Medical Education Part 2      (Part I)
 
by Marjorie Lazoff, MD
Emergency Medicine
Philadelphia, Pennsylvania
Medical Editor
Medical Computing Today

 
accepted for publication in Medical Computing Today July 1997
updated December 1997
 
Originally published in edited form July 1997 in Medical Software Reviews.


Sections
Part I:
Educational Resources (multimedia - CAI - text - multiuser) - CME
Part II: Educators - Computers in Med Ed - Med Ed Software - Institutions - Non-Academic - List of lists


Sections Resources for Medical Educators
Many regional, national, and international medical education projects use the Web to coordinate efforts across distances, collect and share information among their members, and share their philosophy and work with other medical educators. The American Association of Medical College's (AAMC) Group on Educational Affairs (GEA) and two of its four regional organizations -- Central, and Western -- are on line with primarily group-related information. Several of GEA's Special Interest Groups (SIGs) are on line, but only Computers in Medical Education is a fully developed online resource (see below).
 
AAMC's Academic Medicine has online links, articles, and other information regarding, for example, minority, community and student research programs, and a joint managed care/academic medical education initiative. Another AAMC project, The Center for the Assessment and Management of Change in Academic Medicine, offers information about its project involving 14 representative academic medical centers.
 
The Association of Program Directors in Internal Medicine's The Educational Clearinghouse for Internal Medicine is a dated but well-referenced peer-reviewed compendium of (offline) articles, books, and locally produced educational materials. The Society of Teachers of Family Medicine provides administrative information and abstracts from its journal Family Medicine. Online administration information is available for The Association for Surgical Education, a group representing U.S. and Canadian medical schools. The National Academy on Women's Health Medical Education promotes incorporating Women's Health in all levels of medical education. Those interested in the field of health education should check out NYU's Health Education Professional Resources.
 
Educating Future Physicians for Ontario is a collaboration of five Ontario, Canada, medical schools whose Web site showcases newsletters and other organization information. Across the Atlantic Ocean, the Association of Medical Education in Europe has an administrative site on line. The World Federation for Medical Education lists news, conferences, and other professional activities of interest to all medical educators. Administrative information is also available regarding The Network of Community-Oriented Educational Institutions for Health Sciences, which is supported by the World Health Organization. A new nonprofit independent organization with an international membership, Basic Science Education Forum is developing a promising new Web site.
 
Two stellar medical education resources: The Center for Instructional Support (CIS) is a well-organized listing of off- and online resources for academic physicians and other health care educators. Standout sections include information on medical education journals and organizations, most of which are not yet online. Look here too for a listing of educational funding sources and a nicely annotated Links to Other Sites. Electronic journals are rarely as well organized and authoritative as Medical Education Online (MEO). The heart of this all-text quarterly journal is well-referenced articles reflecting all aspects of medical education, but it also has excellent lists of resources for medical educators.
 
Several academic centers describe their research and training programs in medical education online. Among the most popular: Thomas Jefferson University's Center for Medical Education Research and Policy; the University of Washington's Center for Medical Education Research; the University of Illinois at Chicago's Educational Leadership Programs for Health Professionals; the University of North Carolina at Chapel Hill's Center for Research in Medical Education Program; Dartmouth's Center for Evaluative Clinical Sciences; and Michigan State University's Office of Medical Education Research and Development.
 
 
Sections Computers in Medical Education
These sites specifically address the technology and integration of medical CAI, videodiscs, tele-education and distance learning, and virtual reality within a medical school curriculum. This technology, new to mainstream medicine, still lies close to its roots within academic departments of medical informatics or comparable business ventures.
 
It is no surprise that many of these sites emphasize the incorporation of medical informatics into the medical school curriculum. Their reasoning is compelling: biomedical information management is a practical skill applicable not only to understanding and applying computer technology but also to the diagnostic and management skills of clinical medicine. For example, evidence-based medicine is made possible by the search and archival features of today's medical database, together with sophisticated analysis using statistical applications and analysis. The revolutionary aspect of medical informatics is less the technology than how information management will fundamentally change our approach to patient care.
 
