Wednesday, December 23, 2009

Wii - Mario Bros and Film- Avatar!

Technology and Entertainment
This post has nothing to do with medical education but I could not resist capturing some of my thoughts on the week I took off to spend some quality time with my 11 year old and her 6 month older cousin.

While we did a lot of fun stuff this week, the most notable were:
1. Mario and Sonic Winter Olympics on the Wii
2. New Super Mario Bros. on the Wii
3. The new blockbuster film Avatar.

Avatar was a must see after all the hype. The 3D was easily the best I have seen and the stunning visuals were very appropriate for 3D. The story itself was a bit of Matrix with a strong environmental theme bundled together with futuristic action on a far-away planet. The highlight was the the hero character taming a flying banshee and some beautiful flying jellyfish like spores. Were it not for the 3D I would rate this as a B grade movie though.

The Winter Olympics game was fun. Have not explored it fully but it the best games seem to be the ice hockey, curling and bobsleigh. Ice hockey seems quite difficult, curling seems to give an undue advantage to the person playing second and bob sleigh is pure fun. Got a terrific kick out of using the Wii Balance Board to play the bobsleigh. You actually sit down on the board and lean one way or the other to control the sleigh! Some of the games are similar to the Wii Fit games (ski jumps, slalom, etc). The multi-player ability is great!

The highlight of the week was easily the New Super Mario Bros. It was the reason we did not get around the exploring the Winter Olympics fully. This is a typical side scrolling game like the good old games of the past. You can use the Wiimote like a typical control or use it with the nanchuk. But the twist was that all 3 of us could play together! . You have to work as a team to have the best chance of success. But you can "accidentally" push someone off a platform or into danger. There was a lot of shouting, elbowing, accusing, hugging, jumping and laughing. It was great to see 2 similar age kids cooperating and taking turns to defeat the "bosses". Must have spent almost 6 hours playing this in the last 2 days! Will always have great memories of this week spent in such a non-productive manner!

Wednesday, December 9, 2009

Types of Information

Recently I sat through a mandatory 5 hour course (large group lectures) on compliance issues when doing research in human subjects. As slide after slide crammed with information was flashed in front of me, my eyes began to glaze over. Somehow I did not think this was a good use of my time. As my thoughts regarding this course began to crystallize, I felt I needed to jot down these ideas. So why did I not like this course?
  1. It was mandatory - and it was being done for the wrong reasons - for compliance rather than education.
  2. No attempt was made to understand what I already knew about these topics
  3. Too much information was presented in a short space of time
  4. It was very passive - all lectures with little discussion
To be fair, if I was actually about to start a research project I would have found a lot of this information more helpful. When I do start my next human subject research project I may actually go to some of the presenters with questions about the topics presented. If I had not attended this course, I may not have even been aware of the need to learn more on some topics.

So the course was not a total waste of time. In addition I got a chance to actually think about information and how is the best way and time to impart this.

Information has been classified as
  1. Facts -"A unique bit of information that identifies an object, person, place etc". e.g. Prilosec is a brand name for omeprazole which is a proton pump inhibitor
  2. Concept - "A category of items or ideas that share some common features" e.g. Symptoms or presentations of Gastroesophageal refulx disease
  3. Procedure - "A series of steps that show how to make or do something" e.g. how to do an esophagogastroduodenoscopy (EGD)
  4. Process - "A description of how something works or operates" e.g. how is acid or H+ produced in the stomach
  5. Principle - "Rules, algorithms or guidelines" e.g. How to manage GERD, When to do EGD in GERD etc.
As I was thinking about this, it seems there might be another way to classify information:
  1. Information that one should be aware of but don't really need to be able to recite - and is not needed urgently- e.g. the mechanism of acid production in the gastric mucosa
  2. Information that one should either know or be able to find very quickly- name of a PPI and its dose
  3. Information that one would like to validate or learn from others - reading about it alone might not be sufficient - how to do an EGD
  4. Information that one is not aware of and have to make efforts to determine if it exists and to acquire - relative effectiveness of one PPI over another in treating GERD symptoms, or benefits of adding a H2 receptor blocker to a PPI in managing persistent GERD symptoms
It is this last group that is somewhat troublesome. There are a number of online resources and tools that help to find information if you are not aware of it. But if you depend exclusively on this method of information management, you would have a very hard time managing a busy practice. You would spend more time on the computer than with patients. So one of the goals of any personal information management strategy has to be to move more information from the 4th category to categories 1 and 2. This gets back to developing a model for processing information to increase awareness and to help store and retrieve information more efficiently. I had written about this earlier.

Going back to the research course I attended, the organizers could have done it very differently. Their main purpose for doing the course could have been to increase awareness of
1. Common issues that could lead to non-compliance with various funding and regulatory agencies - best done by presenting examples of research studies where these had been factors.
2. Listed resources and procedures in place for helping with these issues
3. Created a simple website to help people find these resources when they needed

This would serve to effectively improve awareness of issues - moving these from category 4 to category 1 and 2. Also for various "exotic"areas like data management the participants would learn how to contact experts (category 3) when needed. The whole course could have been completed in 1 hour!

Thursday, November 26, 2009

Free game to facilitate faculty development on feedback

As an educator one is often asked to help other faculty and house staff learn about some key education principles when working with medical students. Some of these principles apply to any education setting.

1. Understanding the audience - their education level
2. Setting expectations
3. Giving formative feedback or useful feedback
  • Timely
  • Non judgmental
  • Based on observed interactions
  • Include what was done well, what could be done better.
I created a brief interactive game to help facilitators discuss these topics. The game uses an example of a student at a flying school. Facilitators should use this with faculty and house staff by discussing what a student might feel or think at each point before clicking on any option.

Let me know what you think.

Tuesday, November 17, 2009

The Logical Flow of a Physical Exam

The other day I was observing a 2nd year medical student examining a patient in my outpatient clinic. The student did a very good job- doing a very thorough examination of each organ system.

The only problem was the flow of the exam or the lack of one. He would start at the head and examine the mouth and then move down to the neck. Later he would come back to the mouth to check for the midline tongue and the gag reflex.

