Computer-enhanced learning in neuroanatomy

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<ul><li><p>Medical Education 1989, 23,371-375 </p><p>Computer-enhanced learning in neuroanatomy </p><p>C . K . TAN, F. C. T. V O O N &amp; K . RAJENDRAN </p><p>Department of Anatomy, National University of Singapore </p><p>Summary. The recent development of powerful microcomputers and the introduction of object-oriented programming languages has now made available to educationists software tbat can be easily used to design and develop computer-based 'learning material. We have developed courseware m d tutorware in the field of neuroanatomy which are pedagogically struc- tured and yet provide multiple paths of learning for the individual student. Neuroanatomy is a difficult subject to learn because of the structural intricacy and functional correlations that it entails. The courseware enables students to approach the subject at different levels of diffi- culty and progress at their own pace towards a comprehensive understanding of structure and function aided by text integrated with graphics, sound and animation. A significant advantage to authors of similar courseware is the option to update the contents easily when necessary in the future. </p><p>Key words: neuroanatomy/*educ; *computer assisted instruction; education, medical, under- graduate; microcomputers </p><p>Introduction </p><p>There has been an increase in the literacy and awareness of the use of microcomputers among medical students in recent years (Bresnitz et al. 1986). At the same time, microcomputers have also been used increasingly in medical schools (Biran &amp; Biran 1986) since they have been shown to have tremendous potential in medical edu- cation (Murray et al. 1977) and various types of </p><p>Correspondence: Dr C. K. Tan, Department of Anatomy, National University of Singapore, Kent Ridge, Singapore 051 1. </p><p>programmes for computer-assisted learning (CAL) have been written for this purpose (Kenny &amp; Schmulian 1979; Richards 1984; Jensch &amp; Veloski 1986). The use of microcomputers in medical education has recently been reviewed by Prentice &amp; Kenny (1 986a). </p><p>The development of authoring tools has helped academics with little or no knowledge of computer programming languages to prepare tutorware and courseware material for CAL. A number of such authoring systems are currently available and they are increasingly being used to prepare instructional material for medical edu- cation (Desch 1986). CAL programmes have been written in several fields of the biomedical sciences (Michael 1985), in the preclinical cur- riculum (Rovick &amp; Michael 1985; Michael &amp; Rovick 1986) and pharmacology (Pazdernik &amp; Walaszek 1983) and in clinical medicine (Harless et al. 1971; Rovick &amp; Brenner 1983), pathology (Harkin et al. 1986). and anaesthesia (Kenny &amp; Schmulian 1979; Prentice &amp; Kenny 1986b). </p><p>In the Department ofAnatomy at the National University of Singapore, the authors are prepar- ing to introduce computer-enhanced learning in anatomy and are currently engaged in preparing courseware and tutorware material for the medical and dental students. Application soft- ware material is being prepared in the fields of gross anatomy, neuroanatomy and embryology (Tan et al. 1988; Voon et at. 1988a, b, c). The present paper describes the prototype of such a courseware in neuroanatomy which is being developed on the Macintosh SE and I1 micro- computers. </p><p>Methods </p><p>The present project was developed both in black and white as well as in colour. For the black and </p><p>37 1 </p></li><li><p>372 C. K. Tan et al. </p><p>white presentation, the courseware was stored in a Macintosh SE microcomputer with a 20-MB hard disk. The colour presentation was developed on the Macintosh I1 with 5-MB RAM and a 40-MB hard disk. The authoring tool used was Hypercard which was developed for the Macintosh by Bill Atkinson. </p><p>Space constraint does not.permit a full descrip- tion of the use of the Hypercard software. This has been authoritatively described in Danny Goodmans (1987) excellent book and also in the Macintosh Hypercard Users Guide published by Apple Computer Inc. A brief account may also be obtained from the autumn 1987 issue of Wheels for the Mind (Vol. 3, NO. 4). </p><p>Results </p><p>The courseware has been pedagogically struc- tured, though with a major difference from that of a textbook, in that the relevant text, graphics, sound and animation are integrated in an organized form in the microcomputer for indi- vidual interactive learning. The programme begins with a Main Selection Menu which appears to the students when they access the courseware (Fig. 1). They have to select one of the four items displayed by moving the Browse Tool, which is represented by the picture of a hand (Fig. 1). Having made their choice, they select it by clicking on the mouse. </p><p>Selection of the Table of Contents brings them