A qualitative analysis of virtual patient descriptions in healthcare education based on a systematic literature review

Designing and Evaluating an Emotionally Responsive Virtual Patient Simulation

INTRODUCTION

Virtual patient (VP) simulations have been widely used for healthcare training, education, and assessment. However, few VP systems have integrated emotion sensing and analyzed how a user's emotions may influence the overall training experience. This article presents a VP that can recognize and respond to 5 human emotions (anger, disgust, fear, joy, and sadness), as well as 2 facial expressions (smiling and eye contact).

METHODS

The VP was developed by combining the capabilities of a facial recognition system, a tone analyzer, a cloud-based artificial intelligence chatbot, and interactive 3-dimensional avatars created in a high-fidelity game engine (Unity). The system was tested with healthcare professionals at Changzhou Traditional Chinese Medicine Hospital.

RESULTS

A total of 65 participants (38 females and 27 males) aged between 23 and 57 years (mean = 38.35, SD = 11.48) completed the survey, and 19 participants were interviewed. Most participants perceived that the VP was useful in improving their communication skills, particularly their nonverbal communication skills. They also reported that adding users' affective states as an additional interaction increased engagement of the VP and helped them build connections with the VP.

CONCLUSIONS

The emotionally responsive VP seemed to be functionally complete and usable. However, some technical limitations need to be addressed before the system's official implementation in real-world clinical practice. Future development will include improving the accuracy of the speech recognition system, using more sophisticated emotion sensing software, and developing a natural user interface.

"It kinda helped us to be there": students' perspectives on the use of virtual patient software in psychiatry posting

BACKGROUND

At the Faculty of Medicine of the National University of Malaysia, a virtual patient software program, DxR Clinician, was utilised for the teaching of neurocognitive disorder topics during the psychiatry posting of undergraduate medical students in a modified team-based learning (TBL) module. This study aimed to explore medical students' learning experiences with virtual patient.

METHODS

Ten students who previously underwent the learning module were recruited through purposive sampling. The inclusion criteria were: (a) Fourth-year medical students; and (b) Completed psychiatry posting with the new module. Students who dropped out or were unable to participate in data collection were excluded. Two online focus group discussions (FGDs) with five participants each were conducted by an independent facilitator, guided by a questioning route. The data were transcribed verbatim and coded using the thematic analysis approach to identify themes.

RESULTS

Three main themes of their learning experience were identified: (1) fulfilment of the desired pedagogy (2), realism of the clinical case, and (3) ease of use related to technical settings. The pedagogy theme was further divided into the following subthemes: level of entry for students, flexibility of presentation of content, provision of learning guidance, collaboration with peers, provision of feedback, and assessment of performance. The realism theme had two subthemes: how much the virtual patient experience mimicked an actual patient and how much the case scenario reflected real conditions in the Malaysian context. The technical setting theme entailed two subthemes: access to the software and appearance of the user interface. The study findings are considered in the light of learning formats, pedagogical and learning theories, and technological frameworks.

CONCLUSIONS

The findings shed light on both positive and negative aspects of using virtual patients for medical students' psychiatry posting, which opens room for further improvement of their usage in undergraduate psychiatry education.

DEEP LEARNING FOR ANALYSIS OF CHANGES IN VITAL CAPACITY AND BLOOD MARKERS AFTER SWIMMING MATCHES BASED ON BLENDED LEARNING

ABSTRACT Introduction Nowadays, more people are concerned with physical exercise and swimming competitions, as a major sporting event, have become a focus of attention. Such competitions require special attention to their athletes and the use of computational algorithms assists in this task. Objective To design and validate an algorithm to evaluate changes in vital capacity and blood markers of athletes after swimming matches based on combined learning. Methods The data integration algorithm was used to analyze changes in vital capacity and blood acid after combined learning swimming competition, followed by the construction of an information system model to calculate and process this algorithm. Results Comparative experiments show that the neural network algorithm can reduce the calculation time from the original initial time. In the latest tests carried out in about 10 seconds, this has greatly reduced the total calculation time. Conclusion According to the model requirements of the designed algorithm, practical help has been demonstrated by building a computational model. The algorithm can be optimized and selected according to the calculation model according to the reality of the application. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Implementing Remote Collaboration in a Virtual Patient Platform: Usability Study

BACKGROUND

Learning with virtual patients is highly popular for fostering clinical reasoning in medical education. However, little learning with virtual patients is done collaboratively, despite the potential learning benefits of collaborative versus individual learning.

