ASSESSING THE IMPACT OF A MOBILE-SELF- V j ~- *_ .. f INSTRUCTIONAL ENVIRONMENT UPONiMEDICAL , ‘ ‘ STUDENT OUTCOMES INFIVE CLINICAL SEITINGS I Dissertation for the Degree of- Ph. D. MICHIGAN STATE UNIVERSITY, JOEL H. LANPHEAR I 1977 _wsmu..L LIB R A R Y Michigan State University This is to certify that the thesis entitled ASSESSING THE IMPACT OF A MOBILE SELF—INSTRUCTIONAL ENVIRONMENT UPON MEDICAL STUDENT OUTCOMES IN FIVE CLINICAL SETTINGS presented by Joel H. Lanphear has been accepted towards fulfillment of the requirements for Ph.D. Education (SEMI ¢ajor proltéér U Erli S. J gensen degree in Date June 7. 1977 0-7639 IIfllflllljlflll(IIIIIIII'IIIIIIIIII'IIIIL 002 4812 SEE I19 @097 ABSTRACT ASSESSING THE IMPACT OF A MOBILE SELF-INSTRUCTIONAL ENVIRONMENT UPON MEDICAL STUDENT OUTCOMES IN FIVE CLINICAL SETTINGS By Joel H. Lanphear The development of community—based physician training programs has prompted medical schools to explore means for monitoring pro- gram quality and for delivering supporting resources in off-campus clinical locations . The purpose of this study was to assess the impact of employ- ing one type of resource delivery system, the MEME (Mobile Environ- ment for Medical Education), with students enrolled in a six-week Obstetrics and Gynecology Clerkship in off-campus clinical locations The MEME is a portable, self-contained learning carrel. It is equipped with a slide projector and audio cassette playback equip- ment as well as video cartridge playback capability. The MEME, containing appropriate self-instructional materials, was placed in each clinical setting . The sample consisted of seventy-three, third and fourth year medical students at Michigan State University assigned to five clinical communities. Three instruments were used; a clerkship pre-test, a clerkship assessment form to obtain attitudinal and MEME use data, and a clerkship post-test. Joel H. Lanphear A Two Phase design was used. Phase One assessed student attitudes toward the clerkship experiences, the MEME and instruc- tional materials. Student knowledge of clerkship content was measured by pre and post-test. Baseline data from the Phase One assessment were used in examining a series of hypotheses in Phase Two. The hypotheses con- trasted overall MEME use with logistics factors, acquired content knowledge and the importance of the MEME to this and other clerk- ship experiences. Student evaluations of the quality of MEME materials and their preferences for specific materials were con- trasted with use of the materials. Based on the findings, it was concluded that the Ob/Gyn clerk- ship, was a positive learning experience providing students with an appropriate educational "mix" of clinical practice, formal classroom contact and the opportunity to ask pertinent questions. "clinical The clerkship facilitated the students' acquisition of confidence" in their ability to perform obstetrics and gynecology procedures. There was no evidence that the degree of MEME use independently effected student content acquisition. The MEME was used by a significant number of clerkship students primarily as a source of clerkship content. It was used most often ‘between the hours of seven a.m. and midnight, for periods of thirty- onezminutes to one hour in duration. The average weekly use per student was between zero and six hours. Joel H. Lanphear Equipment operation and convenience of location were not major logistical problems. It was determined however that students experiencing difficulty in equipment operation and/or inconvenience in MEME location were low MEME users. For those students who used the MEME, it was an important addition to the clerkship experience. The availability of MEME's for use in other clerkships was a signi- ficant need expressed by students. Textbooks were the most preferred, rated highest in quality, and received the heaviest use of all clerkship resource materials. Video cassettes ranked second in these categories and provided the most viable non—print resource format. Audio cassettes ranked lowest in student preference, quality and use. Preference and per- ceived quality of audio cassettes as well as programmed materials influenced student use of these materials. The delivery of learning resources in support of specific content objectives provides a unique problem for medical schools using community hospitals for clinical training. This study demon- strates the viability of the MEME as one strategy for the delivery of content information to medical students in close proximity to patient care. The MEME as a content resource delivery system is a potentially important vehicle for extending the effectiveness of faculty in community educational sites as well as providing at least a partial strategy for controlling the quality of community— based medical education programs. ASSESSING THE IMPACT OF A MOBILE SELF-INSTRUCTIONAL ENVIRONMENT UPON MEDICAL STUDENT OUTCOMES IN FIVE CLINICAL SETTINGS BY Joel H. Lanphear A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY College of Education Instructional Development and Technology 1977 (910705401 © Copyright by JOEL HENRY LANPHEAR 1977 ACKNOWLEDGMENTS I am indebted to many people for their assistance in the successful completion of this project. The members of the dissertation committee have been a source of support and encouragement throughout. A special note of thanks goes to Dr. Erling Jorgensen, Chairman of the group and Doctoral Program Advisor and to Dr. Tom Parmeter who has so willingly shared his design and analysis expertise with me. I am also indebted to Edward Titus whose imagination and creativity produced the MEME's and has kept them operational for three years. Without the help and understanding of my two typists, Shirley Lambert and more recently Sharon Keefe, I could not have completed this work. I am also particularly grateful to Dr. Gerry Holzman, Clerkship Coordinator, for his enthusiastic support of this project and his willingness to have his program so thoroughly and openly assessed. Finally, to my Dean and Mentor, Dr. Bob Daugherty, I extend my sincere thank you for his interest in, and support of this project and his faith in me as a person. ii TABLE OF CONTENTS CHAPTER I: THE RESEARCH PROBLEM . . . . . . . . . IDENTIFICATION OF THE RESEARCH PROBLEM . . . . . . . PURPOSE OF THE RESEARCH . . . . . . . . . . . . . . . . HYPOTHESES . . . . . . . . . . . . . . . . . . . . . . DEFINITION OF IMPORTANT TERMS . . . . . . . . . . . . . OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . CHAPTER II: REVIEW OF RELATED LITERATURE . . . . . . OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . INSTRUCTIONAL TECHNOLOGY IN NON— CLINICAL MEDICAL EDUCATION . . . . . . . . . . . . . INSTRUCTIONAL TECHNOLOGY IN CLINICAL MEDICAL EDUCATION PORTABLE LEARNING CARRELS . . . . . . . . . . . . . . . LEARNING CARRELS IN CLINICAL EDUCATION . . . . . . . . SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . CHAPTER III: DESIGN OF THE STUDY . . . . . . . . . . . . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . INSTRIHHENTATION . c o o o o o a o u a o 0 DESIGN' . . . . . . . . . . . . . . . . . . . . . Page 10 ll 15 l6 l6 17 21 23 25 27 28 28 28 29 32 TESTABLE HYPOTHESES . . . . . . . . . . . . . . . . . . Logistics . . . . . . . . . . . . . . . . . . . . . Content Knowledge vs Use of Related MEME Materials . On Campus Carrel Use vs MEME Materials Use . . . . . Reported Use of MEME Media Materials vs Perceived Quality of MEME Materials . . . . . . . . . Reported Use of MEME Media Materials gs Preference for MEME Media Materials by Type . . . . . . . . . Content Knowledge vs Average Weekly Use of the MEME Content Knowledge by Area vs Attitude Toward Learning Experiences by Content Area . . . . . . . Overall Content Knowledge XE Attitude Toward Learning Experiences . . . . . . . . . . . . . . . DATA COLLECTION . . . . . . . . . . . . . . . . . . . . DATA ANALYSIS . . . . . . . . . . . . . . . . . . REQUIRED RESOURCES . . . . . . . . . . . . . . . . . . SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . CHAPTER IV: ANALYSIS OF RESULTS . . . . . . . . . . . . . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . PHASE ONE . . . . . . . . . . . . . . . . . . . . . . . Obstetrics . . . . . . . . . . . . . . . . . . . . . Gynecology . . . . . . . . . . . . . . . . . . . . . Ambulatory Experiences . . . . . . . . . . . . . . . Focal Problems Sessions . . . . . . . . . . . . . Objeactives and Data Base . . . . . . . . . . . . . Liai son Experiences . . . . . . . . . . . . . . . . iv Page 36 36 4O 43 44 46 49 49 51 53 54 55 56 58 58 59 60 62 65 66 67 68 MEME Logistics Factors . . . . . . . . . . . . Faculty Attitude . . . . . . . . . . . . . . . Student Use of the MEME . . . . . . . . . . . Patterns of MEME Use . . . . . . . . . . Student Preference for MEME Materials . . Student Ratings of Quality of MEME Materials . Student Use of MEME Materials . . . . . . . . Pre and Post-Test Analysis . . . . . . . . . . SUMMARY OF PHASE ONE FINDINGS . . . . . . . . .. PHASE TWO . . . . . . . . . . . . . . . . . . SUMMARY OF PHASE TWO FINDINGS . . . . . . . . . CHAPTER V: SUMMARY AND CONCLUSIONS . . . . . . . . SUMMARY . . . . . . . . . . . . . . . . . . . CONCLUSIONS . . . . . . . . . . . . . . . . . DISCUSSION . . . . . . . . . . . . . . . . . . OBSERVATIONS FOR FUTURE RESEARCH AND PRACTICE BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . APPENDICES . . . . . . . . . . . . . . . . . . . . . A. MEME SPECIFICATIONS . . . . . . . . . . . B. MEME MEDIA MATERIALS . . . . . . . . . . . C. TYPICAL STUDENT CLERKSHIP SCHEDULE . . . D. CLERKSHIP AND MEME ASSESSMENT INSTRUMENT . E. USE OF MEME MEDIA MATERIALS BY TITLE . . . Page 69 71 72 73 75 77 77 79 84 89 96 98 98 101 105 118 125 128 129 139 159 161 173 CHAPTER II TABLE TABLE 1 2 CHAPTER IV TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE 1 10 11 12 13 l LIST OF TABLES Mean Success Rate by Unit . . . . . . . . . . Content Scores by Treatment Group . . . . . . Obstetrics Experiences . . . . . . . . . . Gynecology Experiences . . . . . . . . . . . Gynecology Experiences . . . . . . . . . . . Gynecology Experiences . . . . . . . . . . . Ambulatory Experiences . . . . . . . . . . Focal Problems Sessions . . . . . . . . . . Objectives and Data Base . . . . . . . . . Resident Rounds, etc., Experiences . . . . . Logistics Factors . . . . . . . . . . . . . . MEME Use and Availability for clerkships . . Patterns of MEME Use . . . . . . . . . . . Preference For and Quality of MEME Materials. Overall Mean Use Scores . . . . . . . . . . . Entry and Final Content Exam . . . . . . . . Pearson Correlation Coefficients . . . . Pearson Correlation Coefficients . . . . . Pearson Correlation Coefficients . . . . . . vi PAGE 19 20 61 63 64 64 65 66 67 68 72 74 76 78 8O 82 83 85 PAGE TABLE 18 Materials Preference by Rank Order . . . . . . . 87 JHABLE 19 - Perceived Quality of Materials by Rank Order . . 87 TABLE 20 — Convenience of Location . . . . . . . . . . . . 90 TABLE 21 - Ease of Equipment Use . . . . . . . . . . . . . 91 TABLE 22 - Importance to the Clerkship . . . . . . . . . . 92 TABLE 23 — Need for Availability in Other Clerkships . . . 92 TABLE 24 - Quality (Audio Cassettes) . . . . . . . . . . . 94 TABLE 25 — Quality (Workbooks, Programmed Materials) . . . 95 TABLE 26 — Preference (Audio Cassettes) . . . . . . . . . . 96 LIST OF FIGURES CHAPTER II PAGE FIGUREl—Mavis..................... 24 CHAPTER III FIGURE 2 — Factors Effecting MEME Utilization . . . . . . 35 viii CHAPTER I THE RESEARCH PROBLEM IDENTIFICATION OF THE RESEARCH PROBLEM In recent years a number of medical schools have developed physician training programs utilizing community—based teaching hos- pitals rather than university—based teaching hospitals. Fourteen of the twenty—three medical schools admitting a first class since 1967 have used only community hospitals for clinical training. 0f the remaining eighty—nine accredited medical schools in the United States, all now have affiliations with community hospitals and/or veterans administration hospitals.1 The College of Human Medicine at Michigan State University is among those institutions that have developed community hospital— based clinical experiences for physician training. Murphree et al., (1972) and Kowalewski (1975), indicate that the community hospital environment provides students with an opportunity to interact with primary care physicians who serve as role models in the training Process. Second, the community hospital setting provides a rich environment within which students participate with physicians in Patient care activities. \—______ 1American Association of Medical Colleges Directory of American Medical Education, 1976-77. 2 While the community hospital setting incorporates these ele— ments important to physician training, the development of such pro— grams has accentuated several educational problems for the college. As an educational institution, the College has goals, objec— tives, and standards which are essential to any educational program. The use of community hospitals as the setting for clinical education is one way of providing clinical training in environments more closely approximating the real world. At the same time, the use of remote clinical settings requires the development of better means to monitor and control the educational quality of community programs. Basic to the issue of quality control is the realization that student progress or achievement is closely linked to the processes of deliv— ery of medical education. Any efforts to provide quality control of student performance in terms of the acquisition of medical content, problem solving and clinical skills must include careful planning and evaluation of the ways in which these elements are delivered and structured as learning experiences for students. Ideally, the community hospital is one in which the student acquires and synthesizes new medical content provided by campus and community physicians in community—based clinical settings. This balance between clinical experience and content acquisition is a critical concern when coupled with the issue of quality control across several communities and hospitals. Community—based educational programs must include components which maximize the availability of a wide variety of learning experiences and resources. In addition, such components must address the issue of quality control through the vehicle of minimum education— al requirements for all students. An additional complication results from the change in learning environment from the University campus to the community setting. While the clinical setting becomes the primary learning environment for Year 3 and Year 4 clerkship students, the needs for means of fac— ilitating the rapid acquisition of medical content continue. On campus, Year 1 and Year 2 students have available to them a wide vatiety of learning resources, specifically developed to facilitate the rapid acquisition of medical content. Such resources include fully equipped learning carrels and a wide range of print and non— print materials appropriate to the curriculum. These resources do not exist in the clinical communities. This fact, coupled with the distance between clinical settings and the main campus as well as difficulty in obtaining rapid access to appropriate materials via traditional loan systems accentuates the problem. It follows then that the education development process faces two primary problems. First, there is a need to develop a set of minimum educational standards based in specific objectives and supported by a wide range of learning resources against which student progress can be measured. Second, there is a need to develop a means by which these learning objectives and supporting resources may be effectively packaged and delivered to students in the community setting. 4 In September of 1974, the College, prompted by pressures from several departments, students in the clinical settings, and community— based faculty, began a process of examining alternative solutions to the problems of quality control and content acquisition in the community setting. A number of alternatives were explored by an ad hoc committeez, constituted by the Associate Dean, which included the development of learning resource centers in each clinical community and/or in each community hospital. A preliminary cost study was done to determine the feasibility of developing learning resources centers in each community. Initial estimates involving fully equipped learning areas ran between fifty and seventy—five thousand dollars per site. This would have placed the total cost for five communities in the area of two hundred fifty to three hundred thousand dollars. Funding of this magnitude was not avail— able to the College for such a project. While the development of fixed learning resources centers in each community was not a viable alternative, neither was acceptance of the status quo. The alterna— tive finally adopted included developing a prototype model involving some form of portable, fully-equipped, unit which would effectively facilitate rapid acquisition of focused content material by medical students in the community setting. The general parameters for this development Were as follows: 2Membership included the Associate Dean, Acting Director-Office 0f Curriculum Implementation, Campus Ob/Gyn Clerkship Coordinator, Director—Learning Resources Center, and Director—Biomedical Commu— nications Center. 5 1. The unit should be easily portable between clinical commu— nities (preferably by one but not more than two persons). 2. The unit should be easily moveable within any one location via hospital elevators, preferably by one person. 3. The unit should contain capabilities for play back of video- tapes and the viewing of slide-tape programs, microfiche and audio programs. 4. The unit should provide space for the storage and efficient retrieval of all materials to be utilized by students. 5. The unit, when in use, should provide as attractive and comfortable an environment for students as possible and when not in use, should be unobtrusive to hospital staff. 6. The unit should be designed and built at a total cost, including equipment, of approximately $5,000.003. After a careful search of commercially available units, it was determined that of those which existed, none met the specified parameters. The final outcome of this process was the development of a portable learning carrel designated the Mobile Environment for Medical Education, acronym MEME (See Appendix A). The MEME is Essentially a mobile, self contained, learning carrel which includes packaged audio—visual material, selected print material, and videotape equipment. The MEME can be located almost anywhere. \g_—__ 3Author's Notes from Development Meetings held in September and 0CtOber of 1974. 