Technology that ‘coaches’ learners: An interview with cardiologist Dr. Richard Judge

Photo by Chris Chapman. Copyright 2015 The Regents of the University of Michigan. Licensed under a CC-BY 4.0 license.

Dr. Richard Judge, renowned cardiologist and pioneer in the development of the pacemaker, originally began his career at the University of Michigan Medical School in 1951. During the latter half of the twentieth century, he directed the course in Physical Diagnosis, and many medical schools throughout the world adopted his book on the subject. When computers became available he realized that this technology could provide students with a means of practicing their observational skills with immediate faculty feedback. He seized the opportunity to marry his interest in technology with his passion for education, and created what is now known as The Professional Skill Builder (PSB), available on the Open.Michigan website.

Editor’s note: This article was co-authored by Dr. Judge and Stephanie Dascola, Publishing and Communications Editor for Learning Design and Publishing, a unit of Medical School Information Services. You may also be interested in this companion interview,Building enduring clinical skills: An interview with Dr. Rajesh S. Mangrulkar.”

What is the Professional Skill Builder (PSB)?

The PSB is a computer-based series of tutorials, which provide learners with an opportunity to practice the cognitive skills required for the examination of patients with cardiac and pulmonary disorders. Like a batting cage in baseball it allows the learner to practice with the help of a coach. A skill by definition is learned only by practice with guidance. The PSB provides both.

It requires no classroom time and can be accessed by the learner anywhere any time. All of the simulated case problems in the PSB are authentic and thanks to video, they are realistically presented. The mentors are all academic cardiologists and pulmonologists.

The PSB focuses on four primary skills: accurate observation, correct description, correct interpretation, and the best method of verification. Two secondary skills, the integration of observations and clinical judgment, are also included.

You mentioned three levels of complexity. Would you explain this?

The PSB is now divided into three levels, each with increasing degrees of complexity.

The first level is designed to augment the introductory course in clinical skills. It focuses mostly on listening to the heart and imprinting the eight basic cardiac sound cadences by means of repetition. This is where we use the Heart Sound Challenge. Correct identification of twenty four cadences in a row.

You can try it too! Heart Sounds Challenge (headphones required)

Second level cases are five to ten minutes in length and are designed to augment the cardiac and pulmonary lectures later in the curriculum. The idea is to give students access to clinical examples of what is described in their lectures. “Bring the patient into the classroom,” so to speak.

Third level cases are longer and more complicated, like being assigned a patient on the medical service or in the outpatient. They provide the learner with one-on-one contact with a series of important cardiac and pulmonary problems, which they might not have been able to work up and examine during their clinical rotations. Each case has a faculty mentor who provides immediate feedback with regard to the accuracy of the learner’s observations and decisions.

How did you come to be involved with PSB?

As Assistant Dean for Student Programs I interviewed many senior students prior to graduation, and I noticed that many of them were not having the opportunity to examine and study patients with some very common heart and lung diseases like community acquired pneumonia or mitral valve prolapse. It occurred to me that we might be able to use computer technology to fill in the gaps.

In 1990, I was 70 years old, and I was leaving private practice to devote all my time to the U-M Medical School as Assistant Dean for Student Programs. I was excited to embark on this new stage of my career. I teamed up with Chris Chapman who is now an Assistant Director for Education with the Medical School Information Services department’s Learning Design & Publishing group, to develop a short series of computer-based heart cases entitled CARDIAX. It was popular with the third-year students and they considered it a valuable adjunct to their clinical experience; and so Chris and I continued to expand it year by year.

In 1997, Dr. Rajesh S. Mangrulkar joined us and with his input, the software was upgraded so we were web-compatible and the content broadened to three levels of complexity for use in all four years of the curriculum. A dozen pulmonary case problems were added along with sections on ECG and chest x-ray. And finally proficiency assessments were created.

What are your favorite aspects of the PSB?

One of the uniquely valuable aspects of the PSB is that the learner receives immediate feedback from a faculty expert for each observation. This feedback loop is vital for the development or improvement of any skill. Unfortunately it is often not available on a busy clinical service.

