Development and evaluation of a multimedia e-learning resource for electrolyte and acid-base disorders

Abstract

This article reports on the development and evaluation of a Web-based application that provides instruction and hands-on practice in managing electrolyte and acid-base disorders. Our teaching approach, which focuses on concepts rather than details, encourages quantitative analysis and a logical problem-solving approach. Identifying any dangers to the patient is a vital first step. Concepts such as an "appropriate response" to a given perturbation and the need for electroneutrality in body fluids are used repeatedly. Our Electrolyte Workshop was developed using Flash and followed an iterative design process.Two case-based tutorials were built in this first phase, with one tutorial including an interactive treatment simulation. Users select from a menu of therapies and see the impact of their choices on the patient. Appropriate text messages are displayed, and changes in body compartment sizes, brain size, and plasma sodium concentrations are illustrated via Flash animation. Challenges encountered included a shortage of skilled Flash developers, budgetary constraints, and challenges in communication between the authors and the developers.The application was evaluated via user testing by residents and specialists in internal medicine. Satisfaction was measured with a questionnaire based on the System Usability Scale. The mean System Usability Scale score was 78.4 ± 13.8, indicating a good level of usability. Participants rated the content as being scientifically sound; they liked the teaching approach and felt that concepts were conveyed clearly. They indicated that the application held their interest, that it increased their understanding of hyponatremia, and that they would recommend this learning resource to others. ELECTROLYTE AND ACID-BASE DISORDERS are clinical problems that are common and may be life threatening. This area is highly integrative and quantitative, and it is one that students and clinicians find particularly difficult to master (9). Medical experts solve most clinical problems using pattern recognition, drawing on a large domain-specific database of schemata or "illness scripts" (15,22,41). When an unusual or complex situation is encountered, however, the expert can draw on extensive relevant basic science knowledge and apply it to the problem (38). This is often required in disciplines such as anesthesiology, nephrology, and intensive care medicine, where much of the clinical reasoning involves the application of physiology (37). 1Electrolyte and acid-base disorders are typical examples common to these disciplines where an understanding of physiology is central to correct diagnosis and treatment. As teachers, our challenge is to help students and clinicians develop an expertise in clinical problem solving that can be effectively applied when they encounter related, but different, problems. This transfer of expertise is difficult to achieve (10,14,39). It can be facilitated by active learning and "deliberate practice" with carefully selected examples (12,13,40,42). This helps to develop...

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