to the Contents Card which displays, very much like the Table of Contents of a textbook, the various chapters. After making their choice, the students again make their selection by mov- ing the Browse Tool to the Chapter of interest followed by a click ofthe mouse. For example, if they select Chapter 19, which is shown in Fig. 2, a Submenu appears on the screen and it gives them further selection choices on the topic of the Visual System. As an example, if they want to know about the structures in the eye which are involved in the pupillary reflexes, they select the appropriate choice in the Submenu and this will bring them to the card in which this information is displayed (Fig. 3). Having studied this card, if they now wish to know more about any item in the Figure, for example the cornea or iris, they move the Browse Tool to the item of choice and click the mouse. This will be followed by the </p><p>display of a new card showing details regarding the topic. </p><p>After students have finished with the card, they can return to the Submenu card and make further selections. For example, they may want to know about the nerves which supply the extraocular muscles. They make the appropriate selection, for example the abducens nerve, and the first card of a series on this topic is displayed (Fig. 4) together with a description of the intracranial course of the nerve. Subsequent cards will then show the extracranial course of this nerve up to the orbit (Fig. 5) where the muscle which it supplies is indicated; in addition, the action of this muscle on the eyeball can be demonstrated by animation. By means of several cards, two of which are shown in Figs 6 and 7, a simple form of animation using Hypercard can be achieved. In each card, the position of the pupil is moved slightly away from that of the previous one. After the animation, the next few cards display what will happen if there is a lesion of the nerve on one side (Figs 8 and 9). </p><p>The other way in which students can learn from this courseware is by using the Index, which is very much like that of a textbook. Selecting one ofthe alphabets in the Index menu (Fig. 10) and clicking the mouse brings them to a card bearing a series of names. Selection of any one of them using the Browse Tool brings them to the appropriate card and the information that they seek. </p><p>At some point in the course of study, students may want to know the meaning of a word and would like a brief description. For this purpose, a glossary of neuroanatomical terms has been included in this courseware. All the students have to do is to get back to the Main Selection Menu (Fig. 1) and select Glossary of Terms. Selecting the appropriate alphabet (Fig. 11) brings them to a submenu in which various terms are presented (Fig. 12). For example, they may want to know the meaning of a difficult word such as Adiado- chokinesis. Selecting this word brings them to the card (Fig. 13) in which a brief description is presented. Here, the origin of the word, its meaning and a synonym are presented. </p><p>Finally, the courseware also seeks to give students some information about neuroscientists who have been responsible for the discoveries in the field of neuroanatomy. Selection of Neuro- </p></li><li><p>Computer-enhanced learning in neuroanatomy 373 </p><p>Figures 1-8 </p></li><li><p>374 C. K. Tan et al. </p><p>Figures e l 4 </p><p>scientists in the Main Selection Menu brings them again to a card bearing all the letters of the alphabet, from which they must select the first letter of the surname of the scientist. For exam- ple, if they click on the letter A, they are presented with a list of names of neuroscientists whose first names begin with the letter A, for example Adamkiecwicz - the appropriate card is accessed and displayed (Fig. 14), his profession and discoveries are displayed and the key words are highlighted. </p><p>Discussion Although only the prototype of the courseware has been developed by the authors, it has found </p><p>favour among the students and teaching staff who have viewed it. It provides students with not only textual information but also demon- strates to them by means of simple animation that neuroanatomy is not a static subject. Such a Courseware would be far superior to the usual two-dimensional learning material. In this respect, Desch (1986) had noted that computer- assisted tutorials were in fact superior to text- books and hand-out learning and that students learned more effectively. </p><p>The present project has shown that with the new authoring tools, any courseware prepared with the microcomputer can be made easy to use and the students have full control over the </p></li><li><p>Computer-enhanced learning in neuvoanatomy 375 </p><p>progress of their study. It provides learners with the ease of accessing whatever they want to learn in the subject. They can also shuttle back and forth from one topic to another easily and rapidly. They can also make