6 When closed, it takes up very little room or hall space and when opened, it provides a complete study unit for the student with a certain degree of privacy and enough room to spread out materials and take notes. These units can be stocked with a complete set of study materials which may be added to or changed as frequently as desired. The MEME is currently being utilized as an integral part of the Ob/Gyn Clerkship which occurs in each of the clinical communities. The total number of Ob/Gyn Clerkships for 1975-76 is fifteen. The Ob/Gyn Clerkship is a six—week clinical experience required of each student. The clinical content is organized around eight subject areas. They are: The History and Physicial Examination; Normal Obstetrics (Pregnancy, Labor and Delivery); Common Obstetri- cal Abnormalities; Gynecology; Endocrinology, Infertility, Dysmenor- rhia; Obstetrics and Gynecology Procedures; Control of Reproduction; and Sexuality. The primary print resource provided to each student is the Departmental Objectives and Data Base Book. This publication, Sponsored by the American Association of Obstetricians and Gynecolo- gists Foundation and endorsed by the Association of Professors of Gynecology and Obstetrics, was modified and adopted for use at Michigan State University in 1973. It contains enabling and terminal student objectives for each of the eight content areas and an out- line for each. Additional print materials include standard Ob/Gyn texts and other pamphlets available in the MEME. In addition, a 7 large number of non—print resources and playback equipment are available to students in the MEME. These mediated, self instruc- tional, materials have been produced and validated by the Steering Committee for cooperative teaching of the Association of Professors of Gynecology and Obstetrics. These materials are an integral part of the Ob/Gyn clerkship and are keyed to the clerkship objectives. They provide the Ob/Gyn Department with a potentially important vehicle for extending a small faculty across five communities; a means to standardize quality of content and a way in which to facilitate rapid student acquisition of medical content. Appendix B, includes a listing and description of each of these media materials. The MEME is available to students on a twenty—four hour basis and is normally placed in one of the sleeping rooms in the obste— trics ward of the community hospital used for the clerkship. Student use of the MEME and media materials is not a required part of the clerkship. Formal learning experiences are coordinated by the campus- based clerkship coordinator, but the majority of clinical teaching is accomplished by community physicians. Campus—based faculty do provide some teaching input in the formal classroom setting during focal problem seminars, but a majority of these seminars are con— ducted by community physicians. In addition to traditional rounds With community physicians and the focal problem seminars, students 31$)spend approximately four hours per week in an outpatient 8 setting in either clinics or physician's offices. Additional formal conferences termed "liaison experiences," are held in the areas of Psychiatry, Radiology and Pathology. Rounds with residents are also held in some communities. Students are expected to take "night call" in the hospital on a rotational basis every four to seven days. A typical student schedule is included in Appendix C. There are several reasons why this clerkship was selected. As was noted earlier, the issue of quality control is of primary concern to both the College and to the Department. The Department of Ob/Gyn is one of the first clinical departments to adopt the educational strategy of "minimum educational accomplishment" as a means to insure quality control. That is, the Department has identified a comprehensive set of performance objectives which represent the minimum standards that students must meet to success- fully complete the clerkship. This strategy in no way precludes Student achievement beyond this level, but it does create a baseline to insure adequate training. Second, the Ob/Gyn clerkship is organized in such a way that Students are provided with an integrated set of clinical learning EXperiences which are identified as such. This set of clinical experiences provides for a balance between content acquisition and Clinical experiences. A third element is the evaluation system employed for the clerkship. It consists of a content exam containing items drawn from a pool of parallel items keyed to the clerkship objectives for W 9 each of seven clerkship content areas. A final element of the Ob/Gyn clerkship is the willingness of the department to be involved in asking difficult educational ques— tions and to expose its programs to critical review as evidenced by extensive evaluation activities over the past five years. It would appear then that the Ob/Gyn clerkship provides a rich, pedagogically sound environment in which to investigate the applica— tion of instructional technology as a potential source for, (1) monitoring and controlling program quality utilizing the "mini— mum standards" strategy, (2) extending campus—based faculty inputs into community programs, (3) insuring more uniform educational experiences between educational sites, and, (4) facilitating student acquisition of medical content. In a broader sense, the study detailed in the following pages will contribute additional information to the current limited body of research literature concerned with the application of instruc- tional technology to medical education, particularly in the clinical setting. In additon, the research will provide information about the effect of utilizing instructional technology to deliver medical Education to remote site locations and in systems utilizing dis— tributed campuses. PURPOSE OF THE RESEARCH The present study investigates the impact of using the MEME with stnidents involved in the Obstetrics and Gynecology clerkship 10 in five clinical communities. The research is divided into two phases. Phase One, is descriptive in nature and examines the following areas of student outcome related to the MEME in the clerk— ship setting. They are: (1) Student attitude toward the clerkship experience and each of its components; (2) Student performance in each component of the clerkship content exam; (3) Student attitude toward the MEME; (4) Student attitude toward the instructional materials placed in the MEME; and, (5) Patterns and degree of student use of the MEME and instructional materials. Phase Two of the study assesses the relationship between these variables to determine how they contribute to the clerkship exper— ience. A series of hypothesized relationships were tested to determine whether or not they were significant. The following general Hypotheses serve to focus the purpose of this study.4 HYPOTHESES l. A relationship exists between logistical factors, i.e., reported convenience of MEME location, ease of equipment use, correct functioning of equipment, adequacy of orien— tation and_overall student utilization of the MEME and media materials. 2. A relationship exists between the reported degree of stu— dent use of on—campus carrel facilities and the reported degree to which they utilize the MEME. 3. A relationship exists between reported student preferences for media materials by type and their reported use of media materials by type. \— 4 Specific research Hypotheses are provided in Chapter III. ll 4. A relationship exists between reported student perception of the quality of media materials by type available in the MEME and their reported use of media materials by type. 5. A relationship exists between reported faculty attitude toward the MEME and student use of the MEME. 6. A relationship exists between student performance on com— ponent parts of the final content exam and their reported use of media materials related to those content areas. 7. A relationship exists between reported student hours per week of carrel use and final content exam scores. 8. A relationship exists between reported student attitude toward component clerkship experiences and final content exam scores on items related to these experiences. DEFINITIONS OF IMPORTANT TERMS Ambulatory Experience: The non-hospital out—patient experience required of each student for one afternoon per week. These exper— iences occur either in a clinic or physician's office. Clerkship: A term applied to a set of clinical learning experiences and anticipated outcomes designed for Years 3 and 4 medical students around a specific body of medical content and encompassing a specific period of time. In this study the Obste— trics and Gynecology Clerkship is utilized and involves the learning eXperiences and outcomes of Years 3 and 4 medical students in commu— nity hospitals in Flint, Grand Rapids, Kalamazoo, Lansing and Saginaw, Michigan. The Ob/Gyn Clerkship is a six-week experience. Clerkship Assessment: A survey instrument designed to obtain data on student perceptions and attitudes relative to the total Clerkship experience. The instrument is designed to obtain data 12 related to each aspect of the clerkship, including the MEME and the MEME materials (See Appendix D). Clinical Medical Education: For the purposes of this study, clinical medical education is that set of undergraduate medical (Years 3 and 4) education experiences for students which occur pri- marily in clinical settings and occurs prior to internship or resi— dency training. Community Hospitals: A community hospital is any hospital which is affiliated with the Michigan State University College of Human Medicine through one of the five community corporations for the primary purpose of medical education. For the purposes of this study, the following community hospitals are included: Flint McLaren Hospital, Hurley Hospital Grand Rapids Blodgett Hospital, Butterworth Hospital Kalamazoo - Bronson Hospital, Borgess Hospital Lansing St. Lawrence Hospital, E. W. Sparrow Hospital Saginaw Saginaw General Hospital Content Exam — Post—Test: The final clerkship examination required of all students. The exam consists of two parts. The exam consists of approximately 200 items of the multiple choice type. Objectives and Data Base: An outline of the Ob/Gyn content basic to the objectives specified for the clerkship. Focal Problems: A series of approximately twenty small group discussion sesSions in each Clerkship involving all clerkship stu- 13 dents. The discussions are organized around common Ob/Gyn problems related to clerkship objectives and clinical experiences. Learning Carrel: For the purposes of this study, a learning carrel is defined in Spangenberg's terms as "the physical setting as needed for individualized (or individualized team) self-paced instruction." In this research, the MEME is the specific type of learning carrel under investigation. MEME: An acronym for the Mobile Environment for Medical Educa— tion, a self—contained, total portable learning carrel equipped with Panasonic NV—5110 Video player, nine inch Panasonic television monitor, Singer Graflex Caramate P, Kodak Ektalite 120 microfiche reader, Wollensak 2505av audio cassette playback unit, study shelf, study lamp, headset and materials storage space (See Appendix A for specifications). MEME Materials: The self-instructional materials keyed to clerkship objectives and stored in the MEME unit for use by students (See Appendix B). For the purposes of this study, the materials are categorized as follows: —Pamphlets/books — print materials which include no specific objectives, and require no overt student response. (N=8) —Audio cassettes — Audiotape recordings of patient interviews keyed to clerkship objectives and the like which are not accompanied by other media forms. (N=3) ~fiAudio cassettes with slides — Audiotape recordings accompanied 13y slides keyed to clerkship objectives. The audio and visual 14 components are designed to compliment each other and the learning experience. (N=5) -Audio Cassettes with slides, objectives, workbooks, post—test and answer key — Slide tape materials keyed to specific learning objectives requiring student responses and providing feedback to students on achievement. (N=ll) -Video cassettes — Panasonic video cartridges keyed to specific clerkship content. Some units include objectives, study plans, practice materials, post-test and answer keys. (N=13) -Print materials including objectives, workbooks, post—test and answer key related to clerkship objectives but involving no projected media. (N=10) Non-Clinical Medical Education: For the purposes of this study non—clinical medical education refers to that set of undergraduate medical education experiences (Years 1 and 2) for students which occurs primarily outside of the clinical setting. Objectives: The set of specified learning outcomes provided to students in the Ob/Gyn clerkship which define the enabling and ter- ndnal behaviors expected of each student. Primary Care: That aspect of health care which involves health PIOblems that can be managed within an ambulatory setting (clinic or Physician office) and for which the individual physician is the first POint of contact for a given patient's medical problem. Egychiatry, Radiology, and Pathology Liaison Experiences: A series of conferences in which students receive instruction involving 15 the relationship and importance of these medical areas to Ob/Gyn in general and in terms of specific patients. Resident Rounds: A learning experience in which students accompany residents on "rounds" as they visit hospitalized patients. Residents use the patient cases as instructional content and students are expected to answer questions related to these cases. OVERVIEW Chapter II, contains a review of the literature pertinent to this research. The review includes the application of instructional technology in non—clinical medical education, the use of instruc— tional technology in clinical education and the use of learning carrels in clinical medical education. In Chapter III, the design of the study is discussed and focuses on the sample, measures employed to obtain data and the specific research design employed. The broad research hypotheses listed in Chapter I, are restated in testable form and the methods of data analysis are discussed. Chapter IV, includes an analysis of the results of the research, including a restatement of the pertinent hypotheses and supportive data when it is found. In Chapter V, a summary of the research and the conclusions drawn from the study are presented. In addition, the broader implications of the research are discussed and suggestions for future research are set forth. CHAPTER II REVIEW OF RELATED LITERATURE OVERVIEW As noted earlier, there is little research literature dealing with the application of instructional technology to clinical medical education. Thus, this section presents a very brief review of the extent research literature pertinent to the study. It is important to acknowledge the influence of S. N. Postlethwait (1964) and his work at Purdue University in undergraduate education upon later systematic applications of instructional technology for self— instruction in medical education. S. N. Postlethwait has noted four important characteristics of the audio—tutorial approach which include an emphasis upon learning as opposed to teaching; student SElection of optimal time schedules for learning; an emphasis upon greater student opportunities for individualized instruction through more effective and efficient use of faculty time; and the capability 0f the audio-tutorial approach to provide a more standardized set of basic learning experiences for students. These four basic con— Cepts, while developed for undergraduate education in the biological Sciences, provide an important referrant for understanding later Studies in medical education. 16 17 The areas of medical education in which limited research and literature do exist and which are germaine to this investigation have been catagorized to include: (1) review of the literature on the application of instructional technology to non—clinical medical education; (2) review of the literature on the application of instructional technology to clinical medical education; (3) review of the literature on learning/study carrel design. INSTRUCTIONAL TECHNOLOGY IN NON-CLINICAL MEDICAL EDUCATION One of the earliest studies involving instructional technology in non—clinical medical education was reported by Hayden et.a1. (1967) and involved the teaching of three dimensional awareness in human anatomy. Hayden was interested in whether or not motion (in this case, film) could facilitate an awareness of three—dimensional— ity more effectively than non-motion (slides). The study involved one hundred nineteen, Year 1 medical and dental students. All students watched an introductory film which utilized camera angle and time lapse techniques to develop the concept of three dimension- ality. Fifty—six of the students were shown the film twice while sixty—three were shown a slide series, taken from the film footage after viewing the introductory film. A twenty-two item achievement test and an attitude measure was administered to each group. The researcher found no significant differences in achievement test scores. Attitude outcomes indicated, however, that eighty—two students preferred film (motion) as a medium for learning three dimensionality (Significant at the .001 level). Both groups preferred film as a 18 means for better understanding three dimensionality. Allen (1968) reported a study utilizing visual and auditory presentations involving dental students comparing conventional labor— atory experiences, lectures combined with laboratory experiences and laboratory experiences combined with self—instructional units. He reported no significant differences between the three approaches in terms of learning outcomes but noted that the primary values of the self—instructional machine presentations for some students was the logical, step by step process provided by this format. Conklin (1970), investigated the effectiveness of self—instruc- tional slide—tape programs for developmental anatomy instruction for Year 1 medical students over a two year period. In the first year, two sections of thirty students each received conventional instruc- tion involving laboratory and lectures. A third group of thirty stu— dents, used study carrels, self—instructional materials and the appropriate media equipment. In the second year, all students util— ized the self-instructional materials. Two sections Viewed the self- instructional materials in the laboratory while one section used Study carrels. All students were pre-tested and were given the same Posst-test. Students utilizing the carrels logged their time. Differences in pre—test scores were not statistically signifi— CaIIt. On the post-test, the mean and median scores of students using the: study carrels were significantly higher. When all three sections uSead the self—instructional materials, there was no significant dif— ference in post—test scores. However, students utilizing the study [T 19 carrels spent fifty percent less time learning the material than did students in other sections. A study reported by Koprowska et.al. (1971) involving the use of self—instructional materials in the teaching of cytopathology sup— ported the general conclusions of the Conklin research. Koprowska summarized the important characteristics of self-instructional materials in non—clinical medical education as facilitating favorable student attitudes; uniform quality of instruction; individualizing student instruction; and better utilization of faculty time. Ways and Fiel (1972) report a study involving the use of four self—instructional units to teach venipuncture, hemoglobin determina- tion, packed cell volume determination and the reticulocyte count to medical students. By varying the amount of time allotted to stu- dents, based in needs of students, they report a mean success rate in meeting the objectives for each unit measured by criterion out— comes and task analyses as follows in Table 1. TABLE I MEAN SUCCESS RATE BY UNIT HEEE.ESBEE Mean Success Ratg Venipuncture 95% Hemoglobin Determination 89% Packed Cell Volume Determination 95% Reticulocyte Court 93% 20 The authors utilized the data from task analysis and criterion outcomes to further refine the units with the objectives of increasing the mean success rates to 95 percent or above. A 1974 study reported by Sandritter and Edzard, investigated the use of seventy self-instructional units in teaching Pathology to one hundred sixty medical students. An "Automat lab" as described by the authors was developed which included audio-cassette and slide projectors at stations throughout the laboratory area. A printed text was available for students for each of the seventy units and a volunteer discussion group was available for students each week. The discussion groups were student led and a graduate student was available to answer questions while students utilized the "automat lab." The one hundred sixty students were divided into five equivalent groups for the study as follows in Table 2. TABLE 2 CONTENT SCORES BY TREATMENT GROUP Group Content Scores (Total = 39) A View Program - Content Exam 3.2 B View Program Twice/10 Minute Discussion/ Content Exam 15.5 C View Program Twice on Two Different Days/ Content Exam 16.0 D View Program Twice on Two Different Days/ 10 Minute Discussion/Content Exam 10.5 E 'View Program Once/Complete Response Sheets/ 10 Minute Discussion/Content Exam 26.5 21 From this data the authors concluded that active student in— volvement in learning activities while utilizing self—instructional materials and as a basis for discussion following the self-instruc— tional activities had an important influence in learning outcomes. They also note that achievement among all students involved in the course had improved. In addition, the authors indicate that the no- tions of self—pacing, student choice of materials withing a broad range of content topics and volunteer involvement in discussion groups have an important impact on student attitude toward the experience. Sandritter and Edzard, also indicate that a typical unit of twenty minute running time requires approximately 5% to 6 hours per week in the "automat lab" and that attendance at volunteer discussion groups is at the ninety percent level. In summarzing this section, it would appear that the application of instructional technology, in the form of self—instructional units with concommitant learning equipment and space has a role in non- clinical medical education, particularly as a means of providing quality control of programs, better meeting student learning needs and for providing more effective and efficient utilization of faculty effort. In the next section, we deal with application of instructional technology to clinical medical education. INSTRUCTIONAL TECHNOLOGY IN CLINICAL MEDICAL EDUCATION Television has been by far the most widely used form of instruc— ficnal technology in clinical medical education. As Judge (1968) States, television provides an effective means of storage and retrieval 22 of medical content; can be used to record events such as surgical pro- cedures that may represent new techniques and/or when the presence of audiences is not possible; to capture an important sequencing of events; to provide repetition of information; and as a means of feed— back to students for evaluation purposes. Film has been used in clinical medical education in much of the same way as television. North (1967), reports the use of eight milli- meter sound film to teach the Gesels neurological and developmental examination to Year 4 medical students. He concluded that all students utilized the film and felt it to be an important concommitant to direct patient contact. Barrows (1968), used a similar approach in teaching students how to do the neurological exam and concluded "the use of self-instructional cartridges in clinical clerkships, with all other factors kept equal, did improve the quality of students neurological examinations." (p. 1096) The use of self-instructional materials involving the slide tape format has also been tried in a limited way in clinical settings. Sly (1975), investigated the use of four slide tape programs with Year 4 students in a Pediatric Clerkship. The medical content involved the atopy, etiology, pathogenesis and treatment of allergic asthma. In this study, the control group listened to the primary physician's explanation of the medical information to parents of allergic children. The experimental group viewed a fourteen minute self-instructional slide—tape unit presenting the same information. All students took a Written content exam immediately after exposure to the content and at 23 the end of the six week clerkship. Mean scores showed no statistical difference for either group. However, the time required to learn specific content was reduced in the experimental group, freeing the physician for more meaningful student contact with the experimental group students. It is important to note that the primary purpose of student involvement in the control group experience was medical con— tent acquisition. Thus, the study supports the argument that the effective and rapid acquisiton of medical content knowledge in the clinical setting can be facilitated by the application of instruc- tional technology. Lange (1966), summarized the advantages of the self-instructional approach in clinical nursing education to include: the release of instructors for more individual student contact; the provision of better quality control across educational locations; and the provision for greater self—pacing in terms of student learning needs. While this section is admittedly brief and the information reported involves exploratory field investigation, the general thread does appear to be logically consistent with the notion that instruc— tional technology can play a meaningful role in clinical medical edu- cation. The next section deals with the literature on learning carrels in the clinical setting. PORTABLE LEARNING CARRELS Spangenberg (1975), has compiled the most comprehensive summary (K the state of the art with regard to learning carrels. Of partic- Mar interest are his comments on portable carrels. Spangenberg notes 24 that portable carrels are primarily used in circumstances where hands— on training on large equipment is required, when a number of work stations are involved or when some form of mobility between areas is required. The specific portable carrel identified by Spangenberg was developed by Lowry Air Force Base for on the job training. Termed MAVIS, an acronym for Modularized Audio Visual Instructional System, this portable carrel contains a viewing unit fourteen inches wide, eighteeen inches high and thirty-two inches deep. The unit is shown in Figure 1 below. MAVIS will accept any two projector combination of 35mm projector, filmstrip projector or 8 mm projector. A cassette tape unit can be placed in a drawer space below the projection screen. The MAVIS is equipped with head phones and a foot operated remote start and stop device for learning situations in which the student needs full use of both hands. Spangenberg does not include data regarding the use of MAVIS in an instructional setting. 