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.

Interning with Open.Michigan at MSIS

Marissa Rivas-Taylor is a second-year MSI student at the University of Michigan’s School of Information. She began interning at Open.Michigan in January 2015 because of her interest in OER and publishing. Her personal research surrounds diversity within education and the social benefits of educating women, first-generation students, and multicultural students in America and in the Global South. 

A brighter world will surface once education is available to all who seek it. My undergraduate education embedded itself into this ideology, from our class discussions to influential conference speakers to global service projects. However, the how was often left to one’s own imagination, passions and determination. As I deciphered my next steps for after graduation, others around me joined organizations to move to North Korea, India, Cambodia and many other places to teach English, Music and other skills for a few years. Others joined organizations that advocate female rights to education, such as Girl Rising. As a Gates Millennium Scholar and a first-generation college graduate, I started working on various writing projects that advised first-generation students on getting into college. But getting published seemed like a daunting task, full of rejection letters and uninterested editors. Young and disoriented, I decided to go to graduate school to delay my venture into the professional world.

(2011_Education_for_All_Global_Monitoring_Report)_-Government_primary_school_in_Amman,_Jordan_-_Young_girls_readingThe University of Michigan’s School of Information Master of Information Science program interested me during my final year of college, mostly due to its reputation of producing highly trained professionals for varying successful jobs as well as its emphasis on practical and engaging internships. By my second month into the program, the power of education ideology introduced itself to me once again, but in the form of Open Access. The University of Michigan’s libraries partnered with the School of Information to host a week-long conference about open access and the effort to make globally available educational materials. By the end of the week, the concept of open access intrigued me, and I sought for ways to get involved.

Within a few months, Open.Michigan, who supported the Open Access Week, opened a few positions within their publishing office and soon I joined the Open.Michigan team. My position as an OER operations assistant is also my MSI internship for my Master’s Degree, which opened up a mentoring relationship with the Open.Michigan OER Publisher and UMSI alumnus Dave Malicke.

I remember during my interview with Dave struggling with two thoughts: Will I be able to do everything this role requires? & I REALLY want this job! I finally found a position where my personal interests, liberal arts educational background, and helping the global education mission all aligned beautifully.

By working with Open.Michigan, my knowledge in the areas of publishing platforms, digital formats, medical education, copyright laws, social media promotion, website management, and accessibility needs exponentially increases every week. Some of my past projects include:

  1. Creating iBook and EPUB versions of Open.Michigan books
  2. Working with Michigan Publishing to create effective tweets for their open access materials to be published with the Open Michigan Twitter
  3. Privacy rights & copyright clearance with the photo materials of the An Atlas of Orthopaedic Pathology
  4. Learning about the Creative Commons & Apache open licenses, and helping with different consultations appointments, copyright clearance for educational materials, and a permission form.
  5. Formatting and publishing these courses on the Open.Michigan website:
  6. Researching different publishing formats (.epub, .mobi, .iba, .azw3, .mobi, etc.) in an effort to expand the potential of Open.Michigan OERs through eBook reader devices.
  7. Researching different Subtitle/Caption processes & softwares and helping to subtitle all of video OER materials.
  8. General copy-editing support for our upcoming books as well as some biographical writing on our authors.

As I enter my final year at UMSI, I will continue my internship with Open.Michigan. I will graduate next May 2016 as a strong and confident woman, knowledgeable about various ways to promote global education as well as be equipped by UMSI and my Open.Michigan internship with the skills to effectively help this mission. Sometimes, I dream about bringing the Open.Michigan model to my undergraduate college as well as other educational institutions.

To sum up my internship experience with Open.Michigan in one idea: Colleges and Universities with the desire to promote global education and open access materials should adopt an Open.Michigan-like model to support their faculty, staff and students in publishing their educational resources for free of use.

Photo by Tanya Habjouqa (UNESCO) [CC BY-SA 3.0-igo (], via Wikimedia Commons.

