Advanced Medical Therapeutics (AMT) for Senior Medical Students
The University of Michigan Advanced Medical Therapeutics (AMT) Course is a completely online course for fourth year medical students. The four week course was established in order to allow students to interview for residency while finishing their medical school curriculum. It was initiated in 2007 and is now a required course for all medical students. The aim of the AMT course is to supplement the senior medical student’s knowledge of medical therapies including medications, surgeries, radiation interventions and other (even non-traditional) interventions. The course is completely online, self-paced, and students are encouraged to read the medical literature with a critical eye. The course is broken up into four 1 week blocks and has 4 components; 1) a weekly series of case-based modules (e.g. cardiology), 2) weekly seminars, 3) weekly on-line, open-book quizzes, and 4) a student research project submitted on-line at the end of the course.
Each week the students must review online modules in several different areas (e.g., cardiology, dermatology). The modules are case-based with follow-up questions and associated resources. Questions are answered in a text format, however each question is also answered by a content expert (e.g. cardiologist) in a 1 -1.5 minute video clip.
The 1 hour course seminars are given online (using Adobe Connect) by UM medical school faculty. Seminars focus on controversial therapeutic issues and on how to critically read scientific articles. Students can sign in from anywhere in the US. Sessions are made more interactive by using a polling function and students are encouraged to actively participate by typing in questions or comments.
The AMT students must complete online quizzes each week. These are open book and designed to challenge the students to delve into the online (or paper) literature. Scores and explanations are available immediately upon answering the quiz questions.
Each student must complete a project on medical therapeutics and submit a powerpoint or Word document online in the third week of the course. In the fourth week each student must evaluate 4 other projects and make confidential remarks about the material. Each project is also graded by the AMT course directors. Students are encouraged to make constructive comments based on the content relevance, presentation, and the soundness of the data.
Cary Engleberg (Faculty, Course Director, Course Designer, Writer, Editor), Chris Chapman (Instructional Designer, Course Designer, Producer), Sandro Cinti (Faculty, Course Director), Casey White (Faculty, Assessment), Aki Yao (Graphic Artist), Jason Engling (Programmer), John Westfall (Media Developer), Steve Lambert (Programmer, Program Designer), Joel Purkiss (Assessment and Evaluation), Cynthia Sharp (Online Testing), Brenda Chism (Online Testing), Jianfeng Weng (Online Testing), Roger Burns (Technical Support), Joseph Fantone (Faculty, Course Designer).
The AMT course was developed to allow 4th year medical students to complete a course while they were traveling and interviewing for residency.
Adult learning principles (e.g., self-paced learning design, authentic problems, open-ended questions, multiple media modalities, etc.) were employed in the instructional design of the course. The over-arching learning objective of the course was to create a course that would promote the development of the clinical reasoning and problem-solving skills of the students (as opposed to rote memorization of fact).
Initially (2007), there were both online and an onsite seminar components offered in the course. Given that most students could not participate in all the seminars, Adobe Connect was eventually used to present all of the seminars online. Students who miss these can see the seminar later via recordings.
The project design was recently changed (2009) to allow students to comment on their classmates’ projects in accordance with trends in peer-to-peer learning and teaching. This enhancement to the course has been well received by the students and the comments are intelligent and appropriate.
We have continued to add content in the topics section with supplementation of literature and addition of new guidelines. Content experts are asked to review their modules each year and make appropriate changes.
Recently (2009-2010) we have been working with our counterparts in Croatia at the University of Zagreb to create a similar course there and a pilot course will be launched in the upcoming year. We intend to continue this relationship.
A course site in CTools is used to host the course. The course itself contains multiple components and applications that are integrated and made accessible to learners through the CTools site interface.
The course components are a combination of CTools tools (e.g., announcements, access control and authentication, assignments and resources), HTML (the course information pages, over 90 interactive web based cases, and supplemental resources were programmed in HTML), and applications (e.g., Adobe Connect and Sitemaker). The HTML files are hosted on the CTools site in the resources area, which allows CTools to act as a web-server. A single sign-on allows users to access all of the course materials via the CTools site.
Peer-to-peer teaching methodologies are used in the project component of the course. Here students are required to review and comment on other peer projects.
The interactive case design utilizes a combination of formalized feedback through text and links to reference articles, clinical guidelines, and instructional PowerPoint presentations. A conversational style of feedback is also used throughout the cases via short video case and question vignettes.
Finally, students are expected to take responsibility for their own learning. For example, when working through the case-based exercises, students are provided with short text and/or video feedback answers to the case questions. Most of the feedback to the questions provides links to additional resources. At each one of these learning junctures it is up to the student to decide (based on the level of their understanding of the material and their personal interests) to continue with the case(s) or branch out to the resources to deepen their knowledge.
One requirement of the course is for students to electronically submit a short research project on a therapeutic topic of their choice to the course system.
Once the projects are submitted, each student is required to review four projects and make constructive comments (based on the content relevance, presentation, and soundness of the data) about each project electronically. The comments can then be viewed by each of the project creators (the names of the students providing the comments are not displayed).
The online seminars (3-4 per course offering) are conducted with Adobe Connect. Using this software, students can communicate with each other and the presenter in real-time via text chat. Additionally, the presenter uses the polling feature of the software to interactively solicit class opinion and answers to questions. The poll results are displayed to the students in real-time.
From a visual standpoint the course is clearly organized and structured.
A course home page is visually arranged into three main sections: 1) Course Description with a link to a student perspective of the course (video), a course introduction (text and video), online modules overview (text and video), individual research description (text and video), and grading criteria (text and video), 2) Syllabus with links to each of the four weekly pages where the bulk of the content is accessed, and 3) Misc (seminar schedule and materials, previous student projects, quizzes, and quiz scores).
