Design and Development of a Medical Education System Using Information Technology: A Case Report from the Pusan National University School of Medicine

The development of information technology (IT) has led to changes in medical education. IT has been used for e-learning and e-teaching, e-assessment, e-logistics, and e-administration. Pusan National University School of Medicine has developed its own educational information system using IT to support students’ learning and assessment and to manage curricular activities. Based on our experience, we propose six suggestions for designing new software, specifically regarding simplifying the design for users, communication with the programmer, a rapid cycle from design to implementation, orientation support for users, backup and security support, and obtaining patents. Collaborating with the Department of Medical Informatics within the School of Medicine has advantages, and an alliance among medical schools can simplify the development of software. In any case, curricular innovation should precede the introduction of technology because all technologies should support curricular goals.ope

Evolution of Post Graduate Curricula in Pakistan

Postgraduate medical training started with the apprenticeship model. This system heavily relied on tradition and subjectivity. In the middle of the 20th century, there was a gradual shift to an objective-based structure which had its roots in the works of Ralph Tyler and Benjamin Bloom. As a result, the curriculum became focused on predefined objectives in the cognitive, psychomotor, and affective domains. This drive was aimed to standardize the learning criteria across various centers and align the tools for assessment for postgraduate medical students.1In our country, the College of Physicians and Surgeons Pakistan (CPSP) has been the main center of postgraduate medical education since its inception in 1962. With both local and foreign-trained faculty members, it was one of the first centers to start training in Medical Education in collaboration with the World Health Organization in 1979.2 Various supervisor workshops and certifications by the Department of Medical Education helped equip the faculty with the tools required for curricular development.3 Thus new curricula in each discipline were developed and were called “structured training programs”. They were based on the objective approach and largely focused on summative assessments with very few formative assessments.4In the last two decades, new evidence and methods of postgraduate teaching and assessment have evolved in the west.5 Due to technological enhancements in patient care and vast development in the scientific pool of medical knowledge, there was a demand to define outcome-based competencies that strongly align with the demands of the workplace. As a result, competency-based curriculum models were developed which “de-emphasized time-based training and promised greater accountability, flexibility, and learner-centeredness”.1 CANMEDS (Canadian Medical Education Directives for Specialists) and ACGME (Accreditation Council for Graduate Medical Education) are two of the most popular systems having a competency-based framework which has been developed and successfully implemented in North America.Competency-based programs differ from objective-based ones in the fact that instead of prescribing how to teach or learn, they focus on the demonstration of various competencies required for practice. A competency-based curriculum must exhibit “teacher-learner relationship and responsibility, workplace-based assessment approach, alignment of competencies with criterion-referenced assessment, and flexible training duration”. 6 The system focuses on the attainment of competencies by the trainee to determine readiness for unsupervised practice rather than the length of their training.The structure of a competency-based curriculum is not based solely on objectives but rather uses defined Entrustable Professional Activities (EPAs) which align the teaching and assessment at the workplace with the competency frameworks. Another key aspect of this curricular structure is milestones which are based on the skill development framework of Dreyfus and Dreyfus.1 Both these key elements ensure that the trainee has attained the desired level of clinical skill to practice.The teaching of these competencies is often done in a workplace setting. Assessments employ Work Place Based Assessment (WPBA) tools such as Directly Observed Procedural Skills (DOPS) for procedural skills, Mini Clinical Evaluation Exercises (Mini-CEX), and Chart Based Recall (CBR) for clinical reasoning skills and 360-degree feedback for professionalism, interpersonal and communication skills. The system also caters to the extent of differential achievement of learners by offering targeted help to trainees in form of regular formative feedback which is an essential component of WPBAs.7As with other, in vogue ideas of medical education, the College of Surgeons and Physicians Pakistan was the first to develop a competency-based curricular framework nearly a decade ago. It was centered on patient care and involved professionalism, pedagogy, and advocacy as essential competencies to be acquired by the specialists.4,8 One key area where the CPSP fellowship program has developed since then is the development of portfolios 9 in the form of an electronic log (e-log) system for regular monitoring of training. The e-log system also includes reflections by supervisors and trainees which is a step in the right direction.10 Other technological solutions such as learning management systems, mobile applications, simulation, and social media if added could further enhance student learning and engagement.11,12 A close inspection of the current fellowship and membership structured training programs of CPSP reveals that despite the claim of running a competency-based framework, none of the key features of this system like defined EPAs, milestones, and WPBA strategies exist. Also, there is a lack of curricular alignment with the core competencies. So, it is difficult to consider it as a competency-based framework of postgraduate medical education in a true sense.Other medical universities in the country have relatively recently developed their Master of Surgery (MS) and Doctor of Medicine (MD) curricula. Wide variations exist in their induction, teaching & learning, assessment, and evaluation criteria. Also, limited literature is available to study their curricular structural design. Instead of adopting the new competency-based framework, most have chosen to retain the archaic objective-based curricular model. Unfortunately, with no guidelines from the nascent Pakistan Medical Commission, most programs tend to evolve in the light of the Higher Education Commission’s curriculum recommendations which are based on the older objective-based approach.13Rawalpindi Medical University right from its inception had the vision to develop a University Residency Program for post-graduate studies in Medicine, Surgery, and allied disciplines based on ACGME competency-based curriculum. Under this program, we train hundreds of trainees with regular monitoring via workplace-based assessment and 360-degree feedback forms. These are evaluated by the Quality Enhancement Cell in 6 monthly cycles with feedback provided to the trainees, supervisors, and administration. The trainee is also required to log cases and activities with reflections in their logbooks. Each clinical case is also added to their online portal for record and evaluation. These regular formative tools with monitoring and feedback help the trainee assess their weaknesses, supervisors plan their trainee's progress and administration take decisions for improvement. Formative assessments are done at the end of each year comprising of MCQ, SAQ, and OSCE formats. At the end of the program, a comprehensive summative assessment is also conducted to certify competence.Nine years ago, Wasim Jafri14 wrote that “The competency-based model provides an exceptional opportunity for Pakistani postgraduate medical institutes”. We believe that today Rawalpindi Medical University is a pioneer among the medical sector universities in providing this excellent opportunity to its trainees and supports other partnering universities in developing competency-based curricula

