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Clinical Epidemiology and Internet

Naoko TAJIMA <ntajima@jikei.ac.jp>
Noboru KAWAMURA <durian@jikei.ac.jp>
Jikei University Faculty of Medicine


The Internet is used widely in the medical field; however, it has not yet been fully utilized as an educational tool for medical students in Japan. In view of this, we have established an exercise-style class in a newly developed curriculum called "Clinical Epidemiology and Internet" for third-year medical students. In the class, students learn about epidemiology from the world's top epidemiologists via the Internet as well as sharpen their problem-solving ability.

The second and third classes were practical training classes using personal computers connected to the Internet. Students could choose one of the 40 "Supercourse" lectures on the University of Pittsburgh home page. They outlined the contents, extracted the question and the solutions, and stated how they used the home page to answer the questions. The papers from the students were evaluated with the importance placed on the process of solving the problems and not only on whether they were able to solve their problems. Also, the students rated the "Supercourse" lectures and the class itself.

All respondents showed high grades, which indicated that students accepted this course with interest. Their comments were very constructive and provided us with helpful information for revising the class in the future. Also, it seems to have made them realize the importance of the Internet, manipulating computers, clinical epidemiology, and English. The course has clearly made a great impact on the students.



Until recently, books have been widely used as teaching materials. Books have the advantage of enabling one to reread; however, because they provide us with information printed on paper, they are limited in terms of net weight, communication speed, and the number of printed photographs. The Internet, with its function as multimedia and network, has removed all of the limitations of books and provided us with numerous ways of gaining access to information easily. This easier access to information offers possibilities for a new system of medical education.

On the other hand, e-mail has become an indispensable tool in the exchange of information among physicians. In addition, resources related to medicine on the World Wide Web have been increasing annually, and they now serve as sources of information that are as important as books. Under such circumstances, the Internet has developed rapidly in the medical field as well, and the importance of medical information in medical education has been recently recognized. However, although there are medical universities that use the Internet in their classes, there are still very few that make use of resources on the network in their medical education.

We have therefore tried to verify the possibility of using the environment and resources offered by the Internet for medical education and to develop a new method of education. We actually used the resources on Internet in our third-year medical students' curriculum, the "Supercourse." Here, we report on the results of our new trial.

Subjects and methods

Computer network facilities

The Supercourse is opened on the computer system of Pittsburgh University. To avoid a possible interruption of the class due to network failures, we transferred the Supercourse onto our university server system as well, so that students could choose from either system. The training was done using the 30 personal computers connected to the Internet.

Figure 1: Classroom


Subjects for the trial class were 87 third-year students at Jikei University School of Medicine. In their freshman year, these students had completed classes on the use of personal computers, but they never had taken a class on the Internet.



Courses on using resources on the Internet, the Supercourse, represent 3 of 15 classes (each class lasting 3 hours) of Statistical Practice 2. The summary is shown in Table 1.

Table 1. Curriculum on clinical epidemiology research and the Internet
Day Style Contents Person in Charge Instruments and Materials Used Student Presentations
1st day Lecture 1 Orientation Prof. Tajima (Jikei Univ. School of Medicine)    
Lecture 2 Introduction to global health network Prof. LaPorte (Univ. of Pittsburgh) Videotape  
Lecture 3 Introduction to clinical epidemiology Dr. Sekikawa (Univ. of Pittsburgh) Videotape  
Q&A 1 Questions and answers Prof. LaPorte and Dr. Sekikawa (Univ. of Pittsburgh) Overseas call  
Lecture 4 Why is clinical epidemiology important for doctors? Dr. Nishimura (Univ. of Pittsburgh) Cassette tape, Wide World Web  
Q&A 2 Questions and answers Dr. Nishimura (Univ. of Pittsburgh) Overseas call  
2nd day Training 1 Extract of questions Prof. Tajima (Jikei Univ. School of Medicine) and others Internet, personal computer Questionnaire survey 1
3rd Day Training 2 Collection of evidence Prof. Tajima (Jikei Univ. School of Medicine) and others Internet, personal computer Questionnaire survey 2, paper

All teaching hours are between 1:00 and 4:00 p.m.

Class method

Two classes in training form entitled "Clinical Epidemiology Research and Internet [1, 2]" were prepared. In these classes, personal computers connected to the Internet were used, and students chose 1 of 40 lectures on epidemiology that were opened from the University of Pittsburgh's homepage. The purpose was to learn the way to solve the problems they chose, using the resources on the Internet. In evaluating students on this training, we focused on the process of solving the problems and the abilities it involved rather than on whether the problems were solved.

Material used

The material we used for this course was the Supercourse, which was prepared for remote education as one of the activities of the Global Health Network Project by Prof. LaPorte and others. The Supercourse consists of a collection of lectures on various subjects by epidemiologists worldwide; at present, there are 65 lectures, including those that are translated. Peer review has been practiced to ensure that the information is accurate. Information on public health and preventive medicine is concisely arranged in slides.

This material is available to the public on the World Wide Web. The Supercourse can be found using browser software on a personal computer connected to Internet. At the time of this class (July), 36 courses are available. Each course consists of 20 to 30 pictures. The objective of this course is to enable medical students and others to be exposed to the minimum joint knowledge in epidemiology, regarded as necessary on a worldwide level.


At the time of the two trainings, we handed out questionnaires asking all 87 students attending the training to evaluate the Supercourse. In addition, students were required to hand in papers to see whether they had understood the purpose of the class and accomplished its goals.