Another valuable feature is its availability online to learners everywhere whenever they have the time and the interest use it.

So what is the Professional Skill Builder like now?

There are now over sixty long and short case problems as well as exercises in the PSB. There are also basic science correlations, a “tool box” which provides the learner with “Just-in-Time” factual information and several levels of self-assessment.

What else is new with the PSB?

PSB is now available on different platforms including the Mac, PC, iOS, as well as on the web, as a mobile app, and Raspberry Pi. More content has been added to the pulmonary medicine modules, and both a Course Director’s Guide and a User’s Guide have been created.

We applied a Creative Commons license, CC BY-SA 4.0, making it available for remixing and/or local hosting via GitHub and it’s available on the Open.Michigan website. And because of the Creative Commons license, the PSB is being used by Khan Academy, a popular online educational platform.

The Creative Commons license will also aid in our plan to distribute to medical schools, schools of nursing including nurse practitioners and clinical nurse specialist programs, and schools for physician assistants. We’re developing continuing medical education (CME) programs, and plan to make it available on MedEdPORTAL. These are all very important and valuable dimensions to the PSB’s use.

Whats next for the PSB?

We are currently evaluating how long the Level Three cases should be for the modern student. We feel that the proper length depends on the complexity of the case. The more complicated problems require time, and all medical students are short on time. One answer might be to divide each case into several shorter units. But there is no quick fix in learning a cognitive skill. It takes time and practice, just as it does to improve your golf swing or to play the guitar.

Many universities develop online content and tools that they make available publicly but under strict terms of use licenses (e.g. All Rights Reserved). Why did you choose to apply an open, Creative Commons (CC) license?

I thought it was important to have this available, and I made the time and put in the effort to make it happen. I saw a need in Africa, China, and other institutions that have small medical schools with limited faculty or those without as many resources as U-M. Even programs closer to home could benefit.

Learn more about CC BY-SA 4.0.

What keeps you motivated?

I’ve long been interested in pairing technology with learning as well as finding ways to integrate technology into the classroom. The Medical School has given us the tools and technical support to develop something which could benefit learners, not just at the University of Michigan, but nationally and internationally; and not just medical students and physicians, but also clinical nurse specialists, physician assistants, and the like. For this I am grateful.

How was it working with Chris Chapman?

We have worked together since 1990. We’re very close. Many of the innovations that make the PSB especially attractive were not created by me or Dr. Mangrulkar, or any other faculty member for that matter, but by Chris. His contribution has been profound. For example, the Heart Sounds Challenge in Level 1 was Chris’ idea—to make it like a game; and 92% of students get 24 in a row. He’s an expert on using computer technology for education. His designs have been excellent. He applied learning techniques that balanced the project.

Give it a try! Heart Sounds Challenge (headphones required)

What advice would you offer to colleagues who may be interested in using technology in an innovative way?

In order to use educational technology properly, it is going to take time and commitment. Before you start, decide whether the technology is going to provide substantial improvement in what you are teaching. If the answer is “yes,” then give it all you’ve got. But it isn’t like putting together a PowerPoint presentation. To create good, freestanding, online instructional media, you have to really be committed and invest substantial effort and time.

More Information

You might also be interested in the journal articles where Dr. Judge, et al., showed that students who used ‘Cardiacs’ showed profound knowledge retention:

You may enjoy reading these UMHS Headlines articles, “Mobile app makes learning heart sounds easier” and “The Professional Skill Builder: A virtual coach for cardiology and pulmonary medicine.”

Learn how to share your content under a Creative Commons license.

Contact MSIS Learning Design and Publishing and Open.Michigan for assistance with publishing, educational projects, and Creative Commons licenses.

Building enduring clinical skills: An interview with Dr. Rajesh S. Mangrulkar

Photo by Aki Yao. Copyright 2011 The Regents of the University of Michigan. Licensed under a CC-BY 3.0 license.

Dr. Mangrulkar is the Marguerite S. Roll Professor of Medical Education, the Associate Dean for Medical Student Education, Associate Professor of Internal Medicine, and Associate Professor of Learning Health Sciences.