OBJECTIVE

This paper describes the implementation of student collaboration in a virtual patient platform. Our aim was to allow pairs of students to communicate remotely with each other during virtual patient learning sessions. We hypothesized that we could provide a collaborative tool that did not impair the usability of the system compared to individual learning and that this would lead to better diagnostic accuracy for the pairs of students.

METHODS

Implementing the collaboration tool had five steps: (1) searching for a suitable software library, (2) implementing the application programming interface, (3) performing technical adaptations to ensure high-quality connections for the users, (4) designing and developing the user interface, and (5) testing the usability of the tool in 270 virtual patient sessions. We compared dyad to individual diagnostic accuracy and usability with the 10-item System Usability Scale.

RESULTS

We recruited 137 students who worked on 6 virtual patients. Out of 270 virtual patient sessions per group (45 dyads times 6 virtual patients, and 47 students working individually times 6 virtual patients minus 2 randomly selected deleted sessions) the students made successful diagnoses in 143/270 sessions (53%, SD 26%) when working alone and 192/270 sessions (71%, SD 20%) when collaborating (P=.04, η²=0.12). A usability questionnaire given to the students who used the collaboration tool showed a usability score of 82.16 (SD 1.31), representing a B+ grade.

CONCLUSIONS

The collaboration tool provides a generic approach for collaboration that can be used with most virtual patient systems. The collaboration tool helped students diagnose virtual patients and had good overall usability. More broadly, the collaboration tool will provide an array of new possibilities for researchers and medical educators alike to design courses for collaborative learning with virtual patients.

Experiencing a virtual patient to practice patient counselling skills

INTRODUCTION

Virtual patients (VPs) are a safe and standardised method of simulating clinical environments but few studies have explored health care professional's experiences of learning via a VP. This study explored how users experienced and used a VP that aimed to teach the user to deliver non-vitamin K oral anticoagulant patient education.

METHODS

The study used semi-structured interviews with pharmacists and pre-registration trainees from a wider research study. Interview topics were based on key areas concerning VP use. Interviews were audio-recorded and transcribed verbatim before being analysed using the framework approach to thematic analysis. Ethical approval was granted by Keele University.

RESULTS

There was variation in the type and nature of use of the VP and in the reported learning, which included reinforcement of knowledge, an opportunity to promote reflection, and acquisition and application of knowledge to clinical, patient-facing interactions. The VP was seen as an adjunct to other education and training. The majority of users indicated that they used the VP more than once. Some users seemed to have gamified their learning with a drive to achieve perfect feedback rather than true engagement with the learning, whereas for others the learning appeared to be deep with a reflective focus.

CONCLUSIONS

The VP offered an educational use as experiential learning, although the users experienced the VP differently; commonly the VP facilitated learning via reinforcement of pre-existing knowledge. The users reported that the VP had value as an adjunct to other education and training resources.

Establishing the acceptability and usability of an animated virtual patient simulation

Background

An animated, video-based, virtual patient (VP) has been developed to allow pharmacists to learn how, and practice how, to advise patients taking non-vitamin K oral anticoagulants, a group of high-risk medicines. VPs are well-established resources but have historically only been accessed within specific online teaching sessions or at university sites; this new VP represents a mobile design that can be accessed from anywhere.

Objective

To investigate the usability and acceptability of the VP application with a focus on exploring perspectives on accessibility.