The patient would have to lie down for the abdominal exam, and then sit up to have the lumbar spine examined; lie down for the Straight Leg Raise test and sit up for the knee and ankle jerk; you get the idea.

It seemed an example of a logical flow of a physical exam that combined the elements of:
  1. Going down from head to toe
  2. Patient comfort and convenience
  3. Efficiency
might be helpful. Of course everyone will have a slightly different protocol for doing this.

As I was wondering how to present this information, I came across a cool mindmapping tool. So I created the following schema of the Logical Flow of a Physical Exam using

The problem is that the site is transitioning to beta and is very very slow! Also if you use the beta it does not let you share the mind map or embed the code. So here it is in its slow but still glorious 1.0 form (Click the - sign in upper left to zoom out. Click and drag to see different elements, to see the full size, click the read only link at the bottom):

If you want to check it out on, here is the read only link

Monday, November 16, 2009

What EMRs can learn from Twitter

One day I got a message in the EMR from a consultant cardiologist. This was a patient I had sent to the cardiologist after a positive stress test. The message said, click to review the consultant's note in the EMR.

I opened the note and saw an incredibly long note with results of every stress test, lipid, echo and cath done on the patient in the last 10 years pasted into the note. In addition there was even the informed consent statement prior to the cath included in the note. There was a note by the PA and then a note by the consultant buried in this morass of digital ink. It took me 10 minutes to find the consultant's assessment and plan which said to continue medical management. Apparently there was one small vessel that was stenosed and was not worth the risk of intervention.

Got me to start wondering if EHRs have caused us to lose our way; we have forgotten that the primary purpose of the medical record is communication. It seems that E/M coding and medico-legal issues are all that EHRs are being used for.

Can we save the EHR? What if we have a field at the top of each EMR note that allows only 140 characters like a Twitter update and each doctor has to populate this with a summary of assessment and plan before the note can be closed? E.g. "80% 1st diag, stable angina, not worth risk of intervention, recc aggressive medical Mx" This would still leave 53 characters to reach the 140 character limit! Could use this to provide a link to the actual chart note!

We could even make the poor Infectious Disease consultant happy. Every time someone copies and pastes their note into their own, there would be automatic attribution like a RT @IDdoc!

We could have a twitter like list of our patients that we follow and we can see tweets about them by all docs!
So what do you think? Any takers?

Sunday, November 1, 2009

Social Media and the balance between work, personal and social lives!

I have been struggling with this question, more so recently since I started spending more time on FB, Twitter, Second Life etc.
I find these Social Media sites to be terrific in several ways
  1. Learn a lot from Tweets by other people with similar interests whom I follow on Twitter
  2. Helps me keep up with updates in medicine, technology, education and combinations of these
  3. Stay current with friends and family efficiently and effectively - Friended Dad on FB so he can see my daughters soccer videos and dance performances.
  4. Learn about interests and hobbies of "friends" on FB - developed even more respect for them and got something new to talk about when we meet next
  5. Twitter helps me find and exchange ideas with an amazing group of people on the planet - something that I cherish more and more
  6. Learn techniques of communication - mutual respect, prompt feedback, sharing with attribution that I can bring back to live meetings
The question that keeps niggling in the back of the mind is "Is the time I spend on Social Media take me away for 'real work'?" Recognition in academic medicine is tied to research and publication in peer reviewed literature. I don't see medical schools promoting a faculty to full professor for the number of tweets, followers, friends in Twitter and FB anytime soon.

But why not?
One of the key parameters used in promotion is "recognition by your peers". So if your peers who work at other academic medical centers follow you on Twitter, it should help right?
When you post a blog and get comments from several followers, is this not a transparent peer review process?
If you do meta-analyses and you poll the twitterverse for unpublished studies, your systematic review will have less of the publication bias right?

As far as other "work" goes, I am on the social media committee for my institution and that blurs the distinction even more. Experience with social media has helped me suggest/develop solutions like
  1. Using Yammer and biomedexperts within the institution to help people find mentors and coaches - creating groups for each major competency or area of interest
  2. Creating a FB page for a non-profit physician organization to improve communication between members
  3. Using Google groups for our medical students to share information and resources
  4. Using Zotero for our medical students to collect evidence from their online assessment system and cite it when writing their ePortfolios
  5. Creating a Chronic Disease curriculum with students and selected patients communicating in private groups in FB/Ning
  6. Using Second Life to help students practice and learn history taking and communication skills in a non-threatening environment
  7. Etc.
On a personal/family level it has been incredibly gratifying.
  1. Pre-teen daughter picked up blogging as a way of journaling her thoughts and experiences. She has now gone on to help several of her classmates set up their own blogs.
  2. She learned with me how to edit and stitch together her soccer videos using windows movie maker and post on YouTube and share with her friends (private limited URL) - She had to select the "good" parts and eliminate the videos of "mistakes". This helped her to review her soccer skills and identify areas for improvement. (Sneaky heh? Hope she does not find this post!)
  3. Wife and daughter get invited to dance at various social events (e.g. weddings). Helped them create coaching dance videos and share with attendees before the event on YouTube. The people who saw the videos felt comfortable joining them for a group dance at the end of their performance!
  4. Found that wife and I tend to post news items of each others accomplishments on FB. Recognized that we value and respect each other more than we might have let on before! It seems to mean even more than telling each other - great job on that seminar or dance!
  5. Etc
Seems like a win-win right?
Still I think we still need to find a balance in our work, personal and families and computers and the Internet can be a challenge in this struggle. Used creatively social media might actually help solve the problem.

