Notre Dame College and Ludwig Maximilian University

The history of multimedia in medical education has been a short and fast moving one. This presentation traces the genesis and historical development of case-based multimedia education from some of its earlier hard wired, hard drive based computer-based instruction (CBI)programs including the PlanAlyzer CBI for teaching diagnosis of chest pain and anemias (1986-1992),VideoAtlas, (1990-1995), the Computerized Interactive Medical Authoring System (CIMAS 1992-1997) to the present CASUS authoring environment for web-based instruction. All of these programs have in common the use of the Slice of Life and Slice of Brain videodiscs as sources for their imagery. The earlier PlanAlyzer programs are in many ways quite primitive(hardwired, dependence on skilled programmer for authoring and changes, not accessible to others on other platforms, CD-ROM, or the Internet) using today's standards.

However the HyperCard-based PlanAlyzer program was the subject of a classic carefully controlled evaluation (NLM funding for 5 years) which showed that students using this CBI were significantly more efficient (43%) in mastering the clinical reasoning and diagnostic process than students without the CBI but with the same case content in text format. (Academic Medicine, 67(12),Dec 1992.821-828). (PlanAlyzer was also the vehicle for a thorough scientific study of how students most effectively interact with CBI to solve medical problems conducted in Munich, Germany by Dr. Heinz Mandl and his colleagues, the outcomes of which eventually led to the development of CASUS). PlanAlyzer's need for more flexibility and authoring capability led to the development of VideoAtlas, (Lyon& Healy, "Computer-assisted instruction in laboratory medicine education." American Journal of Clinical Pathology, 1994 Jul;102(1):142-3), another HyperCard-based program which offered reasonably"user-friendly" authoring capability and which was initially dependent on a direct linkage to the Slice of Life Videodisc for its images, thereby necessitating all of the cumbersome laserdisc hardware for use, and which was not widely available on CD-ROM or the Internet.

VideoAtlas, in turn, led to another generation of an even more "friendly" authoring shells(again HyperCard-based), called CIMAS, in an effort to create an ever more friendly authoring environment for busy clinicians and to enable the importing of Slice of Life images into the program itself to free users from the laserdisc hardware. However, though widely used at Dartmouth (created by Gonzales, Lyon, and Longnecker) it still offered no wide use either via D-ROM or the Internet, though many of these CIMAS cases would later became content for internet-based CASUS cases. Through cross-Atlantic corroboration between the developers of these early interactive programs and motivated German medical educators, these U.S. programs became models for the improved development of the current "friendly" CASUS web based authoring environment and platform for medical teaching cases.

Significantly, Dr. Mandl’s cognitive pedagogical research showed that two pedagogical components are highly significant in using CBI to teach students problem solving: 1) frequent over-the-shoulder expert feedback from the case content expert, and 2) a graphic method of prompting the thinking of students each time a new finding (clue) appears in the problem about what new hypothesis this finding suggests followed by the hypotheses the expert has in mind at this point. CASUS attempts to seamlessly provide both of these important pedagogical elements to student users and authors of cases, there by making it, with its six years of careful formative evaluation. It still uses in many of its cases(over 100 in use at this time), Slice of Life and Brain images from the University of Utah¥s website. The authors have also shared their lessons learned in corroboration with Swedish colleagues, who have created and evaluated an effective web-based dental education program called the Virtual Interactive Periodontist (Rolf Attstrom, Anders Nattsted), sharing with these colleagues their mistakes, helping to eliminate their making of the same mistakes made by the authors over the past 15-years.

This excellent Swedish work has provided a synergy to others in our networks, stimulating new thinking and ideas as well. Many lessons were learned during the author¥s 15 years of international corroboration and these will be shared during this presentation, including strategies for integrating these programs in to the curriculum. The current state-of-the-art of web-based, case-based medical education programs have had a short but interesting history moving from the earlier very limited hard-wired, hard-drive dependency to CD-ROM, and now cross-platform Internet programs which are available to students world-wide. International corroboration among many of the people here at this meeting has been a significant factor in this successful genesis.

Participants will benefit from the pedagogical,technical, and international collaborative lessons shared in this presentation.

Harold C. Lyon, Jr. Ed.D.
Until April 30, 2001: Amalienstr. 38, No. 28,
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