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Open Access Research article

Reinforcing outpatient medical student learning using brief computer tutorials: the Patient-Teacher-Tutorial sequence

Martin V Pusic1*, Wendy A MacDonald2, Harley O Eisman2 and John B Black3

Author Affiliations

1 Division of Pediatric Emergency Medicine, Columbia University, 622 W 168th St, PH1-137, New York, NY 10032, USA

2 McGill University, Department of Pediatrics, McGill University, Montreal, QC, Canada

3 Teachers College, Columbia University, New York, NY, USA

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BMC Medical Education 2012, 12:70  doi:10.1186/1472-6920-12-70

Published: 8 August 2012



At present, what students read after an outpatient encounter is largely left up to them. Our objective was to evaluate the education efficacy of a clinical education model in which the student moves through a sequence that includes immediately reinforcing their learning using a specifically designed computer tutorial.


Prior to a 14-day Pediatric Emergency rotation, medical students completed pre-tests for two common pediatric topics: Oral Rehydration Solutions (ORS) and Fever Without Source (FWS). After encountering a patient with either FWS or a patient needing ORS, the student logged into a computer that randomly assigned them to either a) completing a relevant computer tutorial (e.g. FWS patient + FWS tutorial = “in sequence”) or b) completing the non-relevant tutorial (e.g. FWS patient + ORS tutorial = “out of sequence”). At the end of their rotation, they were tested again on both topics. Our main outcome was post-test scores on a given tutorial topic, contrasted by whether done in- or out-of-sequence.


Ninety-two students completed the study protocol with 41 in the ‘in sequence’ group. Pre-test scores did not differ significantly. Overall, doing a computer tutorial in sequence resulted in significantly greater post-test scores (z-score 1.1 (SD 0.70) in sequence vs. 0.52 (1.1) out-of-sequence; 95% CI for difference +0.16, +0.93). Students spent longer on the tutorials when they were done in sequence (12.1 min (SD 7.3) vs. 10.5 (6.5)) though the difference was not statistically significant (95% CI diff: -1.2 min, +4.5).


Outpatient learning frameworks could be structured to take best advantage of the heightened learning potential created by patient encounters. We propose the Patient-Teacher-Tutorial sequence as a framework for organizing learning in outpatient clinical settings.