Before you jump headfirst into this, one suggestion - if you can, use 2 computers:
  • Computer 1 (AKA work computer) - turn off e-mail, FB and Tweet alerts. On that computer, make sure you don't visit any social media site. Use this for collecting and analysing your research data, writing your articles, completing your patient visit notes and other electronic health record tasks, etc.
  • Computer 2 (AKA SM computer) - keep several tabs open on your Social Media related sites. Google reader, Tweetdeck etc. also get used on this computer. Make sure to keep it on mute so you cannot hear alerts.
Then every 1-2 hours (or whatever works for you) when your mind is exhausted turn to computer 2 and have a refreshing, rejuvenating experience!
Does this work? Well seeing that I started doing this only recently and this is my first Blog in over a month, it seems it does.
So which computer did I use to write this blog? The work computer of course!

Tuesday, September 15, 2009

Fist Bump against Flu

Last year a simple fist bump by President Obama got politicized.  But this year it has come back with a new purpose.  With the swine flu pandemic threatening to get worse with students returning to school and college and the seasonal influenza season just a few weeks away, hand washing has become the mantra for flu prevention.  

But what if you don't have your hand sanitizer ready.  Every time you shake hands you worry about contributing to the spread of the virus.  For physicians it is a specially relevant issue.  You walk into an exam room and shake hands with your patient.  Everything you touch thereafter has a chance to get contaminated - the keyboard, the mouse, the table surface, the stethoscope etc.  Even though you sanitize your hands religiously between patients, you probably don't sanitize them right after each handshake.

Enter the fist bump.  Walk into the exam room and do a fist bump with the patient.  Not only does it prevent your palms from getting contaminated but it gives you a great opportunity to start talking about the flu.  We know that patients put a high value on their physician's opinion.  A fist bump to start the office visit will give you a great chance to mention the importance of hand washing and educate the patients about how to prevent the spread of the virus.

I tried this today with all my patients and it worked!

Friday, June 12, 2009

What do we need in Health reform?

Just read this article in the NY times by Pauline Chen M.D. Also I just recently completed my in-patient rotation in the hospital where I was very disheartened by the fact that almost every patient I saw had been in the hospital recently and was very likely to get readmitted in the next 6 months.

Our burden of chronic disease is huge and growing. In a lot of cases the patients' lifestyles contributed to the chronic disease. We are spending huge chunks of health care dollars to treat these patients and keep looking at ways to cut this spending to decrease health care costs - the totally useless "length of stay" parameter comes to mind.

What we need to do is invest in the future so we can change lifestyles before they lead to chronic diseases. Also, we need to provide early treatments of chronic conditions like hypertension before we get into renal failure, heart failure and strokes. This will let us have a healthier productive tax-paying population that will help balance the budget.

The article points out how frequent contact between physician and patients may help in changing lifestyles and improve compliance with medications. With the advent of social networking tools we don't need to physically bring the patient into the office for this purpose. We can repurpose/create secure social networking tools for this.

The barriers:
  1. Physicians are inundated with work... a lot of it due to bureaucracy - filling out forms, documenting for purpose of billing, multiple pharmacy call backs due to multiple/illogical formularies
  2. There is no model for reimbursement for physician-patient contact outside of the office. And the payment is for the complexity of the office visit. Thus if you call and talk to the patient 15 times in a year and get him to take his meds, exercise and lose weight, you would be paid zilch! But if you see him twice a year, give him more medications as his diabetes and blood pressure go up and he gains weight, and then see him in the hospital when he get a heart attack you gets tons of money.
  3. Due to point # 2 the health care system is too top heavy with more specialists than generalists. Hospitals have invested huge amounts of money into high tech and not much into prevention.
If we want physicians to work with patients to prevent onset of chronic disease or complications of chronic disease, we need to change our financial model for reimbursement. We need to pay health center to prevent outcomes. We need a secure networking tool that can allow patient - physician communication, motivational "interviewing", and a way to pay for this.

Saturday, May 9, 2009

Do our medical schools need to adopt new education technology?

A recent article in Campus Technology by Trent Batson "Horns of the Dilemma for Faculty: Legacy Demands and Technology Expectations" discusses how universities have failed to change while educators have adopted all the web 2.0 technologies at home. Also there is this terrific presentation.

How does this apply to medical education? Is it important to adopt new technology for teaching our medical students? I love technology but I find myself thinking that the battle we need to fight is to make medical school education more student centered and not necessarily the immediate adoption of new technology.

Going from lectures to problem based learning is more important than changing the old chalkboards to electronic whiteboards! Getting our medical schools to move from grades to portfolios would be worthwhile cause to fight for but Portfolios can be done on paper. Students can use a paper textbook, they don't have to start medical school with a Kindle DX loaded with all their textbooks. Students can go to a "real" classroom as long as the "teacher" promotes active collaorative learning, they don't need the presentations loaded on their iPod or a virtual classroom.

Once we get our faculty to adopt a more collaborative and active learning approach, the adoption of the appropriate technology will follow. Technologies will be superseeded by newer ones, but the key principles of education should be more enduring. The current web 2.0 applications seem to be designed perfectly for collaborative learning and it would be great to integrate these into our curriculum delivery and assessments as we make adopt a more constructivist approach to medical education. But if I were to have one or the other, it would have to be the collaborative learning approach and not the technology! It does not have to be a dilema.

Thursday, April 30, 2009

Collaborative learning in Medical Education - Where is the Patient?

For a while now I have been muddling over a few thoughts in my head. These were prompted by

  1. Medicine's incredible success at treating acute problems and thus bringing chronic problems to the forefront e.g. patient survives a stroke but is left with bed sores, incontinence OR survives an acute heart attack and is left with congestive heart failure. A William Schwab put it at a recent grand rounds, "Success brings failure" and thus our success in treating acute problems has brought us an excess of chronic problems.
  2. Increasing popularity of social media tools like Facebook, Twitter and Second Life. A recent study that I discussed earlier showing students were more likely to use Facebook for a course discussion than the University's learning management system.
  3. Medical education moving from a traditional "talking to the boards" model to a small group collaborative problem solving model - can we use this momentum for including patients into the learning "group"? This thought was resurrected by a post I read by Anne Marie Cunningham.
It seems that learning how to treat an acute problem is something we can do well in our current model of education which has minimal involvement of the patient (in most schools). As our population ages, has more chronic problems, a model that does not involve the patient in the learning process is not going to succeed.

