Marc M. Triola, M.D.

New directions in e-learning research in health professions education: Report of two symposia
Triola, Marc M; Huwendiek, Soren; Levinson, Anthony J; Cook, David A
2012 ;34(1):e15-e20, Medical teacher
Background: The use of Computer Assisted Instruction (CAI) is rising across health professions education. Research to date is of limited use in guiding the implementation and selection of CAI innovations. Aims: In the context of two symposia, systemic reviews were discussed that evaluate literature in Internet-based learning, Virtual Patients, and animations. Each session included a debate with the goal of reaching consensus on best current practices and future research. Methods: Thematic analysis of the discussions was performed to arrange the questions by theme, eliminate redundancy, and craft them into a cohesive narrative. Results: The question analysis revealed that there are clear advantages to the use of CAI, and that established educational theories should certainly inform the future development and selection of CAI tools. Schools adopting CAI need to carefully consider the benefits, cost, available resources, and capacity for teachers and learners to accept change in their practice of education. Potential areas for future research should focus on the effectiveness of CAI instructional features, integration of e-learning into existing curricula and with other modalities like simulation, and the use of CAI in assessment of higher-level outcomes. Conclusions: There are numerous opportunities for future research and it will be important to achieve consensus on important themes
— id: 149966, year: 2012, vol: 34, page: e15, stat: Journal Article,

Virtual patients: are we in a new era?
Triola, Marc M; Cook, David A
2011 Feb;86(2):151-151, Academic medicine
— id: 122537, year: 2011, vol: 86, page: 151, stat: Journal Article,

Enhanced virtual microscopy for collaborative education
Triola, Marc M; Holloway, William J
2011 ;11:4-4, BMC medical education
ABSTRACT: BACKGROUND: Curricular reform efforts and a desire to use novel educational strategies that foster student collaboration are challenging the traditional microscope-based teaching of histology. Computer-based histology teaching tools and Virtual Microscopes (VM), computer-based digital slide viewers, have been shown to be effective and efficient educational strategies. We developed an open-source VM system based on the Google Maps engine to transform our histology education and introduce new teaching methods. This VM allows students and faculty to collaboratively create content, annotate slides with markers, and it is enhanced with social networking features to give the community of learners more control over the system. RESULTS: We currently have 1,037 slides in our VM system comprised of 39,386,941 individual JPEG files that take up 349 gigabytes of server storage space. Of those slides 682 are for general teaching and available to our students and the public; the remaining 355 slides are used for practical exams and have restricted access. The system has seen extensive use with 289,352 unique slide views to date. Students viewed an average of 56.3 slides per month during the histology course and accessed the system at all hours of the day. Of the 621 annotations added to 126 slides 26.2% were added by faculty and 73.8% by students. The use of the VM system reduced the amount of time faculty spent administering the course by 210 hours, but did not reduce the number of laboratory sessions or the number of required faculty. Laboratory sessions were reduced from three hours to two hours each due to the efficiencies in the workflow of the VM system. CONCLUSIONS: Our virtual microscope system has been an effective solution to the challenges facing traditional histopathology laboratories and the novel needs of our revised curriculum. The web-based system allowed us to empower learners to have greater control over their content, as well as the ability to work together in collaborative groups. The VM system saved faculty time and there was no significant difference in student performance on an identical practical exam before and after its adoption. We have made the source code of our VM freely available and encourage use of the publically available slides on our website
— id: 123209, year: 2011, vol: 11, page: 4, stat: Journal Article,

Teaching physicians to address unhealthy alcohol use: a randomized controlled trial assessing the effect of a Web-based module on medical student performance
Truncali, Andrea; Lee, Joshua D; Ark, Tavinder K; Gillespie, Colleen; Triola, Marc; Hanley, Kathleen; Gourevitch, Marc N; Kalet, Adina L
2011 Mar;40(2):203-213, Journal of substance abuse treatment
BACKGROUND: The authors developed and evaluated an interactive, Web-based module to train medical students in screening and brief intervention (SBI) for unhealthy alcohol use. METHODS: First-year students were randomized to module versus lecture. Change in knowledge, attitudes, and confidence were compared. Performance was assessed by objective structured clinical examination (OSCE) and analyzed by intention to treat and treatment received. RESULTS: Of 141 consenting students, 64% (n = 90) completed an intervention (54% lecture vs. 70% Web assigned). Knowledge, confidence, and attitudes improved in both groups, with more improvement in Advise-Assist knowledge for Web students (14% vs. -3%, p = .003). Web students outperformed their lecture peers in both general communication (65% vs. 51% items well done, p = .004) and alcohol-specific tasks (54% vs. 41%, p = .021) on OSCE. Analysis by treatment received enhanced between-group differences. CONCLUSION: Use of a Web-based module to teach SBI is associated with greater knowledge gain and skills performance compared with a lecture covering similar content. The module provides an efficient means for training in this area
— id: 138090, year: 2011, vol: 40, page: 203, stat: Journal Article,

