1. STFM 2010 Pre-doctoral conference Jacksonville, FL
Evaluation of a web-based family medicine case library for self-directed learning in a third-year clerkship Family Medicine 2010, in press Jay Morrow, DVM, MPH; § Dan Sepdham, MD; Alison Dobbie, MD, MRCGP; Laura Snell, MPH; Gurjeet Shokar, MD; Carolyn Lindeman, BA
STFM 2010 Pre-doctoral conference
Jacksonville, FL §

2. Background
Ensuring an equivalent educational experience is an LCME requirement.1
Geographic separation
Faculty/curriculum variability
Non-uniform schedules
Students rate overall didactics low
Web-based cases increasingly used, and are well-accepted.1
Clerkship response, AY
Implementation of a self-directed, online case requirement to replace traditional didactics
1. Leong SL, Baldwin CD, Adelman AM. Integrating web-based computer cases into a required clerkship: development and evaluation. Acad Med. Mar 2003;78(3):

3. Objectives
Gap: No studies addressing student use patterns in web-based case self-directed learning programs
To evaluate third year students’ use of a web-based case program for self-directed learning in a Family Medicine clerkship
Analyze web-based case use patterns
Evaluate student satisfaction

4. Research questions What are the most and least chosen cases?
Does case choice vary by time of academic year?
What are students’ rationales for case choices?
What are students’ opinions about case-based versus traditional didactic learning?
Does web-based case learning impact Board scores?
Descriptive use of cases and what students thought

5. Methods Setting and Subjects
Academic family medicine department
Class size 200+ per year
3rd Year Family Medicine Clerkship – 4 wks in duration
8 different clerkship rotation sites
2 sites > 60 miles away from med school
Other 6 sites return for didactics on Fridays

6. Methods Study design
One-year cross-sectional study of Design A Case© web based clinical case usage
Students required to complete 3 cases during their 4-week rotation
Completion of all 3 cases was worth 2 points of the final course grade
Cases
52 case, peer-reviewed library
Cases are interactive and provide immediate feedback based on student responses
Designed by Dr. Gary Shokar at UTMB. Describe DAC – 52 clinical vignettes, take about min to complete. We recommended students complete 1 per week
Pilot with previous year’s MS3’s – implemented AY (1st 6 mo) - collecting data via Survey Monkey

7. Methods Data Analysis Research questions Data collection Analysis
1. Content of top ten most and least chosen cases.
System database, all students (n=210)
Frequency
2. Case choice by time of academic year (1st 6 mos. vs. versus last 6 mos).
Chi square analyses for case completion during “early” vs. “late” rotation categories
3. Rationale for choosing (or not choosing) cases.
SurveyMonkey, consented students (n=85)
4. Student-reported strengths and weaknesses of self-directed, case-based learning vs. traditional didactic schedule.
5. Whether Web-based case learning impacted Board scores (using historical controls).
Departmental database
One-way ANOVA on board scores from 2004 – 2009

8. Results n n% Clerkship students, AY 2008-09 210 100
Total cases completed*
843
Average cases / student 4 −
Completed 4 or more cases 85 40
Completed 3 required cases
205 98
Consented to survey
* Average time to complete 1 case = 50 minutes

9. Results Case Selection
Most selected cases were biomedical content
(e.g., Abdominal pain, Adult Type 2, Rash neck)
Least selected cases were cultural competence
(e.g., Family Care Ruiz, Jackson Family, Washington family)
Students chose cases for “right” reasons
Expand knowledge of condition (87%)
Practice managing conditions not seen in clinic (65%)
Reinforce conditions seen in clinic (64%)
Students disagreed that they chose randomly (72%), or because cases were easy (67%) or short (71%)
Three cases selected more often in late AY vs. early AY
Designed by Dr. Gary Shokar at UTMB. Describe DAC – 52 clinical vignettes, take about min to complete. We recommended students complete 1 per week
Pilot with previous year’s MS3’s – implemented AY (1st 6 mo) - collecting data via Survey Monkey

10. Results Case Evaluations (n=85, RR=40%)
Had sufficient time to complete cases (96%)
Found cases relevant to clinic (91%)
Preferred web format to traditional didactic (77%)
Learned more with web format (64%)
Did not think cases were too easy for their level of education (71%)
Board scores were equivalent to scores from previous 5 years.
Designed by Dr. Gary Shokar at UTMB. Describe DAC – 52 clinical vignettes, take about min to complete. We recommended students complete 1 per week
Pilot with previous year’s MS3’s – implemented AY (1st 6 mo) - collecting data via Survey Monkey

11. Discussion
Wide variety of cases selected, emphasizing clerkship objectives
Case selection: expand/reinforce learning, relevant, informative, and applicable (survey self-report)
Cultural competence cases
Not selected, HOWEVER,
Content woven into entire case Library
Students may value cultural competence teaching less than biomedical content.2,3
Case studies increase student satisfaction when they replace other activities and are not additional tasks.4
2. Beagan BL. Teaching social and cultural awareness to medical students: "it's all very nice to talk about it in theory, but ultimately it makes no difference". Acad Med. Jun 2003;78(6):
3. Dobbie AE, Medrano M, Olney C, Welsh K, Tysinger J. Acurriculum in health beliefs for first-year medical students. Presented at the 2002 Society of Teachers of Family Medicine Predoctoral Education Conference in Tampa, Fla.
4. Berman N, Fall LH, Smith S, et al. Integration strategies for using virtual patients in clinical clerkships. Acad Med. Jul 2009;84(7):

12. Limitations Single institution; single clerkship
Case titles may not reflect expected case content
Validity of student self-reports?
Monitoring is necessary
Removing sutures = cultural competency

13. Conclusions
Web-based cases are easy to implement/administer in any clerkship
Consider replacing some traditional lectures when adding new online case content

14. Questions?