Students taking the third-year required internal medicine clerkship during the 2003–2004 academic year at our institution were offered the opportunity to participate in the study. Those agreeing to participate were randomized into to one of two arms of the study. The random assignment of students to the two arms of the study was done within each community to control for the potential of community differences. The control group traveled to the host community campus and attended the live lectures with their colleagues who chose not to participate in the study. The experimental group stayed at their home campus on the same day and completed a parallel set of CD-ROM-based multimedia modules made from digital recordings of the previous year's lectures. They completed these digital lectures in computer laboratories in either the community campus office or within one of the teaching hospitals.
The series included six lectures covering asthma, coronary artery disease (CAD), acute renal failure, liver disease, thyroid disease, and antibiotic pharmacology. The Clerkship Education Committee chose these topics based on their perceived importance and consistency with the Society for General Internal Medicine/Clerkship Directors of Internal Medicine (SGIM/CDIM) Curriculum Guide[5
Between the 2002–2003 academic year when the lectures were taped and the 2003–2004 academic year when the study was conducted, the clerkship faculty decided to revise the lecture series to be more case-based though the topics were kept the same. Two of the lectures, CAD and renal failure, were not modified and kept as consistent as possible with the previous year in order to conduct the study. Though there might have been minor inconsistencies between the digital and live versions of these two lectures, the same faculty member presented each lecture during both the 2002–2003 academic year when the lectures were taped and the 2003–2004 academic year when presented live. The two lecturers also attempted to keep the live lectures as consistent as possible with the digital lectures and used the same slides that they had used the previous year. While the format of the other four lectures changed, the material covered and instructional objectives remained consistent.
At the end of the live lecture series, students were asked to complete a short examination that included four to five questions based on each of the six lectures. These questions were written by the presenters of the lectures and designed to assess student mastery of the lectures' key objectives. The students were informed that the purpose of the examination was to provide them with feedback on the mastery of the material and the presenters with feedback on the effectiveness of the lectures, and would not impact on their clerkship grade. After the students completed the exam, they were given a copy that included the correct answers and a short explanation for the correct answer. The exam forms contained no student identifiers, but students in the control group were asked to indicate on the examination form that they had agreed to participate in the study so they could be differentiated from the students who had chosen not to participate in the study.
Students in the experimental arm of the study completed the same examination in their home community after they had completed the digital lectures. They were also asked to complete a short feedback form asking whether they had any technical problems using the modules, to rate their agreement with what the researchers felt to be three potential advantages and three potential disadvantages of the modules, and whether they felt the modules could serve as a suitable replacement for live lectures.
The specific questions are listed below.
Advantages of the Modules
• Convenience of viewing the presentations when you choose.
• Avoiding having to travel to another community for an all day lecture series.
• Ability to keep copies of these presentations for use in the future.
Disadvantages of these modules
• Inability to ask questions of the presenter
• Lack of group interaction/discussion of a topic
• Just not like being in the room with the presenter
The CD-ROM modules were created using a technique developed by the first author. A manual outlining how to develop these modules is available from http://www.msu-im.org/CDIM/manual.pdf
. They included digitized video and audio from the taped presentation inserted as a window in the PowerPoint®
slides from the presentation. As students displayed each of the slides, they were able to observe the presenter in the multimedia window discussing the slide that was being viewed.
Nine of the items on the exam focused on the material in the CAD and acute renal failure lectures, where the lecturers presented the lectures in the same format as they had used in the previous year when the lectures were taped. The remaining 20 examination items covered material in the other four lectures. Group differences were tested for statistical significance by both an independent sample t-test for means and a Mann-Whitney test for ranks. A Levene's test for equality of variance between the two groups was also performed. These analyses were conducted separately for the subset of items covering the material in the CAD/acute renal failure lectures and the other four lectures. A power analysis was conducted to assess the magnitude of the difference between the groups that would likely be detectable given the number of students participating in the study. The coefficient alpha reliability of the exam was also estimated. The data were presented descriptively using means, standard deviations and mean ranks within the control and experimental groups. All analyses were conducted using the Statistical Package for the Social Sciences version 11. Approval for the project was obtained from the University Committee for Research Involving Human Subjects within our institution.