25 LEARNING CARRELS IN CLINICAL MEDICAL EDUCATION The field of Obstetrics and Gynecology has been a forerunner in the application of instructional technology involving learning car— rels to clinical medical education. Russel (1966), provides some insight into why Ob/Gyn has played a leading role. He notes that the concept of "ward teaching" room on the Ob/Gyn floor of Royal Victoria Hospital developed out of patient irritation with the amount of teach— ing done at the bedside and the fact that wards and corridors were too busy to allow students and physicians to congregate. A third factor indicated by Russel involves the ”personal nature" of Ob/Gyn. That is, while some patients are willing to be examined by groups of students, others are very reluctant. Through the use of audiotape, videotape, film and slides developed around the cases of consenting patients, medical content could be delivered to students with less disruption of the primary hospital routine of patient care. Chez and O'Gorman (1974), have reported the evaluation results of carrel based self-instructional materials program for Ob/Gyn clerk- ship students in a teaching hospital. This clerkship involves eight to sixteen students per six week session and occurs eight times in each academic year. The program had been in operation for approxi- mately three years at the time of the study. The primary purposes for utilizing the carrel based, self—instructional approach as indi— cated by the authors were: to provide effective presentation of did- acticrnaterial; to support student initiative and responsibility for Mflf—learning; and to enhance more effective use of faculty-student Contact time. 26 Four learning carrels containing cassette player, headphones, slide projectors, eight millimeter projector, X-ray view box, rubber models and programmed textbooks were available to students on a twenty—four hour basis. There were thirty-two units developed for the program with an aggregate audiotape running time of fourteen hours. The results of the study indicated that twelve percent of the students used the carrels from 12:00 midnight to 6:00 A.M. and twenty—four percent used them from 6:00 A.M. to 8:00 A.M. Sixty- four percent of the students used the carrels between 12:00 noon and 6:00 P.M. The average length of use was two hours with approx- imately thirteen total utilizations per student for each six week period. The primary use of the carrels was in conjunction with patient care. In addition, ninety-nine percent of the 192 students surveyed preferred the self—instructional materials over lectures as a means of acquiring medical content knowledge. The concept of portability of learning carrels is not addressed in the existing literature to any extent. However, Lange (1966) briefly notes the advantage of portability of self—instructional materials between locations for nursing education. It would appear, however, that the work of Russel, as well as Chez and O'Gorman, support the notion that further study of the concept of carrel-based, self—instructional approaches in the area 0f clinical medical education. 27 SUMMARY This review has examined the extant literature involving appli- cation of instructional technology to medical education in three categories: (1) non-clinical medical education; (2) clinical medi- cal education; and, (3) learning carrels in clinical medical educa- tion. The literature, though limited, tends to support the concepts that: students can learn medical content through self-instruc- tional approaches; the use of instructional technology can provide more effective and efficient use of faculty and student time; the use of self—instructional material can provide a measure of quality of control between educational locations; and that the use of self— contained learning areas by students can provide a means of decreasing the disruption of hospital routine. Clearly, however, more research is required before any definite conclusions may be drawn. The research proposed in this document is an attempt to extend this research. This research proposes to study, in-depth, one application of instructional technology in the clinical setting by isolating and examining the interrelationships between the variabil— ity of student attitude toward the technology, the utilization of the technology, attitude toward the clinical experience and the acquisition of medical content. CHAPTER III DESIGN OF THE STUDY INTRODUCTION This investigation examines the impact of MEME upon students en— rolled in the Ob/Gyn Clerkship. As a field study, the research is designed in Kerlinger's (1966) terms as exploratory in the sense that it attempts to delineate important variables in the field situation anti to examine relationships between these variables. Hypothesis tessting is employed as a means for assessing these relationships. SAdflPLE The study sample consists of sixty—three, Year 3 and Year 4 stu— dents enrolled in the Ob/Gyn Clerkship in five clinical communities. Tile communities are: Flint, Grand Rapids, Kalamazoo, Lansing and Séiginaw, Michigan. The clerkships utilized are those occurring in the SIDring, Summer and Fall Term, 1976. Of the seventy—three subjects, Sijity-one are classified as Year 3 students, while twelve are classi- fixed as Year 4 students. Forty—nine are male and twenty—four are female. The male to female ratio of .67 to .33, closely approximates the: .70 and .30 ratio of male to female admissions for these two Classes. The sixty—one students comprise sixty percent of the Year 3 Class and the twelve Year 4 students comprise twelve percent of that class. 28 29 Strict random assignment of subjects for the study was not pos— sible since clerkship rotation assignments in each community are a function of the availability of positions during any one term. How— ever, the original assignment of students to clinical communities was random. That is, student names were drawn using a table of random members for assignment to communities. In addition, students in this study were "pooled" across different communities and different times to cancel out effects of selection based on such factors as interest in Ob/Gyn, preferences for type of practice and the like. In examin— :h1g the major characteristics of students there appears to be no bias. As noted earlier, the sample consists of Year 3 students (61) and Yezir 4 students (12) in clerkships occurring at different times. For 3115 reason, pre—test scores are used as covariates with clerkship most—test scores to control for sources of unknown bias. Although Imast students are enrolled in the Ob/Gyn Clerkship as one of their first clinical experiences following the primary clerkship (Fundamen— tals of Patient Care) there are some who may have had at least one Prtior clerkship. The use of pre—test scores as covariates of post- tesst scores was an important design consideration in controlling for enizering differences and to minimize their affects on findings. INS TRUMENTATION Three different instruments were used to obtain data in this Study. They are the clerkship content pre—test, the clerkship con— tent post—test, and the clerkship/MEME assessment form. 30 The clerkship content pre-test has been utilized for the past two years with Ob/Gyn Clerkship students. It is a multiple choice exam and is similar in format to the post—test. Pre—test items are not drawn from the same item pool as the post—test. The reliability of the pre-test is above .80, estimated by the KR-20 reliability coefficient formula with similar groups of Ob/Gyn Clerkship students at Michigan State University. The same pre—test instrument was used throughout the study. The clerkship post-test has also been used with Ob/Gyn students for the past two years and has a reliability which varies between .75 and .85 as estimated by the KR-ZO reliability coefficient for- mula. The post—test used on all subjects in the study is composed of items initially drawn randomly from an item pool of parallel items keyed to clerkship objectives. The initial selection of the items was based on the following criteria. 1. All items were keyed to clerkship objectives. 2. All items were reviewed and found appropriate by three past clerkship students and the clerkship coordinator. 3. All items were selected to provide a balance between those rated moderately difficult by reviewers and those rated quite difficult. 4. All items were selected to provide an equal ratio of items for each set of objectives. 5. All items were selected to provide an equal balance in orientation between the areas of basic science, behavioral science and clinical sciences. The clerkship assessment is a self-reporting instrument con- sisting of two parts. The first portion is an assessment of the 31 six major component parts of the clerkship. They are: Obstetrics, Gynecology, Ambulatory Care, Focal Problems, Departmental Objectives and Data Base, and Liaison Experiences (ie. Resident Rounds, Psy— chiatric Liaison, Radiology and Pathology). A copy of this instru— ment is included in Appendix D. This portion is the final form of a similar instrument which has been utilized for the past two years with Ob/Gyn Clerkship students and was developed by the researcher with expert input from the clerkship coordinator and the Ob/Gyn Faculty. This part of the clerkship assessment includes thirty-three items. The second part of the clerkship assessment form focuses on the MEME and the materials placed in the MEME. The MEME assessment is the product of three months development by the researcher. As a part of the development process, the alternate form method was utilized. Alternate forms of the initial instrument were com- pleted by twelve Ob/Gyn Clerkship students upon completion of the clerkship experience and six week exposure to the MEME and MEME materials. Student comments on each of the questions were soli- cited to determine whether or not the items were understood in the context for which they were intended. As the questionnaires were administered in small groups, a discussion of each item followed administration of the instruments. Written documentation of these discussions as well as audio tape recordings were used to "capture” all feedback data. Thus, the instrument is assumed to have face validity based on expert opinion but is ofunknown.reliability. 32 DESIGN Kerlinger (1966), defines field studies as ex-post facto scientific inquiries aimed at discovering the relations and inter— actions between attitudes, values, perceptions and behaviors in real social structures (p. 387). The potential strength of field studies lies in their realism, richness of variables, social signi— ficance and plethora of potential hypotheses. Kerlinger also notes that there are significant weaknesses inherent in field studies which must be considered in the research design. Among these weaknesses are the ex—post facto character of field studies render— ing weaker casual relationships, difficulty in controlling and separating variables and lack of precision in measurement. The narrative that follows, describes the logic and design of the study aimed at capturing the richness of data inherent in the field study while minimizing the potential weaknesses. In order to assess the impact of using the MEME with Ob/Gyn Clerkship students, the design of the study includes two phases. The first phase is descriptive in nature and was designed to answer such representative questions as: 1) Do students use the MHHE and MEME materials and to what extent? 2) What are the patterns of student use of the MEME and materials? 3) What preferences do students have for print and non—print instructional materials? Q What are student attitudes toward the clerkship experience? 3 What are perceived faculty attitudes toward the MEME? 6) Are Here significant differences among students content knowledge when flmy enter the clerkship? 7) Do student achievement levels differ 1, ~._\,.,4 33 upon completion of the Ob/Gyn Clerkship? 8) Are the materials avail- able in the MEME valuable to students in learning clerkship content? 9) Were there logistics factors which precluded student use of the MEME and MEME materials? This phase of the study then serves two important functions. First, it delineates the variables under inves- tigation and separates them in such a way that they can be measured. Second, it develops a baseline of information which can later be used to exclude alternative explanations. In short, by defining and assessing these variables, a greater degree of control is achieved. By employing a pre and post—test, the entry and exit levels of student content knowledge are established. These pre—test scores used as covariates provide a measure of control for entering differences. The clerkship and MEME assessment form provides baseline data on stu— dent attitudes. Phase One then serves to better describe and delin- eate the broad categories of variables which follow. The major dependent variable is medical content acquisition while the intervening variables are, student attitude toward the MEME, student attitude toward the MEME materials, and student attitude toward the clerkship experiences. The patterns and degrees of MEME and MEME materials utilization are treated as intervening/dependent variables. That is, these variables may be dependent upon such logistics factors as ease of equipment use, convenience of MEME loca— tion and the like, but may also impact directly upon the dependent variable. The time of clerkship occurrence and community location are treated as independent variables and are not manipulated. 34 While Phase One serves to better define and describe the para- meters of the variables under study, Phase Two was designed to assess the relationships between these variables. The basic design strategy for Phase Two relied on the use of crossbreaks to assess hypothesized relationships. Figure 1 on page 37 is representative of the types of crossbreaks that are utilized. The use of crossbreaks to assess a large number of posited rela- tionships is an important part of the design strategy for field studies. By employing a design that assesses a wide range of posited relationships, the researcher is better able to discard alternative explanations. For instance, in this study such factors as awareness of the availability of the MEME, adequacy of the orientation, con— venience of location, ease of equipment use, ease of materials loca— tion and the like are sub-sets of the larger variable "logistics." By carefully examining each of the sub—sets of the larger concept logistics greater control over the variable is obtained and a better case can be made for discarding alternative hypotheses. The same design argument is set forth with regard to other pos— ited relationships such as the relationship between student attitude toward clerkship experiences, use of the MEME and MEME materials and student content outcomes. By collecting relatively large amounts of data on specific learning experiences, logistics, attitudes and pre- ferences and by assessing their interrelationships, the design attempts to control for those effects which are not specifically attributable to the MEME. Thus, alternative explanations for main effects may be discarded. 35 FACTORS EFFECTING MEME UTILIZATION (i.eq Convenience of Location—Ease of Equipment Use) LO HI LO OVERALL USE OF MEME HI FIGURE 2 As with any field study, the design is limited to some extent by the circumstances of time and location, the variety of ways in Which data may be handled and the number of subjects available. Nevertheless, the field study employing two phases for delineating potentially important variables and then assessing hypothesized relationships between these variables provides a scientific approach to capturing rich data in the real world. The hypotheses which fOllow represent the strategy for assessing the relationships between the major study variables. TESTABLE HYPOTHESES LOGISTICS (1) (2) (3) Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: 36 No difference will be found between the number of students reporting high and low levels of use of the MEME media materials when contrasted with that group of stu— dents reporting high convenience of loca- tion and that group reporting low con- venience of location. Ho: f1 = f2 . . . = f4 f1 = High Use, High Convenience f2 = High Use, Low Convenience f3 = Low Use, High Convenience f4 = Low Use, Low Convenience H1: f1, f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low levels of use of the MEME media materials when contrasted with that group of students reporting high ease of equipment use and that group reporting low ease of equipment use. H : f = f . . . = f4 f1 = High Use, High Ease of Equipment Use f2 = High Use, Low Ease of Equipment Use f3 = Low Use, High Ease of Equipment Use f4 = Low Use, Low Ease of Equipment Use H ° f f . . f are not all equal. 1' 1’ 2 ° 4 No difference will be found between the number of students reporting high and low levels of use of the MEME media materials when contrasted with that group of students reporting high awareness of availability and that group reporting low awareness of availability. (4) (5) Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: 37 H ' f = f . . . = f o' l 2 4 f1 = High Use, High Awareness of Availability f2 = High Use, Low Awareness of Availability f3 = Low Use, High Awareness of Availability f4 = Low Use, Low Awareness of Availability H1: f1, f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low levels of use of the MEME media materials when contrasted with that group of stu— dents reporting high adequacy of orienta— tion and that group reporting low adequacy of orientation. H : f = f . . . = f o 1 2 4 f1 = High Use, High Adequacy of Orientation f2 = High Use, Low Adequacy of Orientation f3 = Low Use, High Adequacy of Orientation f4 = Low Use, Low Adequacy of Orientation H1: f1, f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low levels of use of the MEME media materials when contrasted with that group of stu— dents reporting high occurrence of equip- ment failure and that group reporting low occurrence of equipment failure. 38 High Use, Low Occurrence of Equip- ment Failure Legend: f f = High Use, High Occurrence of Equip— 2 ment Failure f3 = Low Use, Low Occurrence of Equip- ment Failure f4 = Low Use, High Occurrence of Equip- ment Failure Alternative Hypothesis: H1: f1, f2 . . . f4 are not all equal. (6) Null Hypothesis: No difference will be found between the ‘ number of students reporting high and ‘ low levels of use of the MEME materials when contrasted with that group of stu— dents reporting high negative faculty reaction toward the MEME and that group reporting low negative faculty reaction to the MEME. '1: : = ...