An Innovative Web-Based Interactive Problem-Solving Learning Tool
Howard S. Seiden, MD and Graeme Frank, MD, Department of Pediatrics, Albert Einstein College of Medicine
Steven & Alexandra Cohen Children’s Medical Center of NY, North Shore-Long Island Jewish Health System
Abstract
Background/Goals
Current challenges to medical education include
less direct patient contact (work hour restrictions),
less independent thinking and problem solving
(increased requirements for direct attending
supervision), and less teaching and feedback (less
protected time for attending physicians). The goal
of this project was to create a web-based,
interactive, problem-solving learning tool to address
these challenges.
Methods/Results
We developed a web-based program that allows
the creation of level-specific Case Studies (CS) and
Assessments. During the CS, the learner is
provided information (history, physical examination,
test results, or clinical course) in a series of steps.
For each step, the learner must develop and
prioritize differential diagnoses (with rationale), and
make decisions how to proceed, including ordering
tests (with justification), until ultimately, the learner
reaches a final diagnosis. Immediate feedback is
provided to the learner in the form of a side-by-side
comparison between the learner’s responses and
the CS creator’s “Perfect Path”. The scoring
system takes into account the differential diagnosis,
the appropriateness of tests ordered, and the final
diagnosis. The CS end with a Final Discussion
aimed at providing a summary of the topic and
clinical practice guidelines. After a predetermined
time, the learner is invited to complete an
assessment aimed at assessing retention of
knowledge acquired. All learners who complete a
CS have access to a Bulletin Board for further
communication with each other and the CS creator.
User-specific reports can be generated to assess
learners’ performance against peers, and program
directors can assess performance of learners,
teachers, and the program itself.
Conclusions
We developed a web-based, interactive, problemsolving program that can be used as both a
learning and assessment tool. It provides
immediate feedback, assessment of retained
knowledge, and reporting tools. Finally, the
program directly addresses each of the General
Competencies, satisfying requirements of the
ACGME.
Access
Web-Based
Case Review
The Perfect Path
Color Coded Review/Explanations
Assessments
General Competencies
Case Study Tests
After completion of a Case Study, the learner
is invited to complete a test to assess retention
of knowledge
Patient care
Learning in the context of a virtual clinical
environment. Promotes critical thinking
and problem solving skills using a case
based approach.
Medical knowledge
Opportunity to provide clinical practice
guidelines and reviews of clinical topics.
Level-Specific Cases-Browse or Assigned
Final Discussion
Topic Summary
Clinical Practice Guidelines
PDF, Word, Powerpoint, Image, Movie, Links
Feedback
Case Studies
Initial Step
Presentation
Differential Diagnosis (with rationale)
Series of Steps
Additional Data
-History/PE/Clinical Course
-Order Tests (with justification)
-Test Results
Scoring System
Diagnoses-Points are earned for correct
development of differential diagnoses in each
Step, as well as for the correct Final Diagnosis.
Color Coded Review/Explanations
Communication
Bulletin board feature provides an
avenue for communication between
teachers and learners as well as learners
who have completed the same case
studies.
Pool tests
All questions from the Case Study Tests
populate a large Pool. Learners may be
assigned to complete a Pool Test, which the
program generates by randomly selecting a
predetermined number of questions from the
Pool. The questions are selected from the
Pool with a relative distribution from the
various disciplines and levels determined by
the Teacher.
Practice-Based Learning
Feedback features allow learners to
identify strengths and weakness in critical
thinking and medical knowledge and
quantitatively assess practice
performance.
Uses information technology as a
learning tool.
Tests-Points are earned for ordering
appropriate tests and deducted for ordering
tests that are unnecessary and may be
expensive or harmful to the patient.
Reporting System
Snapshot Reports
Learner
Learner Feedback
Questionnaire
Differential Diagnosis (with rationale)
Case Studies Pass/Fail Ratio
The Ratio of Passed Case Studies to Failed Case Studies for Individual Learner
Assessments Pass/Fail Ratio
The Ratio of Passed Assessments to Failed Assessments for Individual Learner
Case Study Rank
Rank of Case Study Ratio compared to all other Learners at same level
Assessment Rank
Rank of Assessment Ratio compared to all other Learners at same level
Number of Case Studies Complete
The number of completed Case Studies
Average Number of Case Studies Complete
The average number of completed Case Studies for other Learners at same level
Number of Pending Case Studies
The number of assigned Case Studies that are not complete
Number of Pending Assessments
The number of assigned Assessments that are not complete
Teacher
Live Case Studies
The number of live Case Studies created by Teacher
Live Assessments
The number of live Assessments created by Teacher
Number of Case Studies Completed
The total number of case studies created by Teacher completed by Learners
Highest Average Case Study
The Case Study created by Teacher with the highest average score
Lowest Average Case Study
The Case Study created by Teacher with the lowest average score
Most Taken Case Study
The Case Study created by Teacher completed most often by Learners
Number of Learners with Pending Case Studies
The number of Learners with Case Studies assigned by Teacher that are not complete
Number of Learners with Pending Assessments
The number of Learners with Assessments assigned by Teacher that are not complete
Program/Course Director
Bulletin Boards
Teacher/Learner
Case Study
Final Step
The Final Diagnosis is chosen
Advanced learners can also assume role
of teacher by creating new case studies.
Total Active Accounts (Teachers/Learners)
The number of active Teacher and Learner accounts
Total Number Live Case Studies
The total number of live Case Studies in the system
Total Number Live Case Studies
The total number of live Assessments in the system
Number of Case Studies Completed
The total number of Case Studies completed by active accounts
Highest Average Case Study
The Case Study in the system with the highest average score
Lowest Average Case Study
The Case Study in the system with the lowest average score
Most Taken Case Study
The Case Study in the system completed most often by Learners
Highest Average Learner
The Learner in the system with the highest Case Study/Assessment average
Lowest Average Learner
The Learner in the system with the highest Case Study/Assessment average
Most Pending Learner
The Learner in the system with the most incomplete assigned Case Studies/Assessments
Crystal Reports
Dynamic multi-variable reports for in-depth
analysis of Learners, Case Studies, and the
effectiveness of the Program
Systems-Based Practice
Scoring system and feedback that
provides side-by-side comparison with
“Perfect Path” promotes appropriate
utilization of resources and responsible
ordering of medical tests.
Professionalism
Flexibility of case study design allows
development of case studies designed to
teach principles of professionalism.
Feedback features promote
accountability.
Creation of the AKESO program was supported by
the John Michael Giordano Foundation.
AKESO is a product of AIS Solutions, Inc.
Website images reproduced with permission