Those interested in this subject have several online articles to reference: Medical Informatics Meets Medical Education, an article written in 1995 by Edward Shortliffe, MD, PhD, and Director of Stanford's Medical Information Sciences Training Program (CAMIS); Drs. Berner and Boulware from the University of Alabama School of Medicine coauthored Medical Informatics for Medical Students: Not Just Because It's There; IAIMS at University of Washington's Learning in Hyperspace is a practical article relating several learning theories to Web education. Web based teaching -- a Medical Viewpoint posted in May 1997 by author Sean Hickey of Mater Hospital, Ireland, and Director of the Institute of Healthcare Informatics; Computer Education in Emergency Medicine Residency Programs described a questionnaire survey conducted by Dr. Barbosa, et al., out of the University of Illinois at Chicago; the University of Mississippi's Gary Theilman, PharmD's Distance Learning via the Internet is a clever 1996 slide show with audio plug-in.
 
AAMC's GEA SIG in Computers in Medical Education runs the gamut, from curriculum and faculty development and management to medical informatics and computer literacy to student-oriented computer applications. Its no-frills, all-text, menu-laden interface buries layers upon layers of wonderful links and information. To those interested in the practical applications of computing, this is a site to get lost within.
 
Australia's Monash University has posted Technology in Medical Education, a content rich hypertext guide to basic interactive multimedia, CAI, and Web applications for medical education. Educators interested in learning specifically about testing using computers, the Web or tele-education will find the University of Iowa's working document on the Evaluation of Test Management and Delivery Systems helpful. Included are a checklist of practical criteria with which they will assess a number of software products, and an excellent list of online references. The DR-ED user group maintains a running summary on The Debate over Student Computer Purchase Requirements. In 1996 only two medical schools required its medical students to have personal access to a computer; as of June 1997, nine medical schools had such a requirement.
 
The University of South Florida's Medical Informatics is a comprehensive online introductory course. Stay clear of Fun Stuff and Miscellaneous, and use either the excellent Overview site map or Course Contents' image maps. Links to other sites are included at the end of most sections. Weaknesses include the seemingly arbitrary starring of selected links, a plethora of random graphics against an otherwise well designed and sophisticated image map, and lack of scholarly references on each subject.
 
A number of computer-related projects in medical education share their vision and results online. A WWW Based Distance Education Programme describes activities within the Virtual Study Center (VSC), a consortium of Dublin universities and hospitals. The University of Leeds heads a consortium of English universities supporting BioNet, a project to mainstream Internet technology into biology and preclinical medicine instruction. The site offers interactive teaching projects online and as downloadable software. Medical College of Virginia's Computer-Based Instruction Lab has a full Web site sharing its philosophy and listing their medical education resources, including its newsletter. Medical Informatics Curriculum Survey Site is a work-in-progress project by medical student Jeremy Espino. It lists computer requirements and official use from a number of medical schools; contact names are included.
 
The Web showcases computers in medical education from a number of perspectives. Computers in Healthcare Education Symposium, a joint conference by Thomas Jefferson University and Health Sciences Library Consortium, offers four years of its respected symposium abstracts and papers online. The UCLA MedNet site Technology Transfer Innovation includes links to research within UCLA in medical education, among other health sciences. Stanford University's SUMMIT also describes its research and computer development in medical education and informatics. John McNutley, MD, of Loyola University showcases his Spring 1997 students' computer projects in medical education on line. Most have limited utility as educational sites and at least one site is clinically inaccurate, but these students' laudable efforts should be of interest to other educators teaching or creating similar projects. One project, a java-scripted Online Clinical Calculator is very well conceived (if not wholly intuitive) and seems to work fine.
 
The University of Utah's Spencer S. Eccles Health Science Library's well regarded Slice of Life is a nonprofit project developing multimedia applications for use in health sciences education. The site includes further information about the project, its annual workshop on multimedia and interactive computer applications, and an online catalog. The Yale School of Medicine's Center for Advanced Instructional Media (C/AIM) has a beautiful Web site housing some of the best medical art on the Web: look under Gallery. They spill some of their secrets in the Web Style Manual, now in its second edition. Sadly, none of their multimedia medical educational projects is on line. Similarly, the University of Michigan's Learning Resource Center showcases its wonderful resources by description and order form.
 