Methods

The study used an exploratory sequential mixed method design consisting of a satisfaction survey and interviews. Survey data were analysed descriptively to assess satisfaction with the application and to identify interview discussion areas. Interview data were analysed using the Framework Approach to thematic analysis. Participants were hospital or community pharmacists, or pre-registration pharmacists.

Results

A total of 94 survey responses were collected and 22 respondents went on to take part in an interview. Participants reported liking the concept and delivery of the VP, particularly the high-quality technology. They also reported finding it usable, and appeared to favour its mobility and accessibility, particularly as the VP can be used on any internet accessible device, including mobile phones, with no specific requirements. Amendments that were suggested included quickening the delivery of some animations and improving navigation within the application, possibly through a button to return to the previous step should a mistake be made.

Conclusions

The mobile VP appeared to be functional and usable, with the majority of users reporting satisfaction with use across a range of devices. Users reported positively about the VP's remote access, but navigation around the application requires development.

Development of a Framework for Problem Domain Transference in Health-Related Problem Based Learning and Assessment

ObjectiveInvestigate the capability of a knowledge-based framework and architecture, used in a specific health domain problem that can utilise transfer learning, to speed virtual patient development for problem-based training and assessment in other health domains.MethodsAnalysis of a case study, based on a virtual patient used in the training of pharmacy students, to discover the viability of using generic, ontological knowledge capable of transfer to virtual patients in other health domains.ResultsAreas of the virtual pharmacy patient knowledge-base were identified, along with corresponding expected student questions, that are generic to other health domains. Using the framework from the case study to develop a new virtual patient for problem-based learning and assessment in a new health domain, these generic target questions could be utilised to speed up the development of other learning stimuli in future projects involving different health domains, such as nurse training in pain management.ConclusionsWith some modification, the framework of the case-study virtual patient was found to be capable of supporting generic expected student questions capable of re-use in virtual patients with new clinical conditions.

The Evaluation of the Distance Learning Combining Webinars and Virtual Simulations for Senior Nursing Students during the COVID-19 Period

Background

The outbreak of COVID-19 has forced many schools to adopt distance teaching. This study developed a distance learning program that combines webinars and virtual simulations to meet students’ learning needs.

Methods

A descriptive and quasi-experimental design was used. Thirty-five students participated in this distance learning program. Toward the middle and the end of the webinars, computer-based examinations were conducted to assess students’ theoretical knowledge. The Clinical Thinking Ability Scale was administered before and after virtual simulation. Academic Self-efficacy, Student Engagement, and Students’ Satisfaction Scales were administered after completing the learning program.

Results

The students obtained high scores on the theoretical knowledge examinations and virtual simulation scenarios. The virtual simulation led to an improvement in clinical thinking ability. Students displayed high levels of academic self-efficacy and student engagement and expressed high satisfaction with this program. Moreover, there were significant differences between genders in learning behavior self-efficacy, and learning effectiveness.

Conclusion

This distance learning program could meet the learning requirements of senior nursing students, in a flexible manner, in a safe environment during the COVID-19 outbreak.

Virtual patients reflecting the clinical reality of primary care - a useful tool to improve cultural competence

BACKGROUND

Virtual patients are educational tools that may be described as case-based interactive computer simulations of clinical scenarios. In terms of learning outcomes, improved clinical reasoning skills and knowledge acquisition have been shown. For further exploring the role of virtual patients in medical education, a greater focus on context-specific cases, combined with suitable educational activities, has been suggested. A knowledge gap has been identified in cultural competence in primary care. As primary care physicians are often the main medical providers for patients with refugee backgrounds, they would probably benefit from improved training focusing on how to apply cultural competence in everyday work. Using virtual patient cases, as a complement to clinical training, may be one way forward. The aim of this study was therefore to explore a learner perspective on the educational use of a virtual patient system designed to contribute to training in cultural competence in a primary care context.