Mining the Medical and Patent Literature to Support Healthcare and Pharmacovigilance

Recent advancements in healthcare practices and the increasing use of information technology in the medical domain has lead to the rapid generation of free-text data in forms of scientific articles, e-health records, patents, and document inventories. This has urged the development of sophisticated information retrieval and information extraction technologies. A fundamental requirement for the automatic processing of biomedical text is the identification of information carrying units such as the concepts or named entities. In this context, this work focuses on the identification of medical disorders (such as diseases and adverse effects) which denote an important category of concepts in the medical text. Two methodologies were investigated in this regard and they are dictionary-based and machine learning-based approaches. Futhermore, the capabilities of the concept recognition techniques were systematically exploited to build a semantic search platform for the retrieval of e-health records and patents. The system facilitates conventional text search as well as semantic and ontological searches. Performance of the adapted retrieval platform for e-health records and patents was evaluated within open assessment challenges (i.e. TRECMED and TRECCHEM respectively) wherein the system was best rated in comparison to several other competing information retrieval platforms. Finally, from the medico-pharma perspective, a strategy for the identification of adverse drug events from medical case reports was developed. Qualitative evaluation as well as an expert validation of the developed system's performance showed robust results. In conclusion, this thesis presents approaches for efficient information retrieval and information extraction from various biomedical literature sources in the support of healthcare and pharmacovigilance. The applied strategies have potential to enhance the literature-searches performed by biomedical, healthcare, and patent professionals. The applied strategies have potential to enhance the literature-searches performed by biomedical, healthcare, and patent professionals. This can promote the literature-based knowledge discovery, improve the safety and effectiveness of medical practices, and drive the research and development in medical and healthcare arena

Teaching Nuclear Medicine

Nuclear medicine (NM) has been taught in the medical program at the University of Bergen (UiB) since 2006. Despite many incremental improvements in content delivery including a full set of online lectures since 2006, my teaching failed to captitative my target audience, leading to disappointing student responses over many years. The new curriculum “Medisin 2015” introduced e-learning/blended learning based on UiB’s new learning management system (LMS) https://mitt.uib.no, while at the same reducing the volume of face-to-face (F2F) teaching. This forced me to redesign my teaching in NM from the ground up. Inspired by team-based learning, I introduced each course module by new succinct online-lectures, followed by an online readiness assessment test (RAT) in the LMS. To engage the entire audience during the F2F sessions, I not only taught with live case in interactive format as under the old curriculum but introduced a classroom response system. Finally, I shifted the focus from transferring knowledge to teaching PET/CT reading competency both in the third and the fifth year. In the following I describe my development as a university teacher and outline my teaching philosophy

How to assess the acceptance of an electronic health record system?