 
Sections Medical Education Software
Dozens of free medical software products can be downloaded from WWW sites. Most are labor-of-love or precommercial versions made available by their creator/ developers or organizations. Please note that information regarding medical education software is limited to what appears on their Web sites; the software itself has not been reviewed. Those interested in commercial medical education software products are referred to Yahoo's Medical Education Software, which lists 37 online companies, or to one of several online software databases.
 
AAMC's Computers in Medical Education Task Force on Medical Education Software Resources has no listings at present, but describes its ambitious project and invites reader participation. The University of Aberdeen and Leeds' BioNet offers a Software Compendium covering basic and clinical sciences, information technology, and statistics, many of which use (and hence require) Toolbook. At time of writing NYU's Resources for Health Education -- Software has two offerings: NUDIST Qualitative Analysis Software, and EMPOWER, for teaching and implementing community health projects. The Centers for Disease Control site has reputedly excellent epidemiology and statistical software that can be freely downloaded. Included here is also at least one interactive learning program. Epidemiology, statistical, and new problem-based learning software is available for downloading from MEO's Resource Section.
 
The University of California at Irvine's MED-ED Software Archives has a large assortment of downloadable programs dating back to 1992. Some software is available from Stanford University's Courseware Distribution Site. Anesthesia freeware is available from GASNET's Software Directory. For those who love surprises, many unidentified medical programs are listed in the _Brazilian Medical Software Archives File Transfer Protocol (FTP) site; everyone else should first look at the program descriptions. Fans of the Newton handheld palmtop should find Newton Medical Web Site useful.
 
The Web has individual software packages that can be freely downloaded. For example, Anthony Chiaramida, MD's Juxtaposition of Several Electrocardiographic Postulates and Heurisms (JOSEPH) is a DOS-based freeware file of EKG tutorials and drills used as a teaching adjunct at Robert Wood Johnson. The University of Virginia's Dept. of Radiology offers Windows freeware in radiology differential diagnosis, and Boards preparation. AlgoSim: The Difficult Airway Algorithm Tutorial/Simulator is freeware created by Robert C. Jones, MD, George J. Sheplock, MD, and Michael Goldstoff, MD
 
Those who create and design medical educational programs for the Web may be interested in WebCT. Their nonprofit arrangement: download the software and use it freely, and pay only if the result is a finished program used by students.
 
Andrew Miller, MD, a neurosurgeon at Cornell, has made public NeuroModeller, beta release freeware that allows surface 3D reconstruction of medical images stored either in DICOM or BMP formats. Software can be downloaded from this site, as can a sample screen shot and a large amount of background information.
 
Finally, as one of the first ventures into professional testing, Microsoft has its logo on Primum, a computer-based Case Simulation, which the National Board of Medical Examiners (NBME) plans to introduce as part of its USMLE Step 3 examination in Fall 1998. Information about the simulations÷not the program itself÷and other NBME computer-based training projects is available on line.
 
 
Sections Medical Schools & Post-graduate Training Programs
All U.S. and many international medical schools, and an increasing number of residency and fellowship programs, have a presence on the Web. At a minimum these sites house basic admission and administrative information, but many sites take advantage of online benefits such as e-mail correspondence with prospective applicants, more timely information updates, marketing strategies, and opportunities to share resources and opportunities with an international audience. Disadvantages include the expense of Web site design and upkeep if no one on staff is computer literate, and being judged by the quality of one's Web site rather than the academics of the program and staff. Applicants should remember that Web site design and upkeep do not necessarily correlate with the strength or weakness of the school or department's medical computing activities.
 