He was kind enough to take time out of his busy day to talk us about the Professional Skill Builder (PSB). Developed collaboratively between faculty of the U-M Medical School and Medical School Information Services, the PSB is an engaging, safe environment for learners to enrich pulmonary and cardiac clinical skills.

Dr. Mangrulkar joined the team growing the PSB in 1997; it was, and continues to be, an evolutionary project that combines his passion for education, training in medicine, and background in computer science.

You may also be interested in this companion interview,“Technology that ‘coaches’ learners: An interview with cardiologist Dr. Richard Judge.”

How did you come to be involved with PSB?  

I knew rather early in my internal medicine residency training that I wanted to be an academician. In my fourth year, when I was serving as chief resident, I realized that what I really wanted to do with my career was to dive in-depth into the scholarship of learning and teaching.

One of my mentors, David Stern, said, “I’d like you to meet some people…Dr. Richard Judge and Chris Chapman.” They were working on the PSB, which was called ‘Cardiax’ back then. I felt like I had found my kindred spirits! They were developing something that was really exciting.

The focus of the project was on education and heart sounds using a CD-ROM that was inserted into the computer; there was no internet-based portal or any of the platforms we have today. My goal became to determine if there was a transferability that could result in better clinical skills by physicians, residents, and students.

We are confident about the quality. There’s a lot of attention to detail. This is part of the reason for engaging Jasna Markovac and her MSIS Learning Design and Publishing team – to address how we can promote it more so that we can have more use and then we’ll learn more from it. It’s not much different than what we had before; it’s just on a different scale.

The pacing of PSB is a little more deliberate. We made it a slower process, which is helpful with the imprinting, especially for the fundamental foundational skills. There must be this intentional pace. You have to think about what’s the right feedback and when to give it. It’s more helpful in the long run, especially for skills that you need to come back to. If it’s about getting new pieces of knowledge, if you’ve got good scaffolding, then you can instantly get it. The knowledge is also transient. Knowledge changes, but the skills are enduring. That really is an important part. The skills of talking to patients, asking the right questions, listening to their heart…those aren’t going to go away. They may change in how they are done, but they’re not going to go away.

Try it! “Aortic regurgitation due to a bicuspid aortic valve (headphones required)

Many universities develop online content and tools that they make available publicly but under strict terms of use licenses (e.g. All Rights Reserved). Why did you choose to apply an open, Creative Commons (CC) license?

Our team believes that the natural default should be that everything is open. We’re at a university that supports this value, so it’s hard for me to think about not using a CC license. Some people will disagree, but if you return to our goal which was to get it out there for people to use, then the license makes perfect sense. If you restrict the content, then you’re really not congruent with that goal. Our motivation is the developing student; our motivation is better learning; our motivation is getting it out there; all of which can be done under a CC license.

How do current learning trends and needs compare with those when the PSB was first conceived?

Originally we were concerned about how students were learning and retaining fundamental clinical skills. But I would say that 20 years later we still have a profound need for building those basic skills. The clinical environment has gotten much more complex than ever; some people would say that it has become less supportive because of the pressures in the healthcare environment. The time to teach, the time to go to the bedside, the amount of time to spend with the patient, has gotten increasingly disrupted. It’s become very work-focused, but there still needs to be learning in that environment. The necessity for tools like the Professional Skill Builder is even greater than it was before.

IT capability has also changed and grown. When I first started, the PSB was on a CD-ROM. This was when the Internet was starting to really expand, and I pushed the idea of putting it on the Internet. Now it’s about platform neutrality, apps, and opencourseware. Technology has changed the way that students fundamentally learn. They’re not buying books; they’re using digital information in an on-demand style.

Our challenge with the PSB is to continue lay a good foundation but acknowledge and embrace those other ways that students learn, including the on-demand model. This format allows students to easily access information in a less disruptive way which becomes the bridge between learning and patient care. How we capitalize on that is a significant trend in education.

What is your favorite aspect of PSB?

One of my favorite components of the PSB is the Heart Sounds Challenge. I love that game. You have to get a certain number of correct identifications correct in a row, and the moment you get one wrong you have to start over.

