Health OER Network Design Jam November 2010

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"Diagnose This" Update
Since the Design Jams held in November, we have been working hard on conducting an environmental scan of the current tools that exist for creating and publishing single page medical cases. Through this process, we discovered that there is a lot of current interest in the ability to create media-rich interactive medical scenarios for the purpose of medical education. However, we did not find one specific tool that encompassed all of the functionality that we envision for "Diagnose This". On the other hand, we found a lot of great quiz/case editing tools in existence that further refined our project ideas and proposed features. Currently, we are investigating the feasibility of designing a case authoring tool that contains the following features:
 * Open source platform to maximize sharing
 * Cases organized on home page with search feature and ability to browse by topic
 * Ability to include media (video, audio, images) in cases with image "hotspots"
 * Multiple choice questions with single best answer and feedback on every response
 * Content will carry Creative Commons licenses that allow for derivatives
 * Create derivative feature that allows existing cases to be remixed and published
 * Comments and comment rating system
 * Ability to export cases and an offline player for exported cases

As we move forward with this project, our next steps involve refining the preliminary mockups to reflect our updated list of desired features. Furthermore, we are considering the most relevant educational context in which to design and implement "Diagnose This".

Post-Event Update
Thank you again to those of you who participated in the Open.Michigan design jam(s) in November. It was truly a pleasure to have a group with such diverse expertise assist us in exploring ways to engage more students in the African Health OER Network. Below is an overview of the proposed project that resulted from your input:


 * "Diagnose This" would be a website with openly licensed short and long clinical cases. The website would include a tool that allows users to easily author, view, and create derivatives of cases. This would make diagnosis an interactive, educational exercise. The intended audience for the site would be health science students and academics. We expect most of the authors to be lecturers. While anyone may author a case, in order to ensure accuracy, cases would not be posted until they have been approved an administrator. An administrator would also review the content for any copyright or privacy concerns. A user may access cases individually or select 10 or 20 random cases within a given category or subcategory. A user can review the cases through a 5-star rating and comments system. Cases would also have multiple choice questions and answers. After a user answers a question, they would be able to view how others responded. This would be a simpler version of the New England Journal of Medicine's interactive cases (http://www.nejm.org/multimedia/interactivemedicalcase) and yet more detailed than their Image Challenge (http://www.nejm.org/image-challenge). This project would fall under the umbrella of the African Health OER Network activities (http://www.oerafrica.org/healthoer/). It would focus on African patients and African procedures for diagnosis with participating institutions having an administrator. However, anyone worldwide could submit a case for review.

For a more-detailed overview, see the [[Media:2010.12.15_Health_OER_Design_Jam_Summary_-_Diagnose_This_-_Public.doc|3-page summary of the project]], including design jam participants, project rationale, user scenarios, functionality, and next steps. You may also view [[Media:2011.01.19_Diagnose_This_Mockups.pdf|preliminary mockups]]. If you would like to stay involved with the project going forward, please contact kludewig@umich.edu.

Intro to the Jam
Looking for a meaningful, tangible project to apply the analytical and technical skills that you’ve developed here at U-M? Ever wonder how you can have a lasting long-term impact in increasing access to education in developing countries? This event is an opportunity to apply some course concepts to a real world problem with a small time commitment.

The African Health OER Network is a joint project with the U-M Medical and Dental School and a number of health science institutions in Africa. Through the project, we work with our collaborators to develop teaching materials and share them worldwide under an open license (Creative Commons) so that they can be used, copied, adapted, integrated, and shared worldwide. Our goal is to advance health care education in Africa by using OER to share knowledge, address curriculum gaps, and build communities of practice around healthcare education. We have been working primarily with institutions in Ghana and South Africa but we continue to draw in more African and, eventually, global participants.

This design jam will bring together students across U-M. This event is an opportunity to apply some course concepts to a real world problem with a small time commitment. There may also be opportunities for continued involvement in the project.