AAMC Medical Education section lists Accredited Medical Schools of the U.S. and Canada alphabetically, with links to their home pages and e-mail addresses. On line specialty organizations often link to U.S. programs, such as AAFP's Family Practice Residencies on the WWW and SAEM's Catalog of Emergency Medicine Residencies. Family Medicine lists a number of Foreign Medical Schools, and for the price of a free registration Avicenna offers a nice listing of international medical schools and medical centers. Mike Woo-ming, MD's The Residency Page gives links to many U.S. residencies, arranged by specialties. Another list of U.S. residencies with Web sites, with an emphasis on osteopathic programs, is Residency Programs on the WWW!. This site uses frames to provide seamless navigation. Residency Programs illustrates how a well-designed personal home page can be helpful to others applying to Midwestern medical, neurology, or psychiatry University programs.
 
Career Insights MD offers a popular search engine of all programs by specialty and state; choose Residency Database off the left-side frame. It also contains a separate reference specific to those programs with Web sites and/or online comments directed at prospective applicants. Although updated since last reviewed, the list is still not as comprehensive or accurate as one would anticipate; for example, University of Pennsylvania and Temple University are not listed among Emergency Medicine residency programs, and Allegheny's program is still listed by its old name everywhere.
 
 
Sections Non-academic Resources for Students & Residents
These sites contain professional and personal information and resources, fostering comradeship and support among peers regionally, nationally, and internationally. For students and residents, three Web sites are most important: The Web site of the American Medical Student Association contains an active bulletin board and resources for medical students. Its international offerings and fine graphics make it a prototype for comparable physician organizations. Anglophiles will love the Student B.J.. Its Web site offers a few articles from the monthly journal online, along with the cutesy-titled but excellent monthly annotated list of Web sites, Net.Philes, listed under Links. Students with an international outlook may also be interested in the International Federation of Medical Students' Associations and Student Network Organization.
 
AAMC's Medical Education provides a reference of Residency Issues, including information about national organizations and several articles in the style of position papers.
 
As the online resource of the print publication for medical students contemplating residencies and specialty choices, Career Insights MD maintains more than just the residency listings described above. Also, Al Davies, MD, director of the Critical Care Medicine Training Program and a member of the Internal Medicine Residency Selection Committee, Baylor College of Medicine, advises medical school, residency, and fellowship applicants in a series of articles on Mediscene, his family business site.
 
Medical students construct and maintain several excellent sites for their own use. The Interactive Medical Student Lounge is a popular and well-designed site filled with resources, including links to many student and health bulletin boards. Stanford's MedWorld is another well-regarded site. It opens with a random generated group of clinical medical questions, which once properly answered grants entry to the site; Explorer visitors need to scroll down the blank-appearing page to access their link. At the time it was developing an interesting new project called Worldview. Its technically impressive bulletin board fortunately continues to post.
 
Medstudents, a student-created and run Virtual Medical Journal from The Federal University of Rio de Janeiro (Brazil) offers forgettable instructional articles and case studies but has a reasonable medical procedures section and nonacademic information for medical students. It makes excellent use of frames by having on one page the linked table of contents from the latest issues of the New England Journal of Medicine, Annals of Internal Medicine, and The Lancet. An outstanding online reference for all physicians at all levels of training, it has the interesting side-effect of showcasing NEJM's generosity against Annals' and The Lancet's more stingy online offerings. The ambitious but over designed National University of Singapore includes a Cyberspace Hospital, CyberMedical School, and Student Lounge.
 
An enterprising group of medical students and residents that writes advice books for its peers has designed a clean, attractive Web site Student 2 Student to promote its work and share information of common interest. Its NetForum is quite active, and has good links.
 
A number of labor-of-love home pages also offers students and residents valuable insight and links. Last updated almost a year ago, Mike Woo-Ming, MD's Home Page is a casual site with several informative sections, including a residency page, a nice medical software reviews section, and some medical links. Saabry's USMLE Home Page offers information about U.S. medical licensure and residency from the author's perspective, an otherwise incognito international medical graduate. Nice features include a list of e-mails and a java-programmed chat line to contact others at various stages of application. Non-U.S. medical students, residents, or physicians wishing to train in the U.S. may find helpful the many Web links on IMGWeb Residency. New features include IMGs on the Web.
 