Try it! The Heart Sounds & Murmur Library (headphones required)

The PSB was developed to be a balance between authenticity and in-depth learning and assessment. You can make things really in-depth and complicated, but then it loses the authentic feel. Or you can make things extraordinarily authentic but then you are just skimming the surface and not capturing the real learning that is going on. We’re always walking that balance whenever we’re doing any of these designs. It’s a fun puzzle.

I also like the coaching aspect of the PSB. It’s critical, really. The faculty used to be those coaches, but it’s more difficult to do that now. We need these virtual coaches now more than ever because of the challenging clinical learning environment, and we need to be able to use the technology to transmit feedback. A coach can provide corrective information, and is focused on performance, and helping you achieves your goals. The virtual coach of the PSB is always watching and providing feedback just at the right moment it is needed, but not in an overwhelming way. The tool allows the learner to try again, to practice it again, like a player in the batting cage or the football stadium or the hockey rink. That’s what they do in the athletic domain, and that’s how the PSB is built. It gives the learner a safe place to try again and a safe space to fail.

What keeps you motivated?

There are two things that keep me motivated. The first is the students—seeing the students use the PSB, listening to how they use it, understanding how it improves their skills. If we’re not doing this for students or learners, then I’m not really interested. From the beginning it’s always been about how can we change the way students think, and how can we change the way that they believe about fundamental skills and build their confidence.

The other thing that keeps me motivated is the team. This is a phenomenal team! My relationship with Dr. Judge is longstanding and deep and professional, but also personal. Same with Chris Chapman. Both of them are remarkable people, and being able to interact with them and the other wonderful members of the team like Marc, John, Jason and Aki, is a true privilege for me. Tracing each other’s journey in education and educational leadership has been fascinating and inspirational.

What advice would you offer to colleagues who may be interested in using technology in an innovative way?

Having been now in this field for nearly 20 years, where technology has been the centerpiece of my academic development, the most important lesson is this: technology is not the answer. Technology is the facilitating factor in education and learning.

We have to think about the wrapper, the delivery method, to maximize its learning impact. Thinking about the wrapper around the tool is really important from an educational principle. Tools are always implemented in a context, whether it be a lecture, small group session, a new case, or technology. If we are just developing a tool because it’s the coolest new technology or the hottest new trend, then we will distract ourselves and lose the focus on learning.

What potential do you see for the PSB?

There are many opportunities for the PSB including research, international use, expanding to other health professions such as nursing, as well as other medical and health professions schools across the country.

Additionally, mobile apps are the future of medical education, and we need to embrace the mobile platform to bring education to the bedside. This is what really keeps me interested: how can technology advance to facilitate better learning? When I hear the students’ positive feedback like, “The PSB really helped me because I had a patient and heard something that I remembered from a particular module, and I was able to help my patient.” That is really motivating for me personally. I see the technology being able to augment that experience.

We can help other schools–not just globally, but other schools across the United States, especially through MedEdPORTAL. The teacher’s manual is designed to help other schools use the tool. We had a great experience with Dartmouth, when Dr. Judge was over there. I think other schools could use it. I’d love to see how they do. The Heart Murmur Library is used within lectures on Khan Academy. And the course materials are available on Open.Michigan, which has an international audience. That’s pretty amazing.

What is the future of the PSB?

We want to continue to set the goals of keeping students motivated about the fundamental clinical skills. I think we’ve flipped as a profession. We’re less about talking and observing, and more about diagnostic testing; I fundamentally disagree with that. Tools like the PSB can help us keep that goal of dialog and observation. When I see students embracing that, getting jazzed about that, I feel like we’re making really good progress there. When I see faculty really enjoying creating new modules, it becomes fun for everyone. That’s honestly what this should be. Returning to the connection between the care provider and the patient without the interference of a technology interface. There are ways to design the interface that actually promote the connection.

The future is going to the on-demand model, which will be mediated by mobility including platforms that are open. We have to figure out a way to bring the learning to the patient, and then connecting the patient and the physician together. More modules that will be available on demand as well, with an eye for an easier way to search for things that you need, like a reference book in your pocket. This would be for both practicing physicians and students. For example, if I’m in clinic and I hear a heart sound I don’t recognize, can we use technology to match what I’m listening to with the answer?