Longitudinal research databases in medical education: facilitating the study of educational outcomes over time and across institutions
Cook, David A; Andriole, Dorothy A; Durning, Steven J; Roberts, Nicole K; Triola, Marc M
2010 Aug;85(8):1340-1346, Academic medicine
Many education research questions cannot be answered using participants from one institution or short periods of follow-up. In response to societal demands for accountability and evidence of effectiveness, new models of research must be developed to study the outcomes of educational activities. Following the 2007 Millennium Conference on Medical Education Research, organizers assigned a task force to explore the use of longitudinal databases in education research. This article summarizes the task force's findings. Similar to the Framingham studies in clinical medicine, longitudinal databases assemble prospectively collected information to retrospectively answer questions of interest. Many studies using such databases have been published. The task force identified three general approaches to database-type research. First, institutions can obtain identified information from existing sources, link it with school-specific information and other identified information, deidentify it, and merge it with similar information from other collaborating schools. Second, researchers can obtain from existing sources deidentified information on large samples and explore associations within this dataset. Third, investigators can design and implement databases to prospectively collect trainee information over time and across multiple institutions for the purpose of education research. Although costly, such comprehensive, purpose-built databases would ensure the availability of information needed to answer a variety of medical education research questions. Millennium Conference participants believed that stakeholders should explore the funding and development of such prospective databases. In the meantime, education researchers should use existing sources of individualized learner data to better understand how to develop competent, compassionate clinicians
— id: 114541, year: 2010, vol: 85, page: 1340, stat: Journal Article,

Computerized virtual patients in health professions education: a systematic review and meta-analysis
Cook, David A; Erwin, Patricia J; Triola, Marc M
2010 Oct;85(10):1589-1602, Academic medicine
PURPOSE: Educators increasingly use virtual patients (computerized clinical case simulations) in health professions training. The authors summarize the effect of virtual patients compared with no intervention and alternate instructional methods, and elucidate features of effective virtual patient design. METHOD: The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, and Scopus through February 2009 for studies describing virtual patients for practicing and student physicians, nurses, and other health professionals. Reviewers, working in duplicate, abstracted information on instructional design and outcomes. Effect sizes were pooled using a random-effects model. RESULTS: Four qualitative, 18 no-intervention controlled, 21 noncomputer instruction-comparative, and 11 computer-assisted instruction-comparative studies were found. Heterogeneity was large (I>50%) in most analyses. Compared with no intervention, the pooled effect size (95% confidence interval; number of studies) was 0.94 (0.69 to 1.19; N=11) for knowledge outcomes, 0.80 (0.52 to 1.08; N=5) for clinical reasoning, and 0.90 (0.61 to 1.19; N=9) for other skills. Compared with noncomputer instruction, pooled effect size (positive numbers favoring virtual patients) was -0.17 (-0.57 to 0.24; N=8) for satisfaction, 0.06 (-0.14 to 0.25; N=5) for knowledge, -0.004 (-0.30 to 0.29; N=10) for reasoning, and 0.10 (-0.21 to 0.42; N=11) for other skills. Comparisons of different virtual patient designs suggest that repetition until demonstration of mastery, advance organizers, enhanced feedback, and explicitly contrasting cases can improve learning outcomes. CONCLUSIONS: Virtual patients are associated with large positive effects compared with no intervention. Effects in comparison with noncomputer instruction are on average small. Further research clarifying how to effectively implement virtual patients is needed
— id: 113655, year: 2010, vol: 85, page: 1589, stat: Journal Article,

Virtual patients: a critical literature review and proposed next steps
Cook, David A; Triola, Marc M
2009 Apr;43(4):303-311, Medical education
CONTEXT: The opposing forces of increased training expectations and reduced training resources have greatly impacted health professions education. Virtual patients (VPs), which take the form of interactive computer-based clinical scenarios, may help to reconcile this paradox. METHODS: We summarise research on VPs, highlight the spectrum of potential variation and identify an agenda for future research. We also critically consider the role of VPs in the educational armamentarium. RESULTS: We propose that VPs' most unique and cost-effective function is to facilitate and assess the development of clinical reasoning. Clinical reasoning in experts involves a non-analytical process that matures through deliberate practice with multiple and varied clinical cases. Virtual patients are ideally suited to this task. Virtual patients can also be used in learner assessment, but scoring rubrics should emphasise non-analytical clinical reasoning rather than completeness of information or algorithmic approaches. Potential variations in VP design are practically limitless, yet few studies have rigorously explored design issues. More research is needed to inform instructional design and curricular integration. CONCLUSIONS: Virtual patients should be designed and used to promote clinical reasoning skills. More research is needed to inform how to effectively use VPs
— id: 114542, year: 2009, vol: 43, page: 303, stat: Journal Article,