Press Release: Open Access Journal from the University of Michigan and BioMed Central Publishes First Issue

New journal offers peer-reviewed articles from top names in the field of diabetes and endocrinology research

ANN ARBOR, Mich. – June 15, 2015 – Clinical Diabetes and Endocrinology launches its very first issue, a peer-reviewed, online, open access journal that aims to promote better care for people with diabetes and endocrine disease. To achieve this, the journal publishes for health professionals and researchers on a variety of aspects related to diabetes and endocrine diseases and their management.

“The idea behind the journal is to contribute new knowledge related to these diseases,” says Meng H. Tan, M.D., Editor-in-Chief and Professor of Internal Medicine in the Division of Metabolism, Endocrinology and Diabetes at the University of Michigan. “There is a wide audience who will find value in these articles, including physicians, researchers, nurses, nutritionists, pharmacists, podiatrists, psychologists, epidemiologists, exercise physiologists, and health care researchers.”

Our launch issue features a review by Hahr and Molitch from the United States sharing guidelines for managing hyperglycemia in the large group of patients with diabetes complicated by various stages of renal impairment. In addition, Minanni, et al. from Brazil describes their rare complex case of fatal factitious Cushing Syndrome as an example of Münchhausen’s Syndrome. It took a team of clinicians and laboratory scientists to solve this complex challenge, and you can follow their story in the inaugural issue.

Why open access?

With the goal of supporting the University of Michigan’s desire to share knowledge with the world, the collaborators of this journal chose to make this an open access journal to make it more available to health professionals on a global scale. While access is free to readers, authors pay a fee to publish and are the copyright holders of their articles (BioMed Central copyright and license agreement).

Tan explains, “By publishing this journal this way, we can make the knowledge readily and freely available to anyone, without subscription charges or registration barriers.”

“This unique academic-private initiative offers a high-quality, reputable open access journal in a growing field,” says Jasna Markovac PhD, Director of Learning Design & Publishing, Medical School information Services. “This is a worthy alternative to the traditional subscription-based journals.”

To learn more, including how to submit an article, visit the Clinical Diabetes and Endocrinology website. You can sign up for email alerts or follow BioMed Central on Twitter to stay in touch with the latest news and developments. For more information about publishing, open access, or Medical School Information Services Learning Design & Publishing, please contact Jasna Markovac at

The article was written by Stephanie Dascola, Publishing & Communications Editor, and Molly Kleinman, Publishing Associate, Medical School Information Services Learning Design & Publishing, and, except where otherwise noted, is published under a Creative Commons Attribution 4.0 license. Contact us:


Media contact
Stephanie Dascola, Medical School Information Services Learning Design & Publishing,, 734-545-8851

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.

Respected Orthoptist Updates Textbook

At the University of Michigan (U-M) in 1957, there were more than 21,000 students, Harlan Hatcher was president, and an addition was being built onto the Michigan Union.  And, Ida Lucy Iacobucci was just beginning her career at U-M’s Department of Ophthalmology.

Professor Iacobucci, adjunct clinical associate professor at U-M, received her Bachelor’s degree from U-M in 1955 and earned her Orthoptist certificate in 1957. Her clinical and research focus is strabismus, which is the diagnosis, evaluation, and treatment of conditions such as crossed eyes (strabismus) and lazy eye (amblyopia). (Learn more about strabismus on Wikipedia.) She pioneered many of the advances in the field over her long and illustrious career.

Miss Ida, as she prefers to be called, was kind enough to grant us an interview highlighting the second edition of her textbook “Clinical Approach to Ocular Motility: Characteristics and Orthoptic Management of Strabismus, Second Edition.”

image of Miss Ida

 You published your first textbook, “Clinical Approach to Ocular Motility,” in 1980. Why did you decide to take on the considerable task of updating it?  

