Technology in education, necessary but not sufficient : understanding learning with virtual patients

With the rapid technological development and the broadening access to computers over recent decades, several technological innovations have emerged in medical education, including virtual patients. Students’ use of virtual patients is proposed to fill gaps in clinical exposure, and train clinical reasoning. However, higher education faculties have been slow to adopt new technology as a regular part of curricula. Virtual patients and similar technologies have either been implemented by enthusiastic teachers or by university policy directives. A possible reason for the low uptake of virtual patients in curricula is a lack of a clear understanding of how their use contributes to student learning. The four studies described in this thesis address learning with virtual patients from three perspectives: the student perspective on learning with virtual patients; the course integration perspective; and the individual study strategy perspective. A mixed methods approach was used given the overarching interest to seek understanding and clarification of student learning with virtual patients. Data were gathered by research interviews with medical students during clerkship, and by questionnaires in clerkship preparatory courses. Interview data was analysed by a phenomenological approach, and scales were formed from questionnaire responses which were analysed cross-sectionally for the four teaching hospitals affiliated with the medical programme at Karolinska Institutet. Use frequency, students’ perceived benefit of virtual patients, their wish for more guidance on using virtual patients and, wish for more assessment and feedback on virtual patient work were targeted in the questionnaires. Furthermore, the students’ preferences of study strategies were analysed in relation to the virtual patient activity using regulation strategy scales from the Inventory of Learning Styles devised by Jan Vermunt. The findings suggested that virtual patient learning activities offer possibilities of applying biomedical knowledge to clinical cases in a way that was engaging and supported decisionmaking. Furthermore, the virtual patient learning activities were perceived as having an intermediate function between textbook learning and learning with actual patients. The consequences of integration strategies in the course context were influential for how students perceived the benefit of learning with virtual patients. Intensity of processing of virtual patient cases, and presenting cases for other students were associated with high perceived benefit of virtual patient learning activities. Students’ self-regulation abilities were also associated with perceived benefit of the virtual patient learning activities, although to a lesser extent than the influence of the course context. The technology of virtual patients provides possibilities that enhance student learning, and should thus be a necessary part of education. However, this research show that an educational integration strategy is needed that supports students’ active processing of virtual patient cases

Validating e-learning in continuing pharmacy education : user acceptance and knowledge change

BACKGROUND: Continuing pharmacy education is becoming mandatory in most countries in order to keep the professional license valid. Increasing number of pharmacists are now using e-learning as part of their continuing education. Consequently, the increasing popularity of this method of education calls for standardization and validation practices. The conducted research explored validation aspects of e-learning in terms of knowledge increase and user acceptance. METHODS: Two e-courses were conducted as e-based continuing pharmacy education for graduated pharmacists. Knowledge increase and user acceptance were the two outcome measured. The change of knowledge in the first e-course was measured by a pre- and post-test and results analysed by the Wilcoxon signed–rank test. The acceptance of e-learning in the second e-course was investigated by a questionnaire and the results analysed using descriptive statistics. RESULTS: Results showed that knowledge increased significantly (p < 0.001) by 16 pp after participation in the first e-course. Among the participants who responded to the survey in the second course, 92% stated that e-courses were effective and 91% stated that they enjoyed the course. CONCLUSIONS: The study shows that e-learning is a viable medium of conducting continuing pharmacy education; e-learning is effective in increasing knowledge and highly accepted by pharmacists from various working environments such as community and hospital pharmacies, faculties of pharmacy or wholesales

SvalSim—field work simulation system for problem-oriented learning in petroleum geology

The Educational Technology Unit at Karolinska Institutet (KI) in Sweden has developed an on-screen simulation software, SvalSim, that simulates field work for problem-oriented learning in petroleum geology. The system is using numerous authentic geological data, takes the time aspect into account and lets users control almost all events resulting in a very realistic simulation. The educational setting for use of the simulation software is general training in geosciences and field courses in Norway e.g., at Svalbard. This article describes the system and the pedagogical objectives

Should the PBL tutor be present? A cross-sectional study of group effectiveness in synchronous and asynchronous settings