Statins lower risk of first cardiovascular event in patients with high C-reactive protein and normal LDL cholesterol
Jha A.K.; Hwang U.; Keyhani S.; Shah N.R.; Friedberg M.W.; Bitton A.; Triola M.M.; Block J.P.
2009 ;16(1):9+12-13, Journal of Clinical Outcomes Management
Objective. To determine whether statin treatment can lower cardiovascular events in men and women with normal low-density lipoprotein (LDL) cholesterol and elevated C-reactive protein levels. Design. Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), a randomized, double-blind, placebo-controlled trial. Setting and participants.17,802 men (aged [greater-than or equal to] 50 years) and women (aged [greater-than or equal to] 60 years) from 1315 sites in 26 countries with LDL cholesterol < 130 mg/dL, high-sensitivity-reactive protein(hs-CRP) level [greater-than or equal to] 2.0 mg/L, and triglycerides < 500 mg/dL were randomizedto either rosuvastatin 20 mg daily or placebo. Patients were excluded if they werecurrently or had previously been on lipid-lowering therapy or were actively beingtreated with hormone replacement therapy; had evidence of hepatic dysfunction,a creatine kinase level [greater-than or equal to] 3 times the upper limit of normal, serum creatininelevel [greater-than or equal to] 2.0 mg/dL; a recent history of alcohol or drug abuse, cancer within 5years, diabetes, uncontrolled hypertension or hypothyroidism, or an inflammatorydisorder such as severe arthritis, inflammatory bowel disease, orlupus; or wereon immunosuppressant therapy. Patients were included in thefinal sample ifthey had 80% compliance during a 4-week pla-cebo run-in period.At enrollment,the median LDL level was 108 mg/dL in both arms, andhs-CRP levels were 4.2 and 4.3 mg/L in the rosuvastatin and placebo arms,respectively. Mainoutcome measure. Combined primary endpoint of anycardiovascular event, including myocardial infarction,stroke,arterialrevascularization, hospitalization for unstable angina, or death fromcardiovascular causes. Main results. The trial was stopped short oftheplanned 4 years of follow-upbecause the prespecified number of primaryendpoints in the trial was reached earlier than expected. After a medianfollow-up of 1.9 years, patients in the rosuvastatin group had a 44% lower rateof the combined endpoint than the placebo group (0.77 vs. 1.36 person-years offollow-up, respectively; hazard ratio [HR], 0.56 [95% confidence interval {CI},0.46-0.69]; P < 0.001). The trend for a reduced rate ofcardiovascularoutcomes was evident for each of the individual outcomes aswell, including death from cardiovascular causes (HR, 0.53 [95% CI,0.40-0.69]; P< 0.001) and death from any cause (HR, 0.80 [95% CI,0.67-0.97]; P=0.02).Rosuvastatin decreased LDL cholesterol by 50% and hs-CRP by 37%. After 12months of follow-up, the median LDL cholesterol and hs-CRP levels were 55 mg/dL and 2.2 mg/L in the rosuvastatin arm as compared with 110 mg/dLand 3.5 mg/L in the placebo arm. Triglycerides were also significantly lower inthe rosuvastatin group at 1 year (99 mg/dL vs. 119 mg/dL). No increase inmyopathy or cancer was noted in the rosuvastatin group, although there was ahigher incidence of physician-reported diabetes. Conclusion. In patients with highhs-CRP and normal LDL cholesterol, statin treatment lowers the risk of majorcardiovascular events.
— id: 97491, year: 2009, vol: 16, page: 9+12, stat: Journal Article,

Comparative effectiveness in hypertension: What can we accomplish?
Jha A.K.; Shah N.R.; Triola M.M.; Hwang U.; Friedberg M.W.; Block J.P.; Keyhani S.; Bitton A.
2009 ;16(2):59-61, Journal of Clinical Outcomes Management
— id: 97867, year: 2009, vol: 16, page: 59, stat: Journal Article,

Impact of a Web-Based Alcohol Screening and Brief Intervention Module
Lee, J.; Gillespie, C.; Gourevitch, M. N.; Hanley, K.; Jay, M.; Paik, S.; Richter, R.; Triola, M.; Zabar, S.; Kalet, A.
2009 OCT ;30(2):204-204, Substance abuse
— id: 114207, year: 2009, vol: 30, page: 204, stat: Journal Article,

CLINICAL CORRELATIONS: A DAILY DOSE OF MEDICINE
Litvin, CB; Brenner, J; Triola, MM; Poles, MA; Shapiro, N
2009 APR ;24(10):264-265, Journal of general internal medicine
— id: 99174, year: 2009, vol: 24, page: 264, stat: Journal Article,

