The idea that a microscope wouldn't be needed in a med-school course covering a subject such as histology might have met with ridicule 20 years ago, but it's become a reality at UCLA. "The entire course has been transformed," says Anju Relan, director of the Instructional Design and Technology Unit ( www.medsch.ucla.edu/idtu/ ) at the David Geffen School of Medicine at UCLA. Relan's IDTU, working with the faculty member who teaches the histology course, created a CD-ROM that is distributed to students. Slides are digitized and students can navigate the labeled images through virtual reality technologies. The instructor even decided to replace lab-based exams, which are susceptible to human error as slides shift under the microscope, with web-based tests. "All of this has challenged some very embedded notions of how histology should be taught," Relan says.

First-year medical students at UCLA learn from "Interactive Histology," a CD-ROM/web-based application (Source: Instructional Design and Technology Unit, David Geffen School of Medicine at UCLA)

The IDTU, established the same year UCLA's medical school instituted the computer requirement, assists faculty in designing, developing, implementing and evaluating instructional technology initiatives. Relan's staff originally included two full-time programmers and a part-time faculty member, but within two years her office was assisting on so many faculty-initiated projects that it was necessary to expand. IDTU began by awarding grants to faculty for innovative curricular projects using technology. "Our biggest contribution has been in facilitating the customization of projects," Relan says. "Most faculty come here with a very specific idea about how they want to use technology in their courses, and we take that idea, refine it, and give them a product that meets their needs."

From integrating graphics and multimedia into course websites, to revamping entire curricula to use technology throughout, educators in UC's health sciences programs consider technology an indispensable tool for educating students.

Revising the Curriculum to Exploit Technology's Power

At the UC San Francisco School of Pharmacy, a re-evaluation of the curriculum several years ago led to many changes, including a new requirement on computer literacy; purchases of hardware and software, including a CD-ROM with course software and databases; a required course in pharmacy informatics; and the establishment of the school's Informatics Resource Center, a computer and videoconferencing lab ( www.ucsf.edu/sopirc/ ) used both for formal teaching and informal uses, including research and e-mail.

Pharmacists are increasingly relying on information technology - from researching drug interactions and contra-indications to unraveling the genetic basis of disease in the emerging field of pharmacogenomics - and students are best served when they are made to be active learners, says Christopher Cullander, the school's associate dean for student and curricular affairs and instructional resources and technology. "This provides a depth of understanding that is more exciting and embeds the information much more firmly than lectures," he says.

Cullander notes that moving students into an online environment has brought side benefits, including the ability of course instructors to update the syllabus with materials, which can be sent to students as e-mail attachments as late as the day before the class is to meet. It has also facilitated more thorough teaching evaluations. "Before, students had to write down comments in the last few minutes of the class on the last day, and there was always some concern that someone might recognize their handwriting," Cullander says. "Now, a web interface gives them total anonymity. Teachers can ask more detailed questions and students can take their time to write extensive comments outside of the class."

The medical school at UCSF instituted its computer requirement in the fall of 2001 as part of a larger effort that included a shift to an integrated, non-discipline-based curriculum and the establishment of iROCKET (Interactive Resources Online Cultivating Knowledge through Educational Technology), online courses designed to supplement and enhance classroom and clinical instruction.

iROCKET courses are delivered through WebCT, commercial instructional software that was licensed at UCSF. In addition, the School of Medicine developed a curriculum management tool called Ilios ( www.som.ucsf.edu/ilios ) that enables faculty members to log into the system and create curricular content, from lectures and small-group learning experiences to virtual labs. "They can schedule it to a date and time, write learning objectives, write exercises that the students complete during the teaching session, and create PowerPoint presentations, streaming video or any kind of teaching media and upload it into the system," explains Kevin Souza, the school's director of educational technology.

By allowing faculty members to conduct searches to see what their colleagues are teaching, Ilios facilitates better coordination of content, so that repetition is avoided and gaps can be filled, Souza adds. And, by standardizing the template across all first- and second-year courses, iROCKET eliminates time students would otherwise have to spend becoming familiar with the online environment with each new course.

iROCKET has proved popular among students, who use the program not only to access course materials, but also for scheduling and threaded discussions. "The online discussions have been far more popular than we ever imagined," says Souza. "They extend the learning that takes place in the lecture. A question that came up in the class discussion will be posted and students will discuss it online, then the instructor can also log in, review the students' comments and join in."