Thus we know what an obese patient with poorly controlled diabetes needs to do to bring his/her condition under control and maintain it there. Patient also often knows this. Still optimal outcome occurs only rarely and if it does, it is not sustained.

In managing chronic conditions, the patient has to learn to take control of his/her condition and the physician is only a part of the solution to make this happen. Our medical students learning is designed to occur either in classrooms or in hospitals - both of which are perfect for acute condition management. The exposure to outpatient chronic condition management where they can interact with the same few patients longitudinally does not occur in most schools.

The reasons for this are mostly logistic. Scheduling students to be in the clinic the same time as specific patients is a logistic nightmare. How about a model using social media?

Can we have students create limited, private accounts in a social media site like Facebook or create a specific site using Ning and invite consenting patients to be their "friends". We could have a list of patients with different conditions and abilities to use these social media tools. The sites would not be accessible except to invitees. The students would collaborate with a set of patients over their entire medical school experience. The patients would post/tweet about their symptoms, office visits, hospitalizations, test results and the students would learn/read up about these and explain these to the patients. In addition, they would work on skills like motivational interviewing, negotiated goal setting to help the patients take better control of their conditions.

This model will allow students to learn the role they have to play in management of chronic conditions and prepare them for the future!

Wednesday, April 29, 2009

3 Apps I love for capturing what's on the screen

For years I had taught people how to do screen captures with the Print Screen button and continued to be mildly surprised when people who get excited when they learned that there was actually a purpose for tha button on the keyboard! I still use that when I am not at my own computer.
Since I have to do some faculty development sessions, training medical educators on use of technology in education, I had to find some tools that were easier to use. So here is my very short list of 3 applications that I find very useful.

1. Jing - This is a great tool for capturing a portion of the screen and annotating it with arrows and text. While it does do screencasting, the free version has limits on time of a single movie and it puts its logo prominently at the end of the movie. It also allows to upload the captured image to its online repository. I do not use that much as I need to save and reuse the images for other purposes.

2. Wink - After a lot of trials and errors, I have settled on Wink for screencasting. It creates a flash movie from a window that you select on your screen. You select the number of frames/sec and it will capture these faithfully. It has a builtin annotation tool for adding callouts, textboxes etc. Also automatically adds pauses to the movie and you can add navigation buttons for the user so they can read the text and then proceed with the movie. You can delete unnecessary frames and thus keep the movie short and sweet. The only problem I had was deciding on the resolution. I used the Firefox window resizer add-on and captured at 800X600 so I could put the flash file in a frame or otherwise have room left on either side.

3. FRAPS - this is the only one of the 3 that I spent money on (35 dollars). I use Second Life for various educational purposes and FRAPS allows me to record the machinima in SL - both audio and video. It is very easy to use and has a hot key to start, stop the recording. The only thing to keep in mind is the incredibly HUGE file size. For one 20 minute recording it used up 10 GB of space on my HD. The solution is to use Virtual Dub to compress this to MPEG4 and the same file become close to 400 MB.

So that's it! Jing, Wink and FRAPS.

Thursday, April 23, 2009

Second Life and virtual patient interviews

So today was a special day. The study that we were working on for the past 3 months finally got underway - "Feasibility of using Second Life to train medical Students on patient interviewing skills".
So how does this work?
A medical student interviews a patient - both are in Second Life sitting face to face in an exam room. They "talk" to each other using headsets with microphones. They use lip-synching so when they talk, their lips move. They also use speech gestures so when they talk their hands and arms move around like most people in real life. The patient also has a number of pre-programmed gestures - crying, laughing, frowning, wringing ones hands, etc.
So why is this a good idea? Can't they just meet in some place in real life and do this? Can't they just talk over the phone?

They can meet in real life but that can be inconvenient. With S/L the 2 people can be poles apart! In addition, with S/L they are anonymous - the patient can be controlled by a physician without the student being aware of who it is. Also it can be less intimidating for a student than being face to face.

Does S/L add anything over and above a phone encounter? I sure hope so. There is good data that being in a MUVE affects spatial behavior. In addition the Social Identity model of Deindividuation Effects (SIDE) has shown that anonymity can have profound effects on group interactions. Does it make the encounter appear more real? We are interviewing the students to find out.

There are other advantages:

  1. The encounter can be captured digitally using software like FRAPS.

  2. The encounter can be viewed by anyone later - student or faculty. The faculty member can provide feedback to the student. Would be great to use VoiceThread for this.

  3. There are few geographic barriers. This could be offered as a service run by retired clinicians to train medical and nursing students in patient interviewing skills - a little bit like outsourcing your OSCE's.

As I was viewing the macinima of the first 2 patient interviews, I could recognize several teaching moments. What if we give this recording to a clinician educator not involved with the study, have them record their comments as annotations on the video (like VoiceThread) and then share with the student or even with other students?

The possibilities are numerous. I cannot post the machinima without student consent. Will write more about this once we get some feedback!

Wednesday, April 15, 2009

Does emotion help learning? Duh!

Educators have always known that getting emotions attached to learning material helps memorizing it. Did you ever doubt it?

Say you were trying to teach the lyrics of a song "I dreamed a dream" or you wanted to teach a group of kids (all adults) not to judge a book by its cover, you could show this video (which half the world seems to have seen already).

See the first 5 minutes and then if you disagree post a comment.

I rest my case. Go Susan Boyle. (My heart keeps telling my cynical side that this was not staged by the marketing gurus at "Britain has got talent").

If after watching the video, you want the lyrics, here they are:

Lyrics | Fantine - I Dreamed a Dream lyrics

Saturday, April 11, 2009

Chemistry of Facebook

Innovate has an interesting article (Have to go through free registration to read the full article) on use of Facebook to create an online community for students enrolled in an Organic Chemistry Lab at Iowa State University. The authors (Jacob Schroeder and Thomas Greenbowe)compared the use of WebCT and Facebook for discussions regarding the course material. While all 128 students were required to use WebCT (e.g. to get their grades), the use of Facebook was optional.

