Digital diagnosis:  the development of electronic laboratory simulations to promote active learning in hematology among first-year medical students

Abstract BACKGROUND Hematology inundates learners with facts and details. Teaching students to identify patterns and render diagnoses poses significant challenges. Bloom's taxonomy reminds us of the hierarchy of learning objectives. Students succeed in remembering and understanding new information. However, applying, analyzing and evaluating concepts can be quite daunting. The laboratory has been the playground for these higher-level tasks. Unfortunately, the wet lab is now dry and learning has become passive. The wonder of scientific discovery has been lost. PURPOSE Striving to apply many of the principles taught during our didactic sessions, the online laboratory allowed first-year medical students in our hematology survey course to utilize a digital images and results to solve clinical cases. Outcomes measure the accuracy of the responses (number of correct items) are subsequently be correlated with performance on standardized assessments (unit quizzes). Secondary outcomes include improved confidence and reduced distress. HYPOTHESIS The implementation of electronic problem sets enhances the learning experience of first-year medical students in a foundational Hem/Onc course. STUDY POPULATION 107 undergraduate medical students enrolled in the Hem/Onc unit of the foundational curriculum during Spring of first year METHODS Learners were asked to complete two electronic problem sets consisting of short clinical cases followed by a question stem emphasizing important laboratory methods and techniques. Scanned images of blood smears, lymph node sections, bone marrow aspirates and biopsies along with dot plots, histograms, electrophoresis gels and karyotypes encouraged students to explore and diagnose. Common hematologic conditions were represented. Assignments were graded on completion and reviewed in person before the formal exam. OUTCOMES Following implementation of the digital problem sets, student performance on written assessments increased from 82% to 86%. Likewise, quantitative feedback rating the overall quality of the unit increased from 2.5 to 3.2 (on a 5-point Likert scale) with an increased number of students rating 4 or 5 (21.6% vs. 39.3%). The perceived utility of the homework was 3.8 (on a 5-point Likert scale) with 64% of students rating a 4 or 5. Qualitative thematic analysis of narrative feedback emphasized the desire to apply knowledge (“Provide more practice problems”), the need to appreciate relevance (“What do we need to know?”) and the satisfaction of collaborating with colleagues (“We worked together”). CONCLUSION The completion of electronic problem sets which required medical students to apply facts and principles presented in didactic sessions facilitated knowledge acquisition, promoted engagement with the material, reduced learner distress and fostered interest in hematology and laboratory medicine. SPONSORSHIP This project was completed under the auspices of the ASH-MEI (Medical Educators' Institute).