Residents were oriented to the intranet site during the first session of the community medicine course. Each week, residents were asked to respond to an on-line discussion question. Homework exercises and additional reading assignments were also posted on-line. Residents were required to use several internet links to gather neighborhood public health data and to propose a COPC project. FINDINGS TO DATE: 73% of the residents who participated in the community medicine course (11/15) responded to an anonymous post-course evaluation posted on the intranet website. 73% of the respondents (8/11) found the intranet site enhanced their learning of community-oriented primary care. 9% (1/11) found it neither enhanced nor detracted from their learning experience and 18% (2/11) felt it detracted from their learning. 40% of the respondents (4/10) used the intranet site more than once per week; 50% (5/10) used it once per week; 10% (1/10) used the site less than once every two weeks. The median number of visits to the intranet site during the eight-week Community Medicine course was 11 per resident (range 3 to 60). Seven residents did not participate in the on-line discussion groups. Key reasons for lack of participation included the amount of work assigned for the course (33%), lack of internet access at home (27%) and difficulty navigating the intranet site (20%). KEY LESSONS LEARNED: Use of an intranet website shows promise as a tool to facilitate rapid learning of concepts in community-oriented primary care. STATEMENT OF PROBLEM OR QUESTION: A significant portion of graduate medical education is based on exposure to a variety of clinical experiences. For residents training in internal medicine the majority of these interactions occur in the inpatient setting. It is important not only to document the range of diagnoses that residents encounter, but also to track length of stay and readmission rates, two important markers of the quality of inpatient care. Quality markers may be linked to attendings supervising the residents and may indicate topics for faculty development. OBJECTIVES OF PROGRAM/INTERVENTION: We developed a computerized database to 1) track inpatient diagnoses that IM residents encounter on a general medical service; 2) track length of stay, readmission rates, and other performance quality measures for particular diagnoses; and 3) link resident practice measures with supervising attendings to identify areas for faculty development. DESCRIPTION OF PROGRAM/INTERVENTION: We created a computerized database in Microsoft Access. The database documents every patient admission to the internal medicine teaching service; the medical team (residents and attending) responsible for the patient's care; primary and secondary diagnoses listed for the patient (from the discharge summary); admission and discharge dates. The database user interface is organized with multiple data tables supporting``drop boxes'' to click on the appropriate physician names and diagnoses. An administrative assistant enters the data, and any diagnoses not listed in the data tables are referred to a physician for clarification. FINDINGS TO DATE: This computer-based information system allows tracking of all diagnoses seen by IM residents on a general medical service. The data can be used to compare each resident's exposure to specific diagnoses with his/ her performance on in-training exam sub-scale scores; educational interventions can be developed to enhance medical knowledge in those areas identified as having low exposure and low in-training score. The documentation of residents' experiences also fulfills the Residency Review Committee's requirement for documentation of IM residents' diagnostic experience. The database is used as part of hospital-wide disease-specific quality improvement initiatives to review length of stay and readmission rates on the teaching and non-teaching services, and to target physician education at all levels to improve patient outcomes. Future links between this database and pharmacy and laboratory utilization measures will permit even more detailed analyses of physician performance. KEY LESSONS LEARNED: An accurate computerized tracking system is a useful educational and quality improvement tool for residents and attendings in internal medicine residency programs. This database recognizes the value of integrating measures of quality improvement into residency training, and may be used by training programs in other disciplines to track clinical performance. STATEMENT OF PROBLEM OR QUESTION: When faced with teaching physical examination skills to a large class of medical students (as well as coordinate the teaching efforts of a diverse group of physician teachers), it is a challenge to ensure that students are exposed to a common set of physical exam findings and find techniques that optimize their opportunity to develop physical exam skills. OBJECTIVES OF PROGRAM/INTERVENTION: To expose students to certain common abnormal physical exam findings and enhance learning of physical examination skills through the integration of new technologies and traditional educational strategies. DESCRIPTION OF PROGRAM/INTERVENTION: Computer-based technology is becoming an integral part of curriculum innovation at Ohio State University. As a part of this pedagogical effort, an innovative, highly interactive website was