Publications

Berman NB, Fall LH, Maloney C, Levine DA: Computer-Assisted Instruction in Medical Education: A roadmap to increasing CAI implementation. Advances in Health Sciences Education 2008; 13: 373-383.

This reflection is based on the premise that clinical education can be improved by more widespread use of computer-assisted instruction (CAI) and that a roadmap will enable more medical educators to begin using CAI. The rationale for CAI use includes many of its inherent features such as incorporation of multimedia and interactivity yet the use of CAI remains limited, apparently because educators are not convinced about the role for CAI. Barriers to CAI use are discussed including misinterpretation of the literature for CAI effectiveness; a disconnect between CAI developers and the educators who make decisions about CAI use; and the paucity of knowledge regarding how to integrate CAI effectively into clinical education. Specific roles for CAI in undergraduate and graduate medical education can include improving uniformity of instruction, providing documentation of exposure or competence, improving the learners' educational experience or outcomes, and assessment that is matched to learning. Funding for CAI remains an important barrier but the authors believe that this will be overcome when use of CAI becomes more widespread.

Fall LF, Berman NB, Smith S, White CB, Woodhead JC, Olson AL: Computer-assisted Learning In Pediatrics Project (CLIPP): Multi-institutional Development and Utilization of a Computer-assisted Learning Program for the Core Pediatric Clerkship. Acad Med. 2005; 80:847–855.

Computer-assisted instruction (CAI) holds significant promise for meeting the current challenges of medical education by providing consistent and quality teaching materials regardless of training site. The Computer-assisted Learning in Pediatrics Project (CLIPP) was created over three years (2000-2003) to meet this potential through multi-institutional development of interactive Internet-based patient simulations that comprehensively teach the North American core pediatrics clerkship curriculum. Project development adhered to four objectives: (1) comprehensive coverage of the core curriculum; (2) uniform approach to CAI pedagogy; (3) multi-institutional development by educators; and (4) extensive evaluation by users. Pediatrics clerkship directors from 30 institutions worked in teams to develop a series of 31 patient case simulations. An iterative process of case content and pedagogy development, case authoring, peer review, and pilot-testing ensured that the needs of clerkship directors and medical students were met. Fifty medical schools in the United States and Canada are presently using CLIPP. More than 8,000 students have completed over 98,000 case sessions, with an average of 2,000 case sessions completed per week at this time. Each CLIPP case has been completed by more than 3,000 students. The current cost of CLIPP development is approximately $70 per student user, or $6 per case session. The project's success demonstrates that multi-institutional development and implementation of a peer-reviewed comprehensive CAI learning program by medical educators is feasible and provides a useful model for other organizations to develop similar programs. Although CAI development is both time-consuming and costly, the initial investment decreases significantly with broad use over time.

Berman NB, Fall LH, Smith S, Levine DA, Maloney C, Potts M, Siegel B, Foster-Johnson L: Integration Strategies For The Use Of Virtual Patients In The Clinical Clerkship. Academic Medicine July 2009; 84 (7) 942-949.

Purpose: To explore students’ perceptions of virtual patient use in the clinical clerkship and develop a framework to evaluate effects of different integration strategies on students’ satisfaction and perceptions of learning effectiveness with this innovation.

Method: A prospective, multi-institutional study was conducted at six schools’ pediatric clerkships to assess the impact of integrating Web-based virtual patient cases on students’ perceptions of their learning during 2004-05 and 2005-06.  Integration strategies were designed to meet the needs of each school, and integration was scored for components of virtual patient use and elimination of other teaching methodologies. A student survey was developed, validated, and administered at the end of the clerkship to 611 students.  Data were analyzed using confirmatory factor analysis and structural equation modeling.

Results: A total of 545 students (89%) completed the survey.  Overall student satisfaction with the virtual patients was high; students reported that they were more effective than traditional methods. The structural model demonstrated that elimination of other teaching methodologies was directly associated with perceived effectiveness of the integration strategies. A higher use score had a significant negative effect on perceived integration, but a positive effect on  perceived knowledge and skills gain. Students’ positive perceptions of integration directly affected their satisfaction and perception of the effectiveness of their learning.

Conclusions: Integration strategies balancing the use of virtual patients with elimination of some other requirements were significantly associated with students’ satisfaction and their perceptions of improved knowledge and skills.

Berman NB, Fall L: The Computer-Assisted Learning in Pediatrics Project (CLIPP): National Consensus and Development of a Comprehensive Computer Assisted Instruction Program

Presented at the American Academy of Pediatrics 2002 National Conference and Exhibition, October 18-23, 2002.

Inga Hege, Martin Adler, Markus Kernt and Martin R. Fischer, University of Munich, Medizinische Klinik Innenstadt, Germany; Norman Berman and Leslie Fall, Dartmouth Hitchcock Medical Center, Lebanon, NH USA: Visualizing the Hypothetical-deductive Process: A Web-based Mapping Tool for the Case-based Learning System CASUS

Presented at the Slice of Life/Computers in Health Care Education Symposium, June 18-22, 2002, Toronto, Canada.

Berman NB, Fall L: Integrating Computer Assisted Instruction (CAI) Into the Pediatric Clerkship

Presented at the Council on Medical Student Education in Pediatrics Annual Meeting, March 15, 2002.

Berman NB, Fall L: The Computer-assisted Learning in Pediatrics Project (CLIPP): National Consensus and Development of a Comprehensive Computer Assisted Instruction Program

Presented at the Slice of Life/Computers in Health Care Education Symposium, August 1-4, 2001, Munich, Germany.