= Symbolica ly Ho f1 f2 f4 Legend: f1 = High Use, Low Negative Faculty Reaction I ‘ f2 = High Use, High Negative Faculty 1 Reaction ‘ f3 = Low Use, Low Negative Faculty Reaction f - Low Use, High Negative Faculty i Reaction ‘ Alternative Hypothesis: H1: f1, f2 . . . f4 are not all equal. (7) Null Hypothesis: No difference will be found between the number of students reporting high and low levels of use of the MEME media materials when contrasted with that group of students reporting high diffi- culty in locating materials in the MEME and that group reporting low difficulty in locating materials in the MEME. Symbolically: Legend: Alternative Hypothesis: (8) Null Hypothesis: (9) Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: 39 H : f = f . . . = f o 1 2 4 f1 = High Use, Low Difficulty in Locating Materials f2 = High Use, High Difficulty in Locating Materials f3 = Low Use, Low Difficulty in Locating Materials f = Low Use, High Difficulty in Locating Materials H1: f1, f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low levels of use of the MEME media materials when contrasted with that group of students reporting high desire for a copy of scripts of each of the media units and that group reporting low desire for a copy of scripts of each of the media units. HO: f1 = f2 . . . = f4 f = High Use, Low Desire for Scripts f = High Use, High Desire for Scripts f3 = Low Use, Low Desire for Scripts f4 = Low Use, High Desire for Scripts H1: f1, f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low levels of use of the MEME media materials when contrasted with that group of students reporting a high preference for written descriptions of media mater- ials and that group reporting a low preference for written descriptions of media materials. Symbolically: Legend: Alternative Hypothesis: (10) Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: CONTENT KNOWLEDGE vs USE OF 40 H : f = f . . . = f o 1 2 4 f1 = High Use, Low Preference for Written Description f2 = High Use, High Preference for Written Description f3 = Low Use, Low Preference for Written Description f4 = Low Use, High Preference for Written Description H : f f . . . f4 are not all equal. No difference will be found between the number of students reporting high and low levels of use of the MEME media materials when contrasted with that group of students reporting high ease in studying effectively at home and that group reporting low ease in studying effectively at home. Ho: fl = f2 . . . = f4 f1 = High Use, Low Ease in Studying at Home f2 = High Use, High Ease in Studying at Home f3 = Low Use, Low Ease in Studying at Home f4 = Low Use, High Ease in Studying at Home H1: f1, f2 . . . = f4 are not all equal. RELATED MEME MATERIALS (11) Null Hypothesis: No difference will be found in average students scores on the normal obstetrics portion of the content exam between that group reporting high use of the MEME (12) (13) Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: 41 materials related to these items and that group reporting low use of MEME materials related to these items. 0 1 2 M1 = Group Reporting High Use of MEME Materials M2 = Group Reporting Low Use of MEME Materials H1: MI > M2 No difference will be found in average student scores on the abnormal obstetrics portion of the content exam between that group reporting high use of the MEME materials related to these items and that group reporting low use of MEME materials related to these items. H0: M1 = M2 M = Group Reporting High Use of MEME l . Materials M2 = Group Reporting Low Use of MEME Materials H1: M1 > M2 No difference will be found in average student scores on the Gynecology portion of the content exam between that group reporting high use of the MEME materials related to these items and that group reporting low use of MEME materials related to these items. HO: M1 = M2 M1 = Group Reporting High Use of MEME Materials M2 = Group Reporting Low Use of MEME Materials H1 M1 > M2 (14) Null Hypothesis: (15) (16) Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: Legend: 42 No difference will be found in average student scores on the History and Physical portion of the content exam between that group reporting high use of the MEME materials related to these items and that group reporting low use of MEME materials related to these items. Ho: M1 = M2 M = Group Reporting High Use of MEME 1 . Materials M2 = Group Reporting Low Use of MEME Materials H1 M1 > M2 No difference will be found in average student scores on the Endocrinology por- tion of the content exam between that group reporting high use of the MEME materials related to these items and that group reporting low use of MEME materials related to these items. HO: M1 = M2 M1 = Group Reporting High Use of Media Materials M = Group Reporting Low Use of Media Materials No difference will be found in average student scores on the Contraception portion of the content exam between that group reporting high use of the MEME materials related to these items and that group reporting low use of MEME materials related to these items. Ho: M1 = M2 M1 = Group Reporting High Use of MEME Materials 43 M = Group Reporting Low Use of MEME 2 Materials Alternative H th ' : : > ypo e815 H1 M1 M2 (17) Null Hypothesis: No difference will be found in overall average scores on the Clerkship content exam between that group reporting high use of the MEME materials related to these items and that group reporting low use of MEME materials related to these items. 1' : z = Symbo 1cally HO M1 M2 Legend: M1 = Group Reporting High Use of Media Materials M2 = Group Reporting Low Use of Media Materials Alternative Hypothe51s: H1: M1 > M2 ON CAMPUS CARREL USE vs MEME MATERIALS USE (18) Null Hypothesis: No difference will be found between the number of students reporting high and low weekly hours of carrel use on campus when contrasted with that group of stu- dents reporting high use of MEME mater— ials and that group of students reporting low use of MEME materials. Symbolically: HO: f1 = f2 . . . = f4 Legend: f1 = High Weekly Hours of Carrel Use, High Use of MEME Materials f2 = High Weekly Hours of Carrel Use, Low Use of MEME Materials f3 = Low Weekly Hours of Carrel Use, High Use of MEME Materials f4 = Low Weekly Hours of Carrel Use, Low Use of MEME Materials Alternative Hypothesis: H : f f . . . f are not all equal. 1 1’ 2 4 44 REPORTED USE OF MEME MEDIA MATERIALS vs PERCEIVED QUALITY OF MEME MATERIALS (19) Null Hypothesis: No difference will be found between the number of students reporting high and low degrees of use of pamphlets avail- able in the MEME when contrasted with the group reporting that pamphlets in the MEME were of high quality and the group reporting that pamphlets available I in the MEME were of low quality. Symbolically: Ho: fl = f2 . . . = f4 Legend: f1 = High Use, High Quality f2 = High Use, Low Quality f3 = Low Use, High Quality f4 = Low Use, Low Quality Alternative H : f , f . . . f are not all equal. . l 1 2 4 Hypothes1s: (20) Null Hypothesis: No difference will be found between the number of students reporting high and low degrees of use of the objectives and data base available in the MEME when contrasted with the group reporting that the objectives and data base in the MEME were of high quality and the group reporting that the objectives and data base available in the MEME were of low quality. Symbolically: HO: f1 = f2 . . . = f4 Legend: f1 = High Use, High Quality f2 = High Use, Low Quality f3 = Low Use, High Quality f4 = Low Use, Low Quality Alternative H1 = f1, f2 . . . f4 are not all equal. Hypothesis: (21) Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: (22) Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: (23) Null Hypothesis: 45 No difference will be found between the number of students reporting high and low degrees of use of the audio cas- settes available in the MEME when con— trasted with the group reporting that audio cassettes in the MEME were of high quality and the group reporting that audio cassettes available in the MEME were of low quality. HO: f1 = f2 . . . = f4 f1 = High Use, High Quality f2 = High Use, Low Quality f3 = Low Use, High Quality f4 = Low Use, Low Quality H1: fl’ f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low degrees of use of the audio cas— settes and slides available in the MEME when contrasted with the group reporting that the audio cassettes and slides in the MEME were of high quality and the group reporting that the audio cassettes and slides available in the MEME were of low quality. H : f = f . . . = f o l 2 4 f1 = High Use, High Quality f2 = High Use, Low Quality f3 = Low Use, High Quality f4 = Low Use, Low Quality H1: f1, f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low degrees of use of the video cas— settes available in the MEME when Symbolically: Legend: Alternative Hypothesis: (24) Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: 46 contrasted with the group reporting that the video cassettes in the MEME were of high quality and the group reporting that the video cassettes available in the MEME were of low quality. H : f = f . . . = f o l 2 4 f1 = High Use, High Quality f2 = High Use, Low Quality f3 = Low Use, High Quality f4 = Low Use, Low Quality H1: f1, f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low degrees of use of the workbooks and programmed materials available in the MEME when contrasted with the group reporting that the workbooks and pro- grammed materials in the MEME were of high quality and the group reporting that the workbooks and programmed materials available in the MEME were of low quality. H : f = f . . . = f o 1 2 4 f1 = High Use, High Quality f2 = High Use, Low Quality f3 = Low Use, High Quality f4 = Low Use, Low Quality HI = f1, f2 . . . f4 are not all equal. REPORTEI) USE OF MEME MEDIA MATERIALS vs K—fl PREFERENCE FOR MEME MEDIA MATERIALS BY TYPE \_———_—___ (25) Null Hypothesis: No difference will be found between the number of students reporting high and low use of pamphlets available in the (26) (27) Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: 47 MEME when contrasted with that group reporting high preference for pamphlets and that group reporting low preference for pamphlets. o 1 2 4 fl = High Use, High Preference f2 = High Use, Low Preference f3 = Low Use, High Preference f4 = Low Use, Low Preference HI = f1, f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low use of objectives and data base available in the MEME when contrasted with that group reporting high preference for objectives and data base and that group reporting low preference for objectives and data base. H : f = f . . . = f o 1 2 4 f1 = High Use, High Preference f2 = High Use, Low Preference f3 = Low Use, High Preference f4 = Low Use, Low Preference H1 = fl, f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low use of audio cassettes available in the MEME when contrasted with that group reporting high preference for audio cassettes and that group reporting low preference for audio cassettes. (28) (29) Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: Legend: 48 fl = High Use, High Preference f2 = High Use, Low Preference f3 = Low Use, High Preference f4 = Low Use, Low Preference H = f f f are not all equal. 1 1’ 2 ° ° ' 4 No difference will be found between the number of students reporting high and low use of audio cassettes and slides available in the MEME when contrasted with that group reporting high prefer- ence for audio cassettes and slides and that group reporting low preference for audio cassettes and slides. Ho: f1 = f2 . . . = f4 f1 = High Use, High Preference f2 = High Use, Low Preference f3 = Low Use, High Preference f4 = Low Use, Low Preference H1 = f1, f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low use of video cassettes available in the MEME when contrasted with that group reporting high preference for video cas- settes and that group reporting low pre- ference for video cassettes. HO: .f1 = f2 . . . = f4 f1 = High Use, High Preference f2 = High Use, Low Preference f3 = Low Use, High Preference f = Low Use, Low Preference Alternative Hypothesis: (30) Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: 49 HI = f1, f2 . . . f4 are not all equal. No difference will be found between the number of students reporting high and low use of workbooks and programmed materials available in the MEME when contrasted with that group reporting high preference for workbooks and programmed materials and that group reporting low preference for workbooks and programmed materials. Ho: f1 = f2 . . . = f4 f1 = High Use, High Preference f2 = High Use, Low Preference f3 = Low Use, High Preference f4 = Low Use, Low Preference HI = f1, f2 . . . f4 are not all equal. CONTENT KNOWLEDGE VS AVERAGE WEEKLY USE OF THE MEME (31) Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: No difference will be found in average student final content exam scores between that group reporting high weekly use of the MEME and that group reporting low weekly use of the MEME. M = Group Reporting High Average Weekly Use of the MEME M = Group Reporting Low Average Weekly Use of the MEME H1: MI > M2 EXTENT KNOWLEDGE BY AREA vs ATTITUDE TOWARD LEARNING EXPERIENCE BY CONTENT AREA (32) Null Hypothesis: No difference will be found in average student scores on the normal obstetrics Symbolically: Legend: Alternative Hypothesis: (33) Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: (34) Null Hypothesis: Symbolically: 50 portion of the final content exam between that group reporting positive learning experiences in the obstetrics portion of the clerkship and that group reporting negative learning experiences in the obstetrics portion of the clerkship. Ho: M1 = M2 M1 = Group Reporting Positive Learning Experiences M = Group Reporting Negative Learning Experiences H1 M1 > M2 No difference will be found in average student scores on the abnormal obste- trics portion of the final content exam between that group reporting positive learning experiences in the obstetrics portion of the clerkship and that group reporting negative learning experiences in the obstetrics portion of the clerk- ship. Ho M1 ‘ M2 M1 = Group Reporting Positive Learning Experiences M = Group Reporting Negative Learning Experiences H1 M1> M2 No difference will be found in average student scores on the gynecology portion of the final content exam between that group reporting positive learning experiences in the gynecology portion of the clerkship and that group reporting negative learning experiences in the gynecology portion of the clerkship. Legend: Alternative Hypothesis: 51 M1 = Group Reporting Positive Learning Experiences M2 = Group Reporting Negative Learning Experiences > H1 M1 M2 OVERALL CONTENT KNOWLEDGE VS ATTITUDE TOWARD LEARNING EXPERIENCES (35) (36) Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: No difference will be found in average student scores on the final content exam between that group reporting positive learning experiences in ambulatory care experiences and that group reporting negative learning experiences in the ambulatory care experiences. Ho' Ml — M2 M1 = Group Reporting Positive Learning Experience M = Group Reporting Negative Learning Experience No difference will be found in average student scores on the final content exam between that group reporting positive learning experiences in focal problem sessions and that group reporting nega- tive learning experiences in the focal problem sessions. Ho: M1 = M2 M1 = Group Reporting Positive Learning Experience M2 = Group Reporting Negative Learning Experience (37) (38) (39) Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: Legend: Alternative Hypothesis: Null Hypothesis: Symbolically: 52 No difference will be found in average student scores on the final content exam between that group reporting positive learning experiences in liaison exper- iences and that group reporting negative learning experiences in the liaison experiences. Ho: M1 = M2 M1 = Group Reporting Positive Learning Experience M2 = Group Reporting Negative Learning Experience Hl MI > M2 No difference will be found in average student scores on the final content exam between that group reporting a positive attitude toward the departmental objec- tives and data base and that group reporting a negative attitude toward the departmental objectives and data base. HO: M1 and M2 M1 = Group Reporting a Positive Attitude Toward Departmental Objectives and Data Base M = Group Reporting a Negative Attitude Toward Departmental Objectives and Data Base H1: MI > M2 No difference will be found in average student scores on the final content exam between that group reporting a positive attitude toward the obstetrics exper- iences and that group reporting a nega- tive attitude toward the obstetrics experiences. 53 Legend: M = Group Reporting a Positive Attitude Toward Obstetrics Experiences M = Group Reporting a Negative Attitude Toward Obstetrics Experiences Alternative H : M > M Hypothesis: (40) Null Hypothesis: No difference will be found in average student scores on the final content exam between that group reporting a positive attitude toward the gynecology experiences and that group reporting a negative atti- tude toward the gynecology experiences. Symbolically: Ho: M1 = M2 Group Reporting a Positive Attitude Toward Gynecology Experiences :2 ll Legend: M = Group Reporting a Negative Attitude Toward Gynecology Experiences Alternative H : M > M Hypothesis: DATA COLLECTION PROCEDURES The following procedures were employed to collect the data necessary for the study: 1. As part of the standard procedure for the clerkship, each student received a set of objectives for his/her successful comple— tion of the clerkship. These objectives represent the "minimal educational accomplishment" level for each student. Satisfactory completion of the content exam, clinical assessment and clerkship assessment was a written requirement for each student. 2. 0n the first day of the clerkship the pre—test was adminis— tered and students had approximately one and one—half hours to com- plete the exam. The exam items were discussed by the clerkship 54 coordinator and clerkship students. The numerical scores for each student were forwarded to the campus clerkship coordinator. 3. During the final week of the clerkship, the content exam was administered and proctored by the Community Clerkship Coordina— tor. Students were given three hours in which to complete the exam. 4. On Monday of the final week of the clerkship, students were given the clerkship assessment. They were asked to work indepen- dently and to complete the assessment by Wednesday of that week and to return it to the community coordinator. 5. The clerkship coordinator in each community collected the content exams, clerkship assessment and clinical skills assessments and forwarded them to the Evaluation Office no later than one week after the final day of the clerkship. 6. All students received a content exam score. Results of the MEME portion of the clerkship assessment were also made available to students. DATA ANALYSIS The pre—test, post—test and clerkship assessment data were machine and hand scored. Statistical analysis of the data took several forms. Analysis of covariance was employed as noted earlier with pre and post-test scores to control for entering student differences and to minimize the potential introduction of bias. For nominal data such as that collected on logistics variables, on—campus vs MEME media materials use, use of MEME media materials Kg perceived quality of MEME materials and use of MEME media gs 55 preference for MEME media materials, the chi—square test was used. An alpha level of .05 was specified. With regard to continuous data such as that collected on con- tent knowledge gs use of related MEME media materials, content know- ledge vs average weekly use of the MEME and content knowledge gs attitude toward learning experiences attest for significance was was used. Pooled two-tailed tests were utilized with an alpha level of .05 specified. The data analysis was done on the Michigan State University CdC6500 computer. REQUIRED RESOURCES Personnel As noted earlier, the development and preparation of the clerk- ship assessment was accomplished by the investigator. Seventy—three (73) subjects were involved in the study. The administration of the pre—test, clerkship assessment and post-test was the responsi- bility of the clerkship coordinator in each clinical community. The investigator was responsible for coordinating the processing of all data with personnel of the evaluation unit, within the Dean's Office, College of Human Medicine. The transportation and placement of the MEME and MEME materials was accomplished by the staff of the Learning Resources Center, College of Human Medicine as requested by the investigator. The Director, Learning Resources Center and his staff were responsible for keeping the MEME operational in each community. 