The main finding in this exploratory study was that while only about 40% of students used the Facebook discussion board, they used it in richer ways (posting photos of molecule structures, links etc) and for a longer period. The discussion group on WebCT was not used much and quickly petered out.

We don't know from the available data whether students who used Facebook were already using it socially? The authors were also not able to survey the students regarding the reasons why they used or did not use a specific tool. Thus we are left to wonder...

One guess is that if you are already using Facebook, clicking over to your Organic Chemistry Group to check something out or put in a comment would be quick and easy. Problem is getting the other 60% of students to also use this tool. Would love to know if it was their learning style, attitude towards technology, use of other social networking sites, or some other reason that prevented them from joining this discussion board. Is it even important to get them to join? What if only 10% of students had joined? What is the critical mass for something like this to be meaningful? The activity required instructor time to moderate the group. If a number of students were using another site like MySpace, would it be possible to moderate 2 groups? What about 3?

What if WebCT had a facebook widget or the other way around so both the WebCT and Facebook users could participate without having to log in some where else?

Thursday, April 9, 2009

Practical model for using the Information Processing Theory to stay current with (medical) literature

The Information Processing Theory compares the human brain to a computer and suggests that just like we can make a computer work better by changing the processor, motherboard or RAM and the programming, the human can also become more sophisticated thinkers with appropriate strategies, sensory inputs and rules.

While I don't know how well validated this theory is, it does describe an interesting flow of information from the sensory register to short term memory to long term memory.
The wikipedia describes it thus

Sensory register: the mental processing unit that receives information from the environment and stores it fleetingly.
Short-term memory: the mental processing unit in which information may be stored temporarily; the work space of the mind, where a decision must be made to discard information or to transfer it to permanent storage, in long-term memory.
Long-term memory: the encyclopedic mental processing unit in which information may be stored permanently and from which it may be later retrieved.

The way I understand it, Constructivism works great for understanding how we can facilitate learning of new concepts e.g. medical students learning anatomy in their first year. Active learning, Problem based small group discussions, etc.

When we think about how to help a practicing physician keep up with medical updates in his or her specialty, it is a different setting. The person already knows the subject, is busy and probably does not have much time for collaborative learning in small groups. The constructs have already been formed during medical school, residency and subsequent experiences. It seems self directed learning using the principles of the Information Processing Theory would very helpful to help the physician refine these constructs on a longitudinal basis. Let me show you a model of how this would work.

Software needed:

  1. Google Reader This is a free web application and all it requires is a free Google account.
  2. Zotero I have referred to Zotero in a previous post. It is a free bibliography and citation tool that works as an add on to Firefox.
Screen shots of the Model:

Overview of Google Reader

Google Reader Detail:

Zotero Overview:

Zotero Details:

Retrieval from Zotero:

Steps in the Model:

  1. Set up RSS subscriptions to your specialty medical journals in Google Reader
  2. This allows abstracts of articles flow into your Reader automatically and allows you to view these in one place
  3. This is equivalent to the sensory register mentioned above. When you browse through the RSS feeds, you "receive the information from the environment and store it fleetingly"
  4. As you scan through the abstracts, you can in Google Reader mark the ones that seem significant and relevant with a star. The Google Reader automatically tracks the ones you have browsed and removes them from the "home screen".
  5. You have thus gone through the process of determining whether the abstracts are to be discarded or to be processed for storage in long term memory. This is similar to the short term memory proposed in the Information Processing Theory.
  6. When you have more time and inclination, you return to the Google Reader using Firefox that has the Zotero plug-in installed.
  7. You click on the hyperlink to the abstract and from there to the full text article if you have access. You read the abstract and determine that it is worth "storing". Zotero allows you to take a "Snapshot" of the article and annotate it with notes, keywords and highlights. The bibiliography information of the article along with the annotated snapshot and notes and keywords are all stored in your Zotero library
  8. Zotero allows each reference item to be included in several collections. Thus as an Internist, I have collections for all subspecialties of medicine - e.g. Cardiology, Pulmonary etc.
  9. This process of analysing the article, annotating it and adding keywords, notes and sorting into collections is similiar to encoding that is described in Constructivism and helps move the information into a more permanent long-term storage.
  10. The entire Zotero library is searchable and allows for easy retreival of previously processed information. As information is recalled and applied more often, it is more likely to become true knowledge.
Try it out, you have nothing to lose and possibly a lot to gain!

Sunday, April 5, 2009

Creating from Scratch!

Scratch is a great way to get way to create interactions, animations and games. It is extremely easy to learn. Almost anyone can learn to use this and be up and running in a few minutes. Once you spend a few minutes learning Scratch, you create games like this one which was my first attempt.
GOAL: Get the cat to chase and catch the red ball of wool. Have to get the mouse pointer exactly over the red ball. I forgot to de-link the mouse pointer from the cat so you have to click on the red stop sign to stop the script. Hey you live and you learn right?

Learn more about this project

After you spend more than a few minutes working on Scratch, you can create something like this:
Learn more about this project
Key features
1. Free programming tool with a terrific user interface from
2. Requires JAVA
3. Free hosting service on Scratch servers
4. You can download and examine the code for all uploaded projects
5. Code is "written" by stacking blocks on each other!
6. Once uploaded to Scratch servers, you can embed the "game" into your blog or web page like I just did.

So how can you use this?
1. Teach logic
2. Teach the concepts of programming
3. Create educational games - that teach medical concepts e.g. A red blood cell moves through the circulation and you have to click on the appropriate valve in appropriate sequence to get it through from the vena cava to the Right Atrium to Right ventricle to Lungs to Left Atrium to Left Ventricle to Aorta. Or you could allow them to click on a valve to create a state of Stenosis or regurgitation and show what happens.
4. You could embed this into a LMS or Assessment tool or even PowerPoint to help make for more active learning!

Sunday, March 29, 2009

"Dad! There is nothing good on television!"

Once when my daughter was watching what I considered "junk" on TV, I pointed out that there was good stuff on Discovery, THC or TLC. Problem was finding a good show, appropriate for her and then making sure she was free at that time or tape it for future viewing (what a pain).