I have so many ideas based on this concept of the PSB. For example, maybe we’ll create a heart device that would feed the patient’s heart sound into the app and match it to the module that has the particular heart sound. All these things that a mobile device has that we haven’t even thought about yet.

That kind of mobility for education is the next frontier. I think the tools haven’t caught up, not embraced that part of the technology as much. Neither have we. We’ve only created a couple of different apps. I think we need to do more, and patients have to be part of that. They’re going to have access to this information anyway, thanks to the Internet. The technology could help patient monitor their own condition, collect data and share with the doctor. There are so many games that are available for patients to manage their own health, especially those who have diabetes or hypertension. I don’t think there’s any reason why patients can’t have games around their heart disease or their symptoms. I’m not sure the PSB is the right platform for it, but it’s definitely a trend globally in education: how patients can be engaged using that.

I personally have always wanted to see how much impact it would have on actual learning in the clinical setting. It’s just really hard to do those research studies. I’m hopeful that part of this publicity outreach will be to get people who are interested in studying its impact into the team as well.

More Information

You might also be interested in the journal articles where Dr. Mangrulkar, et al., showed that students who used ‘CARDIAX’ demonstrated knowledge retention:

You may enjoy reading these UMHS Headlines articles, “Mobile app makes learning heart sounds easier” and “The Professional Skill Builder: A virtual coach for cardiology and pulmonary medicine.”

Learn how to share your content under a Creative Commons license.

Contact MSIS Learning Design and Publishing and Open.Michigan for assistance with publishing, educational projects, and Creative Commons licenses.  The article was written by Stephanie Dascola, Publishing & Communications Editor, Medical School Information Services Learning Design and Publishing, and, except where otherwise noted, is published under a Creative Commons Attribution 4.0 license.

Publishing Collaboration Results in Second Patient-Authored Book About ICD

Newly published: ICD Connection: Living with implantable cardioverter defibrillator (ICD). A collection of stories from women and men. The book, which is available print-on-demand or freely as OER on the Open.Michigan website, focuses on life for patients with ICDs from men’s and women’s points of view.

About the size of a stopwatch, an implantable cardioverter defibrillator, ICD, is an electronic device that gives immediate therapy to life threatening arrhythmia (irregular heartbeat) via a painless pacing sequence or jolt of electricity. Some ICDs also act as pacemakers.

Book cover image for ICD Connection: Living with implantable cardioverter defibrillator (ICD). A collection of stories from women and men

After taking part in and receiving much positive feedback from both patients and healthcare providers for the collaborative ICD Connection: Living with an implantable cardioverter defibrillator. A collection of stories from patients and their families, editor Helen McFarland, R.N., was inspired to explore experiences of living with an ICD from perspectives unique to each gender.

“Although much of the experience of having an ICD implanted is shared between the genders, there are unique experiences that only another woman can understand and vice versa for men…Connecting with others who are experiencing similar situations can help us find encouragement and hope in our own situations. Thank you [contributors] for your generosity.”

An ICD has a significant impact on a patient’s life. This new book is filled with touching stories from women and men of all ages, and how the ICD implant affected their life, their challenges and struggles and what was (or wasn’t) helpful in adjusting to life with an ICD. The heartfelt stories talk about patients feeling scared or depressed (which is common), and fears that loved ones will be afraid to touch them. The book also answers some practical questions specific to women (mammogram, undergarments, pregnancy), and to men (intimacy, everyday activity, and even microwave ovens).

This is the second time McFarland has worked with Open.Michigan, and applied a Creative Commons license to her work, citing her positive experience with the first publication as well as wanting this book to have as broad impact as the first, including a global audience.

McFarland says, “The first time around I felt like I was trying to move a mountain, and Jasna Markovac, Director of Medical School Information Services Learning Design and Publishing, and her team skillfully guided me through the entire process. This time I felt empowered to produce the book.”