A unique role for dental school faculty: telephone triage training and integration into a health departments' emergency response planning
Fernandez, Jill B; Glotzer, David L; Triola, Marc M; Psoter, Walter J
2008 May-Jun;3(3):141-146, American journal of disaster medicine
OBJECTIVE: Dental professionals with proper training and integration into existing protocols for mobilization can be one additional resource during catastrophic events. A pilot project on training of dental school faculty in telephone triage in the event of an avian flu pandemic is described. A partnership was established with a grant from the Department of Justice/Department of Homeland Security, between the New York City Department of Health and Mental Hygiene, and New York University to initiate a pilot program to increase the manpower resources available to the health agency should an overwhelming public health event be present in the New York City area. METHODS: Eight faculties from New York University College of Dentistry were selected to receive telephone triage training consisting of 15 hours of formal presentations. This training was specifically designed to give participants a background in 'outbreak investigations,' and included a mock influenza outbreak. Also, a 'phone triaging' training during a surge event was practiced. RESULTS: The training resulted in enabling alternative healthcare providers as capable personnel and one alternative source for a surge manpower pool. This was the innovative use of dental school faculty to bolster critically understaffed and overwhelmed areas in the NYCDOHMH infrastructure, such as call centers and for telephone triage, in their disaster scenarios, particularly in their response to avian flu. CONCLUSIONS: The established public health systems and medical community must understand the need to preplan for medical surge events and accept that a potential source of additional manpower could be the dental profession or other nontraditional healthcare personnel
— id: 95047, year: 2008, vol: 3, page: 141, stat: Journal Article,

Working with patients with alcohol problems: a controlled trial of the impact of a rich media web module on medical student performance
Lee, Joshua D; Triola, Marc; Gillespie, Colleen; Gourevitch, Marc N; Hanley, Kathleen; Truncali, Andrea; Zabar, Sondra; Kalet, Adina
2008 Jul;23(7):1006-1009, Journal of general internal medicine
INTRODUCTION/AIMS: We designed an interactive web module to improve medical student competence in screening and interventions for hazardous drinking. We assessed its impact on performance with a standardized patient (SP) vs. traditional lecture. SETTING: First year medical school curriculum. PROGRAM DESCRIPTION: The web module included pre/posttests, Flash(c), and text didactics. It centered on videos of two alcohol cases, each contrasting a novice with an experienced physician interviewer. The learner free-text critiqued each clip then reviewed expert analysis. PROGRAM EVALUATION: First year medical students conveniently assigned to voluntarily complete a web module (N = 82) or lecture (N = 81) were rated by a SP in a later alcohol case. Participation trended higher (82% vs. 72%, p < .07) among web students, with an additional 4 lecture-assigned students crossing to the web module. The web group had higher mean scores on scales of individual components of brief intervention (assessment and decisional balance) and a brief intervention composite score (1-13 pt.; 9 vs. 7.8, p < .02) and self-reported as better prepared for the SP case. CONCLUSIONS: A web module for alcohol use interview skills reached a greater proportion of voluntary learners and was associated with equivalent overall performance scores and higher brief intervention skills scores on a standardized patient encounter
— id: 82918, year: 2008, vol: 23, page: 1006, stat: Journal Article,

Improving residents' doctor-patient communications skills in the electronic medical record-enabled exam rooms
Tenner, CT; Cavanaugh, JS; Triola, MM; Ark, T; Schwartz, MD
2008 MAR ;23(2):326-327, Journal of general internal medicine
— id: 78175, year: 2008, vol: 23, page: 326, stat: Journal Article,

Chronic use of thiazolidinediones increases fracture risk
Triola M.M.
2008 ;15(7):322-323, Journal of Clinical Outcomes Management
— id: 81077, year: 2008, vol: 15, page: 322, stat: Journal Article,

Drug-eluting stents improve long-term nonfatal outcomes
Triola M.M.
2008 ;15(11):526+528-, Journal of Clinical Outcomes Management
— id: 91336, year: 2008, vol: 15, page: 526+528, stat: Journal Article,

Achievement of blood lipid targets in patients informed of their coronary risk
Triola MM
2008 ;15(3):115-6 Mar, Journal of Clinical Outcomes Management
— id: 79128, year: 2008, vol: 15, page: 115, stat: Journal Article,

Competency in System Based Practice: Making the system transparent - A web module with "learner appeal"
Zabar, S; Gillespie, C; Morris, K; Bernstein, CA; Ark, T; Triola, M; Holloway, W; Kalet, A
2008 MAR ;23(2):217-217, Journal of general internal medicine
— id: 78173, year: 2008, vol: 23, page: 217, stat: Journal Article,

Using trigger phrases to detect adverse drug reactions in ambulatory care notes
Cantor, Michael N; Feldman, Henry J; Triola, Marc M
2007 Apr;16(2):132-134, Quality & Safety in Health Care
BACKGROUND: As medical care moves towards an outpatient focus, monitoring systems for ambulatory patients are increasingly important. Because adverse outcomes due to medications are an important problem in outpatients, the authors developed an automated monitoring system for detecting adverse drug reactions (ADRs) in ambulatory patients. METHODS: The authors obtained a set of approximately 110,000 ambulatory care notes from the medicine clinic at Bellevue Hospital Centre for 2003-4, and manually analysed a representative sample of 1250 notes to obtain a gold standard. To detect ADRs in the text of electronic ambulatory notes, the authors used a 'trigger phrases' methodology, based on a simple grammar populated with a limited set of keywords. RESULTS: Under current functionality, this system detected 38 of 54 cases in the authors' gold standard set, of which 17 were true positives, for a sensitivity of 31%, a specificity of 98%, and a positive predictive value of 45%. Their proxy measure correlated with 70% of the ADRs in the gold standard. These values are comparable or superior to other systems described in the literature. CONCLUSIONS: These results show that an automated system can detect ADRs with moderate sensitivity and high specificity, and has the potential to serve as the basis for a larger scale reporting system
— id: 72076, year: 2007, vol: 16, page: 132, stat: Journal Article,

