Intra-operative decision making: more than meets the eye.

Operating room teams consist of team members with diverse training backgrounds. In addition to differences in training, each team member has unique and complex decision making paths. As such, team members may function in the same environment largely unaware of their team members' perspectives. The goal of our work was to use a theory-based approach to better understand the complexity of knowledge-based intra-operative decision making. Cognitive task analysis methods were used to extract the knowledge, thought processes, goal structures and critical decisions that provide the foundation for surgical task performance. A triangulated and iterative approach is presented.

Applying multimedia design principles enhances learning in medical education.

CONTEXT: The Association of American Medical Colleges' Institute for Improving Medical Education's report entitled 'Effective Use of Educational Technology' called on researchers to study the effectiveness of multimedia design principles. These principles were empirically shown to result in superior learning when used with college students in laboratory studies, but have not been studied with undergraduate medical students as participants. METHODS: A pre-test/post-test control group design was used, in which the traditional-learning group received a lecture on shock using traditionally designed slides and the modified-design group received the same lecture using slides modified in accord with Mayer's principles of multimedia design. Participants included Year 3 medical students at a private, midwestern medical school progressing through their surgery clerkship during the academic year 2009-2010. The medical school divides students into four groups; each group attends the surgery clerkship during one of the four quarters of the academic year. Students in the second and third quarters served as the modified-design group (n=91) and students in the fourth-quarter clerkship served as the traditional-design group (n=39). RESULTS: Both student cohorts had similar levels of pre-lecture knowledge. Both groups showed significant improvements in retention (p<0.0001), transfer (p<0.05) and total scores (p<0.0001) between the pre- and post-tests. Repeated-measures anova analysis showed statistically significant greater improvements in retention (F=10.2, p=0.0016) and total scores (F=7.13, p=0.0081) for those students instructed using principles of multimedia design compared with those instructed using the traditional design. CONCLUSIONS: Multimedia design principles are easy to implement and result in improved short-term retention among medical students, but empirical research is still needed to determine how these principles affect transfer of learning. Further research on applying the principles of multimedia design to medical education is needed to verify the impact it has on the long-term learning of medical students, as well as its impact on other forms of multimedia instructional programmes used in the education of medical students.