I was diagnosed with myleofibrosis – a form of cancer – in August of 2009. No treatment was available at that time, but I was accepted into a trial study at the University of Michigan Health System in November 2010 and this experimental therapy saved my life. During this long period of illness and convalescence, I needed something to occupy my mind, so I decided to review and update my book, “Clinical Approach to Ocular Motility”, which was published in 1980.

I don’t use computers, so I would write my lectures out longhand and my secretary, Karen Norman, would type them up for me. I’m grateful to and appreciative of my first-year residents and orthoptic students from 2010 to 2014 who helped me by providing suggestions and refining content.

When the time came to publish my book, I heard about the publishing expertise offered by the U-M Medical School Information Services (MSIS) Learning Design and Publishing department, which includes Open.Michigan. They help faculty, students, and staff publish books in print and digital formats. I worked with MSIS Learning Design & Publishing staff to finish preparation of my manuscript and to publish my book.

What advice would you offer colleagues who may be interested in publishing their own materials?

I felt overwhelmed in the beginning, but the Learning Design & Publishing staff had a process in place and they walked me through it step-by-step. And, I am delighted with the final book. It is very gratifying to be able to provide such an affordable textbook.

What goals do you hope to achieve with the publication of this book?

My hope for this book is that it be viewed as a useful working tool and valuable addition to required texts for orthoptic students, ophthalmology residents, and ophthalmic technicians. Orthoptics has been my life’s work and my life-long passion. This book is my legacy.


Here’s what Miss Ida’s colleagues are saying about the book:

Monte A. Del Monte, M.D., Professor, Ophthalmology and Visual Sciences and Pediatrics and Communicable Diseases at U-M, said, “These pages and chapters are filled with clinical and diagnostic pearls, which are the key to success in this challenging field – all presented in a readable and understandable format.”

Bruce Furr, Ph.D., Instructor in Ophthalmology and Visual Sciences at U-M said, “The initial response (to this book) has been overwhelming. Within the Kellogg Eye Center, everyone who has seen the book wants one. Because it includes treatment – a subject often not touched upon in adequate depth with residents and fellows – the book is seen as a great resource.”

Gill Roper Hall, D.B.O.T., Associate Professor of Ophthalmology at the Saint Louis University Eye Institute said, “Writing a book like this is a huge undertaking and not for the faint-hearted. The fact that Miss Ida was able to do this while convalescing is remarkable. But then, what about Ida is not remarkable?”


You can find this book, “Clinical Approach to Ocular Motility: Characteristics of Orthoptic Management of Strabismus, Second Edition”, on Amazon and on the Open.Michigan website. Proceeds from sales will benefit the Ida Lucy Iacobucci Orthoptics Clinic at the Kellogg Eye Center.

Interview March 4, 2015 by Stephanie Dascola and Karen Kost,
MSIS Learning Design & Publishing, University of Michigan, Ann Arbor

2014: A Year in Review

Open.Michigan covered the launch of a new open access journal, and expanded services for publishing open and print-on-demand textbooks and books. It was a good year for MOOCs as well with three Coursera courses offered by U-M faculty that increased their use of Creative Commons licensing for their materials. Our staff traveled quite a bit too, giving presentations locally, nationally, and internationally. One of our most successful collaborations with the U-M Department of Family Medicine wrapped up a multi-year platform conversion and OER project. We celebrated our sixth anniversary, and there are other highlights from the Open.Michigan office, not to mention from around the University and the country!



Open Access Diabetes and Endocrinology Journal

Clinical Diabetes and Endocrinology cover imageThrough a unique publishing collaboration, the University of Michigan and BioMed Central have launched a new open access journal, Clinical Diabetes and Endocrinology, which is now seeking submissions and set to begin publishing in the first quarter of 2015. The journal is led by Editor-in-Chief Meng H. Tan, Professor of Internal Medicine in the Division of Metabolism, Endocrinology, and Diabetes at the University of Michigan. All articles published in this journal will be CC 4.0 or CC 1.0. Read more on the Open.Michigan blog and learn more about Open Access Journals from Wikipedia.