An XML standard for virtual patients: exchanging case-based simulations in medical education
Triola, Marc M; Campion, Ned; McGee, James B; Albright, Susan; Greene, Peter; Smothers, Valerie; Ellaway, Rachel
2007 ;:741-745, AMIA ... Annual Symposium proceedings
Virtual Patients are computer-based simulations of a clinical encounter where the user plays the role of a healthcare provider while receiving in-context instruction. This unique pedagogical approach enables active case-based learning for learners. Academic institutions around the world have developed high-quality virtual patients using many different authoring and playback technologies. However, sustainability and scalability have proved challenging due to the number of cases needed and production costs. In an effort to promote sharing of Virtual Patients and broader adoption into medical education at all levels, MedBiquitous organized an international working group to create an XML-based 'MedBiquitous Virtual Patient Standard' (MVP) describing a common structure for virtual patient content and activities. The MVP enables virtual patient exchange across systems, modification, and display within conformant player software
— id: 95046, year: 2007, vol: , page: 741, stat: Journal Article,

General Health Questions- A Virtual OSCE
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
CHIP Case: 27 Year-old Korean female suffering from normal anxiety and 'worried well.' - We are looking for collaborators to both create and study the impact of Virtual Patients. At this stage of our development, the VP cases are available (after registering with us) to any faculty from an accredited institution. If that faculty wishes to make it available to students in their institution they may do so. The scripts would be available to any faculty/school with whom we are or would be collaborating
— id: 5650, year: 2007, vol: , page: ?, stat: Chapter,

Migraine Follow-up - A Virtual OSCE
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
CHIP Case: 22 year old Chinese Female and 23-year-old White (Non-Hispanic) female dealing with bereavment. -We are looking for collaborators to both create and study the impact of Virtual Patients. At this stage of our development, the VP cases are available (after registering with us) to any faculty from an accredited institution. If that faculty wishes to make it available to students in their institution they may do so. The scripts would be available to any faculty/school with whom we are or would be collaborating
— id: 5648, year: 2007, vol: , page: ?, stat: Chapter,

Psychosocial Aspects of Terrorism and Disaster Medicine
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
Web-based online course (Virtual Patient). Users will be required to complete a registration form on the NYU website before gaining access. Registration is free but is restricted to full-time teaching faculty or administrators affiliated with a recognized educational institution. This online course will provide useful information and tools to address patients' psychosocial responses to terrorist threats or attacks, to help focus responses of health care teams in acute situations, and to fulfill leadership roles in communities. The modules emphasize the most common psychosocial stress responses to bio-terrorism and disasters: 1. Acute Stress Disorder 2. Post-Traumatic Stress Disorder (PTSD)
— id: 5647, year: 2007, vol: , page: ?, stat: Chapter,

Surgical PA - A Virtual OSCE
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
CHIP Case: 31 year-old White male with Acute Stress Disorder. -We are looking for collaborators to both create and study the impact of Virtual Patients. At this stage of our development, the VP cases are available (after registering with us) to any faculty from an accredited institution. If that faculty wishes to make it available to students in their institution they may do so. The scripts would be available to any faculty/school with whom we are or would be collaborating
— id: 5649, year: 2007, vol: , page: ?, stat: Chapter,

The Medical Reserve Corps. an opportunity for dentists to serve
Glotzer, David L; Rinchiuso, Anne; Rekow, E Dianne; Triola, Marc M; Psoter, Walter J
2006 Jan;72(1):60-61, New York state dental journal
The response to the events of Sept. 11, 2001, relied on local resources and personnel. Aware of how important their contribution could be, many people are now inspired to volunteer during times of crisis. The Medical Reserve Corps is a community-based volunteer network of health professionals that trains to respond to large-scale emergencies
— id: 69471, year: 2006, vol: 72, page: 60, stat: Journal Article,

Proposed educational objectives for hospital-based dentists during catastrophic events and disaster response
Psoter, Walter J; Herman, Neal G; More, Frederick G; Park, Patricia; Robbins, Miriam; Rekow, E Dianne; Ryan, James M; Triola, Marc M; Glotzer, David
2006 Aug;70(8):835-843, Journal of dental education
The purpose of this project was to define education and training requirements for hospital-based dentists to efficiently and meaningfully participate in a hospital disaster response. Eight dental faculty with hospital-based training and/or military command and CBRNE (chemical, biological, radiological, nuclear, and explosive) expertise were recruited as an expert panel. A consensus set of recommended educational objectives for hospital-based dentists was established using the following process: 1) identify assumptions supported by all expert panelists, 2) determine current advanced dental educational training requirements, and 3) conduct additional training and literature review by various panelists and discussions with other content and systems experts. Using this three-step process, educational objectives that the development group believed necessary for hospital-based dentists to be effective in treatment or management roles in times of a catastrophic event were established. These educational objectives are categorized into five thematic areas: 1) disaster systems, 2) triage/medical assessment, 3) blast and burn injuries, 4) chemical agents, and 5) biological agents. Creation of training programs to help dentists acquire these educational objectives would benefit hospital-based dental training programs and strengthen hospital surge manpower needs. The proposed educational objectives are designed to stimulate discussion and debate among dental, medical, and public health professionals about the roles of dentists in meeting hospital surge manpower needs
— id: 69470, year: 2006, vol: 70, page: 835, stat: Journal Article,

