Wahlgren Carl-Fredrik, Edelbring Samuel, Fors Uno, Hindbeck Hans, Ståhle Mona
Dermatology & Venereology Unit, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden.
BMC Med Educ. 2006 Aug 14;6:40. doi: 10.1186/1472-6920-6-40.
Most of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning.
Through continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85) or conventional teaching plus NUDOV (n = 31) and comparing the results of the two groups in a final written examination.
The questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60-90 min. However, the intervention group did not score significantly better than the control group in the written examination.
We created a computerised case simulation program allowing students to manage patients in a non-linear format supporting the clinical reasoning process. The student gets feedback through comparison with a specialist, eliminating the need for external scoring or correction. The model also permits discussion of case processing, since all transactions are stored in a log file. The program was highly appreciated by the students, but did not significantly improve their performance in the written final examination.
在医学本科生皮肤病与性病临床教学中使用的众多计算机资源大多以信息为导向，主要侧重于找到“正确”的多项选择题选项或自由文本答案。我们希望创建一个交互式计算机程序，它不仅有助于事实性回忆，还能促进临床推理。
通过与学生的持续互动，开发了一个新的计算机化交互式病例模拟系统NUDOV。它基于真实病例，包含真实患者、演员和医疗服务提供者的图像。学生选择一名患者并提出病史问题，检查皮肤，并建议进行检查、诊断、鉴别诊断和进一步治疗。通过将用户自己的建议与专家的建议进行比较来提供反馈。此外，还记录了学生行为的日志文件。该程序包括大量图像、视频片段和互联网链接。通过学生问卷调查以及将医学生随机分为传统教学组（n = 85）或传统教学加NUDOV组（n = 31），并比较两组在期末笔试中的结果来对其进行评估。
问卷调查显示，90%使用NUDOV的学生表示该程序在很大/非常大程度上促进了他们的学习，71%的学生报告说大量使用真实的计算机化病例使他们更容易理解和学习疾病及其治疗。布局、用户友好性和反馈概念分别被87%、97%和100%的学生评为良好/非常好。日志文件显示，学生们通常每个病例花费60 - 90分钟。然而，干预组在笔试中的得分并未显著高于对照组。
我们创建了一个计算机化病例模拟程序，允许学生以非线性方式管理患者，支持临床推理过程。学生通过与专家比较获得反馈，无需外部评分或批改。该模型还允许对病例处理进行讨论，因为所有操作都存储在日志文件中。该程序受到学生的高度评价，但并未显著提高他们在期末笔试中的成绩。