Join us!
RSVP: http://tinyurl.com/oerdesignjam

Logistics
Session I - African Health OER Network Overview and Discussion Thursday, November 4, 2010 Media Gateway, North Quad 11:30 am-1:00 pm

Want to learn about the African Health OER Network? At this first session we’ll give you an introduction to the project, such as goals, key participants, content developed, and future plans. We will begin brainstorming opportunities for student engagement.

Session II - Health OER Network Design Jam Thursday, November 11, 2010 North Quad 2255 6-8 pm

Bring your vision to the Design Jam! Share your skills, perspective and experiences to help generate strategies for engaging more students around the world as content producers and advocates for health open educational resources.

Session III - Health OER Network Design Jam Wednesday, November 17, 2010 North Quad, Room TBD 6-8 pm

Building on our conversations from the last two sessions we'll be focusing on designing a template based on our idea of building a "diagnose this" platform where students, faculty, doctors and others can post content (based on case studies) with diagnosis questions and comments. This facility would potentially support robust feedback in the form of comments, ratings and discussions that would facilitate communication between learners and instructors both at U-M and at partner institutions in the African Health OER Network.

Background on the Health OER Network
Nov 4, 2010 presentation (Slideshare, [[Media:2010.11.04_Design_Jam.ppt|PPT]]).

Nov 11, 2010 presentation (Slideshare, [[Media:2010.11.11_Design_Jam.ppt|PPT]], [[Media:2010.11.11_Design_Jam_Handout.ppt|handout (.ppt)]]).

For more information about the Health OER Network, visit the Health OER Collaborations page.

The Design Problem
How can we engage students around the world as content producers and advocates for health open educational resources?

Seeds for discussion 1. What can we have students do?


 * Generate demand for OER
 * Organize OER (e.g. keywords)
 * Review OER
 * Facilitate a community (e.g. study group) around OER
 * Other ideas?

2. Which students are we targeting? In which disciplines? At which universities? 3. What are their incentives to participate?

Design Constraints

 * This network will have technical (e.g. website) and social (e.g. community health OER creators and users) dimensions


 * Student involvement - at U-M and other institutions - will most often be on a volunteer basis and may occasionally be through paid, part-time work.


 * Bandwidth varies greatly between countries. Any platform must be accessible (e.g. navigation, file size) from members within Africa as well as observers outside the continent.


 * Since travel is time-consuming and costly, it is difficult for members to gather for in-person meetings.

Nov 4 Agenda

 * 11:30 Food
 * 11:40 Welcome and overview of session
 * 11:45 Introduction to the African Health OER Network
 * 12:05 Individual brainstorming
 * 12:10 Brainstorming in small groups (3 – 5 people)
 * 12:25 Share ideas with other group(s), get feedback
 * 12:35 Return to groups, refine ideas
 * 12:50 Share ideas with other group(s), get feedback
 * 1:00 End

General Discussion
One of the participants asked how U-M and OER Africa plan to organize information that is created as OER. Kathleen is working with a health sciences librarian on a list of health-related topic headings to to browse the resources. There are currently only ~40 resources on the site, but that number will grow rapidly. The U-M/KNUST Ghana Emergency Medicine Collaborative alone will have 400 resources to add to the Network within the next 3 years. The OER Africa site also have a tag cloud with all of the keywords. Right now U-M and OER Africa now we are trying to centralize OER content. Eventually we'd like to provide OER under a more distributed model. Due to bandwidth limitations of our partners, we are hosting content on various servers across Africa, in addition to U-M and MedEd portal. Google is interested in providing search for OER. Pieter, our Open Education manager, will be representing U-M at that meeting.

Photos
Photos are up on Flickr

Notes from Group 1
Participants: Lloyd Mbabu, Deborah Nelson, Ted McCarthy, Dave Malicke, Emily Puckett Rodgers, Susan Topol

What can students do?

Use content, create content, review content

1. Generate awareness


 * Media blitz (use social media to promote)
 * Word of mouth
 * Students could use their social networks to collect anecdotes from other students who have found OER useful
 * Encourage faculty use of OER in classroom.