Brief report: Failure of an electronic medical record tool to improve pain assessment documentation
Saigh, Orit; Triola, Marc M; Link, R Nathan
2006 Feb;21(2):185-188, Journal of general internal medicine
OBJECTIVE: To comply with pain management standards, Bellevue Hospital in New York City implemented a mandatory computerized pain assessment screen (PAS) in its electronic medical record (EMR) system for every outpatient encounter. We assessed provider acceptance of the instrument and examined whether the intervention led to increased documentation of pain-related diagnoses or inquiries. DESIGN: Cross-sectional survey; a pre- and posthistorically controlled observational study. SUBJECTS AND MEASUREMENTS: The utility of the computerized tool to medicine housestaff and attendings was assessed by an anonymous survey. We conducted an electronic chart review comparing all adult primary care patient encounters over a 2-day period 6 months prior to implementation of the PAS and on 2 days 6 months after its implementation. RESULTS: Forty-seven percent of survey respondents felt that the computerized assessment tool was 'somewhat difficult' or 'very difficult' to use. The majority of respondents (79%) felt the tool did not change their pain assessment practice. Of 265 preintervention patients and 364 postintervention patients seen in the clinic, 42% and 37% had pain-related diagnoses, respectively (P=.29). Pain inquiry by the physician was noted for 49% of preintervention patients and 44% of the postintervention patients (P=.26). In 55% of postintervention encounters, there was discordance between the pain documentation using the PAS tool and the free text section of the medical note. CONCLUSION: A mandatory computerized pain assessment tool did not lead to an increase in pain-related diagnoses and may have hindered the documentation of pain assessment because of the perceived burden of using the application
— id: 67351, year: 2006, vol: 21, page: 185, stat: Journal Article,

A randomized trial of teaching clinical skills using virtual and live standardized patients
Triola, M; Feldman, H; Kalet, A L; Zabar, S; Kachur, E K; Gillespie, C; Anderson, M; Griesser, C; Lipkin, M
2006 May;21(5):424-429, Journal of general internal medicine
BACKGROUND: We developed computer-based virtual patient (VP) cases to complement an interactive continuing medical education (CME) course that emphasizes skills practice using standardized patients (SP). Virtual patient simulations have the significant advantages of requiring fewer personnel and resources, being accessible at any time, and being highly standardized. Little is known about the educational effectiveness of these new resources. We conducted a randomized trial to assess the educational effectiveness of VPs and SPs in teaching clinical skills. OBJECTIVE: To determine the effectiveness of VP cases when compared with live SP cases in improving clinical skills and knowledge. DESIGN: Randomized trial. PARTICIPANTS: Fifty-five health care providers (registered nurses 45%, physicians 15%, other provider types 40%) who attended a CME program. INTERVENTIONS: Participants were randomized to receive either 4 live cases (n=32) or 2 live and 2 virtual cases (n=23). Other aspects of the course were identical for both groups. RESULTS: Participants in both groups were equivalent with respect to pre-post workshop improvement in comfort level (P=.66) and preparedness to respond (P=.61), to screen (P=.79), and to care (P=.055) for patients using the skills taught. There was no difference in subjective ratings of effectiveness of the VPs and SPs by participants who experienced both (P=.79). Improvement in diagnostic abilities were equivalent in groups who experienced cases either live or virtually. CONCLUSIONS: Improvements in performance and diagnostic ability were equivalent between the groups and participants rated VP and SP cases equally. Including well-designed VPs has a potentially powerful and efficient place in clinical skills training for practicing health care workers
— id: 67849, year: 2006, vol: 21, page: 424, stat: Journal Article,

Psychosocial Aspects of Terrorism and Disaster Medicine
Triola, Mark; Feldman, Henry; Zabar, Sondra; Anderson, Marian; Kalet, Adina; Kachur, Elizabeth; Lipkin, Mack
2006;:- [Web Site], Nov 9, 2006, MedEdPORTAL
Web-based online course (Virtual Patient). Users will be required to complete a registration form on the NYU website before gaining access. Registration is free but is restricted to full-time teaching faculty or administrators affiliated with a recognized educational institution. This online course will provide useful information and tools to address patients' psychosocial responses to terrorist threats or attacks, to help focus responses of health care teams in acute situations, and to fulfill leadership roles in communities. The modules emphasize the most common psychosocial stress responses to bio-terrorism and disasters: Acute Stress Disorder; Post-Traumatic Stress Disorder (PTSD); Depression / Bereavement; Sub-Diagnostic Distress
— id: 150921, year: 2006, vol: , page: , stat: Web Site,