56 Materials The materials utilized in the study included the MEME and MEME materials developed for the Ob/Gyn Clerkship and are described in Chapter I. In addition, approximately seventy—three (73) copies of the following materials were required to conduct this research: 1. Pre-test/Answer Sheet 2. Post-test/Answer Sheet 3. Clerkship Assessment All copies of the pre—test and post-test instruments were pro- vided by the Department of Obstetrics, Gynecology and Reproductive Biology. Copies of the Clerkship Assessment were provided by the investigator through the Office of Curriculum Implementation, Dean's Office, College of Human Medicine. All pre and post-test answer sheets were machine scored while the Clerkship Assessments were hand scored by trained evaluation staff. SUMMARY The purpose of this study was to assess the impact of utilizing the MEME with Ob/Gyn Clerkship students. In order to accomplish this task, given the strengths and weaknesses inherent in any field study, the design strategy involved two phases. The first phase was essentially descriptive and included the collection of large am0unts of data around the key variables of logistics, MEME and MEME materials utilization patterns, student preferences for media type, student perception of media quality by type, faculty attitude 57 toward the MEME, student attitude toward clerkship experiences and student performance on pre and post-test content exams. Phase Two of the Design involved the testing of hypothesized relationships between these variables as a means of determining the extent to which the MEME and an impact upon students in the clerk- ships. It is hoped that this field study approach will provide additional information to those interested in utilizing this type of instructional technology for medical education in a clinical setting. CHAPTER IV ANALYSIS OF RESULTS INTRODUCTION In Chapter III, a two phase research design was set forth. Phase One data is descriptive and delineates the major variables under investigation including logistics factors related to the MEME and MEME materials, student preferences for various types of media, student attitudes toward the clerkship learning experiences, student content knowledge before and after the clerkship and perceived faculty atti- tudes toward the MEME and MEME materials. Phase Two was then designed to assess the hypothesized relation- ships between these variables. The important hypothesized relationships from Chapter III are included prior to data presented in this Chapter. The tables in Chapter IV, summarize the data derived from the study. In assessing student attitudes toward the clerkship experiences, a four point scale was employed. Thus, a choice of 1, represented a response meaning "No" (Never), where 2, represented a response of "No, with reservations" (Infrequently), 3 represented a response of "Yes, with reservations” (Usually) and 4 represented a response of "Yes" (Always). The mean scores displayed in the tables on pages 64-75, thus represent the mean item response for the number (N) of student responses. The standard deviation for each item is also displayed. 58 59 Attitude toward the MEME was measured using the same four point scale. Other data regarding times and hours of MEME use are shown as percentages. A similar four point scale was used to assess student preference for media types and student perception of the quality of media materials. For both preference and quality, a response of 1, indicated "strongly dislike," 2, indicated "mildly dislike," 3, indicated "mildly like" and 4, indicated "Like very much." The tables displaying these data includethenumber of responses,meanresponse, andstandarddeviation. Finally, a five point scale was used to assess student use of specific materials by type. In this scale, 0, indicated "Not Available," 1, represented "Did Not Use," 2, represented "Skimmed Briefly," 3, represented "Reviewed for Main Ideas," and 4, represented "In-depth Use." In addition, students were asked to indicate "Yes" if the material was of value. Thus, the tables displaying these data ‘ show the mean use score, the range for the percentage of responses in 4 category three and four and the range for the percentage of responses 4 in category three and four and the range for the percentage of stu- dents indicating that the material was of value in each clerkship. PHASE ONE Nine learning experience categories were defined in assessing Student attitude toward the clerkship. The categories consisted of experiences in: Obstetrics; Gynecology; Ambulatory Care; Focal Problem Sessions; Clerkship Objectives and Data Base; Resident Rounds; Radiology; Psychiatric Liaison; and Pathology. I I l I 60 Obstetrics Table 1, on page 64, provides a summary of student responses to the Obstetrics portion of the assessment instrument. The ability to follow patients in labor received the highest mean response of all items in the Obstetrics portion (3.63). Sixty- five percent of the student responses were in the Always (4) cate- gory, Thirty-two percent in the Yes, with reservations, category (3), and Three percent indicated No, with reservations. When asked why they were allowed to follow patients in labor, cooperations and interest by the attending Physician received the highest mean response (3.34) followed by aggressiveness on the students part (3.22) and cooperation and interest by Nursing Staff (3.20). Lack of student aggressiveness received the highest mean score as a reason why they were not allowed to follow patients in labor. The score was (2.20), followed respectively by lack of cooperation and interest by Nursing Staff (2.17), lack of cooperation and interest by attending (1.60) and lack of Physician/Resident time (1.60). Regarding whether or not interaction with staff nurses and nursing supervisors were satisfactory, the mean response score was 3.47. The mean response score for student confidence in providing prenatal care for patients without complications was 3.44 with Forty-nine percent of the students indicating Yes (4), and Forty— seven percent indicating Yes, with reservations (3). .61 TABLE 1 OBSTETRICS EXPERIENCES TOTAL N = 73 MEAN* S.D. I was allowed to follow patients in Labor. Why you were allowed to follow patients. Aggressiveness on my part. Cooperation and interest by attending. Cooperation and interest by Nursing Staff. Why you were NOT allowed to follow patients. Lack of Aggressiveness on my part. Lack of Cooperation and interest by attending. Lack of Cooperation and interest by Nursing Staff. Lack of Physician/Resident Time My interactions with Staff Nurses and Nursing Supervisors were satisfactory I became confident that I could provide pre- natal care for patients without complications I became confident that I could follow a patient without complications in labor, order analgesia, take charge of a-normal spontaneous delivery and provide post— partum care. No (Never) No, with reservations (infrequently) Yes, with reservations (usually) Yes (Always) hMNt-d II II II II 6 2.17 1.17 S 1.60 .89 72 3.47 .63 73 3.44 .62 73 3.42 .69 - u:- -.. 62 Gynecology Student responses to the Gynecology experiences portion of the clerkship assessment are summarized in Tables 2, 3, and 4 on pages 66 and 67. The data indicate that students were more often allowed to per— form pelvic examinations on patients under anesthesia than pre-oper- atively. The mean score for pre—operative pelvic examinations was 3.30 and 3.84 for pelvic exams under anesthesia. The students indicated that residents discussed patient cases with them slightly more often than the attending physicians. The mean score for resident discussion, was 3.12 and 3.05 for attending physicians. When asked why they were allowed to accomplish these activities, cooperation and interest by the attending physician received the highest mean rating (3.33), followed by aggressiveness (3.32) and cooperation and interest by Nursing Staff (2.75). Lack of Physician/Resident time (3.20) was the major reason indicated by students, why they were BEE allowed to perform these functions. Lack of cooperation and interest by the attending physician (2.80), lack of cooperation and interest by Nursing Staff (2.50) and lack of aggressiveness (1.67), followed in order. Eighty-five percent of the students indicated that the right amount 0f emphasis was placed on surgical technique while eleven percent felt there was too much and four percent indicated that there was too little emphasis. Thirty—three percent of the students observed more than fifteen operations and the same number reported seeing 63 TABLE 2 GYNECOLOGY EXPERIENCES TOTAL N = 73 I was allowed to perform pelvic exams on patients pre-operatively. I was allowed to perform pelvic exams on patients under anesthesia. Patient cases were discussed with me by the attending Physician. Patient cases were discussed with me by a Resident. Generally, why were you allowed to do the above? Aggressiveness on my part Cooperation and interest by the attending Cooperation and interest by Nursing Staff Generally, why were you NOT allowed to do the ab ve? Lack of aggressiveness on my part Lack of Cooperation and interest by attending. Lack of Cooperation and interest by Nursing Staff. Lack of Physician/Resident time. The pre-operative learning experience was a valuable learning experience. The operative experience was a valuable learning experience. The post-surgical care experience was a valuable learning experience. *1 = No, (Never) 2 = No, with reservations (infrequently) 3 = Yes, with reservations (usually) _4 = Yes {Alwavsl 64 TABLE 3 GYNECOLOGY EXPERIENCES TOTAL N = 73 Regarding Emphasis on Surgical Technique there was: 1) Too Much 2) Too Little 3) The Right Amount How many total operations did you observe? 1) 1-5 2) 6-10 3) 11-15 4) More than 15 TABLE 4 GYNECOLOGY EXPERIENCES TOTAL N = 73 % BY CATEGORY N 1-3 4-6 7-9 10+ How many Gynecologic Patients did you Average seeing daily? 76 24 0 0 72 How many Work-ups did you complete? 4 37 26 33 73 65 between eleven and fifteen. Thirty—one percent observed six to ten operations and three percent saw between one and five. The largest percentage of students (76%) averaged seeing between one and three patients daily while twenty-four percent saw between four and six. Thirty—three percent of the students completed more than ten patient work—ups while twenty-six percent completed between seven and nine. Thirty-seven percent completed between four and six work-ups and four percent reported completing between one and three work—ups. AmbulatorygExperiences Ambulatory learning experiences were the next clerkship experiences assessed. The data are presented in Table 5. TABLE 5 AMBULATORY EXPERIENCES TOTAL N = 73 N MEAN* S D I saw a wide variety of patients. 73 3.22 .92 I was given sufficient responsibility. 73 3.38 .79 There were peOple to whom I could direct 73 3.67 .62 questions. I felt that there was enough teaching. 73 3.16 .97 *1 = No, (Never) 2 = No, with reservations (Infrequently) 3 = Yes, with reservations (Usually) 4 = Yes, (Always) 66 The highest mean score (3.67) occurred for the item dealing with the availability of persons to whom questions could be directed. The mean student response to whether or not they saw a wide variety of patients was 3.22. The questions regarding sufficient responsi- bility received a mean rating of 3.38. The issue of whether or not enough teaching occurred received a 3.16 mean score. Focal Problems Sessions The data for the Focal Problems Sessions are presented in Table 6. TABLE 6 FOCAL PROBLEMS SESSIONS TOTAL N = 73 N MEAN* S.D. Instructors were often late. 72 2.03 1.16 Students were often late. 72 1.79 .89 The important assigned objectives were discussed. 72 3'44 ’63 Presentations were clear. 73 3.55 .60 There were ample opportunities to ask 73 3 88 33 questions. ' ' *1 = No, (Never) 2 = No, with reservations (Infrequently) 3 = Yes, with reservations (Usually) 4 = Yes, (Always) The item receiving the highest mean score for Focal Problems (3.88) involved the opportunity to ask questions. Students indicated a mean response of 2.03 for tardiness of instructors and mean response 67 of 1.79 for student tardiness. When asked if important assigned objectives were discussed, the mean response was 3.44 and 3.55 for clarity of presentations. Objectives and Data Base The data for the Objectives and Data Base are presented in Table 7. TABLE 7 OBJECTIVES AND DATA BASE TOTAL N = 73 N MEAN* S.D. The departmental objectives were 70 3.67 .53 understandable. The departmental objectives were reasonable 72 3.01 .93 for a 51x week period. It was easy to match the departmental data . . . . 70 3.43 .71 base With the appropriate objectives. The departmental data base made it unnecessary to do additional reading 70 1.37 .68 for assignments. * = No, (Never) No, with reservations (Infrequently) Yes, with reservations (Usually) 1 2 3 4 Yes, (Always) Understandibility of the Objectives and Data Base received the highest mean score in this section (3.67). The mean response to the reasonableness of the Objectives and Data Base for six week clerkship was 3.01. Regarding the ease of matching the departmental objectives 68 with the data base, the mean student response was 3.43. if the Objectives and Data Base made additional reading unnecessary, the mean response was 1.37. Liaison Experiences When asked Resident rounds, Psychiatric Liaison, Radiology and Pathology experiences, were the next clerkship assessment components. for these experiences are presented in Table 8. Data TABLE 8 RESIDENT ROUNDS, PSYCHIATRIC LIAISON, RADIOLOGY AND PATHOLOGY EXPERIENCES TOTAL N = 73 Did this RESID.ROUNDS PSYCH.LIAISON RADIOLOGY PATHOLOGY Experience: * * * t N MEAN S.D. N MEAN S.D. N MEAN S.D. N MEAN S.D. Occur during the clerkship 72 2.74 1.26 69 2.75 1.28 72 2.36 1.29 71 2.66 1.22 at all? Provide you with aPPr°Prlate 61 2.77 1.22 57 2.60 1.22 58 2.50 1.17 60 2.60 1.09 learning experiences? Provide instruc- tion of good 60 2.97 1.18 55 2.67 1.19 56 2.45 1.20 57 2.72 1.15 quality? % % 6 ° Leave you by Category by Category by Category 6 by Category feeling there More Less Same More Less Same More Less Same More Less Same should be - 60 2 38 50 11 39 59 2 39 61 6 I 33 *1 = No, (Never) 2 = No, with reservations (Infrequently) 3 = Yes, with reservations (Usually) 4 = Yes, (Always) 69 When asked whether or not Resident Rounds occurred during the clerkship, the student mean response was 2.74, while the mean response for Psychiatric Liaison was 2.75, for Radiology 2.36 and 2.66 for Pathology. The mean response for appropriateness of learning experiences in Resident Rounds was 2.77 with Psychiatric Liaison at 2.60, Radiology was 2.50 and Pathology received a mean response of 2.60. With regard to the quality of instruction, Resi- dent Rounds received a mean student response of 2.97, Psychiatric Liaison 2.67, Radiology 2.45, and Pathology 2.72. Sixty percent of the students felt there should be more Resident Rounds, fifty percent felt there should be more Psychiatric Liaison experiences while fifty-nine percent desired more Radiology and sixty-one percent felt there should be a greater number of Pathology experiences. These nine categories and the data associated with each, describe student attitudes and perceptions of the major compo- nents of the clerkship experience. The section which follows is derived from the second major portion of the clerkship assessment and contains data on student attitudes toward the MEME and MEME materials. MEME Logistics Factors The data in Table 9 on page 73 provide a summary of student responses related to Logistics Factors involving use of the MEME and MEET materials. The data show that awareness of the MEME's availability received the highest mean score (3.92) of all items in the logistics section. The mean response to the adequacy of the orientation was 3.66. 70 TABLE 9 LOGISTICS FACTORS TOTAL N = 73 I was aware that the MEME was available. The orientation to the MEME was adequate in preparing me to use the materials 6 equipment. The location of the MEME was convenient, ex- cluding defects in equipment 8 materials. I found it easy to use the MEME equipment. Equipment in the MEME was often broken or not functioning correctly. I had difficulty locating materials in the MEME. It would have been valuable to have my own copy of content summaries. Written descriptions of all media materials would have made it easier to skim content. Faculty with whom I had contact reacted negatively to MEME. I was able to study at home. No, (Never) No, with reservations (Infrequently) Yes, with reservations (Usually) Yes, (Always) bump-a N MEAN* S.D. 72 3.92 .44 67 3.66 .75 72 3.21 1.24 63 3.52 .88 61 1.51 .81 60 1.73 .97 55 2.64 1.30 60 3.07 1.01 53 1.45 .87 69 3.57 .76 7l Sixty-seven percent of the students answered Yes (4) to the item involving convenience of location. Twenty—two percent indicated No. The mean response for this item was 3.21. With regard to ease of equipment use, the mean response was 3.52 and 1.51 for frequency of broken equipment and/or equipment malfunction. In terms of difficulty in locating MEME materials, fifty-three percent of the students indicated no difficulty (1), while thirty percent indicated No, with reservations (2). Ten per- cent of the students indicated Yes (4). The mean response for this item was 1.73. Forty—two percent indicated that it would have been valuable to have their own copies of written content summaries of media material, twenty—nine percent indicated that this would not have been valuable. The mean response for this item was 2.64. On a similar item, students were asked if written summaries of media materials would have facilitated "skimming" of content. The mean response was 3.07, with forty-three percent indicating Yes (4) and ten percent indicating No (1). Faculty Attitude Seventy—four percent of the students indicated no negative faculty attitude toward the MEME, while six percent noted negative faculty attitude. The mean response to the item regarding the ability of students to study effectively at home was 3.56, while sixty-eight percent indicated Yes (4). Student Use of the MEME 72 Table 10, below, presents data related to student use of the MEME and MEME materials and attitudes toward their availability in the Ob/Gyn clerkship as well as other clerkships. TABLE 10 able for other clerkships. My primary use of the MEME materials was for: *1 = No, (Never) MEME USE AND AVAILABILITY FOR CLERKSHIPS TOTAL N = 73- N MEAN S.D. I used or reviewed most of the MEME materials. 72 2'46 1’17 Having the MEME available was an important addition to the 67 2.55 1.19 clerkship. . The MEME should be made ava11- 70 3.11 1.07 % RESPONSE BY CATEGORY Review for Reviéw from Cégztzgip Patient Patient Contact Contact 86 S 9 2 = No, with reservations 3 = Yes, with reservations 4 = Yes, (Always) Twenty-eight percent of the students indicated that they used all of the MEME materials, eighteen percent answered Yes, with reservations (3), twenty—six percent responded No, with reservations (2), while twenty-eight percent indicated No. The mean response for this item was 2.46. Thirty-two percent of the students indicated that having the MEME available was an important addition to the 73 clerkship, while seventeen percent answered Yes, with reservations (3). Twenty—six percent felt that it was not an important addition to the clerkship. The mean response for this item was 2.55. Seventy—four percent of the students felt that the MEME should be made available for other clerkships (3 + 4), while twenty-six per- cent felt that it should not. The mean response for this item was 3.11. Eighty-six percent of the students indicated their primary use of the MEME materials was in learning basic clerkship content. Five percent indicated their use based primarily for upcoming patient con— tact, while ten percent noted that their major use was based on review of past patient contact. Patterns of MEME Use Table 11, on page 77, provides data on patterns of student use of the MEME and MEME materials. Ninety-six percent of the students indicated that they used the MEME between zero and six hours per week, while four percent said they used it seven to twelve hours per week on the average. In comparison with on-campus learning carrel use, student use of the MEME was heavier in the zero to six hours per week category and lower in other categories. Eighty percent of the on—campus students used carrels between zero to six hours per week while eleven percent used them from seven to twelve hours and two percent reported use between thirteen and sixteen hours. Thirty percent of the students reported an average time per use for the MEME of thirty minutes while forty-four percent indicated an average use of thirty-one minutes to one hour. Twenty-three percent 74 TABLE 11 PATTERNS OF MEME USE TOTAL N = 73 % by CATEGORY More 0-6 7-12 13-16 Than 16 On the Average, how many hours/week did 96 4 O 0 you use the MEME? On the Average, how many hours/week did you use 80 11 2 7 your Carrel on Campus? % by CATEGORY 30 Min 31 min. 61 min. MOre ' - 1 hr. - 1% hr. Than 1% The Average Length of time I used MEME was 20 44 23 13 % by CATEGORY 12 AM - 77AM — I 5 PM - 7 AM 5 PM 12 AM Generally I used the MEME most Often between 11 44 1 4S 75 of the students indicated using the MEME from one to one and one—half hours per use and thirteen percent indicated an average use of over one and one—half hours per visit. Eleven percent of the students reported using the MEME between the hours of twelve a.m. and seven a.m., while forty—four percent indicated seven a.m. to five p.m. as their prime use time. Forty— five percent indicated that their primary use was from five p.m. to twelve a.m. Student Preference for MEME Materials The next section of the clerkship assessment dealt with student preferences for media by specific type as well as student use of each instructional unit available in the MEME. Table 12 on page 79, summarizes student preferences for media by type and their assessment of the quality of the existing clerkship materials. Textbooks were the most preferred of all media materials with a mean preference score of 3.66. Video cassettes were the second most preferred of the seven media formatswifliameanscore of 3.48. Pam— phlets ranked third with a mean score of 3.22, followed closely by the objectives and data base and workbooks and programmed materials both at 3.19. The audio cassettes with slides ranked fifth in stu- dent preference with a mean score of 2.88, and audio cassettes alone ranked sixth at 2.69. Audio cassettes with slides and audio cas— settes alone were the only media types with mean scores below a mean score of three (mildly like). The overall mean preference score for all media types was 3.19. 