Design, development and evaluation of asynchronous learning networks in primary care medicine: An application of biomedical informatics engineering principles in medical education

This dissertation investigates methods for providing internet-based medical clerkships via online education and proposes a predictive model that will permit course directors to estimate the impact of introducing technology-based educational methods on four metrics: learning effectiveness, cost effectiveness, time reduction and student satisfaction. It also discusses the technical difficulties and barriers that can be avoided and the best economical strategy to be considered when developing and implementing computer supported tools. The algorithms of the model, web-based course, and computer-assisted tools were developed from an extensive series of experiments in the Primary Care Medicine Clerkship at the Vanderbilt University Medical School. A prospective randomized controlled trial that involved senior medical students at Vanderbilt University who were participating in the Primary Care Medicine Core Clerkship was conducted. This study shows that there was no significant difference in students' performance between web-based and classroom-based methods. However, the study found a significant difference in costs of web-based courses with different forms of implementation methods and incorporating models. Results of these experiments showed that providing web-based courses in medical clerkships were fairly costly during the first year of development. Furthermore, the study showed that the costs decreased considerably when using institutional infrastructure, employing students and sharing the facilities with other clerkship programs.; In addition, the study demonstrated that both groups believed that computer supported tools are highly beneficial or beneficial. The online students expended less travel and lecture time and at the same time they achieved similar knowledge scores as traditional students. This study also compared the computer accessibility, skills and attitudes of first and fourth year medical students. Higher percentages of computer literacy were found among first year than that of fourth year medical students. Moreover, faculty members in medical schools devoted more clinical time to see a greater number of patients when using the web-based lectures, and thus, generated more revenue for their medical centers while maintaining their academic activities.