One of the fundamental principles of education is for the learner to learn at their own pace and learn what they are interested in. Maria Montessori advocated the same approach. Setting specific times to learn specific topic based on an arbitrary schedule is contrary to this principle.

Now we have the WWW, great search tools, terrific information resources and ubiquitous broadband access. Still finding good information from reliable sources and separating the wheat from the chaff has been a difficult task. We may just be getting closer to solving this problem. YouTube EDU just went live last week:

From YouTube Blog (3/26/09)
"Do You EDU? Educational Hub Launches: Using YouTube as a vehicle to democratise learning is one of the coolest, unintended outcomes of the site's existence. YouTube EDU is a volunteer project sparked by a group of employees who wanted to find a better way to collect and highlight all the great educational content being uploaded to YouTube by colleges and universities. We'll feature some of these videos on the home page on Friday and elaborate further in a separate post on that day."

As I look at the growing number of sites promoting democratisation of education, I can't help but think that we live in great times! Here is my short list of sites that almost uniformly provide terrific educational value. While the amount of medical information on these sites leaves much to be desired, it is just a matter of time.

Youtube EDU

Academic Earth

TED talks

iTunes University

As a complete TV-Computer integration gets closer, we can easily see this content on our TV screens/monitors. In addition you could dump this into your mobile device like iPod or Zune. Now I will not cringe when I next hear the rant "there is nothing good on television!". When someone has "spare time" and is looking for something mentally stimulating, it may not be hard to find!

Another question is whether these online "universities" can replace classrooms and professors.

We are all familiar with the recent paper on Podcasts replacing Professors by McKinney, Dyck and Luber in Computers and Education. The study abstract:

"iTunes University, a website with downloadable educational podcasts, can provide students the opportunity to obtain professors’ lectures when students are unable to attend class. To determine the effectiveness of audio lectures in higher education, undergraduate general psychology students participated in one of two conditions. In the lecture condition, participants listened to a 25-min lecture given in person by a professor using PowerPoint slides. Copies of the slides were given to aid note-taking. In the podcast condition, participants received a podcast of the same lecture along with the PowerPoint handouts. Participants in both conditions were instructed to keep a running log of study time and activities used in preparing for an exam. One week from the initial session students returned to take an exam on lecture content. Results indicated that students in the podcast condition who took notes while listening to the podcast scored significantly higher than the lecture condition. The impact of mobile learning on classroom performance is discussed."
The study showed that when students listened to the podcast of a "lecture" more than once and took notes (thus transforming or encoding the information) they did better than their classroom colleagues.

I would love to know a couple more things:
1. What was the level of interactivity in the live class? Did students or the professor ask questions? Was there any discussion? Was this captured in the podcast?
2. How big was the class size?
3. Did the professor use an audience response system to gauge student needs, assess comprehension of the material or customize the lecture?
4. Why choose 25 min as the lecture length?
5. What was the complexity of the content compared to the average student's understanding of it?
6. Why choose a week as a recall period?

Education in general is moving away for passive lectures to large groups - because most educators would believe that active learning in small groups which allow for some transformation of the knowledge into non-textual formats works best. Maybe we need to look at this by doing a study that compares one such "ideal" class with a passive podcasts with ability to listen multiple times and take notes.

The other issue is whether we are trying to impart knowledge or educating our learners about how to acquire knowledge.

What one would love to see is a pedagogic model that incorporates podcasts into interactive small group learning. There have been studies where this has been tested and shown to work.

Well sounds like thats enough food for thought for now!

Friday, March 27, 2009

JING - Inserting flash movies into PowerPoint

Have heard a lot about Jing as a great screen capture utility. Some key features of the free version:

  1. Image and video with/without audio capture

  2. Integrated upload to server

  3. Annotation tools - arrows, text, rectangles

  4. Cool interface

I tried it out and while it works as stated I found several issues

  1. The video saves only as swf files (for free version)

  2. The end of the video has a Jing splash page which means you would not use this for any professional use. (the Pro version does not have this)

  3. It does not allow one to select a particluar application window - just has cross hairs to select an area.

So if you want to capture static images from your screen, it works fine but there are several other similar tools to choose from. I found this review by Matthew Ellison which includes reviews of 2 free utilities ScreenHunter 5 Free and TNT ScreenCapture 2.1. Of course One Note does a great job of grabbing the screen shots and then letting you annotate them. The good old method of [Print Screen] and then pasting into your favorite image editing application works too.

For screencasting software or video screen capture (used for software training) I found a list on Wikipedia. In addition Microsoft has a simple tool called community clips recorder.

Having made these screencasts I wanted to put them into a PowerPoint presentation. This was easier said than done. You cannot just insert the swf file created by Jing into PowerPoint. You have to go through some steps which are not difficult. These are outlined here by Geetesh Bajaj. The key step there is to get the Shockwave Flash ActiveX control. Surprisingly neither Microsoft nor Adobe provide this control! But you can get it by just searching in Google.

Summary of steps (PowerPoint 2003):(added 3/28/09)

  1. Save/copy the flash movie to the same folder as your PowerPoint file
  2. Go to the slide where you want the movie to show
  3. View >> Toolbars >> Control toolbar
  4. On Control Toolbox >> click on More Controls >> Scroll down to
    Shockwave Flash Object
  5. If you don't have this option, Google for Shockwave Flash Object ActiveX
    control and install it.
  6. Drag the cross-hairs on your slide and size and position the object
  7. Right click on the window and choose Properties
  8. In the table that pops up do the following:
    a) Opposite Movie type in
    the name of your swf file (since it is in the same folder you don't need to type
    the entire path)
    b) Change Embed to True
  9. Now run the slide show and you should be able to see the movie!

