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Web-based Case Simulations for a Primary Care Clerkship


Section Editor(s): ANDERSON, M. BROWNELL

Annual Feature: in Progress: Reports of New Approaches in Medical Education: Applications of the Internet

Association of American Medical Colleges


Inquiries: Henry Sakowski, MD, Department of Medicine, Creighton University, 601 N. 30th St., Suite 5850, Omaha, NE 68131; e-mail: 〈〉.

    Objective: The increasing use of community clinics and hospitals for educating medical students has created obstacles to delivering a uniform curriculum to learners who may be spread throughout a community and beyond. It may not be feasible to bring students together for regular didactic teaching sessions. Nor is it reasonable to expect community preceptors to provide all the teaching necessary to ensure students' mastery of the curriculum. Innovative techniques are needed to augment clinical teaching in this new environment.

    Description: To address this problem, we developed a Web-based problem-centered case series dealing with complaints and conditions commonly encountered in a primary care clinic setting. Using FrontPage 98 Web-authoring software, we created six interactive case simulations and posted them on the Web. (They can be viewed at 〈〉.) Placing curricular materials on the Web enables learners to access the material at their convenience and to work at their own paces.

    Each case displays the patient's history and physical examination and includes images of physical findings, x-rays, and/or EKGs. After the case presentation, questions pertaining to the case are presented, along with answer pages. Each case also incorporates links to relevant medical sites on the Web, including online journal articles, clinical guidelines, and pharmacopoeia. In addition to improving students' education on the primary care clerkship, this project's intent was to foster self-directed learning by exposing students to the vast array of medical information available on the Web.

    Discussion: We pilot tested the case simulations with students rotating on the primary care clerkship during the second semester of the 1999–2000 academic year. A survey designed to gather student feedback on the case simultations found that the students felt they were an effective (88%) and efficient (92%) method of learning. The students also felt that the case links helped to familiarize them with medical resources on the Internet (96%), and they reported that they were more likely to use these resources in the future (88%). A survey before and after the rotation showed significant improvement in students' confidence in dealing with issues related to the case simulations (Z statistic = 4.4, p < .001) after the clerkship. In addition, there was significant improvement in the students' performances on multiple-choice test items dealing with the subject matter in the case simulations (pretest median 46.7%, posttest 83.3%; Z statistic = 4.2, p < .001)

    When the performance of the students who had received the Web-based case series was compared with that of a control group of students who had received the traditional curriculum for the clerkship, no significant difference in the confidence survey or the knowledge assessment was observed. The small numbers in the sample most likely impaired our ability to detect a difference. A larger study of the effect of the case series on student performance is planned. New cases simulations are also being developed.

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    Section Description

    Annual, Peer-reviewed Collection of Reports of Innovative Approaches to Medical Education

    © 2001 Association of American Medical Colleges