Technology induced error and usability: the relationship between usability problems and prescription errors when using a handheld application
Kushniruk, Andre W; Triola, Marc M; Borycki, Elizabeth M; Stein, Ben; Kannry, Joseph L
2005 Aug;74(7-8):519-526, International journal of medical informatics
This paper describes an innovative approach to the evaluation of a handheld prescription writing application. Participants (10 physicians) were asked to perform a series of tasks involving entering prescriptions into the application from a medication list. The study procedure involved the collection of data consisting of transcripts of the subjects who were asked to 'think aloud' while interacting with the prescription writing program to enter medications. All user interactions with the device were video and audio recorded. Analysis of the protocols was conducted in two phases: (1) usability problems were identified from coding of the transcripts and video data, (2) actual errors in entering prescription data were also identified. The results indicated that there were a variety of usability problems, with most related to interface design issues. In examining the relationship between usability problems and errors, it was found that certain types of usability problems were closely associated with the occurrence of specific types of errors in prescription of medications. Implications for identifying and predicting technology-induced error are discussed in the context of improving the safety of health care information systems
— id: 69472, year: 2005, vol: 74, page: 519, stat: Journal Article,

The relationship of usability to medical error: an evaluation of errors associated with usability problems in the use of a handheld application for prescribing medications
Kushniruk, Andre; Triola, Mark; Stein, Ben; Borycki, Elizabeth; Kannry, Joseph
2004 ;2004(5):1073-1076, Medinfo
This paper describes an innovative approach to the evaluation of a handheld prescription writing application. Participants (10 physicians) were asked to perform a series of tasks involving entering prescriptions into the application from a medication list. The study procedure involved the collection of data consisting of transcripts of the subjects who were asked to 'think aloud' while interacting with the prescription writing program to enter medications. All user interactions with the device were video and audio recorded. Analysis of the protocols was conducted in two phases: (1) usability problems were identified from coding of the transcripts and video data (2) actual errors in entering prescription data were also identified. The results indicated that there were a variety of usability problems, with most related to issues of ease of use. In addition, other problems were identified which were related to limitations of the content of the program. In examining the relationship between usability problems and errors, it was found that certain types of usability problems were closely associated with the occurrence of specific types of errors in prescription of medications. Implications for the improvement of safety of health care information systems are discussed
— id: 45278, year: 2004, vol: 2004, page: 1073, stat: Journal Article,

The Virtual Surgery Patient: Development of a digital, three-dimensional model of human anatomy designed for surgical education
Qualter J; Triola M; Weiner M; Hopkins MA; Kirov M; Nachbar M
2004 ;:34-?, Proceedings (IEEE Engineering in Medicine & Biology Society)
Teaching medical students about the anatomical principles of surgical procedures is achallenging task. In an effort to design a new tool that allows a third year medical student toexplore specific surgical problems, the New York University School of Medicine Department of Surgery and the New York University School of Medicine Advanced Educational Systems lab collaborated to develop a Virtual Surgery Patient (VSP). The VSP is a realistic set of three-dimensional models of human anatomy. Unlike previous applications, our objective was to create lightweight 3-D models with the inherent ability to deform smoothly upon animation,with an architecture that allowed for enhanced texturing as well as polygon reduction.We developed a technique for using reconstructed volume data from the Visible HumanProject to create surface models that were easy to manipulate, avoiding artifacts introducedwhen resurrecting volumes from cadaveric sliced stacks. Surface shading can be used to give the models the appearance of living tissue, as well as allow for enhancements sometimesnecessary to achieve an educational goal
— id: 106186, year: 2004, vol: , page: 34, stat: Journal Article,

A novel feedback system for virtual patient interactions
Triola MM; Feldman HJ; Kachur E; Holloway WJ; Friedman BS
2004 ;2004(CD):1886-1886, Medinfo
NYU School of Medicine, in conjunction with the Centers for Disease Control and Prevention and the Association of American Medical Colleges, has developed a CME workshop to prepare primary care physicians to respond to the psychosocial effects of bioterrorism and disasters and to address patient responses to terrorist threats or attacks. The workshop utilizes standardized patients (SP), allowing participants to have realistic simulated patient interactions. We sought to recreate the SP interaction on the web using a virtual patient. Special emphasis was given to the development of a new feedback system for this online interaction
— id: 45275, year: 2004, vol: 2004, page: 1886, stat: Journal Article,