Being able to access a patient’s clinical data in due time is critical to any medical setting. Clinical data is very diverse both in content and in terms of which system produces it. The Electronic Health Record (EHR) aggregates a patient’s clinical data and makes it available across different systems. Considering that user’s resistance is a critical factor in system implementation failure, the understanding of user behavior remains a relevant object of investigation. The purpose of this paper is to outline how we can assess the technology acceptance of an EHR using the Technology Acceptance Model 3 (TAM3) and the Delphi methodology. An assessment model is proposed in which findings are based on the results of a questionnaire answered by health professionals whose activities are supported by the EHR technology. In the case study simulated in this paper, the results obtained showed an average of 3 points and modes of 4 and 5, which translates to a good level of acceptance.The work has been supported by FCT – Fundação para a Ciência e Tecnologia within the Project Scope: UID/CEC/00319/2019.The work has been supported by FCT – Fundação para a Ciência e Tecnologia within the Project Scope DSAIPA/DS/0084/2018

Development and implementation of clinical guidelines : an artificial intelligence perspective

Clinical practice guidelines in paper format are still the preferred form of delivery of medical knowledge and recommendations to healthcare professionals. Their current support and development process have well identified limitations to which the healthcare community has been continuously searching solutions. Artificial intelligence may create the conditions and provide the tools to address many, if not all, of these limitations.. This paper presents a comprehensive and up to date review of computer-interpretable guideline approaches, namely Arden Syntax, GLIF, PROforma, Asbru, GLARE and SAGE. It also provides an assessment of how well these approaches respond to the challenges posed by paper-based guidelines and addresses topics of Artificial intelligence that could provide a solution to the shortcomings of clinical guidelines. Among the topics addressed by this paper are expert systems, case-based reasoning, medical ontologies and reasoning under uncertainty, with a special focus on methodologies for assessing quality of information when managing incomplete information. Finally, an analysis is made of the fundamental requirements of a guideline model and the importance that standard terminologies and models for clinical data have in the semantic and syntactic interoperability between a guideline execution engine and the software tools used in clinical settings. It is also proposed a line of research that includes the development of an ontology for clinical practice guidelines and a decision model for a guideline-based expert system that manages non-compliance with clinical guidelines and uncertainty.This work is funded by national funds through the FCT – Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project PEst-OE/EEI/UI0752/2011"

Improving the learning of clinical reasoning through computer-based cognitive representation

Objective: Clinical reasoning is usually taught using a problem-solving approach, which is widely adopted in medical education. However, learning through problem solving is difficult as a result of the contextualization and dynamic aspects of actual problems. Moreover, knowledge acquired from problem-solving practice tends to be inert and fragmented. This study proposed a computer-based cognitive representation approach that externalizes and facilitates the complex processes in learning clinical reasoning. The approach is operationalized in a computer-based cognitive representation tool that involves argument mapping to externalize the problem-solving process and concept mapping to reveal the knowledge constructed from the problems. Methods: Twenty-nine Year 3 or higher students from a medical school in east China participated in the study. Participants used the proposed approach implemented in an e-learning system to complete four learning cases in 4 weeks on an individual basis. For each case, students interacted with the problem to capture critical data, generate and justify hypotheses, make a diagnosis, recall relevant knowledge, and update their conceptual understanding of the problem domain. Meanwhile, students used the computer-based cognitive representation tool to articulate and represent the key elements and their interactions in the learning process. Results: A significant improvement was found in students’ learning products from the beginning to the end of the study, consistent with students’ report of close-to-moderate progress in developing problem-solving and knowledge-construction abilities. No significant differences were found between the pretest and posttest scores with the 4-week period. The cognitive representation approach was found to provide more formative assessment. Conclusions: The computer-based cognitive representation approach improved the learning of clinical reasoning in both problem solving and knowledge construction

Assessment of General Practitioners' Performance in Daily Practice

The EURACT Performance Agenda (EUPA) of the European Academy of Teachers in General Practice/Family Medicine (EURACT) is the third paper in a row following the European Definition of General Practice/Family Medicine (WONCA Europe) in 2002 which identified 6 core competencies and 11 abilities every general practitioner (GP) should master, and the EURACT Educational Agenda in 2005 which provided a framework to teach the core competencies by setting learning aims and monitoring their achievement. Performance (in contrast to competence) is understood as the level of actual performance in clinical care and communication with patients in daily practice. Small groups of EURACT Council members from 40 European countries have discussed and developed EUPA since 2007. EUPA is a general, uniform and basic agenda of performance elements every GP masters in daily practice, applicable and adaptable to different countries with different systems. It deals with the process and result of actual work in daily practice, not with a teaching/learning situation. EUPA discusses in depth the psychometrics and edumetrics of performance assessment. Case vignettes of abilities in GPs’ daily practice illustrate performance and its assessment in every chapter. Examples of common assessment tools are workplace-based assessment by a peer, feedback from patients or staff and audit of medical records. EUPA can help to shape various performance assessment activities held locally in general practice/family medicine, e. g. in continuing professional development cycles, re-certification/re-accreditation/licensing procedures, peer hospitation programmes and practice audit programmes in quality management. It can give orientation for self-assessment for reflective practitioners in their continuing professional development. The EURACT Performance Agenda (EUPA) encourages general practitioners to initialize performance agendas adapted to their national health system to further strengthen the role of general practice/family medicine in their country