 * Faculty could present on or use OER in class.
 * Faculty could link to OER content from syllabus or other course materials.


 * Limitations
 * Access to technology (laptops, software, Internet).
 * Training faculty (how to use in curriculum, how students can use it).
 * Can't assume access to Internet.

2. Create: Interact with OER to make it better, more accessible


 * Students could apply tags to print material, collect and analyze metadata from print materials or CD ROMs.

3. Curate/review content


 * Students could find open content that makes it easy to create learning materials

Why would students participate (incentives)?


 * Money


 * Look for sponsors and external funding (e.g. grants, competition for creating best OER)
 * There is funding for cultural exchanges within U-M. GIEU is taking 12 students to Kenya next year. Program is 5-10 years old. Some exchanges are local (Detroit), some worldwide (Europe, Africa).


 * Approach departments? Faculty? Try approaching at department level to raise awareness, funding, student involvement.
 * Class credit (extra .5 credit for making class OER)
 * Volunteer/service opportunities (students come to the U-M library to ask for these)
 * Use badges as a reward system (have to earn XX numbers of badges in order to… earn a degree, get a job, etc.)
 * Project to add to resume (get professional recognition)

General Thoughts about Growing the Network


 * Demand is very important motivator (overwhelming demand in Africa). African faculty would definitely engage if they had the resources (laptop, money). It's easy to convince them to use OER but they need to have technology that would enable them to access it.
 * OER created at UM can be used worldwide. Has a lot of potential. We have the resources, now we need to increase productive use of these resources and broaden scope and access to them.
 * How do we encourage students/other users of OER to get some sort of recognition for this use and this recognition could be standardized across institutions? This shouldn't be linked to accreditation schemes but should be something parallel.
 * How do we gain faculty support?


 * Top down and bottom up approaches (grass roots).
 * Metrics of success at the department level (recruiting better grad students) and faculty level (tenure). OER certification level. OER seal of approval for departments.


 * Liaise with librarians to organize content and make it easily findable


 * Archiving OER content institutional repositories. Doesn't require making large deposits, individual resources are valuable to deposit also.
 * Librarians perspective on two ways of using these resources:
 * 1. Database approach where you search and you know what you're getting.
 * 2. Eventually OER repositories become the destination for searches about health topic, information organized into topics and subject areas and guides created to help find material.
 * Today OER is following the database model.
 * OER has the potential to be unique and distinct from other archives
 * Challenge "go to OER if you're interested in malaria". Assign appropriate subject level.
 * Need context as well. "I found this resource, but now I need to know how to use it."
 * Info communities (follow wiki organization)
 * Problem dealing with success. Challenge for how to organize material. How to compare search results. Where is centralized definite source for malaria resources, etc.

Notes from Group 2
Participants: Will Riley, Charles Ransom, Emily Rinck, Airong Luo, Kathleen Ludewig Omollo

What can students do?

1. Raise awareness


 * Using social media (Facebook, Twitter etc.) to announce what you try to do and distribute some content materials
 * Upload videos to YouTube and ask the students to download and disseminate
 * Mobile Phones, use to connect to Facebook/Twitter
 * Announce activities, events, new content
 * Post resources
 * Videos to YouTube, sent to phones to rate content

2. Review materials


 * Ask the students to rate the materials. Differentiate ratings from students with different backgrounds. We should have ways to track who’s responding for accountability and validation
 * Leaving feedback should be easy and minimal marginal cost.
 * During review process, we would need to manage multiple levels of Communication


 * Content
 * Back &amp; forth critiquing
 * Tangential/broader topics
 * Be able to branch out


 * Need to avoid spam, need ID system (reputation and status of student review vs faculty one is important)

Which students?