METHODS

Three virtual patient cases portraying patients with refugee backgrounds were developed. The cases addressed various issues and symptoms common in primary care consultations, while also incorporating intercultural aspects. The system also provided the informants with individualized feedback. Primary care physicians and medical students were invited to test the cases and participate in an interview about their experience. Data was analyzed using qualitative content analysis.

RESULTS

The analysis generated the theme Virtual patients might help improve cultural competence in physicians and medical students by complementing knowledge gained through the informal curriculum. Informants at different educational levels found it suitable as a tool for introducing the topic and for reflecting on one's own consultations. It could also compensate for the predominant informal manner of learning cultural competence, described by the informants.

CONCLUSIONS

Virtual patients could be useful for gaining cultural competence in a primary care context. Advantages that could benefit learners at both pre- and post-graduate levels are decreased dependence on the informal curriculum and being presented with an illustrative way of how cultural competence may be applied in the consultation.

Connecting a simulated virtual patient program with experiential practicums: Perspectives from year three students

BACKGROUND AND PURPOSE

Research indicates that the simulated learning tools known as virtual patients (VPs) are valued by pharmacy students and impact students' knowledge and confidence. However, research is needed to understand how students can be supported to make intended connections between VP cases and real-life clinical scenarios. The purpose of this study was to examine whether and how VP cases influence students' clinical reasoning skills, confidence, thought processes, and preparedness for their experiential practicums.

EDUCATIONAL ACTIVITY AND SETTING

Third-year entry-to-practice doctor of pharmacy students who had completed at least one VP case in second year prior to their experiential practicums were surveyed in fall 2018 after having completed their experiential practicums. Surveys were structured to solicit student perceptions related to how students bridged VP cases and real-life clinical scenarios and were analyzed using a mixed-methods design.

FINDINGS

Forty-three students completed the survey. Students perceived that VP cases most significantly impacted their clinical reasoning skills due to the opportunity cases afforded them to explore patient data and navigate relevant information. The largest limitation of VP cases to students' learning was that the cases differed from their experiences. Students' suggestions included opportunities for more practice using VP cases and an expanded repertoire of medical conditions offered through case exposure.

SUMMARY

More research is needed to understand how to help students connect VP cases to their experiential practicums to make them more effective learning tools.

Improving competence and safety in pain medicine: a practical clinical teaching strategy for students combining simulation and bedside teaching

BACKGROUND

Pain is a devastating sensation and has to be treated immediately. Therefore, we developed a training program to improve the knowledge of medical students in the field of pain medicine. In the present study, the applicability and efficacy of this training program was tested.

METHODS

Half of the students attended first a training with simulated patients (SP) followed by bedside teaching (Group 1). Group 2 performed the training programs in reverse order. The evaluation based on standardized questionnaires completed by students (self-assessment) and all students took part in two practical examinations after the learning interventions.

RESULTS

This study included 35 students. The quality of the simulation was evaluated by the students with average grade 1.1 (1 = very good, 6 = very bad). The practical work on the ward with patients was rated with grade 1.4 of 6, the whole course with 1.1. Students of Group A were significantly better in the final examination (grade 1.7 vs. grade 2.2, p < 0.05). To rate the improvement of skills (self-assessment) we used a Likert Scale (1 = very certain, 5 = very uncertain). The following skills were similar in both groups and significantly better after the course: taking responsibility, expert knowledge, empathy, relationship building and communication.

CONCLUSIONS

Training with simulated patients in combination with small-group teaching at the bedside with real patients achieves a dramatic increase in student competence. Students prefer learning from the simulation before bedside teaching and propose to include simulation into the curricular teaching of pain medicine.

Lack of Diversity in Simulation Technology: An Educational Limitation?