developed to promote active learning at a level appropriate for undergraduate medical students and to be compatible with the current Physical Examination Course curriculum. This web-site makes use of Macromedia Flash, video streaming, and SMIL technologies to bring to life portions of the physical exam and to make available common abnormal findings often difficult to demonstrate to medical students at any specific time. It emphasizes learning through reading, hearing, seeing, and doing in a sequence designed to capture the learner's attention and to make information available through multiple sensory modalities. There are 6 core modules (HEENT, pulmonary, cardiac, abdominal, neurologic, musculoskeletal) under development. Each module includes the following: a Flash-based interactive component highlighting important anatomy and physiology; web text and video clips discussing and demonstrating essential physical examination skills; Flash-based interactive components where students hear findings or practice selected physical examination skills (e.g. taking a blood pressure and hearing Korotkoff sounds); a glossary of clinical terms; links to clinical pearls and additional explanations of techniques or abnormal findings; and clinical correlates where students practice integrating physical examination findings. This exhibit will showcase interactive portions of the modules via a CD-ROM presentation. FINDINGS TO DATE: Pilot data were collected and of the nine respondents, all reported that this site was an excellent learning tool, desired further development of similar technology, and would recommend this site to other students. Eight of the nine students reported being able to navigate the site and use the interactive Flash components without difficulty, and stated they would be more likely to use this site than the textbook to prepare for practice sessions with faculty tutors. Overall, students found it helpful to hear findings, liked the links built into the site, and enjoyed the clinical correlates component. The only weakness identified was the time to download the video clips if access was obtained from modems as opposed to a high-speed internet connection. KEY LESSONS LEARNED: Next Steps: Data are currently being collected with a larger sample concerning the use and effectiveness of this site to guide subsequent revision of current modules and to plan the design of future ones. Also being considered is the development of patient cases representing core disease presentations, as well as modules specifically designed for educators in this area. STATEMENT OF PROBLEM OR QUESTION: Advances in evidence-based research, together with unprecedented access to original sources of information, provide a unique challenge to medical decision-makers that may improve the quality of care provided to their patients Ð if they can find and correctly interpret this readily available information. OBJECTIVES OF PROGRAM/INTERVENTION: Our aim was to instruct clinicians accessing and interpreting online sources of evidence-based research using a cognitive theory that has been applied to clinical decision-making. DESCRIPTION OF PROGRAM/INTERVENTION: Decision-making tasks concerning chest pain evaluation in women were developed for medical students and internal medicine residents. The cognitive theory Ð fuzzy-trace theory Ð guided the selection of online sources (e.g. target articles) and decision-making tasks. FINDINGS TO DATE: Thiry-four participants (12 students and 22 internal medicine residents) attended didactic conferences emphasizing search, evaluation, and clinical application of evidence. A 17-item Likert scale questionnaire assessed participants' evaluation of the instruction. Ratings for each of the 17 items differed significantly from chance in favor of this alternative approach to instruction. KEY LESSONS LEARNED: Fuzzy-trace theory was found to be a useful guide for developing internal medicine learning exercises in medical informatics and decision making. However, studies with more learners and behavioral evidence of improved clinical decision-making skills and, ultimately, patient outcomes are needed. STATEMENT OF PROBLEM OR QUESTION: Scheduling conflicts prevent many residents, especially those on``non-ward'' rotations, from attending morning report. Even when able to attend, however, residents may miss salient learning points presented during those conferences. In order to circumvent these problems, we created eReports, electronic summaries of morning report distributed to all of the internal medicine residents by E-mail. OBJECTIVES OF PROGRAM/INTERVENTION: The goals of our intervention were: 1) to provide all of our residents with the learning opportunities of morning report even if unable to attend; 2) to model the practice of asking and answering patient-centered questions in an evidence-based way; and 3) to strengthen the educational impact of morning report by cogently synthesizing information presented, further emphasizing salient teaching points, and providing additional relevant information. DESCRIPTION OF PROGRAM/INTERVENTION: Each day, we developed a summary of the material presented in morning report and distributed it to all of the residents by Email. These summaries, which we called eReports, mirrored the structure of our morning reports. Each eReport began with follow-up information that included clinical follow-up to previously presented cases and literature-based answers to questions generated by those cases. We then summarized the two new cases discussed in morning report. At the end of each eReport, a task (e.g., view the peripheral smear) or a central question (e.g., how helpful would a positive result of your planned diagnostic test be?) was generated for each new case. FINDINGS TO DATE: Residents were asked to complete an anonymous survey prior to the dissemination of eReports. 