 * Think about target audience and community. e.g., a premed club will be a good fit)
 * Students who are tech savvy could review production values, rather than just the content itself, rate if boring or worthwhile
 * Focus on health sciences field (e.g. pre-med) and work with existing groups (e.g., UROP)
 * Levels/types of Review


 * Health student
 * Art student
 * Faculty reviewer

'''Why would they participate? (incentives)'''


 * People want to feel like they contribute useful intellectual labor. How can you make students feel like they have made a good contribution? Some design ideas to make students feel that they make impact:


 * 1) giving people some usage information . E.g., Google Map visualization so that people know who are listening and feel that people from the world are viewing their rating, E.g., # students vs. # faculty who downloaded content.
 * 2) people should be able to give feedback to the items they’ve used
 * 3) keep discussion threads so that people can access multi-cultural and multi-discipline discussions, be inspired and the discussion will grow and expand


 * How can we use ratings as an accountability design?


 * Students can influence teaching at their institution
 * We should get faculty members to respond to students’ rate so that students feel that their rating makes impact, faculty members care about their rating and they learn things from rating
 * Students need assurance and feedback that faculty receive their input


 * Opportunity for multicultural encounters
 * Put on a resume, Med School application
 * Opportunity to interact directly with own faculty, which may be difficult in class due to large lectures

Nov 11 Agenda

 * 6:00 Participants arrive
 * 6:10 Welcome and overview of session (Emily)
 * 6:15 Introduction to the African Health OER Network (Kathleen)
 * 6:30 Questions? (about the project, about the design challenge)
 * 6:40 Break into groups, numbering off (3 – 5 people per group)


 * Introductions in small groups


 * 6:45 Brainstorming in small groups
 * 7:05 Food
 * 7:15 Share ideas with other groups, get feedback
 * 7:25 Return to groups, refine ideas
 * 7:45 Share ideas with other groups, get feedback
 * 7:55 Closing (Kathleen &amp; Emily)

Participants
Guests


 * Will Riley, first year PhD student at SI, community informatics and social computing
 * Matt Simpson, 4th year Med student, 1st year MPH student, first group of Med School dScribes
 * Cameron Gibley, grad student physics, 4th year
 * Sandra Danso-Bamfo. 5th year medical student at University of Ghana, doing 3-week Ob/Gyn rotation at U-M
 * Adam Rahman, lecturer, Department of Communication Design, Kwame Nkrumah University of Science and Technology

Open.Michigan Team


 * Kathleen Ludewig Omollo (moderator)
 * Pieter Kleymeer
 * Emily Puckett Rodgers
 * Susan Topol

Photos
Photos are up on Flickr

Introduction
The goal of the session is to identify ways to involve students, either as advocates for OER or as content creators themselves. Students at our partner universities in Africa are tech savvy. They want access to information, but the universities struggle with infrastructure challenges (e.g. buildings that were built before the rapid increase in student enrollment, very expensive bandwidth, high faculty to student ratio). Students are excited about the potential for OER to enhance their learning. Using OER as learning materials, students have access to clinical experiences (e.g. videos of procedures) they otherwise might have trouble viewing in person due to crowded classrooms and ward rounds.

We skipped the background presentation since several of the participants were already familiar with the African Health OER Network. Rather than breaking into groups, we discussed the design challenge as a large group.

Discussion
What project(s) could we have students work on? “Diagnose This." This would be website which has individual medical cases (like cases in the modules that Cary worked on, but as individual resources instead of a package). Students and/or faculty could participate in writing cases and also review (like a 5 star rating and comments) on the cases. This would be a simpler version of the New England Journal of Medicine's interactive cases (http://www.nejm.org/multimedia/interactivemedicalcase) and more content than their Image Challenge (http://www.nejm.org/image-challenge), but it would feature African patients and African procedures for diagnosis. This would make diagnosis an interactive, educational exercise.

Why this project idea? 1. Students and professors who conduct research or participate in clinical rotations abroad comment on the differences between clinical examinations in Africa and the U.S., particularly the diagnoses procedures. U.S. hospitals are more likely to rely on expensive equipment to assist their diagnoses, equipment that is often not available in hospitals in developing countries. Matt commented that his peers who did some of their clinical rotations abroad come back with more confidence in their diagnoses b/c they had learned to rely on their knowledge and simpler equipment.

