1. Interactive Computer-Assisted Instruction in Acid-Base Physiology for Mobile Computer Platforms Kenneth J. Longmuir Department of Physiology & Biophysics longmuir@uci.edu This presentation is available for download as both.ppt and.pdf https://webfiles.uci.edu/longmuir/aime

2. Acid-Base Physiology. Year 1 1.CO 2 -Bicarbonate Buffer System at Physiologic Conditions 2.Other Physiologically-relevant Buffer Systems 3.Physiologic Classifications of the Acid-Base Disorders 4.Representative Examples of Acid-Base Disorders In previous years: 3 lectures, 1 review session These traditional lecture-hall presentations were eliminated and replaced with interactive computer-assisted instruction http://medphys.biomol.uci.edu/acidbasehttp://medphys.biomol.uci.edu/acidbase (uci.edu domain only) https://eee.uci.edu/12f/94550/acidbase https://eee.uci.edu/12f/94550/acidbase username and password: “medphys” without quotes

3. Student survey – Responses to specific questions (n=56) What type of computer did you use the most for viewing the on-line modules in acid-base physiology? 56% - desktop or laptop computer 42% - iPad 2% - tablet computer/mobile device other than iPad Did you study the on-line acid-base modules by yourself or in groups? 84% - always by myself 16% - primarily by myself, but also in group study 0% - primarily or always in group study How did the amount of time spent learning the content by on-line instruction compare to the time you would have spent learning the material by classroom lecture? 74% - It required less time to learn the material on-line 20% - It required about the same time 6% - It required more time to learn the material on-line Was the interactive nature of the on-line instruction of value? 93% - It improved the learning experience 7% - It made little to no difference in the learning experience

4. Student survey – Responses to specific questions (n=56) How do you rate the quality of the three learning modules (not the clinical cases)? (Scale of 1 to 5) mean: 4.60 s.d.: 0.60 How do you rate the quality of the clinical cases? mean: 4.49 s.d.: 0.72 On a scale of 1 (worst preference) to 5 (best preference), how would you prefer to learn acid-base physiology? (You can use the same value more than once.) On-line, interactive instruction. mean: 4.56 s.d.: 0.79 Self-study with a textbook. mean: 3.18 s.d.: 1.25 Classroom lecture. mean: 3.05 s.d.: 1.33 Small group discussion. mean: 2.65 s.d.: 1.77

5. Student survey - Narrative Positives: Interactivity Well-arranged, side-by-side presentation of text and images Embedded question-and-answer Self-paced instruction Learning more "efficient" compared to the lecture hall Negatives: Inability to highlight and annotate Clinical cases too complicated

6. "I really enjoyed the acid base modules and thought they were very effective. This really seems like a platform for learning in the future." …………. "However, I want to express a limitation I foresee to this learning platform. For this learning platform to be effective, the material REALLY needs to be presented clearly. Without access to a professor for clarification or to ask questions like in an in class session, poorly presented material will render this platform useless." …………… "Unfortunately, I have reservations about the ability of other professors to present the information in a similarly clear manner. I think this learning platform has the potential to transform education and be wildly effective, however the effectiveness of it relies on the ability of the professor to present information clearly." Student survey - Narrative Greatest Student Concern: Quality of Instruction

7. February 2013 Exam Scores - 2013 Respiratory 78.9 % Renal 76.7 % Acid-Base Learning Mod. 78.2 % Clinical Cases 61.8 % This project should be accompanied with discussions about approaches to learning....1) serious statements regarding the expectations of independent study in a medical education program and...2) a discussion of the conceptual complexity of the subject matter and the time required to master that complexity.

8. February 2013 February 2014 Exam Scores - 2013 Respiratory 78.9 % Renal 76.7 % Acid-Base Learning Mod. 78.2 % Clinical Cases 61.8 % Exam Scores - 2014 Respiratory 81.8 % Renal 78.5 % Acid-Base Learning Mod. 80.0 % Clinical Cases 71.8 %

9. Interactivity in Computer-Assisted Instruction Level 1: No interaction "Passive Learning", "Page Turning" (pdf's, Word documents, non-interactive powerpoints, podcasts) Level 2: Simple interaction Straightforward learner responses to uncomplicated instructional cues. (Question and answer, identify regions on a graph, learner control of the sequence of presentation, branching for further information.) Level 3: Complex interaction Complex instructional cues. (Text entry, manipulation of graphical objects, branching dependent upon learner response.) Level 4: Real-time simulation (Training for industrial process control.)

10. Interactive Computer-Assisted Instruction vs. Active Learning ED-5-A. A medical education program must include instructional opportunities for active learning and independent study to foster the skills necessary for lifelong learning. 1.Broad definition of active learning: "Any instructional method that engages students in the learning process." "It requires the students to think about what they are doing.“ 2. A more stringent definition: "Challenge the student to think critically about the concepts, and to use the concepts in problem-solving activities." The clinical case modules fit this definition.

11. Multimedia Design Principles Design principles incorporated 1.Presentation of essential content on a single screen - NO scrollbars 2.Careful side-by-side arrangement of visuals with associated text 3.Management of complexity by dividing content into smaller sections 4.Extensive learner control of navigation and sequencing of presentation 5.Use of interactivity to promote critical thinking. Design principles not incorporated 1.Use of audio 2.Sequential presentation of information at pre-determined time intervals.

12. Intellectual Property “Ownership of the rights to Course Materials, including copyright, shall reside with the Designated Instructional Appointee who creates them.” http://copyright.universityofcalifornia.edu/ http://copyright.universityofcalifornia.edu/resources/ownership-course-materials.html “Ownership of the rights to Course Materials created, in whole or in part, by Designated Instructional Appointees with the use of Exceptional University Resources shall be governed by a written agreement entered into between the Originator(s) and the University. The agreement shall specify how rights will be owned and controlled and how any revenues will be divided if the materials are commercialized.” However, there are exceptions: Exceptional University Resources: University Resources significantly in excess of the usual support generally available to similarly situated faculty members.

13. Human Subjects 1.Submit IRB human subjects determination form. 2. In my case, data could not be related to individual, identifiable human subjects. No further IRB review was required. 3. Most published studies that collect data involving students appear to undergo IRB review, and receive “exempt” status.

14. Is It Worth It? Entire project: >250 hours of faculty time 50 hours - reading, literature research 150 hours - use of the instructional software (45 min - 1 h per screen) 50 hours - implementation, data collection, publication of findings 1.Planned use for several years 2. Published in peer-reviewed journal 3. Recognized in academic review.

15. 1.Neither students nor faculty understood what interactive computer-assisted instruction actually looks like. The publication describes the characteristic features of interactive computer-assisted instruction, and the procedures for implementing it. 2.A single faculty member, working alone, without additional resources, and without programming assistance, can implement computer-assisted instruction as a significant part of his/her teaching. 3.Many students did not exhibit acceptable independent learning behaviors. 4.Medical education programs do not have administrative systems in place that are needed to manage innovations in medical education effectively.

16. Everyone Has Responsibilities Faculty: Many of these educational innovations require interactive instruction. Students: Far greater emphasis on unscheduled, self-directed, independent learning. Medical Education Governance: No longer manageable by controlling hours of scheduled instruction.

17. Acknowledgements Harry Haigler Jeff Ingeman Mark Golesorkhi The AIME leadership