Meeting requirements and changing culture. The development of a web-based clinical skills evaluation system
Triola, Marc M; Feldman, Henry J; Pearlman, Ellen B; Kalet, Adina L
2004 May;19(5 Pt 2):492-495, Journal of general internal medicine
The Accreditation Council of Graduate Medical Education (ACGME) and the Residency Review Committee require a competency-based, accessible evaluation system. The paper system at our institution did not meet these demands and suffered from low compliance. A diverse committee of internal medicine faculty, program directors, and house staff designed a new clinical evaluation strategy based on ACGME competencies and utilizing a modular web-based system called ResEval. ResEval more effectively met requirements and provided useful data for program and curriculum development. The system is paperless, allows for evaluations at any time, and produces customized evaluation reports, dramatically improving our ability to analyze evaluation data. The use of this novel system and the inclusion of a robust technology infrastructure, repeated training and e-mail reminders, and program leadership commitment resulted in an increase in clinical skills evaluations performed and a rapid change in the workflow and culture of evaluation at our residency program
— id: 45276, year: 2004, vol: 19, page: 492, stat: Journal Article,

Computer simulation of pathogen transmission in the medical intensive care unit: a comparison of two probabilistic methods
Triola, Marc M; Holzman, Robert S
2004 ;2004(6):1277-1281, Medinfo
The quantitative evaluation of pathogen transmission in the medical intensive care unit (MICU) is difficult given the small number of patients and the complexity and severity of illness. We sought to evaluate the suitability of a probabilistic computer model of our MICU, with which we could rapidly simulate infection control measures and other clinical interventions that would be impossible to perform in the real clinical setting
— id: 45274, year: 2004, vol: 2004, page: 1277, stat: Journal Article,

The Effect of Length of Stay (LOS) on Infection Rates in the Medical Intensive Care Unit (MICU)
Holzman RS; Triola MM
41st Meeting of the Infectious Diseases Society of America San Diego CA, Oct. 9-12, 2003 (Abstract # 550) ,
Introduction: Over 12 years both nosocomial infection rates and LOS declined in a medical intensive care unit (MICU). When
— id: 3110, year: 2003, vol: , page: , stat: Chapter,

Enhancing medical and public health capabilities during times of crisis
Psoter, Walter J; Triola, Marc M; Morse, Douglas E; Rekow, E Dianne
2003 May;69(5):25-27, New York state dental journal
Terrorist attacks and other catastrophic events will create demands that severely challenge the capacity of the medical/public health system. To meet the surge, a cadre of professionals should be trained to operate around the nucleus of medical/public health officials. At New York University, an inter-institutional team is considering specific roles for and an approach to training dentists to enable these health care professionals to supplement medical/public surge needs based upon informatics systems that provide critical information
— id: 45277, year: 2003, vol: 69, page: 25, stat: Journal Article,

Modeling Transmission of Pathogens in the Medical Intensive Care Unit (MICU): Length of stay (LOS) is an Important Determinant
Triola MM; Holzman RS
41st Meeting of the Infectious Diseases Society of America San Diego CA, Oct. 9-12, 2003 (Abstract # 549) ,
Introduction: We created a computer-based virtual MICU in which to investigate the determinants of transmission of nosocomial
— id: 3109, year: 2003, vol: , page: , stat: Chapter,

An email alert system for internal medicine physicians
Triola, Marc M; Blaser, Martin J
2003 ;189(3):1035-1035, Proceedings (AMIA Annual Symposium)
This study evaluated the effectiveness of an email-based alerting system for internal medicine house staff and faculty in geographically dispersed locales. Responses to a test alert email message were used to quantify the rapidity by which physicians read the message, and to define subgroups in which this communication modality proved most successful. The results of this study are being used to improve our preparedness for emergencies
— id: 43535, year: 2003, vol: 189, page: 1035, stat: Journal Article,

Risk of melanoma in medium-sized congenital melanocytic nevi: a follow-up study
Sahin S; Levin L; Kopf AW; Rao BK; Triola M; Koenig K; Huang C; Bart R
1998 Sep;39(3):428-433, Journal of the American Academy of Dermatology
BACKGROUND: The risk of the occurrence of malignant melanoma (MM) in medium-sized (1.5 to 19.9 cm in diameter) congenital melanocytic nevi (CMN) is the subject of controversy. Universally accepted recommendations regarding the management of such lesions have not been made. OBJECTIVE: Our purpose was to assess the risk of MM arising in medium-sized CMN. METHODS: The study included 230 medium-sized CMN in 227 patients, first seen in a private dermatology practice from 1955 to 1996, who were followed up for MM arising within their CMNs. Criteria for entry into the study included (1) a clinically diagnosed medium-sized CMN, (2) minimum follow-up period of 1 year, and (3) a photograph of the lesion in the patient's medical record. RESULTS: No MM occurred in a medium-sized CMN during an average follow-up of 6.7 years (median, 5.8 years) to an average age of 25.5 years (median, 19.1 years). CONCLUSION: The results of this short-term follow-up study do not support the view that there is a clinically significantly increased risk for MM arising in banal-appearing medium-sized CMN or that prophylactic excision of all such lesions is mandatory. Lifelong medical observation seems a reasonable alternative for many medium-sized CMN
— id: 57244, year: 1998, vol: 39, page: 428, stat: Journal Article,