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Membership in the GGTA would be an excellent match for my skills and career progression. In addition, as I wind down my PhD studies, this would be a wonderful way in which I could get plugged into the Teaching and Learning community at Columbia. I first became interested in computer-aided instruction during my Pediatric Emergency Medicine Fellowship where my research project was a randomized controlled trial of an interactive text-based computer tutorial compared with a standard lecture on ENT emergencies in children. I found that even a rudimentary text-based tutorial could increase test scores as much as a lecture. As a junior faculty member of the Johns Hopkins Children's Center, I obtained an Ambulatory Pediatrics Association Special Projects grant to develop computer tutorials to be implemented in the Pediatric Emergency Dept (PED). This has been a central theme of my academic activities ever since. This project resulted in two publications. The first was a survey of 75 pediatric residents to assess their attitudes towards Computer-aided Instruction (CAI).1 We found that the residents were generally positively disposed towards CAI though they rarely purchased such materials on their own. While they preferred computer tutorials to other supportive materials such as textbooks and journals, any learning format that included a humanteacher was valued more highly than CAI. Encouraged by these results, I wrote and installed two one-hour computer tutorials in the Johns Hopkins PED. These tutorials were meant to supplement a didactic lecture series that had been inconsistently attended by residents due to scheduling difficulties. We tracked use of the tutorials using computer log files. Over a 9 monthperiod, the tutorials delivered 49 hours of instruction to individual residents.2 Over 25% of the interactions occurred during evenings and weekends when regular didactic teaching was not available. One of the most important lessons was that 60-minute tutorials are too long for a resident to complete in a busy clinical environment. The residents generally took 2-3 sessions to complete a given tutorial. However, these tutorials remain in use at the Johns Hopkins PED to this day. Playing a form of career leapfrog, my wife and I moved first to Halifax and then Montreal where I continued to do CAI projects. In Halifax I created a novel e-mail teaching intervention that solved a unique teaching problem. I presented Mock Codes each Monday morning in which residents would role-play leading the resuscitation of a critically ill child. As usual attendance was a problem. In addition, the trainees had little time to reflect on their learning before picking up their clinical duties for the day. To amplify the residents' learning, I created an e-round in which I e-mailed the residents with a summary of the day's case and its main learning points. In addition, I sent out a second e-mail with a provocative question meant to extend the discussion beyond the content of the Mock Code. Each Friday, the residents' responses were collated with an "expert" commentary. At the end of the academic year, I carried out a modest survey of the 16 residents. Their attitudes towards the eround were universally positive with the majority of the residents reading the e-mails. Interestingly, they 1 Pusic MV. Pediatric residents: Are they ready to use computer-aided instruction? Arch Pediatr Adolesc Med. 1998 May;152(5):494-8.2 Pusic MV, Johnson K, Duggan A. Utilization of a pediatric emergency department education computer. Arch Pediatr Adolesc Med. 2001 Feb;155(2):129-34.rated the e-mail summary of the morning's code more highly than the subsequent discussion. Many of the residents saved the e-mails and referred to them later. A description of the intervention and the results of the survey were published in the Journal of Emergency Medicine.3 However, a more telling endorsement of the technique lies in the fact that the residents voted me to receive the Dalhousie University’s highest residency teaching award. In Montreal, I resumed my study of the use of computer tutorials in the PED. I created a suite of six tutorials on common PED problems. Learning from my Hopkins experience, I shortened and focused the tutorials so that they would take a trainee only ten minutes on average. In addition, I envisioned developing a delivery mechanism in which the tutorials would be a supplement to the clinical encounter. That is, instead of being an optional activity to be done in down time in a place removed from the main clinical activity, I hoped that the tutorials would become an integral part of the workflow of the trainee. For example, if the trainee were to see apatient with a fracture, after the clinical encounter, they would do a 10-minute tutorial on the classification of growth-plate injuries to reinforce their learning. The tutorials were designed for medical students and were presented on a dedicated computer in the central nursing station of the PED. We evaluted the impact of the tutorials using utilization tracking and a randomized controlled trial.4 The students used the tutorials a great deal – 539 times over a 9-month period. In addition residents and allied health professionals also availed themselves of the tutorial. The student's attitudes towards the tutorials were uniformly positive and they rated them more highly than scheduled didactic sessions that were allotted three times more time. The students gained knowledge from the tutorials that supplemented their learning from other sources. When exposed to a tutorial on a given topic, a student showed a 56% greater gain in test score on a corresponding question when compared with their scores for questions for which they were not exposed to a tutorial (overall effect size 0.39).Only a small percentage of the tutorials were used in a "just-in-time" fashion – ie within 8 hours of seeing a relevant patient. This is likely because of the paucity of tutorials (students were randomized to only three of the six available tutorials) and the large number of preceptorswho were not aware of the specific content of the tutorials despite the investigator's best efforts. However, on an underpowered subgroup analysis, tutorials done in this coupled mannerseem to be even more effective. In subsequent years, I dedicated myself to expanding the number of tutorials available. With the considerable aid of medical, nursing, education and computer science students,


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