76 TABLE 12 PREFERENCE FOR AND QUALITY OF MEME MATERIALS Pamphlets Objectives and Data Base Audio Cassettes Audio Cassettes and Slides Video Cassettes Textbooks Workbooks and programmed Materials = Strongly dislike = Mildly dislike = Mildly like = Like very much AMNt—d TOTAL N = 64 PREFERENCE QUALITY * ** N MEAN S.D. N MEAN S.D. 60 3.22 .80 51 3.00 .94 64 3.19 .83 61 3.20 .77 59 2.69 .99 43 2.93 .77 60 2.88 .94 48 3.02 .84 62 3.48 .76 53 3.42 .69 64 3.66 .57 61 3.69 .50 58 3.19 .83 46 2.98 .83 3.19 3.18 ** l = Poor 2 = Less than adequate 3 = Adequate 4 = High 77 Student Ratings of Quality of MEME Materials Textbooks were rated highest in quality with a mean score of 3.69, while video cassettes again ranked second with a mean quality score of 3.42. The objectives and data base ranked third in quality with a mean score of 3.02. Pamphlets ranked fifth in quality with a mean score of 3.00, while workbooks and programmed materials were sixth with a mean score of 2.98. Audio cassettes again ranked last with a mean score of 2.93. With regard to quality, workbooks and pro- grammed materials and audio cassettes were the only media types with mean scores below 3.00. The overall mean quality score for all mater- ials was 3.18 or .01 lower than the overall mean preference score. Student Use of MEME Materials The data for student use of specific media materials by type and title as well as the perceived student value of these materials are presented in Appendix E. Video cassettes received the highest over- all use (excluding texts) with a mean score of 2.62, followed by pamphlets at 2.12, and audio cassettes with slides, objectives, work- books and post-tests 1.94. Audio cassettes with slides ranked fourth and received an overall mean use score of 1.78, followed by print materials fifth at 1.72, and audio cassettes ranked last at 1.57. The departmental objectives and data base was the only single item which received a mean use score of above 3.00 and it was 3.25. An examination of the percentage of students using the material bycategory (i.e., O = wasnotavailable; 1 = did not use; 2 = skimmed briefly; 3 = reviewed for main ideas; 4 = in-depth use) as well as the percentage responses for 3, reviewed for main ideas and 4, 78 in—depth use have been combined. Thus, for video cassettes, the range of percentage responses for the two categories was between thirty-six and sixty-six percent for all items. The percentage range of responses regarding whether or not the material was of value ranged from a low fifty—two percent yes, to a high of ninety- seven percent yes, see Table 13. For pamphlets, the second highest used media type, the combined category three and four percentage ranged from a low of thirty—six percent to a high of sixty-two percent. The percent of students indicating that the material was of value ranged from a low of seventy—one percent to a high of ninety percent. TABLE 13 OVERALL MEAN USE SCORES, COMBINED CATEGORY PERCENT RANGES AND RANGE OF PERCENT FOR YES VALUE SCORES OVERALL RANGE FOR RANGE OF MEAN USE COMBINED % 8 FOR YES SCORES CATEGORY VALUE 3 + 4 Video Cassettes 2.62 21-62 52-97 Pamphlets 2.12 36-66 71-90 Audio Cassettes, Slides, _ _ Workbooks, etc. 1'94 30 48 67 86 Audio Cassettes with Slides Only 1.78 22-46 82-89 Print Materials 1.72 25-40 71-84 Audio Cassettes Only 1.57 24-32 56-60 79 Audio cassettes with slides ranked third in overall mean use. The combined percentages from category three and four ranged from a low of thirty to a high of forty—eight. The value percentages ranged from sixty—seven to eighty-six percent indicating that the .material was valuable. Audio cassettes with slides alone ranked fourth in overall mean use. The combined category three and four percentages ranged from a low of twenty-two to a high of forty-six. The range of percentages indicating the material was of value was eighty-two as a low percentage and eighty-nine as the high. Print materials ranked fifth in overall mean use and the range of combined category use percentages ranged from a low of twenty— five to a high of forty. The range of percentages indicating the material was of value was from seventy-one to eighty-four. Audio cassettes ranked last in overall use. The combined per- centages category for response categories three and four, ranged from twenty-four to thirty—two, while the percentages indicating that the materials were of value ranged from a low of fifty—six to a high of sixty . Pre and Post-test (Content Exam) Analygis Content knowledge prior to the clerkship experiences and follow- ing the clerkship was also measured as part of Phase One of the study. Data for the entry and final content exams are presented in Table 14 on page 83. Mean percentage scores on the entry exam were highest for Physiology (80.12) followed by Endocrinology (73.64), Anatomy (72.12), Histology/Pathology at (70.99) and Embryology/Genetics (53.15). The mean score for all entry exam components was 70.99. 80 TABLE 14 ENTRY CONTENT EXAM AND FINAL CONTENT EXAM TOTAL N = 74 ENTRY CONTENT EXAM MEAN% S D 8 SCORE ' ' RANGE Anatomy 72.12 11.51 38-93 Histology/Pathology 70.99 11.75 27-92 Embryology/Genetics 53.15 15.05 25-83 Physiology 80.12 14.42 43-100 Endocrinology 73.64 12.49 42-90 TOTAL 70.99 8.78 42-90 FINAL CONTENT EXAM MEAN% S D 8 SCORE ' ' RANGE History/ A Physical Exam 76.06 12.41 42-100 Normal Obstetrics 66.55 9.25 44-88 Abnormal Obstetrics 72.05 7.07 48-86 Gynecology 72.21 7.22 60-96 Endocrinology 73.32 9.28 46-93 Procedures 68.82 14.14 29-100 Contraception 78.34 8.07 57-96 Sexuality 74.32 18.02 25—100 TOTAL 73.27 5.52 61-85 81 The final content exam scores indicate that the highest student mean score occurred in the Contraception component (78.34). The mean score for the History and Physical Exam component was (76.06), followed by Sexuality (74.27). Mean student scores for the Endo- crinology component were (73.32) followed by Gynecology (72.21), Abnormal Obstetrics (72.05), and Procedures (68.82). Normal Obste- trics had the lowest mean score of (66.55). The KR-ZO reliability coefficient formula when applied to the two halves of the post-test estimated a reliability coefficient of .79 for the first half and a reliability coefficient of .67 for the second half. Based on the length of the total exam (228 items) and inspection of the item statistics, the lower reliability coefficient for part two is probably a function of fatigue. Pre—test scores were used as covariates to control for sources of unknown bias. NO significant differences were found in pre and post—test content exam scores between high and low MEME users. Pearson Correlation Coefficients were calculated on student scores for each component of the entry and final content exams. These data are presented in Table 15 on page 85. Four correlations were significant at the .001 level. A correlation of .44 was found between the Histology/Pathology scores on the entry exam and those on the Normal Obstetrics component of the final exam. The same correla— tion (.44) was found between the Physiology component scores and Normal Obstetrics scores. Physiology scores were also found to correlate (.43) with the total final content exam score. 82 TABLE 15 mhzmzomzou 2mbzm mmh mo mbzmzomzou ZMWZHmm monHntent preference and production quality influenced student use (DI? video materials in this study, it is possible that the format and eatse of use may also have had an influence. Research comparing ‘Jaidables similar to those used in the study between MEME materials Eis they exist and the existing MEME materials converted to video tape might provide important additional information. 122 Another direction that future research might take, would involve a closer examination and control of logistical factors. ZEssentially, it would be important to know whether or not convenience (of location and/or ease of equipment use will create greater MEME tise. If it were determined that some students will simply not use inoneprint materials, regardless of logistics, then methods should lae developed to better identify users and non-users for more (efficient resource allocation in educational programs. Finally, further research is suggested to investigate the Inelationships between preference, perceived quality and use of non- Ixrint materials in the clinical setting. Assuming that the rapid zacquisition of content material will continue to be an important cxancern of medical educators, it is reasonable to continue the iirvestigation of these alternatives. Within this context the following recommendations are made with rxegard to use of the MEME for clerkship experiences in clinical exammunities affiliated with the College of Human Medicine at Michigan S tate University . 1. The MEME should continue to be used in the Ob/Gyn clerkship. Optimal conditions for its continued use include: a. Placement of the MEME only in the "on call" quarters of the OB ward to which students are assigned. b. Continued on—campus back-up equipment support for MEME equipment and weekly preventive maintenance from main campus. c. Continued MEME orientation sessions for students in the first week of the clerkship with obligatory, supervised equipment Operation practice. 123 The development of a short form materials evaluation instrument stored in the MEME for students to complete after each use. The redevelopment of audio cassette materials to con- form to more modern and mature approaches to females as persons. The expansion in production of media materials in video tape format to include redevelopment of existing materials and expanded production of new materials. Inclusion of the MEME materials descriptions (see Appendix B) as part of the Objectives and Data Base booklet provided to all clerkship students. The Ob/Gyn clerkship assessment should continue to be used but in a shortened format and excluding item by item evaluation of MEME materials. The College of Human Medicine should investigate the possibility of utilizing the MEME in other clerkships such as Pediatrics, Medicine, or the Fundamentals of Patient Care (F.P.C.). Optimal conditions for expanded clerkship would include: a. The existence of M.D. faculty (preferably the clerkship coordinator) willing to work with developers and evaluators to specify objectives, identify materials and to provide input into the assessment process. The availability of evaluation, development and pro- duction expertise to work with content specialists to develop materials, assessment items and objectives. Administrative and fiscal support for the project at the Dean's level in the College of Human Medicine. Implementation of a comparative study of MEME effective— ness in the clerkship(s) selected as proposed in the earlier section of this chapter. 124 4. The Ob/Gyn clerkship should continue to be organized and presented as it now is with greater administrative control of the Liaison Experiences. The results of this study, as is the case in all field studies, are extracted from a millieu of interrelated variables and observa- tions and must necessarily be couched in conservative terms. How- ever, the MEME, provides.atleast, a viable partial strategy for the delivery of learning resources in support of educational objectives, in the context of patient care. Logistical issues such as equipment operation, malfunction and location are important considerations, but can be effectively managed in remote clinical sites. Outcome variables such as content knowledge provide essential quality control measures, but student attitudes expressed in program assessment data also provide important measures of program effective- ness. When educational experiences and supporting resources are developed and selected to compliment each other, as they were in this clerkship, the potential for clinical confidence and positive learning experiences is enhanced. BIBLIOGRAPHY 125 BIBLIOGRAPHY Allen, William H., "A Study of Visual and Auditory Presentation in Dental Lecture and Laboratory Instruction." Department of Health, Education and Welfare Project Number 7-14—1490—294. Los Angeles: University of Southern California, School of Dentistry, May 31, 1968. . American Association of Medical Colleges Directorypof Ameri- can Medical Education. Washington, D.C.: American Association of Medical Colleges, 1976. Barrows, Howard S., "Self-Instructional Film Cartridges in Medical Education." The Canadian Medical Association Journal, 98 (1968) pp. 1094-1096. Chez, Ronald A. and David O'Gorman. "Evaluation of an Audiovisual Carrel-Tutorial Course in Clinical Medicine." Medical World, 25 (1974), pp. 2171-2173. Conklin, James L., "A Two Year Study of A Self-Instructional Slide- Tape Program." Journal of Medical Education, 47 (1972), pp. 806-807. Fiel, Nicholas J. and Peter 0. Ways, "Development and Evaluation of Self-Instructional Materials." Journal of Medical Education, 47 (1972), pp. 822-824. Hayden, J., Husek, T.R. and K. Sirotnik, "An Initial Evaluation of Animated Serial Sections as an Instructional Method for Facili— tating Three-Dimensional Awareness of Anatomic Regions." Journal of Medical Education! 42 (1967), pp. 447-452. Judge, R., "Television in Clinical Medical Teaching." The Canadian Medical Association Journal, 98 (1968), pp. 1109-1113. Kerlinger, Fred N., Foundations of Behavioral Research. New York: Holt, Rinehart and Winston, Inc., 1966. p. 387. Koprowska, Irena, J.E. Imbriglia, and R.M. Weismer, "New Approach to Teaching Cytopathology." Journal of Medical Education, 46 (1971), pp. 250-252. 126 127 Kowalewski, Edward J., "Toward Real Community Involvement." Journal of Medical Education, 50 (1975), pp. 57-61. Lange, Crystal M., "Auto—Tutorial and Mbbile—Tutorial Laboratory Techniques in Nursing Education." Paper presented at the National Conference for Associate Degree. Programs in Nursing, March 1966. ERIC Document Number 014-960. Murphree, Alice H., S. Banks and R. C. Reynolds, "The Community Health Clerkship: Profile of a Program." Journal of Medical Education, 47 (1972), pp. 925-930. North, A. Frederick, "Learning Clinical Skills through the Use of Self—Teaching Films." Journal of Medical Education, 42 (1967), pp. 177—180. Postlethwait, S. N., J. Novak and H. T. Murray. The Audio-Tutorial Approach to Learning Through Independent Study and Integpated Experiences. Minneapolis: Burgess Publishing Company, 1969. Russel, J. K., "Sound and Visual Teaching Aids in Obstetrics and Gynecology." Medical and Biological Illustration, 16 (1966), pp. 218-222. Sandritter, Walter, and Bertram Edward. "Planning the Operation of Audio-visual Aids in Pathology." Beitr. Path. Bd., 157 (1974), pp. 327-333. Sly, Michael R., "Use of an Audiovisual Program for the Instruction of Students, Interns and Residents." Annals of Allergy, 35 (1975), pp. 230—233. Spangenberg, Ronald W., "Human Factors in the Design of Carrels for Learning: State of the Art." Audiovisual Communication Review, 23 (1975), pp. 305-332. Tickton, S. G., "What is Instructional Technology?" In S. G. Tickton (Ed.), To Improve Learning: An Evaluation of Instructional Technology. (Vol. 1), New York: R. R. Bowker Company, 1970. APPENDICES 128 A P P E N D I X A MEME SPECIFICATIONS 129 130 131 MEME DESIGN SPECIFICATIONS FINAL DRAFT October 17, 1974 SUBJECT-Design specifications for MEME units (Medical Education II III :[V Mobile Environment) - A self—contained mobile learning environment for storage of and access to self-instructional materials and equipment. A.) Height 6'8" including casters B.) Width 48" side to side C ) Depth 24" front to back Dimensions, External: Materials, External: A.) External Walls of 3/4" Plywood with weight-reducing cores. B.) External Covering-Textolite, Golden Teak C.) Internal Covering-Textolite, Buttery Mobility and Handling: The MEME unit shall be mounted on four (4) heavy—duty soft- tire casters with locks on all four casters. There shall be three steel bars mounted on the unit to facilitate handling. One bar shall be mounted on the bottom of the unit and shall run front-to-back full length along the center line. One bar shall be on each side of the unit, 36" inches from floor level. The bars at the side shall be inset to provide a flush side surface, and shall run full length front to back in an inset mount. The inset portion of the side wall shall be surfaced in the same manner as the overall external surfacing. Access: A.) Access to the interior, from the front, of the MEME unit shall be center-open key—lock double doors that are the full width and height of the MEME surface. Security should be provided by a center-mounted rod-locking system that secures the top and bottom of both doors. 1.) Door interiors shall be fully lined with sound- retarding material 2.) There shall be a positioning device at thg top of each door, to hold the door open at 90 from full closed position. 132 October 17, 1974 133 B.) 3.) There shall be a strong retractable-leg device on the front edge of each door that shall pre- vent the MEME unit from tipping forward when doors are positioned as in (2) above. This device shall mount on the inside surface of each door. 4.) Two fittings shall be provided on the inside, (and one on the outside) of the left hand door to accomodate 8 x 10 print information sheets. The inside surface of the right hand door shall have imprinted on a plastic backed surface, operating directions for the MEME unit. 5.) There shall be one coat hanger permanently mounted to the inside of each door. The posi- tioning of the hanger shall be such that the use of the hanger shall not block the print information. 6.) There shall be two folding chairs mounted on the inside of the right hand door. The two chairs shall be firmly locked into position by a securing device. The device to secure the folded chairs for transit shall be one-stage locking devices that lock and unlock with a minimum of effort. Access to the interior, from the rear of the MEME unit, shall be by means of a vented, key-locked access panel designed to allow all hardward specified for the MEME to be installed, locked in place and interconnected from the rear of the unit. V Exterior-dimensions and fittings: A.) B.) C.) Actual height of the cabinet portion of the MEME unit shall be from the surface to which the casters are mounted. The external walls of the cabinet surface (door surfaces included) shall extend to within 3 inches of the floor, and shall mask the caster units. The caster locking devices shall be easily accessible and the rotation of the casters shall not be inhibited by the masking. There shall be two lights with 3" red lenses mounted flush with the exterior side surfaces at a height of 5'10" from floor level. These lights shall be wired to indicate when the master AC power switch to the MEME unit is in the on position. There shall be, at the bottom, rear right hand corner of the MEME unit access to a spring loaded A/C power supply cord. October 17, 1974 134 VI Interior-all interior surfaces shall be covered as specified in II (C) A.) Softward storage-Right side: 1.) 2.) 3.) 4.) 