2. Contextually appropriate resources is one of the motivating factors for the African Health OER Network. Many medical textbooks and publications originate in Western countries, and therefore use photographs and examples that are not always suitable for the Ghanaian context. In addition to differences in local equipment or common practices, the manifestation of a disease may vary with skin tone.


 * "When you look in textbooks it’s difficult to find African cases. The cases may be pretty similar but sometimes it can be confusing when you see something that you see in a white skin so nice and very easy to pick up but in the dark skin it had a different manifestation that may be difficult to see. Sometimes it is difficult for the students to appreciate when they see a clinical case that involves an African. I think that [locally developed OER] will go a long way in helping the students appreciate the cases that we see in our part of the world." - Richard Phillips, Professor of Internal Medicine, KNUST

3. Additionally, individual cases are modular. Developing or reviewing them isn't a daunting task for time-constrained individuals.

4. This project would allow us to remix case studies from existing OER.

Target audience

In order of priority:


 * 1) medical students in African institutions (content developers, reviewers and end users): preferably on Ghanaian students who do their rotations in Ann Arbor (since it would be easiest to interact with them)
 * 2) U-M health science students (reviewers and end users): preferably ones who do clinical rotations in Ghana. Students at U-M might not develop content, but they could advocate for and rate content.
 * 3) health academics in Africa (content developers, reviewers and end users)
 * 4) health professionals in other countries (reviewers, end users)
 * 5) users: general public (end users)

Components of each case study/diagnosis


 * Background on symptoms (Required)
 * Multiple choice questions (Required)
 * Explanation of diagnosis (Required)
 * Images to support symptoms
 * Videos to support symptom or diagnosis
 * Oral history (audio clip)
 * Discussion of case
 * Links to relevant OER about condition
 * Creator
 * CC License
 * Content review (user name, user role, 5 star rating, comments)

Features of the System


 * Frame a conversation around diagnosis: Facilitate different levels of interaction (student to student, doctor to student, etc.) Include way to rate content (e.g. user profiles, 5 star rating, comments). Comments should labeled according to role.
 * Simple platform: This should work on mobile devices. MediaWiki and Drupal are two possible open source platforms
 * Integration with Facebook
 * Pre-populate with openly licensed cases from existing repositories
 * User could stop video and ask question (timestamp on video where question occurs)
 * Ease of browsing: Provide different ways to sort (by organ system, or random, select X number of cases).

How: Roles

These resources will be publicly available, but edit privileges will be limited and monitored.


 * Content Creator (Medical journalist): Give doctors and students cameras, they can take nonidentifiable pictures of patients for the case studies, anonymize the data and write a synopsis of the symptoms.
 * Authority (doctor, nurse, etc.)
 * Media contributor /questioner
 * Answerer/speculator
 * Organizer/gardener

Challenges


 * Copyright: We need to teach content creators the DScribe process
 * Liability: The website should include disclaimers that is intended only as information and that individuals should still consult medical professionals. See resources at https://open.umich.edu/education/med for examples.
 * Patient privacy: Local patient privacy practices must be observed. Patient shouldn't be identifiable in photos. Patients should give informed consent. What are policies at each individual institution? Informed consent? Cultural issues? Content would be of academic/instructional quality, not of interest to voyeurs.
 * Bandwidth: YouTube and other streaming video doesn't work well in Ghana. Students have access to wireless and broadband connections, which are slow, but good enough for Wikipedia. Phone friendly versions of websites would be best.
 * Integration into student study habits: Important that students don't have to go out of their way to use tool. Facebook is something they are always in anyways. At UG, students are already using Facebook and Wikipedia for medical images.
 * Accuracy: With multiple editors, we need people to review the accuracy of the content. This will be done in part by user reviews, but should there be an initial review before publication?
 * Reputation: Students and health professionals will only the website if their colleagues recommend it as trustworthy source.
 * Overcoming the closed community of healthcare: Some healthcare professionals enjoy the "brotherhood" where they have confidential, frank discussions with their colleagues. One participant noted, "You spend 7 years in school, you don't want everyone to have access to the same information." In some countries, there is a strict hierarchy in universities with professors at the top and students at the bottom.

