Production, Circulation, and Drainage

Cerebrospinal Fluid:

An interactive tool for undergraduate medical students

Master's Research Project:

learning biostatistics

Background & Rationale

The undergraduate medical program at the University of Toronto has recently incorporated a two-year Health Science Research (HSR) course into their pre-clerkship (Foundations) curriculum. This course aims to help students understand and use research to contribute to the improvement of individual and population health. Currently, the HSR is taught using an asynchronous “blended” classroom approach, which requires students to learn course content outside of class via e-modules and dedicates class time to student-centred learning activities. Among the course’s diverse subject matter, biostatistics is a topic for which students require more support. This suggests that the teaching strategy employed for this conceptually-abstract content may not be optimal for learning. Since a conceptual understanding of biostatistics is essential for critical appraisal of medical literature and the application of research to clinical scenarios, optimization of the learning environment for this material is desirable.


  • Create an interactive multimodal* e-learning environment for biostatistics

  • Contextualize content in relevant clinical cases

  • Draw upon principles of problem- and case-based learning to promote active learning of content

  • Improve interest and learning outcomes in biostatistics as taught within the context of HSR course

  • Employ a user-centred design approach

         *utilizing both semantic (verbal) and visual (non-verbal) modalities


Dr. Shelley Wall, AOCAD, MScBMC, PhD, FAMI

Primary supervisor, Biomedical Communications

Dr. Derek Ng,  MScBMC, PhD

Voting member, Biomedical Communications

Dr. Tim Guimond, MD, FRCPC, PhD 

Content expert, Faculty of Medicine

Dr. Debra Katzman, MD, FRCPC

Voting member, Faculty of Medicine


Pre-clerkship undergraduate medical students enrolled in Health Science Research course  (Foundations Years 1 & 2, University of Toronto)


Interactive, responsive, web-based application


May 2018 - July 2019 (in progress)

Project Development


Identify communication


Define problem space,

project scope,

& timeline



User personas  &

context scenarios

Content mapping & wireframing



Step 1:

Identify a communication challenge

This project began with my interest in scientific research and my curiosity about whether/how clinicians used findings in the research literature to inform their clinical practice. I decided to investigate further by speaking to practicing clinicians as well as medical students at the University of Toronto. From the interviews with medical students, I learned of a relatively new course on evidence-based medicine (Health Science Research, or HSR), which prepares students to be consumers of medical research. Students identified this course as one which could benefit from improvements to the mandatory e-learning tools.


Based on this information, I further investigated the HSR e-modules to identify specific knowledge gaps that might be overcome with visual solutions. I learned that HSR's biostatistics modules presented the most learning challenges for students - as evidenced by students' increased need for support in this subject area relative to other HSR subject areas. In reviewing the biostatistics e-modules in particular, I observed that they were poor in visualizations and afforded few opportunities for active engagement with the content. This was a perfect opportunity for the use of interactive visualizations to support learning of this complex, abstract material.

Step 2:

Define the problem space, project scope & timeline

With a challenge identified, I sought to discover who would use or be impacted by a visual, interactive learning tool for biostatistics, why they would use such a tool, and what other tools exist to achieve similar goals.


To determine the who, I identified and met with stakeholders- HSR course director, Dr. Debra Katzman, and HSR tutorial leader, Dr. Tim Guimond- who then joined the project as supervisors and collaborators. Meetings with stakeholders helped me identify the target audience: pre-clerkship undergraduate medical students.


To determine the why, I conducted preliminary needs assessments to determine the needs, goals, and motivations of the target audience. Methods included informational interviews with medical students and their proxies (HSR course representatives), analysis of HSR course evaluation data, and analysis of HSR exit survey data.


To determine the what, I researched existing solutions to the communication challenge, including literature review and media audit. Key questions I sought to answer through my researched included:

  • What strategies are employed for teaching biostatistics in undergraduate medical curricula, and what are their theoretical underpinnings?

  • How do different teaching strategies affect learning outcomes or attitudes towards learning and/or the content itself?

  • What visual or interaction-centred tools exist for teaching biostatistics, and what are their relative merits?

Upon completion of this preliminary research, the project's scope was determined in consultation with project supervisors and stakeholders, and a project timeline was created:

Step 3:

Project Proposal

Upon completion of the preliminary research stage, I drafted and submitted a formal project proposal for approval by my project committee. You can read my full project proposal here.

In brief, I proposed to develop a series of interactive e-learning modules using a user-centred design approach.

Step 4:


I. User personas & context scenarios

With my project proposal approved, I developed user personas and context scenarios based on information gathered in informational interviews with medical students and discussions with stakeholders. This helped me better understand the needs and goals my tool's end-users were likely to have, and how they might use the tool to achieve their goals. These exercises guided my initial determination of the tool's functionalities and behaviours.

 Multiple iterations of the personas and scenarios were created in response to feedback from peers, project supervisors,  and stakeholders; increased understanding of the target audience and tool usage context over time also spurred the iterative process.

Take a look at an early iteration here and a later iteration here.

II. Content mapping & wireframing

User personas and context scenarios provided a basis upon which I began mapping the structure and flow of the content within the e-modules. Different versions of the information architecture were eventually incorporated into prototypes at varying levels of fidelity and evaluated with target audience members during user testing. Feedback from user testing guided selection of the final structure.


At the same time, I began brainstorming how module pages would appear, focusing on user interface elements critical for navigation and interactive functioning on each page. I captured these ideas in low-fidelity wireframes.

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© Julia Devorak 2020