The next big challenge is to navigate the slide show with the flash movie playing. The normal keyboard arrow key shortcuts do not work to go to next or previous slide while the Flash movie is playing. The best option is to create some action buttons for next and previous slides on the master slide. Make these quite small and size the flash control so that these buttons are not hidden. Then you can navigate the slide show and if you get your timing down you can jump to the next slide just before the Jing Splash page shows up at the end of the movie. If you are going to create the show as a tutorial for someone else to navigate, might be best to set up timings. You can do this by Slide show>> Slide transition >> Advance slide automatically after XX seconds (depending on length of movie).

Have fun!

Saturday, March 21, 2009

Using Zotero in an ePortfolio

Zotero has become one of the most popular Reference management and bibliography tools. Created by the Center for History and New Media at George Mason University with funding from the US Institute of Museum and Library Services, Andrew W. Mellon Foundation and Alfred P. Sloan Foundation. It is an extension (add-on) for Firefox and is free.
Zotero is among the many excellent applications developed by the Center. The appear to have some very creative minds and an excellent team of designers, user interface experts and programmers along with some strong funding.

Zotero is in some ways like other reference managers:
  1. Allows one to build up a library of references along with specific information like Author names, dates, journal name, pages etc...
  2. Has a Word (and Open Office) plug in to insert citations into articles you write and to create a bibliography of the citations you use at the end of the article.
  3. Has multiple styles for citations and bibliographies that you can use based on which journal you are sending your manuscript to.
Zotero is different from out reference managers too:
  1. It is free
  2. It is an extension of a browser - this feature means Zotero understands that most databases of information are now online and people use a browser to search these databases. Even if you do want to add an article from a print journal into your library, you could still go to the appropriate database where this journal is indexed and find that article.
  3. Adding the article's appropriate information to your library is often seamless. A large number of these online databases (e.g. PubMed) are now Zotero ready. What this means is that when the browser opens a web page with information re' say a journal article, Zotero "senses" this and a small icon appears to the right of the URL box. Clicking on this icon adds all the metadata about that article into the appropriate fields in the Zotero Library.
  4. Zotero allows you to tag the article with keywords and also to add it to various "Collections". It also has a powerful search tool to search for through your references.
  5. Zotero allows you to get a "snapshot" of the webpage and annotate your copy of this snapshot (much like highlighting or commenting in a PDF file).
  6. Zotero also allows you to add your notes to the reference.
There are numerous features like this and Zotero is under constant development and new versions are being released regularly with additional features. Zotero user forums help to gather ideas and suggestions from the users and are regularly monitored by the development team. So is Zotero PERFECT?

I have one specific problem when using Zotero for a specific purpose. I am working with a couple of medical students to use Zotero for their ePortfolios. We have a home-grown ePortfolio system where all medical students get narrative formative and summative feedback through out their 5 years. These assessments are competency based (similar to ACGME competencies) and organized into areas of improvement and areas of strength. These are all done online and when submitted, they appear in the students' ePortfolio workspaces. The students write essays (ePortfolios) regarding their meeting various standards in each competency citing the evidence from the assessments.

We use EndNote or RefWorks to allow students to download all their references (assessment information), write their essays, cite the references, and then upload it all into a review area. The citations work as hyperlinks so when reviewer reading the essay wants to look at one of the cited references s/he has to just click on the citation to open a new window where the assessment form is displayed.

The problem I am facing with Zotero is that we cannot figure out how to make the citations in the text of the essay or in the bibliography clickable without going to each one and editing them. Since some of the students have as many as a 100 references in their bibliography this is not a viable solution.

It is very surprising that though Zotero is built on the philosophy of getting the references from online databases, it seems to have neglected that the manuscripts written by people using Zotero would be reviewed online where it would be critical for these citations to be hyperlinks!

I am relatively new to Zotero and am quite possibly missing something. I have scoured the Zotero forums, Googled the web and found nothing so far. Maybe the CSL does not at present allow this to occur? Would it be possible to add a "Web style" to Zotero's growing list of styles? If someone can do that, it will be the most appreciated!

Saturday, March 14, 2009

A 50 dollar Smart Board?

While reading a recent article in Edutopia "Why integrate technology into the curriculum? The reasons are many." I found a post by Chris with a link to Johnny Lee's demo. A few seconds of following hyperlinks brought me to his home page and his Wii Remote Projects website. The website indicates that he is/was at Carnegie Mellon University (of Randy Pausch fame) working on Human Computer Interface. The two projects that are quite fascinating are the 40 dollar smart board and the 10 dollar head tracker.

For the smart board one needs the following:
  1. A bluetooth enabled computer (Win)
  2. A Wiimote (Wii Remote) - need to set up bluetooth connection with computer
  3. An infrared LED pen - could test with just a infrared remote of a discarded appliance?
  4. His software (Free download from his site)
  5. A projector or any LCD display connected to the computer.
Some people have had problems connecting the Wiimote with the computer using bluetooth. Others have struggled to create the LED pen. I am sure someone will come out with a commercial kit for this.
Kudos to Mr. Lee for his imagination and skills in putting this together.

I spent a good 2 hours this morning trying to get this to work. I have a Fujitsu Lifebook tablet PC with a built-in bluetooth adapter. It has Win XP. Its had a Toshiba Bluetooth stack that did not recognize the Wii Remote. So I found a newer version and installed that. Heart stopping moment when it uninstalled the older stack and the installation of the new stack stopped half way. Luckily after a couple of reboots, the new stack was installed and working.

Next the details of the bluetooth connection. I found several tutorials on this and the key things to remember are
  1. Use the 1 and 2 buttons on the Wii Remote simultaneously to put it in Discovery mode. If you want you can use the red button under the battery cover. The 4 blue LEDs at the bottom of the Wii Remote need to be flashing - this means it is in Discovery mode.
  2. Run the bluetooth manager on the PC and it should recognize the Wii Remote. Keep repeatedly pressing the 1 + 2 buttons to keep the LEDs flashing. When asked for a Passkey - choose the radiobutton that says "Do not use passkey". If you do not have that option, you need a newer Toshiba Bluetooth stack.
This allowed me to get the Wii Remote added to my Bluetooth devices. But what do you do with this? Well even without Mr. Lee's software you can use the Wii Remote on your computer to do different things using a software called GlovePIE. This is a free download (Zipped archive that needs extraction). When you start the Program and open a file called testwiimote.pie and run it, it detects the mouse and some numbers change on the screen indicating that it is working.

