title: Reinforcing outpatient medical student learning using brief computer tutorials: the Patient-Teacher-Tutorial sequence.
abstract: BACKGROUND
  At present, what students read after an outpatient encounter is largely left up to them. Our objective was to evaluate the education efficacy of a clinical education model in which the student moves through a sequence that includes immediately reinforcing their learning using a specifically designed computer tutorial.
  
  
  METHODS
  Prior to a 14-day Pediatric Emergency rotation, medical students completed pre-tests for two common pediatric topics: Oral Rehydration Solutions (ORS) and Fever Without Source (FWS). After encountering a patient with either FWS or a patient needing ORS, the student logged into a computer that randomly assigned them to either a) completing a relevant computer tutorial (e.g. FWS patient + FWS tutorial = "in sequence") or b) completing the non-relevant tutorial (e.g. FWS patient + ORS tutorial = "out of sequence"). At the end of their rotation, they were tested again on both topics. Our main outcome was post-test scores on a given tutorial topic, contrasted by whether done in- or out-of-sequence.
  
  
  RESULTS
  Ninety-two students completed the study protocol with 41 in the 'in sequence' group. Pre-test scores did not differ significantly. Overall, doing a computer tutorial in sequence resulted in significantly greater post-test scores (z-score 1.1 (SD 0.70) in sequence vs. 0.52 (1.1) out-of-sequence; 95% CI for difference +0.16, +0.93). Students spent longer on the tutorials when they were done in sequence (12.1 min (SD 7.3) vs. 10.5 (6.5)) though the difference was not statistically significant (95% CI diff: -1.2 min, +4.5).
  
  
  CONCLUSIONS
  Outpatient learning frameworks could be structured to take best advantage of the heightened learning potential created by patient encounters. We propose the Patient-Teacher-Tutorial sequence as a framework for organizing learning in outpatient clinical settings.
authors.affiliation: Division of Pediatric Emergency Medicine, Columbia University, 622 W 168th St. PH1-137, New York, NY 10032, USA. mvp19@columbia.edu
authors.forename: Martin V
authors.initials: MV
authors.lastname: Pusic
authors.forename: Wendy A
authors.initials: WA
authors.lastname: MacDonald
authors.forename: Harley O
authors.initials: HO
authors.lastname: Eisman
authors.forename: John B
authors.initials: JB
authors.lastname: Black
mesh_terms: D002675:Child, Preschool; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D003479:Curriculum; D003968:Diarrhea, Infantile / Q000628:therapy; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D004632:Emergency Medical Services; D004635:Emergency Medicine / Q000193:education*; D005335:Fever of Unknown Origin / Q000209:etiology / Q000628:therapy; D005440:Fluid Therapy; D006801:Humans; D007223:Infant; D017145:Models, Educational; D010372:Pediatrics / Q000193:education*; D011380:Programmed Instructions as Topic; D012054:Reinforcement, Psychology; D014839:Vomiting / Q000628:therapy