Open.Michigan Contributors Publish Open Access Article

Open.Michigan is pleased to share a win for Open Access, thanks to the Journal of Academic Medicine. Kathleen Ludewig Omollo and Airong Luo co-authored an article “Lessons Learned About Coordinating Academic Partnerships From an International Network for Health Education” for the journal’s November 2013 issue. According to the official copyright agreement the journal held a 12-month embargo on the article before it could be shared as Open Access. Omollo wrote to Journal of Academic Medicine to request their permission to add an earlier version to the University of Michigan institutional repository, Deep Blue. According to Omollo, “The journal gave us a happy surprise when they permitted the official version to be immediately available as free, public access.”


Statistics 250 Workbooks

Two new statistics open workbooks by Brenda Gunderson (@bkgundy) are available on the Open.Michigan website with a BY-NC-SA 3.0 license. Interested in a hard copy? They are also offered print-on-demand via Amazon: Interactive Lecture Notes and Lab Workbook.


Children and Teens with Cancer Tell Their Story

Chronicling Childhood Cancer book coverChronicling Childhood Cancer: A Collection of Personal Stories by Children & Teens with Cancer. Trisha Paul (Open.Michigan alum), kids and teens use their own words and drawings to share their cancer experiences. You can purchase the book on Amazon, and excerpts from the book are freely available on the Open.Michigan website. Proceeds will be split between Block Out Cancer, and the Child and Family Life Program at C.S. Mott Children’s Hospital. Follow Trisha on Twitter @trishakpaul2.



Three U-M MOOCs Shared with Creative Commons Licenses

Three U-M Massive Open Online Courses (MOOCs), “Instructional Methods in Health Professions Education,” “Teaching and Assessing Clinical Skills,” and “Programming for Everybody” have applied Creative Commons licenses to their downloadable course materials. Two of the course’s authors, Dr. Caren Stalburg and Dr. Chuck Severance, sat down with Open.Michigan to discuss their MOOCs and to share their motivations for publishing Open Educational Resources (OER).

Check out the discussions on the blog:



Sharing Med Ed Materials, Limited Internet & Electricity

Medical Schools in sub-Saharan Africa commonly struggle with limited availability, high subscription costs, and unpredictable transmission rates of Internet and electricity. Many institutions also lack sufficient staffing to maintain and support networking or other technology services on campus. These barriers make it difficult for students and instructors to access, create, and integrate digital learning materials into their education and research activities.

To address this, Open.Michigan has been exploring, evaluating, and deploying models for sharing digital learning materials at institutions with no or limited bandwidth, no or limited electricity, and limited on-site support for technology. We experimented with two models for a portable, easily customizable wireless area network that can broadcast digital learning materials to anyone in range, regardless of whether Internet and electricity is available. The two devices selected for wireless access points are TP-Link MR3020 and a Raspberry Pi model B. Both devices are small in size (approximately 7 cm x 7 cm x 3 cm), cost under US$50, and can be configured to create a wifi hotspot that broadcasts the contents of a connected USB storage device. From a web browser, people can browse and search the learning resources, as well as other advanced services such as tracking usage over time.

To date, 20 of these devices are currently deployed in Ethiopia, Kenya, and Liberia. For more information about this initiative, please refer to our poster and our wiki.


Celebrating Open Access Week + Why Attribution Matters

Why Attribution Matters presentation slideInternational Open Access Week (OA Week, 20-26 October 2014) was an opportunity for the academic community to promote broader access to the products of research and scholarship. This year’s theme was Generation Open, highlighting the generation of students, citizen scientists and early-career researchers who have grown up learning and publishing on the open Web. Read more about the events on our blog, and see the slides from the MLibrary & Open.Michigan sponsored talk: Why Attribution Matters.


Bob Riddle travels to Texas for Open Ed Jam

Raspberry PiMSIS Technologist and Open.Michigan collaborator Bob Riddle presented at Open Ed Jam on Low-cost technology for distribution of OER using Raspberry Pi. Good thing Bob is resourceful. He had to overcome several last-minute setbacks on his way to Open Ed Jam 2014 with a malfunctioning Raspberry Pi. Learn more about the Raspberry Pi project on SlideShare.