81% of the residents responded. Of these, 71%``almost never'' or only``occasionally'' knew the content of morning report (cases or follow-up) when they were unable to attend. 88%``strongly agreed'' that eReports would be educationally helpful. Further investigation is underway to determine if eReports were, in fact, helpful. For example, did they successfully clarify teaching points, stimulate self-directed learning, or contribute to improved memory of cases and information presented in morning report throughout the rotations studied? KEY LESSONS LEARNED: eReports are a promising way to facilitate case-based learning among internal medicine residents. Not only do they ensure the dissemination of the material presented in morning report, they also afford a synthesis that strengthens the quality and content of that material. STATEMENT OF PROBLEM OR QUESTION: The ACGME has endorsed competencies in 6 core areas as a first step to emphasize educational outcome (rather than process) assessment for residency program accreditation. The guidelines require the residency programs to provide an appropriate educational experience in these areas, evaluate the residents' performance, provide feedback and achieve progressive improvements in residents' competence and performance. In addition the effectiveness of the educational program itself also needs to be evaluated. To achieve the ACGME goals, residency programs must develop a new educational model that will engage residents in a time efficient manner. In addition to their areas of clinical training, the new curriculum should cover areas such as doctor patient communication, medical ethics and professionalism. OBJECTIVES OF PROGRAM/INTERVENTION: We have designed and are now implementing a web-based interactive curriculum that would meet common and specific needs of various residency programs at our institution. The objectives of this web-based program are: 1. The curriculum is available at a convenient time and place convenient to the residents. 2. The residents' decide the order and pace of the curriculum. 3. The curriculum utilizes existing teaching materials as far as possible. 4. The new curriculum makes efficient utilization of educators' time and skills. 5. An efficient and effective evaluation and feedback system is an integral part of the new curriculum. DESCRIPTION OF PROGRAM/INTERVENTION: We designed the web-based curriculum to be based on interactive, question and answer scenarios. The key features of this program are: 1. The curriculum is on a password protected web site 2. The curriculum consists of brief interactive case scenarios that are grouped in the 6 core competency areas endorsed by the ACGME. 3. These case scenarios can be created by any educator by copying and pasting text from a text document into the text box of a separate development web site. Content is automatically converted into interactive HTML format and placed on the web site. Audio, video and graphic files can also be included. 4. Pretests, posttests, multiple-choice questions and free text entry areas can be included to capture the users responses, track performance and assess competency. In order to simulate a real-life scenario, the residents have an option to order consults and clinical tests to solve the cases. 5. The program provides extensive feedback including tracking amount of money spent while resolving a case scenario, amount of questions answered correctly at first attempt, number of attempts and the ability to compare themselves with other residents who have tried that particular scenario. 6. The program creates a customized recommended reading material based on the questions answered incorrectly. 7. If a user leaves a case scenario incomplete, the progress is saved and can be continued from that point when the user logs on the next time. 8. The program uses a database of house staff to create individualized reports for program directors on the participation and performance of their residents, and also is used to assign particular cases to a particular group of residents. FINDINGS TO DATE: We plan to formally implement the program beginning in the July 2001 academic year. Pilot testing has shown this system to be acceptable to the house staff, attractive to the program directors and effective and efficient method of teaching for the educators. KEY LESSONS LEARNED: As new requirements are placed on a medical education system strained for resources and funding, creative solutions are needed that will make efficient use of existing education material, to meet the needs of the students, educators and organizations using current technological advances in computers and the Internet. Using appropriate technology it is possible to create stimulating and educational material that also seamlessly combines tracking, feedback and evaluation and thus efficiently meet the ACGME goals.