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TOJET: The Turkish Online Journal of Educational Technology – October 2012, volume 11 Issue 4 THE EFFECT OF APPLYING ONLINE PBL CASE SYSTEM TO MULTIPLE DISCIPLINES OF MEDICAL EDUCATION Yuh-Ming Cheng Department of Computer Science and Information Engineering, Shu-Te University, Taiwan cymer@stu.edu.tw Sheng-Huang Kuo Department of Computer Science and Information Engineering, Shu-Te University, Taiwan oxbridge@stu.edu.tw Shi-Jer Lou National Pingtung University of Science and Technology, Taiwan lou@npust.edu.tw Ru-Chu Shih * (Corresponding author) National Pingtung University of Science and Technology, Taiwan vincent@npust.edu.tw ABSTRACT Teaching cases in medical education are often exhibited through various professional angles, but for patientcentered teaching cases, the division of labor among different specialties is even more important. However, general medical education platforms cannot provide such mechanisms for physicians. Thus, this study adopted a clinical medical education platform “HINTS” to establish a patient-centered interdisciplinary medical/clinical education mechanism for medical students to obtain a more holistic thinking process in practical training for clinical medicine. Additionally, rule-based and document-view methods were administered to successfully establish methods to edit and present teaching cases, installing them on “HINTS.” The results of the preliminary experimentation show that applying online PBL case system can be very beneficial for the learning effects of medical students. Keywords: Multiple Disciplines, PBL for medical education, integrated teaching case INTRODUCTION Recently many medical schools and centers have adopted a variety of Web-based application systems in an attempt to establish e-learning environments (Holzinger, Kickmeier-Rust, Wassertheurer, & Hessinger, 2009; DxR, 2008; Green, Jenkins, Potter, & Davies, 2000; Richards, 2002; Wong, & Hoo, 1999) for medical education purposes (Alpay, & Littleton, 2001; Dev, 1999; Norris, & Brittain, 2000; Zollo, Kienzle, Henshaw, Crist, & Wakefield, 1999). One such approach has been to introduce Web-based, Problem-Based Learning (PBL) strategies into their training curriculum (DxR, 2008; Maudsley, 2003; Norman, Schmidt, 1992; Oubenaissa, & Giardina, 2002). In the medical field, PBL involves the presentation of clinical cases as a means of learning basic medical and clinical science. In combination with PBL techniques, computers and computer networks can be successfully applied as training tools for physicians or students in medical schools such that they gain the required knowledge and experienceto make accurate diagnoses in their actual clinical practices. In the Webbased PBL systems, students are presented with a challenging medical problem and then retrieve the relevant supporting information from the computer system in order to work their way progressively towards a correct diagnosis. This teaching strategy appears to be reasonably effective, and has been adopted by many websitebased teaching case systems available on the Internet (Dornan, Maredia, Hosie, Lee, & Stopford, 2003; DxR, 2008). However, in this type of teaching system, each teaching case is compiled by an individual instructor working independently. Therefore, the teaching materials can only reflect their particular view of the learning points and may only represent a small portion of the complete picture of the teaching case. As a result, although students experience many different teaching cases from different clinical disciplines during their training, these teaching cases may not be necesary associated with each other. Consequently, it is difficult for the students to relate the learning points gained from one single teaching case to the knowledge acquired from another. Hence, they may struggle to fully develop an integrated multi-disciplinary view and understanding of the clinical knowledge, which they will require in the future clinical practice. Therefore, this study aims to explore how an Web-based PBL teaching case can be presented to the medical school students in such a way that provides an integrated, effective, and efficient mechanism for them to acquire an overall perspective and knowledge of patient care problems. Copyright © The Turkish Online Journal of Educational Technology 283