5.) The right side (when facing the doors of the unit) shall be designed to provide storage, ready access to and visibility of all softward formats. Adjus- table shelving; 8 in number for each unit, shall extend from the top to the bottom of each unit. Adjustment devices shall be designed to hold shelves fixed during transit. There shall be 1/2" lip on the front face of each shelf to aid retention of stored materials during transit. Width of shelve unit shall be 18" from right exterior surface. Depth of shelves, from front to back shall be 16" from back exterior surface. Retention of softward during transit shall be aided by styrofoam "dummies" or forms intended to firmly fix designated material packages. There shall be a fixed counter surface running hori- zontally the full interior width. The counter surface shall be 30" from the floor and, on the right side shall extend 16" from the rear exterior surface. Width of the right side counter surface shall be 18" from right exterior surface. There shall be a fixed vertical divider extending from the top to bottom interior surfaces. The verti- cal divider shall be set 18" from right exterior surface and shall extend 24" from rear exterior surface except for a cut-out area extending upward from the counter surface. The cut-out area shall measure 16" from the rear exterior surface upward and shall curve outward to 24" from rear exterior surface at the level of the upper left hand shelf upon which the television monitor is mounted (18" from top exterior surface of unit). There shall be a fold-down work surface, the width of the shelving and the depth of the right door when in the folded down position. The height of the work surface, when folded down, shall be 30" from floor surface—flush with the horizontal counter surface. The fold-down work surfaCe shall lock firmly in place in the up position, and must provide sufficient support, in the fold down position, to serve as a writing/work surface for the MEME user (3). There shall be a rheostat controlled light, with movable reflector, mounted on the right interior door surface, positioned to illuminate the work sur- face in the fold down position. The rheostat shall be positioned below the lighting fixture and shall be the type that incorporates a power on-off capability. October 17, 1974 135 VET Interior Hardware Storage—left side A.) ITEM The left side of the MEME unit shall be configured and wired to install, mount, and provide access/interconnec- tion to: ITEM 1 - Panasonic TR-910V Video Monitor, 9" ITEM 2 — Audio Selector Dial 2 Position (Headset/Speaker) ITEM 3 — Singer Graflex sound/slide projector Carramate P ITEM 4 - Kodak Ektalite 120 Microfiche Reader ITEM 5 - Wollensack 2505AV Audio Cassette Playback unit ITEM 6 — Self-enclosed 4" Speaker unit ITEM 7 - 2 Position Jack Box for standard phone plug jacks ITEM 8 — Master AC power switch ITEM 9 — Panasonic NV-5110 Video Cartridge Player ITEM 10 - 2 Pair Telex Headsets Model 610-1 or equivalent 1 _. a.) b.) d.) e.) f.) Panasonic TR-910V B + W Video Monitor 9" There shall be a shelf of 15" depth and 15" clearance from rear and top exterior surfaces respectively. This shelf shall extend fully across the left side of the MEME unit. The right corner of the shelf shall have, for install- ation from the rear access panel, a swivel mounting bracket to accomodate the TR-910V. The mounting bracket shalcl) provige for the TR-910V viewing screen to be at 20 to 30 down angle from vertical to provide an acceptable sight-line for seated user. Monitor audio shall be accessed as specified in ITEM 2 (c) & (d). MOnitor video shall be provided from the NV-SllO video cartridge player only. Monitor AC power shall be provided through a fuse system from the master AC power switch. October 17, ITEM ITEM ITEM g.) 2.. a.) b.) 1974 136 The shelf shall be constructed in manner that prevents removal of the video monitor from the front. Install- ation, interconnection and mounting of the monitor shall be as specified in IV (B). Audio Selector Dial: 2 position: Headset and Speaker. The audio selector, 2 position dial, shall be mounted beneath and on the center line of the shelf unit. The 2 position dial shall provide for: Speaker audio for the Wollensack 2505AV through a 4" speaker (Item 6) mounted directly behind the selector dial. Headphone audio for the Wollensack 2505AV through the 2 position jack box for standard phone jack plug. Speaker audio for the TR-910V video monitor through the monitor internal speaker. Headphone audio for the TR-910V video monitor through the 2 position jack box for standard phone jack plug. Speaker audio for the sound/slide projector Carramate P through the Carramate internal speaker. Headphone audio for the sound/slide projector Carramate P through the two position jack box for standard phone jack plug. Sound/Slide Projector Carramate P and Ektalite 120 Microfiche reader There shall be a shelf of 18" depth and 36" height from the rear and bottom exterior surfaces respectively. This shelf shall extend fully across the left side of the MEME unit. The left side of the shelf shall have, for installation, and interconnection through the rear access panel, a mounting bracket to accomodate the Carramate P. The mounging bracket shall position the viewing surface at a 15 angle toward the center line of the left side of the MEME unit. Audio for the Carramate P shall be accessed as specified in ITEM 2 (e) & (f). AC power for the Carramate P shall be provided through a fuse system from the master AC power switch. The shelf shall be constructed in a manner that prevents removal of the Carramate P from the front, but does not inhibit the operation (loading of carousel unit) of the Carramate P. Installation, interconnection and mounting of the Carramate P shall be as specified in IV (B). The right side of the shelf shall have, for installa- tion and interconnection through the rear access panel, a mounting bracket for the Ektalite 120 micro— fiche reader. The mounting bracket shall position the October 17, 1974 137 ITEM 5 - ITEM 6 - ITEM 7 - ITEM 8 - a.) b.) d.) . . 0 . v1ew1ng surface at a 15 angle toward the center line of the left side of the MEME unit. AC power for the microfiche reader shall be provided through a fuse system from the master AC power switch. The shelf shall be constructed in a manner that prevents removal of the Carramate P from the front, but does not inhibit the operating (loading of microfiche & focus) of the microfiche reader. Installation, interconnection and mounting of the Ektalite 120 microfiche reader shall be as specified in IV (B). Wollensack 2505AV Audio Cassette playback unit. There shall be a counter surface that shall extend the full width of the MEME unit, at 30" from floor level. The shelf shall extend the full depth (24") on the left side of the MEME unit. The 2505AV shall be mounted permanently and flush with the counter surface, 12" from the front edge and in the center of the left side counter surface. Audio for the 2404AV shall be pro— vided as specified in ITEM 2 (a) & (b). AC power for the 2505AV shall be provided through a fuse system from the master A/C switch. (see ITEM 2 (a)) 2 position jack box for standard phone plug jack: To accomodate two-headset interconnection to MEME operation; shall be mounted permanently in the left hand corner of the left—side counter surface. Inter- connection through the audio selector dial shall pro- vide Headphone Audio as specified in ITEM 2 (a) (b) (f). Master AC power switch. There shall be permanently mounted next to the audio selector dial unit, a master AC power switch through which AC power is supplied to all equipment specified for the MEME unit. The switch should indicate pp_by means of both letters and red light, on the power switch plate, and by the two red lights on the exterior side walls of the MEME unit as specified in V (B). The master power switch shall route power to, but not bypass, AC power switches on the equipment specified for the MEME unit. There should be a minimum of 2 AC power 3—prong outlets installed in the left side counter area-wired through the master AC power switch. October 17, 1974 138 ITEM 9 - a.) b.) Panasonic NV5110 Video Cartridge Player. There shall be a shelf of 18" depth from the rear ex- terior surface that shall run the full length of the left side of the MEME unit at a height of 12" from the bottom exterior surface. The shelf shall have, for installation and interconnec- tion through the rear access panel, a mounting bracket to accommodate the NV5110. The mounting bracket shall be positioned to allow storage, on the shelf to the right of the NV5110, of 2 pairs of Headphones, Telex Mbdel 610-1 or equivalent (Item 10). Audio and video interconnection to the TR-910V video- monitor should be provided as specified in Item i (d) & (e). AC power shall be supplied through a fuse system from the master AC power switch. The shelf shall be constructed in a manner that pre- vents removal of the NV5110 from the front. A P P E N D I X B MEME MEDIA MATERIALS 139 MEME MEDIA MATERIALS A. PAMPHLETS 1) 2) 3) TITLE: Outline For the Pelvic Examination AUTHOR/DEVELOPER: Gerald B. Holzman, M.D. (N.D.) AVAILABLE FROM: Department of Obstetrics, Gynecology and Reproductive Biology College of Human Madicine Michigan State University East Lansing, Michigan CONTENTS: Five page mimeograph outline DESCRIPTION: An outline and synopsis of the major components of the pelvic examination with emphasis on the asymptomatic woman. TITLE: Modern Obstetrics: Postpertum Hemorrhage AUTHOR/DEVELOPER: The American College of Obstetricians and Gynecologists and the American Medical Association (1974) AVAILABLE FROM: Ortho Pharmaceutical Corporation Raritan, New Jersey 08869 CONTENTS: Eight page printed pamphlet DESCRIPTION: This pamphlet outlines the paramaters of normal bleeding during delivery and describes the major causes of postpartum hemorrhage. It emphasizes the importance of patient reassessment during labor and basic procedures for dealing with postpartum hemorrhage. TITLE: Modern Obstetrics: Pre-Eclampsia-Eclampsia AUTHOR: Unknown 140 141 DEVELOPED BY: The American Association of Obstetricians and Gynecologists and the American Medical Association (1974) AVAILABLE FROM: Ortho Pharmaceutical Corporation Raritan, New Jersey CONTENTS: Nine page printed pamphlet DESCRIPTION: This pamphlet provides a basic discussion of the disease without an etiology. Included are definitions of the stages of the toxemia of pregnancy and descriptions of each stage. Identification of toxemia and treatment regi- mens are also described. Procedures for delivery of patients with mild and severe pre- eclampsia are discussed. 4) TITLE: How to Organize a Basic Study of the Infertile Couple AUTHOR: Unknown DEVELOPED BY: A Committee of the American Fertility Society (1971) AVAILABLE FROM: The American Fertility Scoeity 1801 Ninth Avenue South, Suite 101 Birmingham, Alabama 35205 CONTENTS: Twenty page printed pamphlet DESCRIPTION: A comprehensive introduction to the major aspects of a fertility study. Emphasis is placed upon the doctor/patient relationShip and the importance of sensitivity to human feelings and needs. The pamphlet presents information on the interpretation of fertility factors, classification of sperm and a process for evaluating the major factors of female and male fertility. 5) TITLE: Reproductive Endocrinology AUTHOR: Robert W. Kistner, Faco G., Guest Editor in Chief (1973) DEVELOPED BY: Wyeth Laboratories/Medcom Learning Systems Inc. 6) 7) 142 AVAILABLE FROM: Medcom Learning Systems/Wyeth Laboratories P. O. Box 8299 Philadelphia, Pennsylvania 19101 CONTENTS: Seventy page multicolored, illustrated, printed booklet with self-evaluation providing immediate feedback. DESCRIPTION: The booklet includes three basic chapters pro- viding an in-depth, illustrated review of cur- rent findings in endocrinology. Chapter One, is titled endocronologic basics and reviews the concepts of synthetic hypothalmic releasing factors, hypothalmic-pituitary discharge and ovarian modulation. Chapter Two, emphasizes physician application and includes the basics of ovulation induction and suppression, con- ception control and polycystic ovarian disease. Chapter Three, focuses on the major develop- ments in contraceptive research. TITLE: Contraceptive Technology 1976—77 AUTHOR: Hatcher, Robert; Steward, Gary; Guest, Felicia and Richard Finkelstein (1976) DEVELOPED BY: Authors AVAILABLE FROM: Irvington Publishing Company 551 Fifth Avenue New York, New York CONTENTS: One hundred forty—four pages, printed booklet DESCRIPTION: This booklet presents the major types of con- traception currently available for male and female patients. The positive and negative aspects for each are discussed as are the potential risks involved with each. TITLE: Objectives and Data Base AUTHOR/DEVELOPER: American Association of Obstetricians and Gynecologists Foundation, Inc. (1972) AVAILABLE FROM: American Association of Obstetricians and Gynecologists Foundation, Inc. CONTENTS: One hundred seventy-seven pages, mimeographed looseleaf B. 143 DESCRIPTION: Objectives: An eight unit compilation of ter- minal and enabling objectives covering the following topics, History and Physical Examina- tion; Normal Pregnancy, Labor and Delivery; Obstetrical Abnormalties; Gynecology; Endo- crinology; Procedures; Control of Reproduction and Sexuality. Data Base: Essentially, this volume contains a content outline of major information related to the objectives presented in the first volume. AUDIO CASSETTES 1) 2) TITLE: Postpartum Hemorrhage with Gina Lollipop AUTHOR/DEVELOPER: John Kelly, M. D. (1974) AVAILABLE FROM: John Kelly, M. D. University of Pennsylvania Medical School Hershey, Pennsylvania CONTENTS: Audio Cassette, Thirty minutes DESCRIPTION: In this audio cassette, Dr. Kelly describes the mythical patient "Gina Lollipop." Emphasis is placed upon the detection and identification of postpartum hemorrhage and the major treat- ment regimens and procedures. Clearly sexist in approach. TITLE: Ante-Natal Care with Agent 38-24-34 AUTHOR/DEVELOPER: John Kelly, M. D. (1974) AVAILABLE FROM: John Kelly, M. D. University of Pennsylvania Medical School Hershey, Pennsylvania CONTENTS: Audio Cassette, Thirty minutes DESCRIPTION: This cassette utilizes a case presentation to examine the major considerations of history, current medications, emotional strain, overdue menses and the symptoms of early pregnancy (ie. nausea, lethargy and frequent urination) to explore early diagnosis of pregnancy. The "Mask of Pregnancy, Hypertrophy of Gums, enlarged thyroid and ptyalism are described 144 and the mechanism for each of these temporary symptoms is explained. Clearly sexist in approach. 3) TITLE: Difficult Labor with Mrs. Jan C. Bounce AUTHOR/DEVELOPER: John Kelly, M. D. (1974) AVAILABLE FROM: John Kelly, M. D. University of Pennsylvania Medical School Hershey, Pennsylvania CONTENTS: Audio Cassette, Thirty minutes DESCRIPTION: The case presented in this tape involves a time based simulation of difficult labor beginning in the early labor. The pros and cons of various medications is presented and the impor- tance of the doctor/patient relationship is emphasized. Alternate methods to improve uterine contractions are discussed and the mechanisms involved with each are presented. Clearly sexist in approach. (3. AUDIO CASSETTES WITH SLIDES 1) TITLE: Identification and Evaluation of the High Risk OB Patient AUTHOR/DEVELOPER: Michigan State Medical Society, Committee AVAILABLE FROM: on Maternal and Prenatal Health. The University of Michigan Ann Arbor, Michigan CONTENTS: Sixty-four, 35mm Color Slides, Audio Cassette, Thirty minutes, seven page xeroxed script of audio cassette. DESCRIPTION: This program is a case presentation involving a fifteen year old pregnant female. It details the methodology of identifying and evaluating obstetric patients who have a high risk of developing complications. The content emphasizes the importance of obstetrical, medical and family history, physical exam and appropriate lab tests as critical to proper patient manage- ment. 2) 3) 4) 145 TITLE: Ante-Natal Management of High Risk in OB Patients AUTHOR/DEVELOPER: Michigan State Medical Society Committee on Material and Perinatal Health (1972) AVAILABLE FROM: The University of Michigan Ann Arbor, Michigan CONTENTS: Seventy—seven, 35mm, Color Slides, Audio Cassette Sixty minutes, eleven page script. DESCRIPTION: This presentation emphasizes that high risk pregnancies can often be identified after the first antenatal visit. A management plan including assessment of fetal growth, assess- ment of fetal health, serial laboratory evalu— ation of the patient, appropriate consultation, appropriate timing of delivery, methods of delivery and appropriate location of delivery is presented. Each of these treatment para— meters is described in depth. TITLE: Detection of Fetal Distress in Labor AUTHOR/DEVELOPER: Department of Postgraduate Medicine and Health Professions Education, University of Michigan (1974) AVAILABLE FROM: University of Michigan Ann Arbor, Michigan CONTENTS: Fifty-five, 35mm slides, Audio Cassette, Forty- five minutes, eight page script. DESCRIPTION: The major goal of this presentation is to demonstrate how modern techniques for clinical, electronic and chemical monitoring the labor process can reduce intrapartum fetal deaths as well as the number of infants with low apgar scores. This presentation emphasizes monitor- ing processes appropriate to each stage of la— bor and the abnormalities which may occur at each stage and under different anesthesia con- ditions. TITLE: Endometriosis and Adenomyosis AUTHOR/DEVELOPER: University Extension, the University of Wisconsin and the Department of Obstetrics and Gynecology (1975) 146 AVAILABLE FROM: University of Wisconsin Center for Health Sciences Madison, Wisconsin CONTENTS: Eighty-three, 35mm color slides, Audio Cassettes, Twenty—two and one/half minutes, seven page script. DESCRIPTION: This unit describes and defines the major characteristics of these disease conditions and notes that both are on the rise. The primary diagnostic indications are also shown in several patient case examples. The presenta- tion also explains the relationship between hormonal production and the disease and draws upon current research to describe the treat— ment indicated. Additional references for further reading are provided. 5) TITLE: Perinatal Assessment of Maturation AUTHOR/DEVELOPER: The Audiovisual Committee of the Associa— tion of Medical School Pediatric Depart— ment Chairmen (1972) AVAILABLE FROM: National Medical Audiovisual Center General Services Administration Washington, D. C. CONTENTS: One hundred seventeen, 35mm color slides, Audio Cassette, twenty minutes, twenty-six page script. DESCRIPTION: Three infant cases, each full-term, but each of significantly different maturation and developmental stages are presented and used to describe the importance of maturation to the newborn. This unit presents the major criteria for determining gestational age and methods to be used in the newborn exam. .D. AUDIO CASSETTES WITH SLIDES, OBJECTIVES, WORKBOOKS AND POST-TEST WITH ANSWER KEY 1) TITLE: The Menstrual History AUTHOR/DEVELOPER: California District of the Steering Commit- tee for Cooperative Teaching; Association of Professors of Gynecology and Obstetrics (1974) 2) 3) 147 AVAILABLE FROM: California District of the Steering Commit- tee for Cooperative Teaching; Association of Professors of Gynecology and Obstetrics CONTENTS: Thirty, 35mm color slides, Audio Cassette, Twenty minutes, four page script, post-test and answer key. DESCRIPTION: This presentation is keyed around eight ques- tions considered basic to any satisfactory medical history. The questions include; age of menarche, menstrual interval, duration of menstrual flow, amount of menstrual flow, date of last normal period, premenstrual symptoms, dysmenorrhea and age of menopause. TITLE: The Gynecological Examination AUTHOR/DEVELOPER: Edward H. Bishop, M. D. (1973) AVAILABLE FROM: University of North Carolina School of Medicine CONTENTS: Forty-one, 35mm color slides, Audio Cassette, Thirty minutes, Twenty page script, practice exercises, post-test and answer key. DESCRIPTION: This unit provides an in-depth presentation of the basic components of the Gynecological exam including female genitalia and anatomy, pro- cedures, equipment and interview approach. A six step complete gynecological exam including history, preparation_pf the patient, prepara— tion £25 the patient, general physical exam, pelvic examination and summary are presented. TITLE: Puerperium Evaluation AUTHOR/DEVELOPER: Morgenstern, L., Christian, C. D., Carpenter, C., Harrison, W. T., and Helen A. Toews (1974) AVAILABLE FROM: Medical Audiovisual Services Arizona Medical Center Tucson, Arizona CONTENTS: Thirty-six, 35mm color slides, Audio Cassette, Thirty minutes, nine page script, post-test and answer key. 4) 5) 148 DESCRIPTION: The postpartum or puerperium evaluation as a normal part of past delivery follow-up is pre- sented in this unit. The primary areas for discussion and examination are presented and emphasis is placed on sensitivity to emotional concerns of the patient. The major physical examination emphasis areas are also presented. TITLE: Spontaneous Abortion AUTHOR/DEVELOPER: MacLuchian, T. B., Livingston, R. A., and George J. Furman (1973) AVAILABLE FROM: The Steering Committee for Cooperative Teaching Association of Professors of Gyne- cology and Obstetrics CONTENTS: Twenty-six, 35mm color slides, Audio Cassette, Fifteen minutes, nine page script, post-test and answer key. DESCRIPTION: The presentation includes information on the types of spontaneous abortion and the diagnosis of each based on sets of signs and symptons. In addition, management procedures for each are noted in depth. TITLE: Prenatal Care AUTHOR/DEVELOPER: Edward H. Bishop, M. D. (1973) AVAILABLE FROM: University of North Carolina School of Medicine CONTENTS: Thirty-four, 35mm color slides, Audio Cassette, Twenty minutes, Twenty-two page script, practice exercises, post-test and answer key. DESCRIPTION: This unit provides an in-depth examination of the essential elements of prenatal care. Beginning with the diagnosis of pregnancy, the ~unit describes the principles of immunologic testing, the obstetrical history, pelvic measurement, laboratory examination, the hygiene of pregnancy as well as the dietary implication of pregnancy. Student practice exercises are also provided. 