Charles W. Powell, MD's The Mature Medical Student is a mixture of personal reflections and online resources. Premedical students will appreciate the efforts of Michael Malloy, MD, in creating Premedical.com. The site highlights a survey of MCAT study resources and a list of pre-medical student web sites, including the well-regarded Kaplan courses and Princeton Review. Erick's Guide to Medical School Admission seems a favorite among Web applicants, and has a wonderful Web list of other sites of interest to premedical students. PremedEd is a thoughtful labor of love home page by F. Craig R. Littlejohn. ChronoNet's bookstore arrangement with Amazon is an interesting idea, but the selections need to be expanded. Another example of a well-meaning personal home page, Medical School Apprentice, displays articles for premedical and medical students that unfortunately includes misinformation alongside informative advice. Like most personal Web pages that go beyond sharing one's experiences, references and review of content by professionals (physicians who sit on medical school admissions committees, for example) would lend credibility and balance to this laudable project.
 
 
Sections List of Medical Education Lists
With the plethora of online medical education resources increasing daily, those with a professional or personal interest in medical education are strongly encouraged to browse and discover their own favorite resources. Alas, there is also no paucity of medical lists to assist users in their search.
 
The Web list of lists, WWWVirtual Library:Bioscience:Medicine appears to have been absorbed under the Oregon Health Sciences University's well-regarded CliniWeb project. Two familiar medical lists that link to many medical education resources are Emory University's MedWeb section on medical education (once there try related Keywords) and Medical Matrix's Web sites on basic medicine and other related menus or search engine terms.
 
Readers may prefer to search the Web using Sweden's Karolinska Institute Library, Oregon Health Sciences University's CliniWeb, England's OMNI (also check out their experimental search engine, Harvest), Medical World Search, or Stanford University's MedBot, which permits multiengine searches using both general and medical text and graphics resources. A favorite online Medline search engine is NIH's PubMed, or search 23 online medical journals at SilverPlatter's WebMedLit.
 
Other site lists are specific to medical education. MEd Guide's Medical Education on the Internet is one of the more complete listings. Its medical case presentation listing is particularly impressive.
 
Meducation is a nonprofit organization with a stated primary interest in medical education software, but with a comprehensive listing of medical education sites. Sites are divided into about a dozen categories, so the massive listings can be quickly referenced. The user rating system of sites is an interesting idea that proves inaccurate in practice. As mentioned above, interested users are encouraged to browse AAMC's Computers in Medical Education. The Virtual Hospital's Annotated List of Resources for Health Care Providers is particularly valuable for its multimedia texts, teaching files, and case presentations which, while extensive, does not venture outside the University of Iowa. Northwestern University's Medical Education Sites is an insightful annotated listing of preclinical and clinical sites written for students by students. The University of Tennessee's medical students created a wonderful Medical Education Resources for first and second year students, which lists outside medical education links alongside UTenn's fine resources. The University of Virginia's mistitled Medical Education Software from Other Schools also lists many online resources for students and house staff.
 
A gathering of Online case studies is provided by SilverPlatter's Internet Library. An excellent gathering of free online medical textbooks is available on Michael P. D'Alessandro, M.D.'s MedicalStudent.com.
 
Medical education webmasters familiar with Webrings might consider joining the Medical Education Ring, which presently has 10 members.
 
A significant and growing web medical education reference is online versions of paper journals. MEd Guide's Medical Journals is an exhaustive listing of electronic and print medical journals with Web sites. Medical Journals from Doctor's Guide to the Internet is another useful resource, although the links are to an intermediate reference rather than the journal itself. Stanford University's Biomedical and Clinical Journals Online was one of the best comprehensive lists, but is now outdated. Medsite Navigator's clinical journal listings -- the site also provides an equally comprehensive basic science journal listing -- looks more recent, but isn't annotated. SilverPlatter's Medical Journals is a nice annotated reference that has been recently updated to good effect. Northwestern's Galter Electronic Journals is a nicely presented list of online journals, most of which are from Medscape.
 
Disclosure: The author has co-created a Web section on a not-for profit site (NCEMI) which was mentioned in another context in this review. The author has no relationship to the particular section mentioned.
 
 
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