Additionally, the CTools interface provides easy access to course announcements, course assignments, and the “projects tool.”
The case materials contain feedback in text and video formats. Links to a reference library for each of the course topics are provided from inside each of the case feedback screens (usually a direct link to a suggested resource along with a link to the reference library for that particular topic) as well a links to the topic reference libraries from the navigation menu at the top of each screen. The reference materials are in multiple styles and formats (i.e., practice guidelines in pdf format, PowerPoint lectures, journal articles, etc.).
A course page clearly communicates the course objectives via text links and short video vignettes.
Prompt feedback is used throughout the course (e.g., in the interactive case problems and the online quizzes, etc.).
Active learning techniques are used throughout the course (e.g., web-based cases with authentic problems, problem-based quizzes and a research project). Multiple teaching and learning modalities are employed throughout the course (i.e., video vignettes, images, text, live voice and audio, PowerPoint presentations, journal articles, etc.).
Although the course is information intensive, the instructional objective of the Course Directors was to develop clinical reasoning and problem solving skills in students. To accomplish this, students are provided with authentic case problems in the web-based quizzes and topic cases, and allowed to solve the problems in “open-book” fashion, using a variety of provided resources as well as being able to access the Internet, texts, etc.
Students are accessed across multiple methods: quizzes (60%), projects (20%), and seminar attendance (20%).
Students are required to provide peer-to-peer feedback via reviews of course projects. Peer-to-peer feedback also takes place in the course seminars via text chat and polling.
Student projects are created with PowerPoint. Exceptional student projects are added to the course resources for future course offerings. Some students (with exceptional projects) are also given the opportunity to present their projects to the class via Adobe Connect as part of the seminar series.
The course look and feel is well organized and easy to use. Visually simple, yet attractive, the intent of the design is to keep extraneous overload to a minimum to allow students to focus on learning and making intelligent decisions about their use of the site materials. Student evaluations of the course clearly reflect the high quality of design and usability of the course.
For the 2009-2010 AMT course evaluation, students were asked to respond to the following statement via a Likert Scale (1=Strongly Disagree to 5=Strongly Agree): “All of the on-line course material was easy to access and navigate.” The mean response was 4.37 with a standard deviation of 0.74 (N=105).
Additionally, using the same Likert Scale, students (N=105) also responded to the following statement: “The technology in this computer-based course worked well.” For this item, the mean was 4.54 and the standard deviation was 0.62.
Various types of media (i.e., video, text, images) and modalities (i.e., interactive cases, didactic materials, web conferencing, announcements, and electronic commenting) are used throughout the course to support student learning throughout the various course components and activities.
Because the course is delivered in the CTools environment, students are very familiar with this technology due to the fact that they use CTools throughout their medical school career. Therefore, students do not need a lot of support in using the course. However, in case of technical problems, a link to an electronic help desk is provided on the main page of the course.
Questions or problems addressed to the help desk cue are normally handled within 30 minutes, M-F, 8 am – 10 pm, and Sat-Sun, 12 pm – 10 pm.
Another set of links is provided to students who have questions about the content of the course, course logistics, etc. These links provide email communication with the Course Directors.
During the online seminars, students who are having real-time technical problems are able to chat and/or phone a technical support person for immediate assistance. The tool itself (Adobe Connect) is very easy to use by the students (a simple plug-in is downloaded the first time by each student the first time they use the system). The presenters use a pre-configured workstation and have a technical support person to assist them during the seminars.
The online course in Advanced Medical Therapeutics (AMT) transformed learning for our students on multiple levels:
1) Flexibility: students taking this course are also engaged in residency interviews that require them to travel to locations across the country. The course allows them to simultaneously travel and access the course from any location with a fast Internet connection (1.5 Mbps or above) and a computer. Students feel strongly that the flexibility of the course is very useful to them. In the 2009-2010 AMT course evaluation, students were asked to respond to the statement via a Likert Scale (1=Strongly Disagree to 5=Strongly Agree): “The flexibility in the course provided by computer-based distance learning was of great assistance in scheduling my resident interview.” The mean response was 4.61 with a standard deviation of 0.69 (N=104).
2) Critical thinking: the course teaches students to become problem solvers and critical thinkers, as opposed to purely memorizers of information. Using a case-based, problem-based learning model, the course provides students with access to over 20 therapeutic topics (e.g., Pharmacology, Surgery, Internal Medicine, Emergency Medicine, Family Medicine, etc.) with over 90 interactive cases. All of the cases require students to use and develop their clinical reasoning and problem solving skills in a focused, repetitive fashion. The cases (and quizzes) provide a sizeable amount of focused feedback that guides the students through the development of their problem-solving skills.
3) Intrinsic motivation: students are allowed to pick a research topic of special interest to him/her and present their findings in a PowerPoint presentation or text document. This aspect of the course allows students to take the time to explore their own interests at a high intellectual level. Additionally, students are given the opportunity to learn from the work of their peers by reviewing their colleagues’ projects (four per student) and providing written commentary in electronic format on each. Also, the course allows students to contribute to the learning of future students in that exceptional student projects are added to the resource libraries of subsequent offerings of the course.
4) Intimate instruction: the course is unique in that it consists of approximately 300, one to three minute video clips of over 20 faculty members providing feedback in a conversational tone to learners in response to the cases and case questions. This is a unique and valuable aspect of the course in that the conversational tone of the videos, combined with the real-world explanations and sharing of feelings and insights, provide students with a intimate view of medicine that is difficult to obtain in the texts and medical literature.
5) Electric communication and interaction: the seminar component of the course allows students to participate in online, synchronous communication and education in a group setting. Exposure to this learning and communication modality should be valuable to students in their future training and medical practice, as this modality becomes more predominate in medical education and practice.
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