William and Flora Hewlett Foundation’s Grantees Meeting

Open.Michigan team member Trisha Paul was invited to present at the William and Flora Hewlett Foundation’s OER Grantees Meeting, 22-24 April 2014. The meeting theme was “OER Value Proposition and Evidence of Impact in 2014” and it was hosted by ISKME (Institute for the Study of Knowledge Management in Education). Paul served as a student representative on a panel discussion entitled “OER Users & Makers,” which was moderated by Vic Vuchic. Paul, who received her Honors English degree from the University of Michigan (U-M) in May and will attend U-M’s Medical School starting this fall, shared her experience working at Open.Michigan and described her experiences with OER as an undergraduate.

At U-M Paul co-founded a student organization called “STEM Society,” where undergrads develop science curriculum for high school students. She introduced the STEM Society undergrads to OER, and by incorporating it into their learning materials, they discovered how to make them more exciting for the high school students. With a passion for literature and science, Paul enjoys exploring the intersection of narrative and medicine, and has CC licensed her blog Because of the CC license, educators have reached out to her and were able to reuse her blog materials. Paul also designed and taught a class for freshman at U-M called “Grand Rounds,” which focused on literary narratives around medicine. Paul feels it’s especially important to share resources and experiences in this area, as this field does not have a lot of resources available.

The “OER Users & Makers” panel discussion can be viewed here, with Paul’s remarks starting at around 25:30.


OCWC Global Conference and Published Open Praxis Journal

Open.Michigan data analyst, Jaclyn Cohen, travelled to Ljubljana, Slovenia in April 2014 to present at the OCWC Global Conference. Cohen presented on Open.Michigan’s Dynamic Metrics project and how the Drupal framework that supports the Open.Michigan website can be used to publicly share OER course and resources usage metrics, including total views, downloads, and the top nations visiting a course. The OCWC Global Conference organizers also collaborated with Open Praxis (a peer-reviewed open access scholarly journal focusing on research and innovation in open, distance and flexible education) to publish selected papers from the conference. Cohen’s paper outlining the Dynamic Metrics project, co-authored with fellow Open.Michigan team members Kathleen Omollo and Dave Malicke, was selected and published in this special issue of the journal: Open Praxis, volume 6 issue 2. Slides from the presentation can be viewed at:



A Collaborative OER Success Story

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. Learn more on our blog.


Spotlight on Our Collections

Risk Bites!

Risk Bites feeds your hunger for the science of risk with bite-sized videos. Learn about dioxane in drinking water, nanoparticles, and even alien blood! Have you ever wondered how safe electronic cigarettes are? Or whether HPV vaccines are a smart idea? Check out the Risk Bites YouTube Channel for answers to these interesting questions and more!


Open Health Collections

Our Open Health Collections  contain representative samples of available open health educational resources. Topics include textbooks, courses, audio and video, journals, images (including anatomic plates, illustrations, photos, and diagrams), datasets, and software. Find other health sciences tools on Twitter using the hashtag #openhealthcollections.


Highlights from the Open.Michigan Office

Happy Anniversary to Us!6th Anniversary Cake

We celebrated our sixth anniversary at the University of Michigan on April 29! It has been our pleasure supporting faculty, students, and staff in sharing their open educational materials. A big thank you to all of our collaborators!


International Program Manager Makes a Move

Kathleen Ludewig OmolloKathleen Ludewig Omollo is now the Strategy Officer with the U-M Department of Learning Health Sciences. During her time as Open.Michigan staff, Kathleen led a range of projects, most notably growing and supporting international partnerships in Sub-Saharan Africa, refining dScribe training, coordinating crowdsourcing translation activities, and developing offline approaches to sharing OER. Learn more about her contributions on our Alumni page.