Background: The tutorial group and its dynamics are a cornerstone of problem-based learning (PBL). The tutor\u27s support varies according to the setting, and it is pertinent to explore group effectiveness in relation to different settings, for example online or campus-based. The PBL groups\u27 effectiveness can partly be assessed in terms of cognitive and motivational aspects, using a self-report tool to measure PBL group effectiveness, the Tutorial Group Effectiveness Instrument (TGEI). This study\u27s aim was to explore tutor participation in variations of online and campus-based tutorial groups in relation to group effectiveness. A secondary aim was to validate a tool for assessing tutorial group effectiveness in a Swedish context. Methods: A cross-sectional study was conducted with advanced-level nursing students studying to become specialised nurses or midwives at a Swedish university. The TGEI was used to measure motivational and cognitive aspects in addition to overall group effectiveness. The instrument\u27s items were translated into Swedish and refined with an expert group and students. The responses were calculated descriptively and compared between groups using the Mann-Whitney U and Kruskal-Wallis tests. A psychometric evaluation was performed using the Mokken scale analysis. The subscale scores were compared between three different tutor settings: the tutor present face-to-face in the room, the tutor present online and the consultant tutor not present in the room and giving support asynchronously. Results: All the invited students (n = 221) participated in the study. There were no differences in motivational or cognitive aspects between students with or without prior PBL experience, nor between men and women. Higher scores were identified on cognitive aspects (22.6, 24.6 and 21.3; p \u3c 0.001), motivational aspects (26.3, 27 and 24.5; p = 002) and group effectiveness (4.1, 4.3, 3.8, p = 0.02) for the two synchronously tutored groups compared to the asynchronously tutored group. The TGEI subscales showed adequate homogeneity. Conclusions: The tutor\u27s presence is productive for PBL group effectiveness. However, the tutor need not be in the actual room but can provide support in online settings as long as the tutoring is synchronous. © 2020 The Author(s)

A Qualitative Analysis of Virtual Patient Descriptions in Healthcare Education Based on a Systematic Literature Review

Background: Virtual Patients (VPs) have been in the focus of research in healthcare education for many years. The aim of our study was to analyze how virtual patients are described in the healthcare education literature, and how the identified concepts relate to each other. Methods: We performed a literature review and extracted 185 descriptions of virtual patients from the articles. In a qualitative content analysis approach we inductively-deductively developed categories and deducted subcategories. We constructed a concept map to illustrate these concepts and their interrelations. Results: We developed the following five main categories: Patient, Teacher, Virtual Patient, Curriculum, and Learner. The concept map includes these categories and highlights aspects such as the under-valued role of patients in shaping their virtual representation and opposing concepts, such as standardization of learner activity versus learner-centeredness. Conclusions: The presented concept map synthesizes VP descriptions and serves as a basis for both, VP use and discussions of research topics related to virtual patients

Evaluation of an interactive case simulation system in dermatology and venereology for medical students

BACKGROUND: Most of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning. METHODS: Through continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85) or conventional teaching plus NUDOV (n = 31) and comparing the results of the two groups in a final written examination. RESULTS: The questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination. CONCLUSION: We created a computerised case simulation program allowing students to manage patients in a non-linear format supporting the clinical reasoning process. The student gets feedback through comparison with a specialist, eliminating the need for external scoring or correction. The model also permits discussion of case processing, since all transactions are stored in a log file. The program was highly appreciated by the students, but did not significantly improve their performance in the written final examination

Developing a European longitudinal and interprofessional curriculum for clinical reasoning

Clinical reasoning is a complex and crucial ability health professions students need to acquire during their education. Despite its importance, explicit clinical reasoning teaching is not yet implemented in most health professions educational programs. Therefore, we carried out an international and interprofessional project to plan and develop a clinical reasoning curriculum with a train-the-trainer course to support educators in teaching this curriculum to students. We developed a framework and curricular blueprint. Then we created 25 student and 7 train-the-trainer learning units and we piloted 11 of these learning units at our institutions. Learners and faculty reported high satisfaction and they also provided helpful suggestions for improvements. One of the main challenges we faced was the heterogeneous understanding of clinical reasoning within and across professions. However, we learned from each other while discussing these different views and perspectives on clinical reasoning and were able to come to a shared understanding as the basis for developing the curriculum. Our curriculum fills an important gap in the availability of explicit clinical reasoning educational materials both for students and faculty and is unique with having specialists from different countries, schools, and professions. Faculty time and time for teaching clinical reasoning in existing curricula remain important barriers for implementation of clinical reasoning teaching