Petrusa E R, Issenberg S B, Mayer J W, Felner J M, Brown D D, Waugh R A, Kondos G T, Gessner I H, McGaghie W C
Office of Medical Education, Duke University Medical Center, Durham, North Carolina, USA.
Acad Med. 1999 Feb;74(2):123-9. doi: 10.1097/00001888-199902000-00011.
The pressures of a changing health care system are making inroads on the commitment and effort that both basic science and clinical faculty can give to medical education. A tool that has the potential to compensate for decreased faculty time and thereby to improve medical education is multimedia computer instruction that is applicable at all levels of medical education, developed according to instructional design principles, and supported by evidence of effectiveness. The authors describe the experiences of six medical schools in implementing a comprehensive computer-based four-year curriculum in bedside cardiology developed by a consortium of university cardiologists and educational professionals. The curriculum consisted of ten interactive, patient-centered, case-based modules focused on the history, physical examination, laboratory data, diagnosis, and treatment. While an optimal implementation plan was recommended, each institution determined its own strategy. Major goals of the project, which took place from July 1996 to June 1997, were to identify and solve problems of implementation and to assess learners' and instructors' acceptance of the system and their views of its value. A total of 1,586 students used individual modules of the curriculum 6,131 times. Over 80% of students rated all aspects of the system highly, especially its clarity and educational value compared with traditional lectures. The authors discuss the aspects of the curriculum that worked, problems that occurred (such as difficulties in scheduling use of the modules in the third year), barriers to change and ways to overcome them (such as the type of team needed to win acceptance for and oversee implementation of this type of curriculum), and the need in succeeding years to formally assess the educational effectiveness of this and similar kinds of computer-based curricula.
不断变化的医疗保健系统所带来的压力正在侵蚀基础科学和临床教师能够投入到医学教育中的精力和努力。多媒体计算机教学是一种有可能弥补教师时间减少从而改善医学教育的工具，它适用于医学教育的各个层面，依据教学设计原则开发，并得到了有效性证据的支持。作者描述了六所医学院在实施由大学心脏病专家和教育专业人员组成的联盟开发的基于计算机的四年制床边心脏病学综合课程方面的经验。该课程由十个交互式、以患者为中心、基于案例的模块组成，重点关注病史、体格检查、实验室数据、诊断和治疗。虽然推荐了一个最佳实施方案，但每个机构都确定了自己的策略。该项目于1996年7月至1997年6月进行，其主要目标是识别和解决实施过程中的问题，并评估学习者和教师对该系统的接受程度以及他们对其价值的看法。共有1586名学生使用了该课程的各个模块，共计6131次。超过80%的学生对该系统的各个方面给予了高度评价，特别是与传统讲座相比，其清晰度和教育价值。作者讨论了课程中有效的方面、出现的问题（如三年级安排使用模块的困难）、变革的障碍以及克服这些障碍的方法（如赢得对这类课程的接受并监督其实施所需的团队类型），以及在后续年份中正式评估此类基于计算机的课程和类似课程的教育效果的必要性。