STATEMENT

Despite increased attention on diversity in medicine and healthcare, heterogeneity in simulation technology has been slow to follow suit. In a nonsystematic review of simulation technology available in 2018 with respect to skin tone, age and sex, we found limited diversity in these offerings, suggesting limitations to educators' abilities to represent the full array of patients, conditions, and scenarios encountered in medicine and training. We highlight these limitations and propose basic strategies by which educators can increase awareness of and incorporate diversity into the simulation arena.

Designing virtual patient based self-study quizzes covering learning goals in clinical diagnostic sciences for undergraduate medical students - the radiology example

Background: Diagnostic tests and examinations inform clinical decision making. Thus, an essential part of medical students' workplace-based training is dedicated to core skills in clinical diagnostic sciences. Due to a reduction of clinical internships for fifth-year students in the wake of COVID-19 learning activities replacing this aspect of training were needed. Project description: Virtual Patient online learning materials addressing clinical diagnostic sciences, specifically, radiology, were developed to prepare students for the transition to workplace-based learning. Three types of activities related to interprofessional patient treatment, showing how radiology knowledge improves the diagnosing and treatment of patients, were used to design the narrative of each virtual patient. The materials also showed students "how to learn" in the clinical workplace while showing "what to learn". Students complete relevant tasks and compare their approach with experts' approach in a self-directed way. Results: Twenty self-study quizzes, accompanied by nine interactive Webinars were developed, providing 13% of the overall available replacement learning materials for the summer term 2020. In June 2020, 486 students completed the program and collected a mean share of 16% (SD=10) of their required credits by choosing to learn with these materials. Conclusion: Developing virtual patients based on three types of clinical activities to prepare students for the transition to workplace based learning proved successful and allowed rapid development of learning materials. The presented online quiz format and webinar format showed high acceptance and interest among students.

Communication skills training using virtual reality: A descriptive qualitative study

BACKGROUND

Modern medical pedagogical strategies are shifting toward the use of virtual patient simulations.

OBJECTIVE

This study aims to examine students' users' attitudes and experiences and clinical facilitators' perspectives on student performances in the clinical setting post-virtual patient training.

DESIGN

A descriptive qualitative study design was used.

SETTING

Nursing faculty at a local university in Singapore.

PARTICIPANTS

24 nursing undergraduates and six clinical facilitators.

METHODS

This study is a follow-up of an experimental study on the Virtual Counseling Application Using Artificial Intelligence (VCAAI). The study took place from the academic year 2017/2018 ended in November 2019. Focus group discussions and individual interviews were conducted. All interviews and focus group discussions were audiotaped, transcribed verbatim, and analyzed using thematic analysis.

RESULTS

Two overarching themes (students' virtual patient user experience and clinical facilitators' evaluations of students' clinical communication skills) comprising six themes were generated. Themes under students' user experience included: 1) attitudes toward virtual patient training, 2) virtual patient's role in student development, and 3) enhanced features and implementation suggestions. Themes under clinical facilitators' evaluations included: 1) insights on students' communication skills and 2) approaches to improve communication skills. An overlapping theme titled 'value of technology in teaching communication' comprised of mutual feedback from both students and clinical facilitators. Early implementation, continued accessibility, enhancing realism and technological improvements to the VCAAI were listed as key areas for program improvement, while increased situational sensitivity and language training are recommended to further enhance students' communication skills.

CONCLUSION

The mixed attitudes toward virtual patient interactions and recognitions of the benefits of virtual patient simulations suggest the potential effectiveness of the use of virtual patients in teaching effective nursing communication skills. However, the lack of authenticity and other limitations need to be addressed before official implementations of such trainings with virtual patients to undergraduate nursing curricula.

Comparison of Assessment by a Virtual Patient and by Clinician-Educators of Medical Students' History-Taking Skills: Exploratory Descriptive Study

BACKGROUND

A virtual patient (VP) can be a useful tool to foster the development of medical history-taking skills without the inherent constraints of the bedside setting. Although VPs hold the promise of contributing to the development of students' skills, documenting and assessing skills acquired through a VP is a challenge.

