Virtual patients design and its effect on clinical reasoning and student experience : a protocol for a randomised factorial multi-centre study

Background Virtual Patients (VPs) are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent) and structured clinical reasoning feedback (present or absent). Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent), and structured clinical reasoning feedback (present or absent).The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for both primary outcomes

Factors influencing the implementation, adoption, use, sustainability and scalability of eLearning for family medicine specialty training:A systematic review protocol

Background In 2013, there was a shortage of approximately 7.2 million health workers worldwide, which is larger among family physicians than among specialists. eLearning could provide a potential solution to some of these global workforce challenges. However, there is little evidence on factors facilitating or hindering implementation, adoption, use, scalability and sustainability of eLearning. This review aims to synthesise results from qualitative and mixed methods studies to provide insight on factors influencing implementation of eLearning for family medicine specialty education and training. Additionally, this review aims to identify the actions needed to increase effectiveness of eLearning and identify the strategies required to improve eLearning implementation, adoption, use, sustainability and scalability for family medicine speciality education and training. Methods A systematic search will be conducted across a range of databases for qualitative studies focusing on experiences, barriers, facilitators, and other factors related to the implementation, adoption, use, sustainability and scalability of eLearning for family medicine specialty education and training. Studies will be synthesised by using the framework analysis approach. Discussion This study will contribute to the evaluation of eLearning implementation, adoption, use, sustainability and scalability for family medicine specialty training and education and the development of eLearning guidelines for postgraduate medical education

Development and Preliminary Evaluation of Student-Authored Electronic Cases

In medical education, virtual patients are now widely used to support and enhance clinical teaching. However, there is still only a limited adoption of similar methods in veterinary education. This paper describes an initiative at the Royal Veterinary College (RVC) in London to develop student-authored cases during clinical rotations that were subsequently adapted for self-directed learning in the undergraduate curriculum as virtual patients. This approach was designed to enhance the quality of the clinical learning experience, assist in the development of clinical reasoning skills, and complement the existing teaching caseload. The creation of virtual patients involved a two-stage process. In the first stage, students compiled clinical case data and media from patients admitted to the teaching hospitals. They then used these resources to develop electronic cases using a customized Microsoft PowerPoint template that were presented at grand rounds to clinicians and other students. In the second stage, selected cases were further developed with the integration of self-assessment and additional media to create virtual patients for use in teaching. A survey was used to gather feedback on students' experiences in creating and using electronic cases. It was completed by 163 final-year students (81%) and the results indicated that all respondents had created electronic cases on one or more rotations (mean=4.3 rotations, range=1-9). Overall, the feedback suggested that the students found creating and using these cases useful and that the experience improved their approach to a case