General Notes and Questions for Thought


 * What are basic producers need to do?
 * What are basic actions viewers need to do?
 * What is our first dataset?
 * Who are our first users?
 * How does this fit into existing education system, teaching methods, and study habits?
 * Sandra has used the ob/gyn OER module from UG. She commented that video is really good for reviewing material before exams, but professors grade harder because they know students have the CD as an additional learning resources. The CDs are helpful but sometimes the media gets scratched and there unusable after a certain time.
 * Does content need to be woven into course? Not necessarily. Students seek out additional content beyond the texts their teachers recommend. Once students have finished traditional curriculum, they might have more incentive to seek out additional learning materials. Some health institutions do Problem Based Learning (PBL), also called case based learning, others do not. U.S. medical schools do PBL in the 3rd and 4th years.

Variations/Interpretations of the Proposed Case Study Tool

We had a very diverse, big picture discussion. Here are some of our staff interpretations about the case study tool. We'll reconcile these at the next design jam meeting on Wednesday, Nov 17.


 * Kathleen: "a website which has individual medical cases (like cases in the modules that Cary worked on, but as individual resources instead of a package). Students and/or faculty could participate in writing cases and also review (like a 5 star rating and comments) on the cases. This would be a simpler version of NEJM's interactive cases (http://www.nejm.org/multimedia/interactivemedicalcase) and more content than their Image Challenge (http://www.nejm.org/image-challenge), but it would feature African patients and African procedures for diagnosis. There was talk about integrating into Facebook.
 * Emily: "a 'diagnose this' platform where students, faculty, doctors and others can post content (based on case studies) with diagnosis questions and comments. This facility would potentially support robust feedback in the form of comments, ratings and discussions that would facilitate communication between learners and instructors both at U-M and at partner institutions in the African Health OER Network. "
 * Piet: "my understanding of the tool might be slightly different from others' but essentially this would be a collective/public diagnosis training tool for med students. a select group of people would be able to upload graphics + text (cases) and the crowd could work together to make the most accurate diagnosis of the issue. this could be done through a wiki, Drupal, or a number of other platforms with minimal backend configuration and some added plugins for rating comments and individual commenters. some of the major questions that were brought up were 1) who would be allowed to upload cases (including patient privacy concerns); 2) could med students create their own private networks for diagnosis problems (should this link into Facebook)? 3) does the system need a moderator or other authority figure (is there a "right" answer for the cases)?"

Next Meeting
At the end of the meeting, participants unanimously requested a follow-on meeting to work on some of the details of the proposed project:


 * Wednesday, November 17, 6:00 - 8:00 pm
 * Location: Shapiro Undergraduate Library, 4th Floor, Turkish American Friendship Room
 * Dinner will be provided

Goals:


 * Design a prototype (what does an individual case in this system look like)
 * Create 2 user scenarios (one for content creator, one for user)
 * Develop one page project description/plan

Prep:


 * Review models of existing case studies and diagnosis challenges


 * existing case studies from Health OER modules (below)
 * NEJM Image Challenge (http://www.nejm.org/image-challenge)
 * NEJM Interactive cases (http://www.nejm.org/multimedia/interactivemedicalcase)

Cases from Existing OER to Pre-populate System (~100 to choose from)


 * Buruli Ulcer (KNUST) (9 cases): http://open.umich.edu/education/med/oernetwork/internal-med/buruli-ulcer/2009
 * Automated Blood Count (KNUST) (16 cases): http://open.umich.edu/education/med/oernetwork/internal-med/automated-blood-counts/2009
 * Glucose Tolerance Test (KNUST) (4 cases): http://open.umich.edu/education/med/oernetwork/basic-sci/clinical-chemistry/2009
 * Cases in Clinical Microbiology (KNUST) (over 50 cases) http://open.umich.edu/education/med/oernetwork/basic-sci/clinical-micro-cases/2009
 * Caesarean Section (UG) (3 cases): http://open.umich.edu/education/med/oernetwork/ob-gyn/caesarean-section/2009
 * Mental State Exam (KNUST) (3 cases): http://www.oerafrica.org/healthproject/ProjectResources/tabid/976/mctl/Details/id/37520/Default.aspx
 * Sexually Transmitted Diseases (UG) (9 cases): http://open.umich.edu/education/med/oernetwork/ob-gyn/stds/2009
 * Total Abdominal Hysterectomy (UG) (3 cases): http://open.umich.edu/education/med/oernetwork/ob-gyn/hysterectomy/2009