TOJET: The Turkish Online Journal of Educational Technology – October 2012, volume 11 Issue 4 A prototype system referred to as “HINTS” (Health Information Network Teaching-case System) (Cheng, Chen, Weng, Chen, & Lin, 2009; Chen, Cheng, Weng, Chen, & Lin, 2009) is implemented in this study. This system is an Web-based Problem Based Learning (Web-based PBL) system, which incorporates many actual clinical teaching cases so as to enable the students to acquire an integrated view of the typical clinical cases they will encounter in their future medical practice (Seila, 2000). The basic approach of the proposed system is to take one particular clinical case and to have the various domain experts from the different clinical disciplines edit the related teaching material such that the users can explore the clinical case from a variety of different perspectives. The concept of document-view architecture and a rule-based mechanismare are used in the teaching case system to provide an integrated clinical view of the medical school students’ medical e-learning, which is followed by the method of providing an integrated view of clinical teaching cases and introduction to the concept of the document-view architecture for the system implementation. The plain mode and interactive mode of the system operations are also briefly introduced. Then, the system implementation from an author’s perspective and an engineer’s perspective are discussed. Finally, the reports of the users’ experience and the authors’ in using and developing the prototype system and conclusion are presented respectively. BACKGROUND The Integrated View of Clinical Teaching Cases Based on our previous argument, if the same Web-based PBL teaching case is explored from the perspectives of different disciplines, students should be able to learn in a more effective and efficient way because the overall picture of the case will be seen in a more integrated fashion. In other words, if all the basic subject materials of a teaching case are related to the same patient case, and different domain experts edit the clinical data from the perspective of their own disciplines, the students can understand how a case is viewed from different perspectives. For the sake of argument, we define some terminologies here. If a teaching case is edited by an internal medicine viewpoint, it can be referred to as “an internal medicine view”. Furthermore, the term “a department view” refers to any general view of a teaching case. That is, an internal medicine view is a department view of a teaching case which views the case specifically from the perspective of internal medicine. Concept of Case Templates and Document-View Architectural Pattern Case templates In order to explain how our prototype system was implemented, first of all, the PBL teaching case template concept used in the system is introduced. The PBL teaching case system is essentially a multimedia Computer Aided Instruction (CAI) system (Cheng, Chen, Lin, & Chen, 2003) with knowledge database containing the knowledge of specific topics, which an expert in that particular domain would reasonably be expected to possess. In the system, the knowledge model (Clancey, 1987) contains data related to the many different clinical cases, which are to be taught. Since many teaching cases in the system share similar scenarios, it is possible to use a number of “case templates” (Cheng et al., 2003) to form an abstract model of the domain knowledge. In other words, a template outlines the main contents of a teaching case, and serves as the directory of the case. A template for a typical medical teaching case might include the following sections: (1) basic personal information such as age and gender, (2) brief case history, (3) reported complaints, (4) physical examinations, (5) findings, (6) diagnoses, (7) relevant associated cases, (8) discussions, (9) comments, and (10) learning points. The concept of the document-view Each department in a hospital has its own clinical data representation semantics for its teaching cases and can be edited to its own teaching case templates, which are suitable as the teaching materials of the department. For instance, for the radiology department, the system has the MRI, CT, or X-ray images (Huang, 1999; Wong, & Hoo, 1999), the basic patient information, such as age, sex, and the patient’s chief complaints, etc. Each department has its own emphases and case templates, each of which has specific meta-data to present a specific semantics of a teaching case for the teaching purpose. In general, there are many different department views (perspectives) to look at a teaching case. Within these different department views for the same teaching case, some parts of the case are shared among some department views while some other parts may be used by only one department alone. From a more abstract point of view, the situation is well fitted into the “document-view” architectural pattern (Chang, Chen, & Lai, 1999) in which a document in an interactive system may have many different views depending on what the user wants to be able to visualize the data in hand. The document-view architectural pattern divides an interactive application system into two components. The document component contains the core functionality and data of the object of interest while the view component displays the data of the object of interest to the user and handles user interaction. It can be multiple views of the same document. If the user changes the data of the document, all the views depending on this document should reflect the changes. In the implementation, a rule-based mechanism is used to support the document-view concept of the teaching Copyright © The Turkish Online Journal of Educational Technology 284
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