cross-references easily. This ease of access to information has been stressed by Harden (1986). This is supported by the results of a survey by Prentice &amp; Kenny (1986b) who found that 93% of students favoured learning with a computer. The computer also gives students an opportunity for interaction with the programme (Harden 1986). Moreover, students can learn at their own pace (Prentice &amp; Kenny 1986a). However, i fa tutor is also made available for consultation by the &amp;dents, the useof computer-enhanced learning material can be used to further advantage (Pren- tice &amp; Kenny 1986a). Furthermore, with the computer, course material can be updated easily from time to time (Prentice &amp; Kenny 1986a). </p><p>The new authoring tools also enable the developer of courseware to present images both in two as well as three dimensions. To this the dimension of time and growth of structures can be added (Bunt et a l . 1987; Tan e t al. 1988; Voon, et a l . 1988a). All the advantages that micro- computers have over the traditional textbook- type of learning have established the case for preparing computer-enhanced learning course- ware and tutorware. Harding (1980) had in fact made a plea almost a decade previously that computer-assisted learning should be taken seri- ously in view of the impact computers were already making in the field of education. </p><p>References </p><p>Biran L.A. &amp; Biran L. (1986) Computerised self-assess- ment made easy. Medical Teacher 8, 253-9. </p><p>Bresnitz E.A., Stettin G.D. &amp; Gabrielson I.W. (1986) A survey of computer literacy among medical students. journal ofMedical Education 61, 410-12. </p><p>Bunt S.M., Whitehorn M.A.F. &amp; Dry D.J. (1987) A demonstration of the use of microcomputers in the teaching of Anatomy. Journal of Anatomy 155,221. </p><p>Desch L.W. (1986) Use of commercial authoring systems for medical education. Medical Education </p><p>Goodman D. (1987) The Complete Hypercard Handbook. </p><p>Harden R.M. (1986) Editorial: Computer-assisted </p><p>Harding R.D. (1980) Computer-assisted learning in </p><p>20,417-23. </p><p>Bantam Books, Toronto. </p><p>learning. Medical Teacher 8,4-7. </p><p>higher education. Studies in Higher Education 5 , </p><p>Harkin P.J.R., Dixon M.F., Reid W.A. &amp; Bird C.C. (1986) Computer-assisted learning systems in path- ology teaching. Medical Teacher 8,27-34. </p><p>Harless W.G., Drennon C.G., Marker J.J., Root J.A. &amp; Miller G.E. (1971) CASE: a computer-aided simulation of the clinical encounter. journal of Medical Education 46, 443-8. </p><p>Jensch R.P. &amp; Veloski J.J. (1986) Program for increas- ing use of computers in medical education. Journal ofMedical Education 61, 137-9. </p><p>Kenny G.N.C. &amp; Schmulian C. (1979) Computer-ass- isted learning in the teaching of anaesthesia. Anaesthesia 34, 15942. </p><p>Michael J.A. (1985) Computer-based education in the biomedical sciences. The Physiologist 28,415-59. </p><p>Michael J.A. &amp; Rovick A.A. (1986) Problem-solving in the pre-clinical curriculum: the use of computer simulations. Medical Teacher 8, 19-25. </p><p>Murray T.S., Barber J.H. &amp; Dunn W.R. (1977) The potential of computer-assisted learning in medical education. journal ofthe Royal College of Physicians 11.4014. </p><p>Pazdernik T.L. &amp; Walaszek E.J. (1983) A computer- assisted teaching system in pharmacology for health professionals. journat ofMedicai Education 58, </p><p>Prentice J.W. &amp; Kenny G.N.C. (1986a) Microcom- puters in medical education. Medical Teacher 8, 9-18. </p><p>Prentice J.W. &amp; Kenny G.N.C. (1986b) Medical student attitudes to computer-assisted learning in anaesthesia. Medical Education 20. 57-9. </p><p>Richards J.G. (1984) Computer-assisted instruction and the use of PILOT. Journal of Family Practice 19, 255-7. </p><p>Rovick A.A. &amp; Brenner L. (1983) HEARTSIM: a cardio- vascular simulation with didactic feedback. The Physiologist 26, 236-9. </p><p>Rovick A.A. &amp; Michae1J.A. (1985) Teaching problem solving in physiology with CBE. The Physiologist 28, 435-8. </p><p>Tan C.K., Rajendran K. &amp; Voon F.C.T. (1988) The Revolution in Computer-Based Learning. National University of Singapore Forum on Computer- Based Learning (CBL), Singapore. </p><p>Voon F.C.T.. Tan C.K., Rajendran K. &amp; Teo S.Y. (1988a) Information technology at the heart of effective medical education. I.T. Applications in Health Con- ference, Singapore. </p><p>Voon F.C.T., Tan C.K. &amp; Rajendran K. (1988b) The elemental approach to computer-enhanced learning. Apple World 88 Conference, Singapore. </p><p>Voon F.C.T., Tan C.K. &amp; Rajendran K. (1988~) Reai intelligence in computer-enhanced learning: the human brain within the computer. I.T. Works 88 Conference, Singapore. </p><p>Received 2 September 1988; editorial comments to authors 25 N o v e m b e r 1988; acceptedfor publication 7 February 1989 </p><p>101-14. </p><p>341-8. </p></li></ul>


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