Purchase the ICD Connection on Amazon, or download it for free from the Open.Michigan website.

Learn more about McFarland’s first publication about ICDs on the Open.Michigan blog, “Unique Publishing Collaboration Results in Patient-Authored Book.” You might also enjoy reading the U-M Health System press release, “Unique book gives ICD patients a voice, offers hope to others” by Susan Topol, Marketing and Communications Manager, Medical School Information Services.

Open.Michigan and the Department of Family Medicine Education Modules, a unique OER Success Story

This is the final blog post in a three-part series about the partnership with our collaborators in the University of Michigan Department of Family Medicine and their Education Modules: Open.Michigan and the Department of Family Medicine team up to publish Open Education Modules! and Open.Michigan and Family Medicine: Update on a Thriving Partnership.

 15 authors.
38 modules.
5 languages.
1,400 pages.
111,888+ YouTube Views.


The Department of Family Medicine Education Module Transition is complete! What started as an assignment to find a new platform to host the Department of Family Medicine Education Modules, has evolved into a truly unique partnership between an academic unit, Open.Michigan, and a clinical unit, the Department of Family Medicine (DFM). Both are part of the University of Michigan Medical School.

Through this collaboration, the Department of Family Medicine successfully migrated their content from a closed (soon to be unsupported) platform to public-facing Google Sites.

Project Details

Fifteen authors had a hand in sharing their materials as open educational resources (OER). Facilitated by Open.Michigan, each faculty member chose the type of license that best suited their desired effect of how the materials were to be used. Learn how you can share your materials, too.

The project was completed ahead of schedule.  There are more than 1,400 pages of content, and the platform conversion was completed ahead of schedule. This was due in large part to the proven successful process, documentation, training, and marketing promotion procedures that Open.Michigan had in place. The most time consuming part of the undertaking came from educating the authors about the licenses and helping them select the license that met their needs.

The Modules are still being used for their original purposes (DFM Residency Program training).

This is the first series of materials in the Open.Michigan collection to have translations of both video captions and textual content. The Family Medicine videos have captions in (three languages) along side other Open.Michigan videos with multilingual captions on the Open.Michigan YouTube channel. Additionally, the Integrative Medicine Asthma module has the distinction of being the first complete module, including all the text on the Google Sites, to be translated by a volunteer and is now available in Romanian. The Japanese translation of the Musculoskeletal Knee Examination Module (膝の検査) and all the Musculoskeletal Examination video caption translations were made as part of the Shizuoka-University of Michigan Advanced Residency Training, Education and Research in Family Medicine (SMARTER FM) Project led by Michael D. Fetters, M.D., M.P.H., M.A., professor of family medicine, and supported by Shizuoka Prefecture and funded by the Community Healthcare Revival Fund.


Here are the highlights with a historical and present-day contrast:


  • Then: Closed, 32 separate modules, hosted on SiteMaker

  • Now: 38 openly-licensed, publicly available modules, united on one platform using Google Sites, as well as a presence on the Open.Michigan site


  • Then: Small audience, primarily DFM faculty and residents, occasional guests

  • Now: People from all over the world, including Japan and Africa


  • Then: Supplemental, self-guided learning for DFM residents, sometimes used as reference material by faculty members

  • Now: Remains supplemental, self-guided educational materials for DFM residents, but is more accessible as a reference to anyone, and the materials can be customized to suit individual needs



  • Then: 1 (English)

  • Now: 5 (American Sign Language, English, Japanese, Romanian, and Spanish)


To further the educational impact of the bilingual Sign With Your Baby illustrations developed by Michael D. Fetters, M.D., M.A., M.P.H., professor of family medicine, the images have been separately authorized under a CC BY-SA license and posted to both Wikimedia Commons and Wikipedia (on both sites, search for “baby sign” to find the bilingual collection or go to the “Baby Sign” article on Wikimedia Commons). The Romanian and Spanish translations were achieved through crowdsourcing efforts led by Open.Michigan and the U-M College of LS&AScreen Shot 2014-08-01 at 9.42.07 AM.png

This education modules project has been successful for many reasons: faculty champions and support from leadership in the Department of Family Medicine; a University of Michigan Medical School initiative that enables faculty, students, and others to share their educational resources and research with the global learning community; and dedicated staff members who take advantage of University Resources including the technology tools and branding.