OBJECTIVE

We propose a framework for the automated assessment of medical history taking within a VP software and then test this framework by comparing VP scores with the judgment of 10 clinician-educators (CEs).

METHODS

We built upon 4 domains of medical history taking to be assessed (breadth, depth, logical sequence, and interviewing technique), adapting these to be implemented into a specific VP environment. A total of 10 CEs watched the screen recordings of 3 students to assess their performance first globally and then for each of the 4 domains.

RESULTS

The scores provided by the VPs were slightly higher but comparable with those given by the CEs for global performance and for depth, logical sequence, and interviewing technique. For breadth, the VP scores were higher for 2 of the 3 students compared with the CE scores.

CONCLUSIONS

Findings suggest that the VP assessment gives results akin to those that would be generated by CEs. Developing a model for what constitutes good history-taking performance in specific contexts may provide insights into how CEs generally think about assessment.

Virtual patient technology to educate pharmacists and pharmacy students on patient communication: a systematic review

Background

Virtual patients (VPs) are a sub-type of healthcare simulation that have been underutilised in health education. Their use is increasing, but applications are varied, as are designs, definitions and evaluations. Previous reviews have been broad, spanning multiple professions not accounting for design differences.

Objectives

The objective was to undertake a systematic narrative review to establish and evaluate VP use in pharmacy. This included VPs that were used to develop or contribute to communication or counselling skills in pharmacy undergraduates, pre-registration pharmacists and qualified pharmacists.

Study selection

Eight studies were identified using EBSCO and were quality assessed. The eligibility criteria did not discriminate between study design or outcomes but focused on the design and purpose of the VP. All the included studies used different VP applications and outcomes.

Findings

Four themes were identified from the studies: knowledge and skills, confidence, engagement with learning, and satisfaction. Results favoured the VPs but not all studies demonstrated this statistically due to the methods. VP potential and usability are advantageous, but technological problems can limit use. VPs can help transition knowledge to practice.

Conclusions

VPs are an additional valuable resource to develop communication and counselling skills for pharmacy students; use in other pharmacy populations could not be established. Individual applications require evaluation to demonstrate value due to different designs and technologies; quality standards may help to contribute to standardised development and implementation in varied professions. Many studies are small scale without robust findings; consequently, further quality research is required. This should focus on implementation and user perspectives.

Unrecognized posterior dislocation of the humeral joint – a case report in the electronic decision-making system

The paper presents a description of a humeral joint dislocation case placed in full version in the electronic system of presenting content and making decisions. The purpose of the publication is to draw the attention of especially young, inexperienced adepts of medical art to the fact of making mistakes in the medical art. The process of dealing with the correct and incorrect procedures that occur while trying to identify a medical problem is discussed. The presented case gives the opportunity to have a broad view of the issue and is also faced with the need to make decisions by choosing the course of action, at every stage of analyzing the case. Mistakenly made decisions are explained. Finally, the correct diagnosis and medical procedure about the case of a humeral joint dislocation is presented.

Research in Integrated Health Care and Publication Trends from the Perspective of Global Informatics

BACKGROUND

Integrated care has gained popularity in recent decades and is advocated by the World Health Organization. This study examined the global progress, current foci, and the future of integrated care.

METHODS

We conducted a scientometric analysis of data exported from the Web of Science database. Publication number and citations, co-authorship between countries and institutions and cluster analysis were calculated and clustered using Histcite12.03.07 and VOS viewer1.6.4.

RESULTS

We retrieved 6127 articles from 1997 to 2016. We found the following. (1) The United States, United Kingdom, and Canada had the most publications, citations, and productive institutions. (2) The top 10 cited papers and journals were crucial for knowledge distribution. (3) The 50 author keywords were clustered into 6 groups: digital medicine and e-health, community health and chronic disease management, primary health care and mental health, healthcare system for infectious diseases, healthcare reform and qualitative research, and social care and health policy services.