At UCLA, the School of Nursing has developed the university's first Internet-based degree-granting program ( nursing.uclaonline.org/ ) as an option for students pursuing a master's degree in nursing administration. The program, developed through a grant from eCollege.com, enables participating students to "attend" lectures online, at the hour of their choosing. The lectures include PowerPoint presentations and questions for threaded discussion. (Students are still required to come to campus a handful of times during the year, and to complete community practicums with nursing administration experts.)

"It was always our belief that if we put a program online - especially for nursing administrators, who tend to be busy with full-time jobs - we would be able to increase our enrollment without sacrificing the quality of the instruction," says Adey Nyamathi, the school's associate dean for academic affairs. The online program enabled one student to go the East Coast for an internship while staying hooked into the classroom as if she had never left, Nyamathi notes. Another participated while on maternity leave from her job.

Student evaluations have been overwhelmingly positive in the two years the program has been offered, and Nyamathi says the instructors, like those at the UCSF School of Medicine, have been pleased by the depth of discussion facilitated by the online environment. While the administration program remains the only one at the UCLA School of Nursing with the online option, several individual courses have followed suit and the school is seeking funding to further expand its online offerings.

Revising the Curriculum to Exploit Technology's Power

At the UC San Francisco School of Pharmacy, a re-evaluation of the curriculum several years ago led to many changes, including a new requirement on computer literacy; purchases of hardware and software, including a CD-ROM with course software and databases; a required course in pharmacy informatics; and the establishment of the school's Informatics Resource Center, a computer and videoconferencing lab (www.ucsf.edu/sopirc/) used both for formal teaching and informal uses, including research and e-mail.

Pharmacists are increasingly relying on information technology - from researching drug interactions and contra-indications to unraveling the genetic basis of disease in the emerging field of pharmacogenomics - and students are best served when they are made to be active learners, says Christopher Cullander, the school's associate dean for student and curricular affairs and instructional resources and technology. "This provides a depth of understanding that is more exciting and embeds the information much more firmly than lectures," he says.

Cullander notes that moving students into an online environment has brought side benefits, including the ability of course instructors to update the syllabus with materials, which can be sent to students as e-mail attachments as late as the day before the class is to meet. It has also facilitated more thorough teaching evaluations. "Before, students had to write down comments in the last few minutes of the class on the last day, and there was always some concern that someone might recognize their handwriting," Cullander says. "Now, a web interface gives them total anonymity. Teachers can ask more detailed questions and students can take their time to write extensive comments outside of the class."

The medical school at UCSF instituted its computer requirement in the fall of 2001 as part of a larger effort that included a shift to an integrated, non-discipline-based curriculum and the establishment of iROCKET (Interactive Resources Online Cultivating Knowledge through Educational Technology), online courses designed to supplement and enhance classroom and clinical instruction.

iROCKET courses are delivered through WebCT, commercial instructional software that was licensed at UCSF. In addition, the School of Medicine developed a curriculum management tool called Ilios (www.som.ucsf.edu/ilios) that enables faculty members to log into the system and create curricular content, from lectures and small-group learning experiences to virtual labs. "They can schedule it to a date and time, write learning objectives, write exercises that the students complete during the teaching session, and create PowerPoint presentations, streaming video or any kind of teaching media and upload it into the system," explains Kevin Souza, the school's director of educational technology.

By allowing faculty members to conduct searches to see what their colleagues are teaching, Ilios facilitates better coordination of content, so that repetition is avoided and gaps can be filled, Souza adds. And, by standardizing the template across all first- and second-year courses, iROCKET eliminates time students would otherwise have to spend becoming familiar with the online environment with each new course.

iROCKET has proved popular among students, who use the program not only to access course materials, but also for scheduling and threaded discussions. "The online discussions have been far more popular than we ever imagined," says Souza. "They extend the learning that takes place in the lecture. A question that came up in the class discussion will be posted and students will discuss it online, then the instructor can also log in, review the students' comments and join in."

At UCLA, the School of Nursing has developed the university's first Internet-based degree-granting program (nursing.uclaonline.org/) as an option for students pursuing a master's degree in nursing administration. The program, developed through a grant from eCollege.com, enables participating students to "attend" lectures online, at the hour of their choosing. The lectures include PowerPoint presentations and questions for threaded discussion. (Students are still required to come to campus a handful of times during the year, and to complete community practicums with nursing administration experts.)

"It was always our belief that if we put a program online - especially for nursing administrators, who tend to be busy with full-time jobs - we would be able to increase our enrollment without sacrificing the quality of the instruction," says Adey Nyamathi, the school's associate dean for academic affairs. The online program enabled one student to go the East Coast for an internship while staying hooked into the classroom as if she had never left, Nyamathi notes. Another participated while on maternity leave from her job.