I got this far and then I tried to run another script in GlovePIE (it comes with several) and it stopped detecting the Wii Remote! Also Mr. Lee's software said no Wii Remote detected under HID device list! The Bluetooth manager still showed the Wii Remote as connected to the PC. Did not have time to troubleshoot this further. Needless to say this is not a easy install. People might want to wait for a more seamless solution - a bundled BT adapter + driver/stack + a script to use it as a mouse + some LED pens! I will wait for a while before I will have the time and energy to try this again.
Well ... so much for waiting a while. Came home late tonight and saw the Wii Remote sitting next to the laptop and had to give it one more try. AND SUCCESS! I downloaded the latest version of the Toshiba BT stack (version 6.30.01) and rebooted and it worked like a charm! I had not downloaded this earlier as the website said it was only for Toshiba Laptops.
So it works very well with the GlovePIE software where there is a script for using this with Firefox. Angling the Wii Remote in various directions, moves the cursor. The A button is a left click and the home button is a right click. Now just have to figure out the LED pens and then use the smart board software from Johnny Lee!
Shall I saw a day well spent?

Sunday, March 8, 2009

NPR segment on Clickers in the Classroom

This "All Tech Considered" segment generated quite a buzz.  There was a comment about the limitations of clickers as they can only support multiple choice questions.  Luckily several comments clarified the concept of how these can be used for needs analysis and for leading to active learning using the Think-Pair-Share technique.  

I use the clickers to poll the audience on questions where there may be no right answer (e.g. ethical issues) and then allow them to discuss the issues amongst themselves and then maybe poll again.  I also create questions on the fly to decide on what the class wants to learn or to make sure they understand  the concepts before moving on to the next step.   I create hyperlinks in the presentation that let me jump directly to a specific topic if indicated by the audience responses.

This helps to keep the learning student-centered.  When used appropriately, the clickers are a wonderful tool!

Friday, March 6, 2009

Second Life in Higher Education

Campus technology has an article describing the "ghost towns" created by various corporations and universities. It also describes the SL campuses of several universities like the University of Delaware and Montclair State University.

The question is whether the real use of SL in education is the structures and buildings of these universities or is it the ability to interact with others in a unique way? The ability to cloak oneself behind one's avatar lends a special characteristic to SL interactions.

Physicians are well aware of how some patients are able to ask questions more frankly via e-mail rather than face to face (See article by Daniel Sands Does SL allow a similar disinhibition and thus a more free and frank discussion? Are students more likely to admit that they don't know something and ask more questions? Is the interaction in SL likely to be healthier?

At least with the present technology and bandwidth it is difficult to provide simulations with enough richness and detail in SL. On the other hand the ability to voice chat and convey some emotions maybe sufficient to use SL as a medium for collaborative learning specially when participants are not all at one site.

Wednesday, March 4, 2009

Controversy over use of technology in education

Education Consult Service:: Web-based Best Practices Exchange

Chris Taylor in her recent post cited a recent study re' use of technology in education. The comments highlight some of the potential problems of such studies - the concern being how the teaching method or style may be confused with the actual technology used by the educator. One needs to keep this in mind when appraising literature on this topic.

Sunday, March 1, 2009

Second Life in Medical Education

How can we train medical students to take a good history in a safe environment before they start working with real patients?
One method we often use is "standardized patients" who are trained to act like patients with particular medical problems. These encounters can be video taped for later review. This is generally an excellent method for training medical students but has some drawbacks:
  • Expense
  • Convenience
  • Scheduling problems
  • Shortage of well-trained standardized patients.
  • Informed consent for use of video
It may be possible to use virtual worlds (like Second Life) for this purpose. SL allows for certain gestures and facial expressions. The Avatars can be designed to have a specific appearance consistent with the medical problem e.g. disheveled appearance when depressed. SL now allows for voice chat. The entire session can be recorded as machinima using software like FRAPS. The Imperial College of London has done some work on Virtual Patients and on training for scrubbing prior and positioning patients in SL.

We are working on a project to test the feasibility of using SL for training students on history taking and presented a poster on this at a recent education retreat at Case Western Reserve University School of Medicine. At present we are working on creating the appropriate settings and emotions and gestures for a test case (Special thanks to Sue Shick for these images). Should have some results in the next 12 months.

Addendum (3/30/09)
CNN just ran a story on the Imperial College of London efforts in SL

Friday, February 27, 2009

PowerPoint in Education

Most educators would agree with the constructivism theory. Thus we have in our minds a model to explain what we have experienced and every time we have a new experience, we modify the model.

Educators believe in "active learning" where the process of acquiring and assimilating the information is an active process that helps with the process of modifying the model.

The phrase "PowerPoint presentation" conjures up images of a dark room with a speaker hidden behind a podium droning away at a large audience that is nodding off. The exact opposite of what we would want education to be. Still PowerPoint is one of the most popular tools of teachers and lecturers.

But it is quite possible to use PowerPoint to make fun and interactive presentations. Some examples are:

  1. Audience Response systems
  2. Using a tablet PC to annotate the slides during the presentation
  3. Imaginative use of Action buttons and hyperlinks to customize the presentation to the learning needs of the audience
  4. Making invisible hot spots on images
  5. Use of templates like the Jeopardy Templates.
You can see a tutorial that I have put together on using PowerPoint in education here.

Friday, February 20, 2009

Faculty development on Using Technology in Education

One of the challenges we face is helping faculty get comfortable using technology. We can try and do hands on workshops to train faculty on certain techniques. The problem is that faculty can have varying levels of expertise in the use of the Web and computers.

One way to solve this problem is to get all workshop participants to review a computer and Web skills checklist prior to the actual session. In addition we can provide links to some good tutorials if they need to brush up on specific skills.

I have put together a skills checklist and links to some tutorials that cover basic Windows skills here.