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

Antibodies to Neospora caninum in sheep from slaughterhouses in the state of São Paulo, Brazil

Neosporosis is an emergent disease responsible for considerable economic impact due to reproductive losses. Its zoonotic potential remains unknown. This study involved a survey of antibodies to Neospora caninum in slaughtered sheep and their association with epidemiological variables. Serum samples from 596 sheep from the states of Sao Paulo and Rio Grande do Sul, Brazil, were collected in two slaughterhouses located in Sao Paulo and evaluated by indirect fluorescence antibody test (IFAT), using cut-off titers of 25. Among these samples, 353/596 (59.23%; 95%CI 55.23-63.10) were positive and 263/353 (74.50%; 95%CI 69.71-78.77%) were from Rio Grande do Sul. Statistical associations were determined in the univariate analysis between the serological results and sex, breed and municipality of origin. Sheep that came from extensive breeding system showed higher chance (OR=2.09) of presenting antibodies to N. caninum in relation to those from semi-intensive system. Higher chance was also observed for the different studied breeds, except Bergamacia, in relation to Hampshire Down. The results revealed the presence of infection by N. caninum in sheep from slaughterhouses.A neosporose é uma doença emergente responsável por considerável impacto econômico devido a perdas reprodutivas e seu potencial zoonótico permanece desconhecido. Este estudo envolveu a pesquisa de anticorpos para Neospora caninum em ovinos abatidos e sua associação com variáveis epidemiológicas. Amostras de soro sanguíneo de 596 ovinos, procedentes dos estados de São Paulo e Rio Grande do Sul, Brasil, foram colhidas em dois abatedouros localizados em São Paulo, e avaliadas pelo teste de reação de imunofluorescência indireta (RIFI), utilizando-se como ponto de corte o título de 25. Dentre essas amostras, 353/596 (59,23%; IC95% 55,23-63,10) foram positivas e dentre os ovinos positivos 263/353 (74,50%; IC95% 69,71-78,77%) eram procedentes do Rio Grande do Sul. Associações estatísticas foram determinadas na análise univariada entre os resultados sorológicos e o sexo, raça e município de origem. Ovinos oriundos de sistema de criação extensivo demonstraram maior chance (OR=2.09) de apresentarem anticorpos para N. caninum em relação aos de sistema semi-intensivo. Uma maior chance também foi observada para as diferentes raças estudadas, exceto Bergamácia, em relação à raça Hampshire Down. Os resultados revelaram a presença de infecção por N. caninum em ovinos de abatedouros.Univ Estadual Campinas, UNICAMP, Fac Ciencias Med, Dept Saude Colet, Campinas, SP, BrazilMississippi State Univ, Coll Vet Med, Dept Pathobiol &Populat Med, Mississippi State, MS 39762 USAUniv Estadual Paulista, UNESP, Dept Higiene Vet &Saude Publ, Fac Med Vet &Zootecnia, BR-18618970 Botucatu, SP, BrazilDepartamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista – UNESP, Botucatu, SP, Brasi

Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model

BACKGROUND: E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education. METHODS: We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model. RESULTS: Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance. CONCLUSION: This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings

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