN has also shown progressive increases since the web was established (Fig. 2). The decline in utilization during December and January is attributable to the Christmas holidays and mid-semester break.
Evaluation
Several mechanisms will be used to help evaluate the success of the program. One measure will be the degree of utilization of the material in LUMEN. Statistics on the number of times the web is accessed is automatically generated by the server (Fig. 2). These data are further subdivided according to users here at Stritch and external users. A second measure for evaluation will be the number and quality of projects submitted by faculty and students.
We feel that, initially, between 2-5,000 documents should be added to LUMEN each year. The success and effectiveness of the project will also be evaluated by annual Questionnaires, as well as by student performances on internal and national standardized examinations. Finally, peer review and level of faculty participation will provide an important evaluation tool.