CONCLUSIONS

This paper confirmed that integrated care is undergoing rapid development: more categories are involved and collaborative networks are being established. Various research foci have formed, such as economic incentive mechanisms for integration, e-health data mining, and quantitative studies. There is an urgent need to develop performance measurements for policies and models.

[Digital learning and teaching in medical education : Already there or still at the beginning?]

The current choice of digital teaching and learning formats in medicine is very heterogeneous. In addition to the widely used classical static formats, social communication tools, audio/video-based media, interactive formats, and electronic testing systems enrich the learning environment.For medical students, the private use of digital media is not necessarily linked to their meaningful use in the study. Many gain their experience of digital learning in the sense of "assessment drives learning", especially by taking online exams in a passive, consuming role. About half of all medical students can be referred to as "e-examinees" whose handling of digital learning is primarily focused on online exam preparation. Essentially, they do not actively influence their digital environment. Only a quarter can be identified as a "digital all-rounder", who compiles their individual learning portfolio from the broad range of digital media.At present, the use of digital media is not yet an integral and comprehensive component of the teaching framework of medical studies in Germany, but is rather used in the sense of a punctual teaching enrichment. Current trends in digital teaching and learning offerings are mobile, interactive, and personalized platforms as well as increasing the relevance of learning platforms. Furthermore, didactical concepts targeting the changed learning habits of the students are more successful regarding the acceptance and learning outcomes. In addition, digitalization is currently gaining importance as a component in the medical school curricula.

Designing and Evaluating a Virtual Patient Simulation—The Journey from Uniprofessional to Interprofessional Learning

“Ready to Practice?”(R2P) is a virtual patient simulation designed for undergraduate medical and pharmacy students. After initial prototyping, R2P developed into a screen-based virtual patient (VP) simulation with an intuitive interface using photorealistic images of people and places with speech bubbles and decision menus. We describe the design of the VP, findings from student experiences with the software, and the potential of VPs for interprofessional learning. We used a mixed methods study to assess students’ perceptions of the VP as a learning tool. Qualitative data were gathered using semi-structured interviews and observations, and quantitative data through the Readiness for Interprofessional Learning Scale (RIPLS) and an evaluation questionnaire. Overall, participants showed significantly improved RIPLS scores after participation in the simulation (78.78 to 82.25, p < 0.0001), including in the Positive Professional Identify domain (p < 0.001). Students also showed significant improvement in RIPLS scores in the Teamwork and Collaboration domain when pharmacy and medical students were working together in interprofessional pairs (40.75 to 43.00, p < 0.006) but not when working alone (n.s.). Five themes emerged from interviews where participants identified specific interprofessional insights into each other’s roles and skills. Students found the VP engaging and valuable for their learning and their understanding of teamwork.

Using patient cases to educate health professionals, patients, institutions, and society: the swallowing disorder example

The problems and symptoms of patients are at the heart of medicine and pertinent to information, communication, and education. Patients present their problems to health professionals looking for relief and a cure, while institutions collect data about symptoms of patients and the way health professionals treated them to support society's care providers in administrating and managing care. The information on the problems of patients and the way health professionals treated them, which is gathered and stored in patient files, is valuable as educational material in the field of medicine. Driven by the fast developments of new technical tools case-based information, communication and education starts to enter educational domains beyond the field of medicine, such as school systems and public health services. In our discussion we seek to understand and outline how to use the material gathered and stored in patient files to educate health professionals. Additionally, this paper gives examples of case-based education for all members of society.

The aVOR App Increases Medical Students' Competence in Treating Benign Paroxysmal Positional Vertigo (BPPV)

HYPOTHESIS

Implementation of the "aVOR app" into teaching courses at medical school enhances students' satisfaction with the course and increases their competence in treating benign paroxysmal positional vertigo (BPPV).