View the entire U-M Department of Family Medicine collection on the Open.Michigan site →

Author’s note: Ms. Dascola was invited to give two presentations about this project. Her talk is available on SlideShare with a CC BY license. She also had a poster presentation accepted for the inaugural Michigan IT Symposium. The poster is available for download in PDF and PPT formats on the Open.Michigan site.

Photo attributions:
1. Image by Bill Branson is in the Public Domain.
2. Grey’s Anatomy Slide 348, Public Domain.
3. Image courtesy of the University of Michigan Health System Japanese Family Health Program, CC-BY-SA.
4. Image courtesy of the University of Michigan Health System Japanese Family Health ProgramCC-BY-SA.

Open.Michigan & Family Medicine: Update on a Thriving Partnership

Open.Michigan and the University of Michigan Department of Family Medicine have been working together for over a year to publish a series of modules and videos on topics such as musculoskeletal exams, integrative medicine, and women’s health. Several subjects are still under development, including clinical procedures, gastroesophageal reflux disease (GERD), joint injection, pain management, osteoporosis prevention, among others.

An image from the Complete Musculoskeletal Exam of the Knee YouTube video.

The education initiative has since expanded to include translations for captions that are available in English, Japanese, and Spanish (with more to come) for such videos as the Complete Musculoskeletal Knee Exam. Click on the closed captions (CC) icon to select the language.

Additionally, Philip Zazove, M.D., the George A. Dean, M.D. Chair of Family Medicine, professor, recently spoke about the significant impact of these efforts to a wide audience that includes chairs of family medicine from around the country, residency program alumni, and donors about the impact the units have on high-quality physician training.

The collaboration has been extended to include presentations. The Department of Family Medicine has a pilot project to make available select Grand Rounds lectures via webcast. Since the goal is to eventually share these with the public, lead faculty member, Elizabeth A. Jones, M.D., lecturer, worked with experts from Open.Michigan to learn about the proper use of images. In turn, Dr. Jones presented to the Department of Family Medicine faculty about how to license their own work, find Creative Commons licensed images, and how to correctly attribute those images.

Future enterprises are also being discussed; check back to see the progress. This has most certainly been an exciting relationship, and one that has flourished.

Learn more:

  • Open.Michigan is part of the Office of Enabling Technologies, a unit within the University of Michigan Medical School Information Services organization, that encourages researchers, learners, and instructors to maximize the impact and reach of their scholarly work through open sharing.
  • The Department of Family Medicine is also part of the U-M Medical School, and is celebrating their 35th year of working to meet the needs of patients, and serving as a model for primary care education and research.

Digital Storytelling: Using Narrative and Technology to Enhance Learning

This blog post was co-written by Airong Luo, Ph.D., research area specialist lead, U-M Medical School Information Services Learning Program, and Stephanie Dascola, editorial assistant, Open.Michigan, Office of Enabling Technologies, a unit within the University of Michigan Medical School Information Services organization.

Storytelling is an effective medium to capture and share tacit knowledge, enhance reflective learning, and promote communities of practice. By incorporating multimedia, digital stories strengthen storytellers’ ability to make and share their narratives through multiple modes.

Palliative and end-of-life care involves addressing four dimensions of quality of life—the physical, the psychological, the social and the spiritual. Unfortunately, less than 15% of those who deliver end-of-life care have received professional training on the subject. Instead of traditional didactic and Socratic methods, innovators have called for interactive learning environments that use reflective and experiential teaching methods for addressing the attitudinal barriers that prevent application of core palliative care knowledge. This project started as a way to marry the strength of narrative and technology, and has the potential to encourage reflection and interactive learning and thereby foster students’ palliative care competencies. The process of creating, sharing, and discussing digital stories can therefore be a bridge linking abstract concepts to personal experiences that, overall, enhances the learning experience. Post graduation, nurses may be able to transfer what they learn through their storytelling experience to their professional practice.