Notable at the University of Michigan

Digital Education & Innovation Website

U-M Digital Education and Innovation websiteU-M Digital Education & Innovation launched a new site! Digital Education (DEI) enables engaged, personalized, lifelong learning for the Michigan community.DEI redefines elite public education with the creative use of technology and more!Check out DEI on Twitter @umichDEI, and using the hashtag #umdigitaled. Also see for the latest U-M MOOC offerings.


UMHS Applies CC License to Image Bank

The University of Michigan Health System (UMHS) has a newly-redesigned media bank site! Thanks for sharing this valuable collection with a Creative Commons (CC) BY-NC license.


Global REACH Report

Global REACH Activities Report (FY2013-14): Research, Education & Collaboration for Health (REACH) connects 100s of global health faculty working across 29 departments. Open.Michigan staff and contributions, including the collaboration with St. Paul Hospital Millennium Medical College (@SPHMMCAddis) and an openly licensed book entitled “Building Academic Partnerships to Reduce Maternal Morbidity & Mortality “ are featured on pages 28, 33, & 80.


Other News & Events

President Obama Highlights Open Education

“An educated population is a global asset.”

On 24 September 2014 at the United Nations, President Barack Obama marked the Open Government Partnership’s (OGP) third anniversary by announcing that in addition to the commitments outlined in the current U.S. OGP National Action Plan, “The United States will take additional steps to make our government more open, transparent, and accessible for all Americans.” Read more on the Creative Commons blog. For more information, see the White House Office of Science and Technology Policy blog post, “Promoting Open Education to Help Teachers and Students Around the World.”


Nature Communications Is Fully Open Access

Nature Communications became the first Nature-branded open access only journal. The number one open access journal in multidisciplinary sciences, Nature Communications is Nature Publishing Group’s flagship open access title. The journal ranks as the number three multidisciplinary journal in the world.


Wikimedia Commons Turned 10

Wikimedia Commons recently turned ten years old! Sharing on Wikimedia Commons helps to improve Wikipedia articles, and maximizes educational use of images. Watch this video to learn how to upload images to Wikimedia Commons.


New CEO for Creative Commons

The Creative Commons has named Ryan Merkley as their new Chief Executive Officer. According to Merkley, “A public commons, enabled by the open web, is the most powerful force to foster creativity, inspire innovation, and enhance human knowledge around the world. Those who believe in its potential need to join together in a global movement to ensure its success.”


OpenCourseWare Consortium Gets a Facelift

In May 2014 at their annual conference in Ljubljana, Slovenia, the OpenCourseWare Consortium announced its new name: the Open Education Consortium. According to the consortium “The new name embraces trends in higher education globally towards open sharing and scaling access to education through technology, tools and open content.”


Access to OER Expands in the Middle East and North Africa

US State Department announced it is expanding access to Open Educational Resources in the Middle East and North Africa and is sponsoring a special exchange program on OER for education leaders in the Middle East and North Africa. These OER will include course syllabi and materials, modules, textbooks, streaming videos, tests, and software.


Open Policy Network Launched by Creative Commons

The Creative Commons has announced the launch of the Open Policy Network, a coalition of organizations and individuals working to support the creation, adoption, and implementation of policies that require that publicly funded resources are openly licensed resources.

As textbook costs continue to rise, this CNN story describes how some colleges are offering free open source textbooks as course material.

The goal of the Open Textbook Project is to provide flexible and affordable access to higher education resources in British Columbia, Canada by making openly-licensed textbooks available. The Open Textbook is supported by BC Ministry of Advanced Education.

U.S. Copyright Office Releases Copyright Compendium

Monkey SelfieThis release is the first major revision in more than 20 years, and documents best practices for what is, and is not, copyright protected.

Highlight: Who Owns A Monkey’s Selfie? The U.S. Copyright Office says a monkey’s photo, that is, a photo taken by the monkey itself, cannot be copyrighted because it was not taken by a human being.