BACKGROUND

BPPV is often underdiagnosed and left untreated. One problem in teaching the management of BPPV to health care professionals is the lack of simulation-based training tools. The aVOR app (aVOR = angular vestibulo-ocular reflex) works as a bionic labyrinth that simulates the activation of the semicircular canals by rotational acceleration and the resulting vestibular evoked eye movements.

METHODS

In this prospective, randomized, controlled study, medical students at a university hospital were randomly assigned to two kinds of small instructional groups. Students of the control group (n = 67) practiced diagnostic and therapeutic maneuvers for BPPV on each other, while the participants of the study group (n = 46) used the aVOR app as a virtual patient in addition. At the end of the term, students were asked to arrange the steps of the canalith repositioning procedure in the correct order in a written test.

RESULTS

Quality of the teaching media was rated significantly better in the aVOR group (two-sided Mann-Whitney test: P < 0.00001). Significantly more students of the aVOR group than the control group arranged the steps of the canalith repositioning procedure correctly in the final exam (56.3% versus 25.9%, Fisher's exact test: P = 0.006).

CONCLUSION

Implementation of the aVOR app as a virtual patient into small instructional courses is well adopted by medical students and increases their competence in treating BPPV.

Computer model for the cardiovascular system: development of an e-learning tool for teaching of medical students

BACKGROUND

This study combined themes in cardiovascular modelling, clinical cardiology and e-learning to create an on-line environment that would assist undergraduate medical students in understanding key physiological and pathophysiological processes in the cardiovascular system.

METHODS

An interactive on-line environment was developed incorporating a lumped-parameter mathematical model of the human cardiovascular system. The model outputs were used to characterise the progression of key disease processes and allowed students to classify disease severity with the aim of improving their understanding of abnormal physiology in a clinical context. Access to the on-line environment was offered to students at all stages of undergraduate training as an adjunct to routine lectures and tutorials in cardiac pathophysiology. Student feedback was collected on this novel on-line material in the course of routine audits of teaching delivery.

RESULTS

Medical students, irrespective of their stage of undergraduate training, reported that they found the models and the environment interesting and a positive experience. After exposure to the environment, there was a statistically significant improvement in student performance on a series of 6 questions based on cardiovascular medicine, with a 33% and 22% increase in the number of questions answered correctly, p < 0.0001 and p < 0.001 respectively.

CONCLUSIONS

Considerable improvement was found in students' knowledge and understanding during assessment after exposure to the e-learning environment. Opportunities exist for development of similar environments in other fields of medicine, refinement of the existing environment and further engagement with student cohorts. This work combines some exciting and developing fields in medical education, but routine adoption of these types of tool will be possible only with the engagement of all stake-holders, from educationalists, clinicians, modellers to, most importantly, medical students.

Do virtual patients prepare medical students for the real world? Development and application of a framework to compare a virtual patient collection with population data

BACKGROUND

An important aspect of virtual patients (VPs), which are interactive computer-based patient scenarios, is authenticity. This includes design aspects, but also how a VP collection represents a patient population and how a patient is presented in a VP scenario. Therefore, our aim was to analyze VP scenarios integrated into the combined internal medicine and surgery curriculum at the University of Munich (LMU) and compare the results with data from the population in Germany.

METHOD

We developed a coding framework with four main categories: patient data, patient representation, diagnoses, and setting. Based on the framework we analyzed 66 VP and compared the results with data from the German healthcare system.

RESULTS

Especially in the categories of patient data and patient representation, the VPs presented an unrealistic image of the real world; topics such as unemployment, disability, or migration background were almost non-existent. The diagnoses of the VPs and the onset of diseases were comparable with the healthcare data.

CONCLUSIONS

An explanation for the lack of representativeness of the patient data and representation might be a trend to create VPs based on fictional patient stories with VP authors trying to minimize complexity and cognitive load for the students. We suggest raising awareness among VP authors concerning personalized representations of patients without overwhelming their students. Our framework can support educators to assess the authenticity and diversity of a VP collection.