Student evaluations have been overwhelmingly positive in the two years the program has been offered, and Nyamathi says the instructors, like those at the UCSF School of Medicine, have been pleased by the depth of discussion facilitated by the online environment. While the administration program remains the only one at the UCLA School of Nursing with the online option, several individual courses have followed suit and the school is seeking funding to further expand its online offerings.

Using Technology for Learning in Clinical Settings

Mark Kittleson, a professor at UC Davis School of Veterinary Medicine, originally decided to put together his "Case Studies in Small Animal Cardiovascular Medicine" web site ( www.vmth.ucdavis.edu/cardio/cases/ ) as a way to preserve information from grand rounds sessions that would otherwise be lost.

"As a clinician, I would see students and residents presenting these great cases that educated everyone in the room, and when the session was over that material was gone," he says. "I wanted to save at least some of this material in a format where everyone, including students and clinicians who weren't there, could look at the cases and learn from them." The result is a site now used not only by Kittleson to teach veterinary students and veterinarians but also by numerous veterinarians throughout the world to educate themselves.

The site features case studies of actual small animal patients with cardiovascular disease that have been examined by faculty and residents at UC Davis's Veterinary Medical Teaching Hospital. History and physical examination findings are presented, along with the results of diagnostic studies (thoracic radiographs, electrocardiograms, angiograms, and two-dimensional, transesophageal, color flow Doppler, and spectral Doppler ultrasound exams as still frames and video). Multiple-choice quizzes are provided for many of the diagnostic studies, with instant feedback available upon completion using a Java script program. Once the material is examined and digested, the participant is asked to make a diagnosis, once again using the quiz format. Follow-up information on each patient and a discussion of each case are then provided.

Case-based learning approaches such as Kittleson's and a program developed at UCLA's medical school known as Interactive Multimedia Exercises (IMMEX) have many advantages over traditional didactic approaches, contends Adrian Casillas, assistant professor of medicine at UCLA, who has worked as part of the IMMEX project in implementing tools for case-based delivery and computerized assessment. IMMEX ( www.immex.ucla.edu ) was originally developed by Ron Stevens, a UCLA immunologist who was frustrated by the way his medical students were learning.

"They were basically memorizing a bunch of information and regurgitating it," says Casillas. The program was devised as a method to emphasize the process by which students arrive at answers rather than stressing the answers themselves. In each case, students are given a real-life scenario and asked to solve the problem by navigating the informational resources at their fingertips. The sequence of steps by which students arrive at the solution is recorded and can be used by instructors to evaluate and improve students' problem-solving skills.

IMMEX has proved so popular that what was initially created as exercises in immunology has expanded to include other medical disciplines as well as applications in non-science fields. IMMEX has also been implemented at all educational levels, from K-12 through post-graduate medical training at UCLA and other schools throughout the country. Recently, Casillas helped to develop web-based artificial intelligence techniques to automate the assessment process.

"Now that we've come to an age in which information resources are easy to access, what's most important is how we use the resources - how we integrate the knowledge to reach a successful outcome," Casillas says. "The power of this program is that it's a tool for understanding the process of reasoning as opposed to merely judging the final outcome. It gives us the opportunity to make an impact on students' reasoning processes, and to get a better idea of how effective our teaching is."

Another technology now widely used at the David Geffen School of Medicine at UCLA is the Personal Digital Assistant (PDA), such as those made by Palm and Handspring. Five years after instituting the desktop computer requirement, the school in 2001 began to emphasize PDAs , requiring its third-year students to purchase the hand-held computers. Third- and fourth-year students now access all of the school's web-based materials on their PDAs, from their schedules and course materials to drug references and medical decision-making programs.

"Given the mobile nature of these students' lifestyles - the fact that they move around in different clinics all over the community - the PDA is taking over as the means of communication and centralization of their activities," says Relan. "And to have access to clinical applications at the point of care means they can look up information while they're on cases rather than relying on rote memorization - which is the reality of medicine today."

Although the school has earned a reputation for its widespread use of instructional technology, Relan believes it has only scratched the surface. "There is still a lot of work to be done in this area to really make the best use of it," she says. But, in an acknowledgment of the changes that have occurred since her office was established, she adds: "Five years ago, technology used to be thought of as an innovation; now, it's a routine way of teaching. A computer technology is as natural as a chalkboard for faculty when they think about teaching a course. The issue that we grappled with initially - convincing faculty about the merits of technology - is no longer a concern."