6) 7) 8) 149 TITLE: Early Diagnosis of Pregnancy AUTHOR/DEVELOPER: Caparo, V. J., M. D., Holzman, C. B., McGruder, C. E., Smith, Dennis H., Stickley, W., Wentz, B., Wolfe, W. M., and Bruce A. Work, Jr. (1974) AVAILABLE FROM: Steering Committee for Cooperative Teaching Association of Professors of Gynecology and Obstetrics CONTENTS: Thirty-eight, 35mm color slides, Audio Cassette, Thirty minutes, Ten page script, post-test with answer key. DESCRIPTION: The unit focuses on the medical history as a resource in the importance of early diagnosis of pregnancy. It also emphasizes diagnostic data derived from the physical exam of breasts, vagina, cervix and fundus which may assist the physician in diagnosis. Also included is a discussion of the laboratory tests important to diagnosis of pregnancy. TITLE: Identification of High Risk Pregnancy AUTHOR/DEVELOPER: C. Weir Horswill, M. D. AVAILABLE FROM: Department of Gynecology and Obstetrics University of Wisconsin Madison, Wisconsin CONTENTS: Forty-eight, 35mm color slides, Audio Cassette, Thirty minutes, Eight page script, post-test and answer key. DESCRIPTION: The unit emphasizes the preventive aspects of medical practice as they relate to obstetrics and gynecology. A careful medical history is presented as a major vehicle for early identi- fication of risk factors coupled with appro- priate initial physical exam and laboratory tests. Risk factors which should be considered during each portion of the examination are discussed. TITLE: The Gynecological History AUTHOR/DEVELOPER: Marvin C. Rulin, M. D. 9) 10) 150 AVAILABLE FROM: Steering Committee for Cooperative Teaching Association of Professors of Gynecology and Obstetrics CONTENTS: Sixty, 35mm color slides, Audio Cassette, Forty- five minutes, Eighteen page script, post-test and answer key. DESCRIPTION: This unit describes the rational for and basic content of each of the eight categories of the complete gynecologic history. Included are pelvic pain, bleeding, discharge, pelvic relaxation, menstrual history, obstetrical history, contraceptive history and sexual history. TITLE: Vulvovaginitis: Diagnosis and Treatment AUTHOR/DEVELOPER: Scott, J. C., M. D., Johnson, R. P., and F. Garvecki (1974) AVAILABLE FROM: University of Nebraska Medical Center Omaha, Nebraska CONTENTS: Thirty-two, 35mm color slides, Audio Cassette, Twenty—six minutes, Five page script, post-test and answer key. DESCRIPTION: This presentation includes a description of the signs and symptoms of acute vulvovaginitis and the five primary causes. The diagnostic and treatment procedures involved with the disease are also discussed in detail. TITLE: Ectopic Pregnancy AUTHOR/DEVELOPER: Steering Committee for Cooperative Teaching Association of Professors of Gynecology and Obstetrics AVAILABLE FROM: Steering Committee for Cooperative Teaching Association of Professors of Gynecology and Obstetrics CONTENTS: Eighteen, 35mm color slides, Audio Cassette, Thirty minutes, eight page script, post-test and answer key. DESCRIPTION: In this unit the primary sites of ectopic preg- nancy are discussed as well as the major E. 151 presenting symptoms. The typical findings on physical examination are also presented and it is emphasized that laboratory tests are often of little help in diagnosing an ectopic preg— nancy. Emphasis is also placed on the impor- tance of stabilization of the patient physio- logically. 11) TITLE: The Obstetrical History AUTHOR/DEVELOPER: Hanson, F. M. D., Bragonier, R., Barraga, Carol, M. D., and T. Lebherz (1974) AVAILABLE FROM: Steering Committee for Cooperative Teaching Association of Professors of Gynecology and Obstetrics CONTENTS: Thirty-eight, 35mm color slides, Audio Cassette, Thirty minutes, Eight page script, post-test and answer key. DESCRIPTION: The primary objective of this unit is to teach the student how to complete an obstetrical his- tory and to identify normal and abnormal find- ings obtained from the history. Particular emphasis is placed on findings as they relate to teratogenic risk, bleeding, gravidity, dis- charge, medications, genetic problems and other signs that may affect the course of pregnancy. VIDEO CASSETTES 1) TITLE: Postpartum Hemorrhage AUTHOR/DEVELOPER: The American College of Obstetricians and Gynecologists and the American Medical Association (1974) AVAILABLE FROM: Ortho Pharmaceutical Corp. Raritan, New Jersey 08869 CONTENTS: Cartridge video tape, color Twenty-three minutes DESCRIPTION: The parameters of normal bleeding during delivery and the major causes of postpartum hemorrhage are described in this video tape. Emphasis is placed upon patient reassessment during delivery and the important procedures indicated for dealing with postpartum hemor— rhage. 2) 3) 4) 152 TITLE: Fetal-Maternal Incompatability AUTHOR/DEVELOPER: Sandoz Pharmaceutical Company AVAILABLE FROM: Sandoz Pharmaceutical Company East Hanover, New Jersey 07936 CONTENTS: Cartridge Videotape, Color, Thirty-two minutes DESCRIPTION: This unit presents a discussion of the possible chances of a child being born with RH negative blood. A description of potential explanations for this factor and the procedures for altering blood type are presented. TITLE: The Impotent Husband AUTHOR/DEVELOPER: University of Pennsylvania Medical School (1972) AVAILABLE FROM: Ortho Pharmaceutical Corporation Raritan, New Jersey CONTENTS: Cartridge Videotape, Color, Thirty—five minutes DESCRIPTION: Impotence is presented as a problem common to the middle aged male. In this tape a joint counseling approach is used to model how the physician might help the couple discuss their problems. Replays of significant points are used to emphasize counseling skills. TITLE: The Frigid Wife AUTHOR/DEVELOPER: University of Pennsylvania Medical School (1972) AVAILABLE FROM: Ortho Pharmaceutical Corporation Raritan, New Jersey CONTENTS: Videotape Cartridge, Color, Thirty-five minutes DESCRIPTION: A three phase counseling model is presented in this tape centering around frigidity as a pre- senting problem. Phase one involves the devel— opment of rapport through compassionate concern and active listening skills. Phase two involves the patient appraisal and employs examination of non-verbal cues, patient interraction and patient coping patterns. Phase three involves 5) 6) 153 therapeutic responses, patient education to build self-esteem, tension replacement and finally, motivation for change. TITLE: Development of the Female Reproductive System AUTHOR/DEVELOPER: Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University (1972) East Lansing, Michigan AVAILABLE FROM: Department of Obstetrics, Gynecology and Reproductive Biology (1972) Michigan State University East Lansing, Michigan CONTENTS: Two Videotape Cartridges, Color, Thirty minutes each. DESCRIPTION: This four part, two tape series traces the developmental stages of the female reproductive system in the pre-fetal and fetal state. Beginning with the migration of primordial sex cells into the genital ridge and differentia- tion of the genital ridge into the ovary of the fetus the developmental process moves toward form changes and descent of the ovaries and concludes with development of the uterine tubes, uterus and vagina. TITLE: Pelvic Examination WORKBOOK, AUTHOR/DEVELOPER(S): Hunter, C. A., and A. deLeon, (1974) WORKBOOK, AVAILABLE FROM: Authors, Indiana University Medical Center FILMS DEVELOPED BY: Indiana University Medical Center (1974) FILM AVAILABLE FROM: Indiana University Medical Center CONTENTS: Videotape Cartridge, Color, Fifteen minutes, Script, Post-test and answer key. DESCRIPTION: The primary purposes of this tape are to teach students to describe the pelvic examination including visual observation of genetation including during rest and bearing down. In addition, instrumented observation of the vagina and cervix is shown as is the pap smear 7) 8) 9) 154 technique. Bimanual examination of the cervix, uterus, adnexa and rectum is also shown. TITLE: Normal Labor WORKBOOK AUTHOR/DEVELOPER(S): Hunter, C. A., Wilds, P. L. and W. Johnson, (1974) AVAILABLE FROM: Authors, Indiana University Medical Center FILM DEVELOPED BY: Indiana University Medical Center FILM AVAILABLE FROM: Indiana University Medical Center CONTENTS: Videotape Cartridge, Color, Twenty minutes, Work- book, Post-test and answer key. DESCRIPTION: This videotape emphasizes the identification of characteristics of normal uterine contractile patterns for the six phases or times of preg— nancy. In addition, the fundamental forces of labor are presented. TITLE: Prolongation of Labor Due to Uterine Dysfunction WORKBOOK AUTHOR/DEVELOPER(S): Hunter, C. A., Johnson, W. L. and P. L. Wilds,(l973) WORKBOOK AVAILABLE FROM: Authors, Indiana University Medical Center FILM DEVELOPED BY: Indiana University Medical Center FILM AVAILABLE FROM: Indiana University Medical Center CONTENTS: Videotape Cartridge, Color, Fifteen Minutes, Work— book, Post—test and answer key. DESCRIPTION: This unit emphasizes the diagnosis of prolonged labor as a result of the plateauing of labor in this first stage or lack of progress in the two phases of the second stage. Identification of the causes of abnormal labor and its treat- ment are also presented. TITLE: Normal Delivery WORKBOOK AUTHOR/DEVELOPER(S): Hunter, C. A. and J. D. Lewis (1973) 10) 11) 155 WORKBOOK AVAILABLE FROM: Authors, Indiana University Medical Center FILM DEVELOPED BY: Indiana University Medical Center FILM AVAILABLE FROM: Indiana University Medical Center CONTENTS: Video Cartridge, Color, Fifteen minutes, Workbook, Post-test and answer key. DESCRIPTION: The material emphasizes the management of the normal, spontaneous vaginal delivery process. Included are discussions of correct patient positioning for delivery, cleansing procedures, the rational for episiotomy, the mechanism of the delivery of the fetal head and episiotomy repair. TITLE: Clinical Pelvimetry WORKBOOK AUTHOR/DEVELOPER: Hunter, C. A., Smith, B., and Bernard Leduc. WORKBOOK AVAILABLE FROM: Authors FILM DEVELOPED BY: Ortho Pharmaceutical Company FILM AVAILABLE FROM: Ortho Pharmaceutical Company Raritan, New Jersey 08869 CONTENTS: Videotape Cartridge, Color, Twenty minutes, Work- book, Post-test and answer key. DESCRIPTION: This unit presents a description of the morph- ology and planes of the female pelvis. It is intended to teach the viewer how to perform clinical pelvinmetry including identification of the sub-pelvic arch, measurement of the outlet plane, assessment of the mid-pelvis and measurement of the diagonal conjigate. Finally, the viewer will be able to determine if the boney pelvis is of adequate size and shape to allow passage of a normal size fetus. TITLE: Pre-Eclampsia/Eclampsia WORKBOOK AUTHOR/DEVELOPER: John v. Kelly, M. D. WORKBOOK AVAILABLE FROM: Author F. 156 FILM DEVELOPED BY: American Association of Obstetricians and Gynecologists and the American Med- ical Association FILM AVAILABLE FROM: Ortho Pharmaceutical Company Raritan, New Jersey 08869 CONTENTS: Videotape, Cartridge, Color, Thirty minute, Work— book, Post-test and answer key. DESCRIPTION: The unit presents the four primary objectives in management of the pre-eclamptic patient and the early as well as long term post partum complications for severe pre-eclamptic or eclamptic patients. The management of con- vulsing and hypertensive patients is also pre- sented including potential side effects of drug therapy. The short comings of various anes— thesia types are also discussed. PRINT MATERIALS 1) 2) TITLE: The Menopause AUTHOR: W. E. Easterling, M. D. (1973) AVAILABLE FROM: Author CONTENTS: Twelve page printed workbook, practice cyles, post—test and answer key. DESCRIPTION: This unit presents a description of the known and suspected effects of estrogen deficiency in the pre-menopausal and menopausal woman. The steps in appropriate diagnosis of the menopause and the proper use and contraindica- tions to the use of estrogen in menopausal patients are also presented. TITLE: Drugs Used in Manopause AUTHOR: Tai-Chan Ping, N. D. (1973) AVAILABLE FROM: Author CONTENTS: Twenty-one page printed workbook, post-test and answer key. DESCRIPTION: The climacteric, menopause and post-menopause periods of female reproduction are presented 3) 4) 5) 157 in this unit. In addition, the two conspicuous and characteristic changes in blood level and levels of the four basic hormones present in climacteric and post-menopause women are also discussed. The characteristics of oral estro- gen preparations are also presented as is the role and function of the endocrine system. TITLE: Introduction to the Pharmacology of Estrogen AUTHOR: J. L. Gueriguian, M. D. (1973) AVAILABLE FROM: Author CONTENTS: Twelve page printed workbook, post—test and answer key. DESCRIPTION: The unit presents a description of natural estrogen, steroidal synthetic estrogen and non- steroidal synthetic estrogen and the general principles of relative potency determination of estrogen. Relative degrees of liver inact- ivation of estroidiol and enthinul estradiol are examined and the major routes of excretion for administered estrogen are presented. The side effects and contraindications for estrogen use are also included. TITLE: Background of Normal Labor AUTHOR: Charles H. Hendricks, M. D., (1972) AVAILABLE FROM: Author CONTENTS: Seventeen page print workbook, post-test and answer key. DESCRIPTION: The major physiologic and anatomic changes preceding labor are presented in this unit. Fetal presentation, position and station and status of the cervix in normal labor are also described. "Labor readiness" is defined and described in detail. TITLE: Fetal Growth and Development AUTHOR: Martin, Chester B. and Laura R. Bowen (1970) AVAILABLE FROM: Department of Obstetrics and Gynecology University of Southern California 6) 7) 8) 9) 10) 11) 158 CONTENTS: Fifty-six frame printed linear instructional pro- grams. DESCRIPTION: This program emphasizes the correlation of TITLE: NOTE: TITLE: NOTE: TITLE: NOTE: TITLE: NOTE: TITLE: NOTE: TITLE: NOTE: embryonic/fetal life events with the appropri- ate stages of gestation. The mechanisms and sites of transfer for important metaboletes. between mother and fetus are presented. The important ways in which functioning fetal organ systems differ from adult systems are discussed. Diagnostic Dilemma, Pre—Eclampsia/Eclampsia See Section E, Item 11 Prolongation of Labor Due to Uterine Dysfunction See Section E, Item 8. The Female Pelvic Exam See Section E, Item 6. Normal Labor See Section E, Item 7. Normal Delivery See Section E, Item 9. Clinical Pelvimetry See Section E, Item 10 A P P E N D I X C TYPICAL STUDENT CLERKSHIP SCHEDULE 159 .weam .uoaa omm . . . gaseouaa conuooe< o an M HHH use: nanooeoooaee< noomooam osuomnm arcane IIIIIIII fidflfléillllllflfl§fifl§$flIIIIIJEMflfiWflWIIIII mmmomwo uumom "koamcwoum omzona nonhuman a nueooaam:.|.n.|;mqmnm mam IIIIIIIIII oeudsunz ..aom Housed umom .Ed .380 983.0 zeomnfia % umoum .uo .mOHuHHmauosn< umumofiwue HHH nuu03s0uu=m oulmmlm mono: HH Mmmz IIIIIIIIIII .mflfldwmSEmfiAfl$JW$Ufl9$WIIEEMJEMIIJIIIIIII humonwsmo .un aOfiuuonm .MOfiumeEuocnm uuowwoam omm Hemoo.HH kmowum NIH .HHH nae: nooaoaeas new a one sooneoam osuaanm .oaom.Nsoona< om: mu>H use: esoune< 6H>Hom macs ceaomaaa meanness lam Iswawelawewnm mam mHmanluwem IIIIIIIIIIIIIIIIII ego 2-me I.I.I.Immmmwmwhmmrl.I.IiI&WZMDMHW.I.I.I.I.l.mmmwmwmmmvlymnlflwfll.l.l wwxmomwduw.loMrM#HWI.mmwmmme&m mum: 3:5 86363 Home 63m. 43% wow gamma IIIIII xhsuum .HQ .mawuouflcoz Heuom uuowooam onloalm mmmmosH QIHHH pea: .Honmq newcoaoum I.I.lilmmmmowIHHMLI.I.I.|u.u.| I I.|.I.I.I.I.I.I.I.Ifmmmwnwmm lllllll wwww.IX¢ dado llllll xaoeaoeea> .aa eoaemoeoaao sesame osumaum sheen: cumsom .mm H Mmmz mosobmemzH mm>HHUMHmo UHmOH onHer 'Jz: n-z'lmr sar Ie nth-er 33. Leave you feeling there should be: Use the space below to make additional comments regarding Resident Rounds, Psychiatric Liaison, Radiology and the. Patholog.’ experience: (Use back of page for additional comments) STUDENT [\SSESSIENT OF THE IE" E IN WE 03/GYN CLERKSHIP Consider each of the statements ll'leC about the NEW: in the Old/(DIN Clerkship. Decide how accurate the Statement is. Citcle the numbei that conesponds to vour decision i No No, hith Reservations Yes, With Reservations Yes 1 2 3 4 1. l was aware. that the MD“? was avI'Iilable for this clerkship l 2 3 4 bl c h n U! - Q G o on n In 14 . 15. No No. With Reservations YeS, h'ith Reservations Yes 1 2 3 4 The location of the MEME was convenient ' V 1 ' '2’ 3 4 33. Where was it located? I used or reviewed .most of the MEME media materials (slides/tapes, videOtapes, tapes) 1 2 3 4 Excluding defects in equipment and materials, I found it easy to use the MIME equipment - ' 1 2 3 4 Equipment in the MIME was often broken or not functioning correctly 1 2 3 4 Faculty with whom I had contact reacted negatively to the EIEIE 1 2 3 4 I had difficulty locating (finding) materials in the man I ' 1 2 3 4 ' It would have been valuable to have my own copy of written content summaries (scripts) or. lie-‘33! edia materials (slides/tapes, videotapes, audio tapes) 1 2 3 4 Written descriptions of all media materials would make it .uch easier 0 “skim" and find the content IIIaterial most useful to me 1 2 3 4 Having the MEME available to use was an important addition to the clerkship _ l 2 3 4 I was able to study effectively at home 1 2 3 4 The MEh'IE should be made a\ ailable. (assuming appropriate Interials) for other clerkships 1 . 2 (J! .5 this section, place a check by the answer which most closely represents your utilization of the MES-IE. 0n the average, how many hours per week did you use the ETD-E? [:7 1. 0—6 hours per week [:7 2. 7-12 hours per week [:7 3. 13-16 hours per week E 4. more than 16 hours per week On the average, how many hours per week did you use your carrel on campus? D l. 0~6 hours per week [:7 2. 7—12 hours per week £7 3. 13-16 hours per week 5 4. more than 16 hours per week The. average length of time that I used the MINE at any one time was: 1. 30 minutes or less 2. from 31 minutes to one hour . from 61 minutes to 1‘: hours 3 ‘7' 4. longer than 1'; hours 17. Generally, I used the b11341; most often between the hours of g 1. Midnight - 7:00 a.m. £7 2. 7:00 a.m. - 5:00 p.m. __f:7 3. 5:00 p.m. — Midnight 18. My primary use of the MIME materials was (check more than 1 answer, if appropriate) [—7 1. learning basic clerkship content _/_—_] 2. review for upcoming patient contact _/ _7 3. reviewing questions or problems which arose from patient contact In this section, describe your preference for the type of learning materials available to you in the clerkship and relate this to your opinion of the general quality of these materials and your use of the materials. Circle the number in each column that represents your opinion. If you did not utilize one of the items, leave the quality colimn blank, but complete the preference celwnn blank. Preference £0}; -\_edi_a T‘F‘ZE General Quality g Existing Materials Strongly Mildly Mildly Like Poor Less Than Adequate High Dislike Dislike Like Very Adequate Much I 2 3 4 l 2 3 4 Preference Qual ity 19. Pamphlets (Print) 1 2 3 4 l 2 3 4 20. Objectives and Data Base (Print) 1 2 3 4 l 2 3 4 21. Audio Cassettes ‘ 1 2 3 4 l 2 3 4 22. Audio Cassettes and Slides 1 2 3 4 l 2 3 4 23. Videocassettes 1 2 3 4 1 2 3 4 24. Textbooks - 1 2 3 4 l 2 3 4 25. Workbooks, Programmed Materials ' 1 2 3 4 1 2 3 4 Use the space below to make additional cements on the materials listed above: (Use back of page for additions 1 comments) In this section, describe the extent to which you used the materials and whether or not they were of" Circle the munher which represents your use and place a check in the second column only if the Note that a "0" denotes that the item was not available, missing or lost. value. material was of value. A. F‘ Use of M'xterial s ’th Did Not Skinned Reviewed in Depth Was the l-iaterial of Value ___/./,7 Yes Pmn 11ers (Wyeth) (Martin) AUJZLQ CASS-ms. 1 38-24-34 r Available Use Briefly For Main Use Ideas 0 l 2 3 4 Use 1. Outline for Pelvic hxam 0 l 2 3 2. Postpartum Hemorrhage 0 1 3 3. Pre—Eclampsia/Eclampsia 0 1 3 4. How to Organize a Basic Study of the Infertile Couple 0 l 2 3 5. Reproductive Endocrinology Book . 0 1 2 3 6. Fetal Growth and Development - 0 l 2 3 7. Contraceptive Technology 1975—77 0 1 2 3 8. Objectives and Data Base 0 l 2 3 Postpartum Hemorrhage with Gina Lollipop 0 l 2 3 2. Ante-Natal Care with Agent 0 1 Z 3 3. Difficult Labor with Mrs. Jen C. Bounce 0 1 2 3 AUDlO 94.5333 WITH srnms 1. Identification and Evaluation of- the l-ligh Risk OB Patient 0 1 2 3 2. Ante-Natal Management of High Risk in OB Patients '0 1 2 3 3. Detection of Fetal Distress in r O l 2 3 4. Endometriosis and Adenomyosis O l 2 3 5. Perinatal Assessment of l~laturution 0 l 2 3 I10 t 11 I: I1 D D Value 11 I] 11 13 11 n u 13 D. AUD_l_O_ (‘ts‘sm‘ns h'HH s1. _1L_s, (1111mm , Luzlimts 1L\111L___1os1-1'_1:11 L111 L1~.1L1\: 1177 1. 2. The Menstrual History The Gynecological Exam ination hierpcrium Evaluation Spontaneous Abortion Prenatal Care Early Diagnosis of Pregnancy Identification of the High Risk Pregnancy Gynecological History Vulvovaginitis Ectopic Pregnancy The Obstetrical History VIDIQ CAss1s_rr_1-:s_ (1v. TAPE? ) 1. o to 09 \1 O‘ . 10. 1] Postpartum Hemorrhage Petal— Ma ternal lncomp atibility The Impotent Husband The Frigid Wife Development of the Female Reproductive System A. The Migration of the . Primordial Sex Cells Into the Genital Ridge 13. Differentiation of the Genital Ridge into the Ovary of the Full Term Fetus C. lorm Changes and Descent of the Ovar 105 D. Development of the Uterine Tubes, Uterus and Vagina Pelvic Examination Normal Labor Prolongation of Labor Normal Delivery Clinical Pelvimetry Prc- Ecl amps i a / EC 1 amps i a 01 01 01 0~1 01 2 2 Z 2 2 2 2 2 2 2 UI D onnnnmnnm CHHER F. PR9}; flinging (ommrmzs, womaoox, Fo’sr-nzsr Mn ..wszqu my) 1. 2. 10. .The MenOpause Drugs Used in Menopause Introduction to the Pharmacology of Estrogen Background of Normal Labor Diagnostic Dilemma, Pre- Eclampsia and Eclampsia Prolongation of Labor due to Uterine Dysfunction Female Pelvic Examination Normal Labor Normal Delivery Clinical Pelvimetry O COCO D" Value '3 D D D D m m, 1 1 i .11 A P P E N D I X E USE OF MEME MEDIA MATERIALS BY TITLE 173 174 0N ow MM vq NM N N 0 MM. MN.M 00 MN NN HM NH NN NH OM mH ov.H MM.H MM MN HN MN m MN OH H? 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