Interactive Media Laboratory

Director: Joseph V. Henderson, M.D., M.A., M. Phil.

DESCRIPTION: The Interactive Media Laboratory (IML) at Dartmouth Medical School is a leading developer of technology-based learning, using computers, multimedia, and network communications for health professional education and training. Applying experiential learning models stemming from the philosophy of John Dewey and connectionist learning theory IML has developed a robust model for computer-based professional education generally applicable to a variety of topics, termed "virtual mini-fellowships" or "virtual clinics."

IML has previously developed a number of computer-based multimedia programs to assist patients, students and other health care professionals with decisions regarding problems that may significantly effect quality of life and/or survival. Four Shared Decision Programs, developed for the Foundation for Informed Medical Decision-Making, included benign prostatic hyperplasia, breast cancer surgery, breast cancer adjuvant therapy, and low back pain. In addition, IML developed a computer-based program to assist patients and their families in developing advance directives (Department of Veteran Affairs), and a pilot program to improve compliance in cholesterol reduction treatment (Merck Pharmaceuticals). IML has developed programs that are used in the Medical School curriculum, for CME courses, and.... (see Evaluation).

Instructional programs are currently delivered via CD-ROM and either PC/Windows or Macintosh computers. In the future, the programs will be delivered via the Internet/World Wide Web; development of this capability is central to IML's current research program. IML is currently active in three areas:

1) Cancer Pain: Development and evaluation of an interactive multimedia CD-ROM program for primary care providers on the management of cancer-related pain. This program is in its third year, undergoing summative clinical evaluation using a randomized clinical trial to measure changes in physician behavior and patient outcomes. This work is funded by the National Cancer Institute and done in collaboration with the Center for Psycho-oncology Research at Dartmouth-Hitchcock Medical Center.

2) HIV/AIDS: Extension and updating of an interactive multimedia CD-ROM on primary care of the HIV/AIDS patient. This project is designed to enable more comprehensive learning, dealing with "softer" knowledge ‚ attitudes and habits of perception and thinking ‚ as well as scientific and technical knowledge. The current models, refined from over a decade of experience, are called "Virtual Clinics" or "Virtual Mini-fellowships." These programs seek to provide as close to an ideal continuing education experience as technology will allow. Funded by Simon and Schuster, the features of this project include:

availability on demand, at any time or place, at reasonable cost
application of sound learning models and learning theory in a carefully-designed, well-produced, comprehensive program of instruction
provision of a mentor who is a recognized expert, "personally" guiding the learner and providing "individualized" feedback and case discussions
provision of a simulated teaching case that compresses time, giving the experience, in the course of several encounters, of counseling, evaluating, and managing a "patient" over several years
ability to "interview" real patients, providing a more humanistic view of illness and its management from the patient's perspective
provision of detailed and insightful case discussions, in context with each simulated patient encounter, covering a broad range of practical and vital management topics
offering of "mini-lectures" given by experts, providing grounding in facts and principles of HIV care
provision of additional, computer-based activities that allow learning of concepts in more active, experiential ways

3) Distance Learning System: Development of a prototype Networked Multimedia Distance Learning System for use by the Army and National Guard. This technology development and demonstration project is intended to promote the adoption of network-based multimedia training. With funding from the Defense Advanced Research Projects Agency and the National Science Foundation, the IML has been developing a prototype Distance Learning System (DLS) linking Army and National Guard members to training materials maintained on the DLS server at the Army Training Support Center (ATSC), Ft. Eustis, VA. The DLS will contain:

a generic world-wide-web front end allowing end-users access to any distance learning courseware available in the digital library (in collaboration with and providing close support of ongoing development at ATSC)
software infrastructure necessary to deliver high Quality of Service interactive media in real-time over the network (network/local CD-ROM hybrid; broadband/network-only)
an asset management infrastructure allowing content developers and training administrators to add new applications to the DLS

EVALUATION: Evaluation of all projects is intrinsic to development, with at least formative evaluation being performed. In some cases, extensive evaluation in terms of controlled trials and clinical outcomes is being conducted (cancer pain project), but this is exceptional, given the great cost and difficulty of doing these studies. IML strives constantly to advance its understanding of the educational applications of technology. A measure of that is the steady increase in the number of grants and contracts, and funding by sources known to be selective.

IML programs and products have been adopted by graduate medical education, undergraduate medical education, as well as by the Columbia University School of Nursing. Additionally, the sales of the HIV/AIDS program through Appleton and Lange, a subsidiary of Simon and Schuster, reflects national recognition and demand for the work of the IML.

LONG TERM GOALS: IML hopes to be able to develop future partnerships with other agencies and businesses to advance techniques developed through its current projects IML's longer-term goals include further development and refinement of its approaches to technology-based learning, facilitating the development of an extensive library of health professional educational programs employing the "virtual clinic" (and other appropriate) models. In addition, the IML would like to facilitate the development of a Center for Applied Communications Technologies, dedicated to the application of computer, multimedia, and network technologies to professional and public information services.