Nov 17 Agenda

 * Recap


 * What are OER?
 * What is the Health OER Network?
 * Design Challenge
 * Proposed project
 * what (example case studies)
 * why


 * Goals for Session


 * Refine project scope
 * Develop prototype
 * Develop user scenarios


 * Refine Project Scope


 * What
 * Who


 * Develop user scenarios


 * Content developer
 * End user
 * Reviewer


 * Develop prototype


 * What are the essential components of a case study?
 * What are the actions around the case study? (e.g. feedback)


 * Discuss next steps

Nov 17 Outcomes
Guests


 * Will Riley, first year PhD student at SI, community informatics and social computing
 * Matt Simpson, 4th year Med student, 1st year MPH student, first group of Med School dScribes
 * Sandra Danso-Bamfo. 5th year medical student at University of Ghana, doing 3-week Ob/Gyn rotation at U-M
 * Adam Rahman, lecturer, Department of Communication Design, Kwame Nkrumah University of Science and Technology
 * Ato Ogoe, UMAPS scholar, supervises students who design educational materials, University of Ghana
 * Elsie Kodjiu, final year of medical school at University of Ghana. Doing emergency medicine rotation at U-M.
 * Gin L. Chieng, SI masters student in HCI
 * Patrick Feglo, teaches Clinical microbiology at KNUST

Open.Michigan Team


 * Kathleen Ludewig Omollo (moderator)
 * Emily Puckett Rodgers
 * Susan Topol

"Diagnose this" is proposed name for the system we are designing. Will Riley presented a design document for system. The system should be free for everyone to view, but only medical professionals can post images and comment on content. How do you verify that a person is a medical professional? Each institution decides and controls who can access system. Content is also vetted by professionals. Includes a Google map that shows where content comes from. Could be under pseudonym for individual contributor, but include real name for institution. Why not identify yourself? Users might be afraid to pontificate in case they are wrong. Ability to delete your comments after the fact. Institutional control of quality content assurance. Provide stats on who is contributing actively at the institutional level. Ability to filter information based on medical professional (doctor, nurse, etc.). Info on ratings. Info on structuring content. User contributed questions.

A form would be helpful for submitting information (e.g. about a new vaccine). Allowing everyone worldwide to comment. Important to see where people are coming from. Share and benefit from different views and opinions.

What is OER about? How will it be designed to facilitate learning? What will it include? (Images?) OER could be a venue for discussion of new ideas and topics. Challenge to keep content current. BY the time you publish something on HIV, there is newer material. What is our role in terms of designing learning materials?

Start with case studies from OER we already published. Ability to add comments important (discussion board). Including more topical info. A blog could highlight this type of info too. This interactive component could be a real draw for the website. Possible to develop this like YouTube? Dentistry school at UM. Films from the 70s with dental procedures are openly licensed on YouTube.

Progression from simple to more complex interactions. Take snippets of content from other system and make simpler version in our system. When you select wrong answer it should explain why to facilitate learning. How do we motivate actual users we want to reach to use the system? What are the use cases and how do we translate them into interfaces?

If it helps students pass their exams, that is the best motivation for using the system. Structure follows who contributes content (which institution and which specialties). Facilitate and encourage interaction among students. OER should come up in Google searches (search engine optimization). Reputation of search results very important, especially for medical content. Referrals to other sites for further information. Localization important for including information (malaria).

Who is main audience? Students or professionals? How do you balance control vs. facilitation? Include different levels of interaction on site. Different opportunities for engagement. Exchange ideas? Or present information?