A collaborative team including Airong Luo, Ph.D., research area specialist lead, U-M Medical School Information Services Learning Program, Steve Lonn, Ph.D., assistant director of the U-M USE Lab and library analytics specialist, Linda Strodtman, Ph.D., R.N., assistant professor emerita of nursing, U-M School of Nursing, Deborah Price, R.N., M.S., clinical instructor in nursing, U-M School of Nursing, and Elizabeth Brough, Ph.D., R.N., clinical instructor in nursing, U-M School of Nursing, conducted two pilot studies to understand how digital storytelling affects nursing students’ learning of palliative care concepts during the Fall 2012 term and Winter 2013 term. Findings from these studies were presented at U-M Enriching Scholarship 2013 and Palliative Care Collaborative, 7th Annual Regional Conference. A rich discussion was had by the approximately 50 health professionals in attendance, and they also talked about the methodology and future uses of this method for legacy work.

Dr. Luo is also a researcher at Open.Michigan, part of the Office of Enabling Technologies, a unit within the University of Michigan Medical School Information Services organization, that encourages researchers, learners, and instructors to maximize the impact and reach of their scholarly work through open sharing. One aspect of the digital storytelling project was that students learned how to find and properly attribute openly-licensed images for use in their assignments. Many mentioned that they found it helpful, including one of the students, “I liked that I was allowed to integrate a personal story and apply it to concepts that we learned. I also enjoy making the visual presentations.”

“We hope to develop a repository of digital stories that enable collaborative learning for students and health professionals from different countries. Digital storytelling will offer learners opportunities to acquire tacit knowledge including communication skills, understanding and respecting different cultures, which they cannot learn from lectures and textbooks. After talking to our collaborators in China and South Africa, we decided to start with the pilot projects at U-M to understand the impact of digital storytelling on teaching and learning and how instructors, researchers and technologies can enhance educational impact of digital storytelling,” said Dr. Luo.

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Low-Cost Technologies for Distributing OER in Areas with No or Limited Internet

Common challenges to digital learning in developing countries include high technology costs, limited availability of technical resources or expertise, and an unpredictable infrastructure. A new set of low-cost technologies has the potential to lower barriers to the distribution of Health OER and other materials. Two such options, LibraryBox and Raspberry Pi, provide access to local wireless networks even in areas lacking power or Internet access.

First, on the recommendation of two master’s students from the University of Michigan School of Information, we explored LibraryBox. Through a web browser, users gain access to a list of files available to download. We used TPLink portable routers (approximately $40 each) to serve as the wireless access points. Anyone in range of the wireless access point can connect to browse the contents of the attached USB drive. We gathered Health OER content from dozens of sources to fill a 64 GB flash drive to distribute.

The Raspberry Pi is an ATM card-sized computer that is programmed using open source software to perform many desktop PC functions. Raspberry Pi includes all of the functionality of LibraryBox, and offers many more options in terms of services and customization of the user interface. For example, Raspberry Pi provides the option to connect to the Internet when connectivity is available, to download additional resources, such as syncing with a Dropbox folder. We experimented with multiple Raspberry Pi units, paired with a USB 1 Terabyte external hard drive, to provide access to an even larger collection of digital content over a local wireless network. Additionally, we added a rechargeable battery pack to serve as a backup power source. Setup for distributing offline digital content in this way costs between $100 and $200, depending on the accessories used.

Setting up and configuring these devices takes just a few hours, and does not require extensive technical knowledge. Once they are configured, it is simple to access or update the content. Anyone with a wireless capable device, such as a laptop or mobile phone, can access Health OER from the Raspberry Pi or LibraryBox when they are in range of this wireless network.

These low-cost technologies can provide access to digital content in institutions that are power-challenged, network-challenged, and economically-challenged. Between June and August 2013, we deployed nine Raspberry Pi devices to sites in Kenya and Ethiopia and eleven LibraryBoxes to sites in Liberia, Kenya, and Ethiopia. In the coming months, we will gather more feedback from our African Health OER Network partner institutions about the usability and maintenance for these low-cost, lightweight local networks and report on the results.