Spoonfed MD: An Asynchronous Collaborative Medical Education Application to Facilitate Concept Interrelationship Discovery

We have developed “Spoonfed MD” (sfMD), a Web 2.0 application to help medical trainees discover, review and retain relationships between various medical concepts and assist students in the development of complex knowledge schemas and routines. Problem: Research suggests that the development of expertise in medicine involves the restructuring of knowledge into schemas and cognitive routines that encapsulate complex interrelated concepts. These abstractions enable experts to effectively represent and work with more information in a limited amount of working memory than novices. The typical medical school experience provides students with raw information through lectures, small group clinical exercises and mentored clinical rotations. However, the responsibility for building a structured understanding of medicine remains with the individual student. Medical educators can facilitate this process by providing examples of concept interrelatedness and providing opportunities to discover such relationships. However, the process of restructuring and integrating knowledge during training is complicated by rapidly increasing body of medical knowledge and by the inherent difficulty in integrating concepts that are taught by a wide number of faculty over an extended period of time. We developed sfMD as a tool to help students discover concept relationships and build a more integrated medical knowledgebase. Solution: The application is modeled on the idea of study flash cards. Users can add content to the system as flash cards which are stored in a database accessible through web services. Each card contains a question and answer. Cards can range from simple facts for review to relatively complex questions based on a clinical vignette. A card can also have multimedia files attached to the question and/or the answer. Most importantly, each card is tagged with one or more keywords or phrases. Virtual stacks of cards can be retrieved from the server using tag-based search queries. While reviewing a card, a user can quickly retrieve and review a stack of cards on a related concept by selecting any of the active card’s tags. In this fashion, a student can review recently learned information and quickly discover interrelated concepts thereby integrating new concepts with prior knowledge. In order to make the system function in this manner, users must apply identical tags when referring to identical concepts and/or the application must understand synonymous terms. sfMD uses Metamap (developed by Dr. Alan Aronson, National Library of Medicine) to provide a suggested list of tags by mapping Unified Medical Language System (UMLS) terms onto the question and answer text. The application also leverages the synonymy represented in the underlying UMLS ontologies. Additional features allow users to create custom sets of cards for review, rate cards on quality and difficulty, filter out cards based on these ratings and/or based on properties of the card’s author. In addition, users can post comments to cards. A card will retain a complete history of its comments as well as a complete history of edits, allowing a user to access the version of a card that pertains to a specific comment. []