Evaluation of the Supercourse by students

The questionnaire survey carried out at the end of the first training concerned each lecture. The contents of the questionnaire are given in Figure 2, and students answered in five stages. A space was provided for further comments.

Evaluation of the class by students

We carried out our original questionnaire survey at the end of the second training. In this questionnaire, we provided even more concrete questions on the Supercourse, as shown in Figure 3. Here, too, the students were asked to give answers in five stages, along with additional comments.

Evaluation of students

At the end of the training, we asked students to report on the Internet resources that they used to solve the problems and to evaluate them. This was done to evaluate the process of their approach in solving the problems, not whether they solved them.


Selection of courses

Table 2 indicates the course number, contents, language used, and the number of students who attended courses of the 36 provided in the Supercourse. The 36 courses were basically in English, some of which were also translated into other languages. Six were translated into Japanese, and as a result, students selected five of these six courses in Japanese.

Table 2. Courses chosen by students and the number of students who attended
Course No. Contents Language Used Students Attended
1 Introduction of the Supercourse EJ 5
3 Disease monitoring EJ 6
4 Epidemiology of insulin-dependent diabetes mellitus EJ 41
6 Toxic oil syndrome EJ 26
31 AIDS and sexually transmitted diseases in Africa I: problem E 2
36 Epidemiology of Minamata disease E 4

EJ under "Language used" indicates the possible use of English (E) and Japanese (J) courses.

Evaluation of Supercourse by students

The graphs in Figure 2 show the results of the first questionnaire, which were obtained at the end of the first training. Given four basic questions, students rated each area highly.

Figure 2: Evaluation of Supercourse. Score: 1 = strongly disagree, 2 = disagree, 3 = so-so, 4 = agree, 5 = strongly agree.

In overall rating, 69% of the students rated the Supercourse 4 (very good) or 5 (excellent). These high ratings, together with students' comments on the questionnaires, showed that the students realized the advantage of the Supercourse.

Evaluation of the class by students

Figure 3 shows the evaluation of the class by students. The score was high on the whole, and all answers showed a similar pattern.

Figure 3: Evaluation of the class "Clinical epidemiology and the Internet." Score: 1 = strongly disagree, 2 = disagree, 3 = so-so, 4 = agree, 5= strongly agree.

Evaluation of students

We evaluated the papers from the students in three stages. The students' results were poor for 18.4%, average for 39.1%, and good 42.5%.


In selecting teaching materials, their reliability and up-to-date status are very important factors to consider. The Supercourse is prepared by methods that could be examined by the University of Pittsburgh staff led by Prof. LaPorte and by all the people who have seen the lectures. Also, a mail space is prepared for comments to be sent from anyone who has seen the course on the Internet. This system has contributed to the high reliability of the Supercourse.

The medical information is constantly changing; therefore, it is important to allow the addition of even trivial new topics, as needed, and to draw users' attention to them. To enable this, it is important that the people who develop the teaching materials be able to renew the contents easily. With Supercourse, the file can be transmitted easily via the Internet. In addition, the file itself can be prepared in a way that is similar to that of the customary slide preparation. Thus, the Supercourse is capable of maintaining up-to-date resources. Several courses are changed into new versions already.

Preparing the Supercourse just by ourselves would have required an enormous amount of time and effort, and a class such as the one in our experiment would have been given up at the planning stage. Small contributions from many people can result in a considerable collection of teaching material. Because it is easy for anyone to participate in preparing the teaching materials, the number of lectures has increased from 36 to 65. The requests for increasing the number of courses, such as those in the comments from students, would be realized in due time.

As seen in the results of the questionnaires, the Supercourse is valued highly by students. The high rating as a teaching material signifies that as well as its satisfying contents, it suited the class. For example, students were required to choose one lecture in the first 3-hour training session and to select problems from it. One topic consisted of 20 to 30 pictures, and this amount was adequate for a student to look over several courses and choose one within a given time.

As shown in Table 2, 93% of the students chose courses translated into Japanese. Judging from their conversation during the training and questionnaire results, the students seemed to avoid lectures in English. During our preparation stage, we discussed whether preparing the teaching material in English. One opinion was that the contents of the Supercourse were basic enough for the students to understand in English, and the other opinion was that the English problem might become a bigger issue than the purpose of the course. This time, we took the latter stand. We thought that in order to draw attention of the beginners to the contents of the course, their understanding of the Japanese version would be necessary first, and we allowed the students to choose for themselves. However, because most of the references on the Internet were in English, those who chose a Japanese version were faced with the necessity of English knowledge. We have not come to a conclusion yet but will continue to discuss this interesting subject.

When we think of a new teaching material, we are likely to consider the use of multimedia and the necessity of providing a highly efficient machine to put it into practice. However, with the Supercourse, we need to use only very basic functions. The reasons we were able to acknowledge the usefulness of the Internet as a teaching material of the Supercourse and to use the Supercourse in problem-solving training were due to the fact that we could use simple functions of the World Wide Web. The Supercourse and this class show how teaching materials ought to be used in the coming information-oriented society.


  1. LaPorte RE, Global public health and the information superhighway: BMJ, 1308:1651-1652. 1994
  2. Akira S, Akiko K, Toshihiko S, et al., New Trends Practice in Telecommunication Applied to Preventive and Environmental Medicine: Environmental Health and Preventive Medicine, 2:45-48, April 1997
  3. Toshihiko S, Takahashi K, Yahata K, et al., Application of Internet Technology in Public Health: Environmental Health and Preventive Medicine, 2:518-522, July 1997
  4. Supercourse, http://www.pitt.edu/~super1/

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