User Scenarios
Are Design Jam participants saying: students are audience but not authors of cases? Or anyone can author, but content needs approval to be posted? Moderated content protects reputation of institutions.

Task
Develop storyline for users, what is that use case?

Educators
Professors, Medical educators, university level: includes residents, faculty, community physicians, pharmacists, community health workers, paramedics, public health professionals, local experts, midwives

Goal

Create content for teaching purposes

Use case, these different educators are trying to create content to use for teaching. What is our site going to provide for them? How will we structure the content? Provide multiple presentations of materials (text, image, video, widgets). First encounter should pull them in and then they would search for additional info. Explore disease and create a case out of it to publish and share (pneumonia: x-ray, chest sounds, quiz – include these elements in the module). How much do you want to teach them? What is appropriate length (a 3 hour video is too much)? Minimal amount of content and add links to further content. Don't want to overload learners with too much info (multiple presentations OK, but info overload might cause them to leave). Just because you have technology doesn't mean you have to apply it if it is not appropriate or adding value. Refresher knowledge versus thorough instruction. ("There is learning and there is LEARNING!")

Educator Scenario

Faculty in ER: Pneumonia starts with clinical presentation of patient. Take medical history (ethnographic information). Identifiers, current complaint and past history. Perform physical exam (clinical tests). Request relevant lab tests. Review tests. Include mixed media (like audio of chest sounds, written medical history, and images -- x-ray). Determine diagnosis and management. Could be presented as quiz/hidden text/full case.

Provide derivative creations based on this case. Throw in additional variables and see how that effects the outcome.

Second user could see this case and build on it to create another quiz or additional learning materials. How is this going to be a learning experience? How does user know who to trust in terms of materials? Traditional educational materials are authoritative by nature. How to we ensure quality for OER?

Add different variables as the scenario unfolds. Provide derivative creations (download files, repurpose same files, upload the new content). Keeps history, knows what media is linked to other media. Leverage advantages of OER and openly licensed content. Localization important. Different institutions might prescribe different antibiotics for pneumonia.

How do we deal with feedback? How do we assess level of understanding from the content? (Look at quiz performance.)

Present info at different levels of complexity (student level, professional level). Ranking system for cases, display which are most popular.

Student Scenario
Final year med student in pediatrics. It's 3:00am and a student just learned that malaria will be on the clinical exam. She knows the basics about lifecycle and cause &amp; effect, but wants to learn more detailed information and walk through an example diagnosis. She asks her peer on Facebook who reminds her the Prof. recommended this OER site with case studies. She goes to the site &amp; searches for malaria. She finds short and long cases. Plus a place to provide feedback.

Design Considerations Students need to research both treatment and prevention. Narratives (Malaria):


 * Describe physical symptoms
 * Lifecycles of plasmodium
 * Cause &amp; effect
 * Risk factors
 * History (salient/factual)
 * Sociological aspects

Drugs.

Interface Styles


 * Wikipedia
 * YouTube
 * Facebook
 * How-to

Interface Design

Long Cases, Short Cases, Discussion (Search across all three)

Example: Malaria

Diagnosis:


 * Hx (full with key parts highlighted, adult and pediatric)
 * Exam
 * Investigation

Management:


 * Supportive (IV, Angyramin)
 * Definitive, Drugs, Types (Pagunil, Chesgive), MOA, SEE, Dosage
 * Long Term, Prevention (Medical, Social, National)

Media:


 * Pictures (blood stain)
 * Video (how to)

Background information:


 * History
 * Epidemiology
 * Sociology

Large Group Discussion
Disclaimers important for liability protection. Also need checks and balances to ensure that materials are credible.

Objective of system is important. Should complement what is taught in class. Lots of variation in how information is presented by different instructors. By providing OER will students stop going to the wards or to class? OER can't replace real experiences.

Dr. Ginsburg, OER helps maximize professionalism component of learning and practicing medicine. Info is out there. How can I make coming to class more relevant for you? &lt;/div&gt;&lt;/div&gt;


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