Co-funded by the European Unionelectronic VirtualPatients

Samuel Edelbring from the Karolinska Institutet in Stockholm, Sweden recently visited the Department of Educational Development & Research at Maastricht University in The Netherlands as a ‘visiting scholar’. Both institutes are involved in the eViP programme. During his stay he discussed his work shared ideas on virtual patients (VPs) with fellow researchers. Here he talks to Sian Claire Owen from The University of Warwick, UK, about his experience and outlines the importance of collaboration and exchanging ideas.

Firstly Samuel, can you tell us about your line of research?
My research is about the role of VPs in health profession education. This technology has been around for many years, but the educational implementation is still hesitant. One reason for that, in my point of view, is that a VP has it’s own character as a learning tool – it is not a paper case, it is not a seminar and it is not a real patient. The role(s) of VPs needs to be clearer for teachers and students before we see a massive regular use of VPs.

My research is about finding out what kind of a learning tool VPs are, and under what conditions they contribute well to student learning. I do that by using student interviews and questionnaires that address student conceptions of the role and nature of different study situations with VPs.

You recently came to Maastricht University as a visiting scholar to discuss your work on virtual patients. What were the objectives, and what did you hope to achieve?
I wanted to present my personal work and also the work of the VP-lab and Centre for Medical Education at Karolinska Institutet research group. We hope to establish connections between us and important nodes in the medical
education community. The guys here at Maastricht play an influential role in the scientific growth of the community.

Did you feel that your visit was valuable?
Oh yes, it was very valuable. I got to meet and discuss with researchers to get a sense of how they work, what issues that are important to them, and observe how they approach research education and educational research in a professional way.

I also got to present my own work and received valuable feedback on it. It gave me a lot of food for thought and directions for future research. I would like to congratulate Prof. Cees van der Vleuten who has a great team of researchers here: Prof. Jeroen van Merrienboer, Dr. Diana Dolmans and Dr. Bas deLeng to mention just a few of them.

How important is collaboration between different medical institutions in terms of developing ideas?
Academic development both in terms of knowledge and theory, as well as products and their implementation, is of little value if we don’t share our ideas and results between different institutions and stakeholders. This is widely acknowledged.

Still, in general people tend not to collaborate to any great extent with others because in practice it takes its toll, and it can be frustrating to realise that others have different conceptions and driving forces than yourself. Collaboration doesn’t make things easier – but it certainly makes them better, so the conclusion is that there are few alternatives to it. Personally I’ve have learned a lot by collaborating in this project, not only about VPs but about how other European countries deal with education and research.

What are your plans for the future?
Oh, I have great plans Sian! I’m half way through an exciting research project on education, and I have about two years left of work to finish my thesis.
After that I’m looking forward to exploring further how we learn and make best use of technology in that process.

Technology has increasingly taken the role of what we use to call our environment – it means that our environment, and consequently conditions for learning and living our lives, will change quite rapidly. You and I and others all need to follow and report on these developments closely.

Dr Martin Fischer and Dr Marzellus Hofmann from Witten/Herdecke, in Witten, Germany talk about past and present e-learning opportunities at the university.

In the past, a combination of a lack of resources, didactic hesitations and concerns about curriculum integration have hampered the full integration of e-learning resources at Witten/Herdecke.

However, as Martin and Marzellus explain, an increase in student numbers and increased involvement on the part of the teachers in developing e-learning content has resulted in more e-learning opportunities.

They have introduced the CASUS system to clinicians, and have allowed clinicians to review the content before they are offered as an additional tool for students.

The need for e-learning resources, including Virtual Patients, is growing, as is the need to integrate English and German cases into the curriculum, in particular to prepare medical students for both German and US medical examinations on offer.

There are certain challenges in the future, however when integrated into the curriculum in an appropriate way, e-learning tools can be very effective.

Watch the video of Dr Martin Fischer and Dr Marzellus discussing these issues. Please note this video is in German.

Video transcript

With special thanks to Dr Daniela Kempkens at Witten/Herdecke University for this translation.

Martin: We have the oppotunity to add e-learning activities to our current curriculum, and in the past there have also been efforts.

Marzellus: Yes. Between 2001 and 2003 there was a project within this faculty which was financed by the German Federal Ministry for Education and Research. It was concerned with the implementation of problem-orientated learning into the e-learning environment. The purpose was to adapt complicated patient cases – including the history, physical examination, and lab values, etc – to e-learning.

Unfortunately, continuous funding could not be secured and the project had to be discontinued. It was not intergated into the curriculum. It was clear from the beginning that it would have needed one or two full time equivalents to maintain and continuously update these cases.

Martin: Do you think it was mainly a problem of resources, or were there also ddactic hesitations or hesitations about curriculum intragration?

Marzellus: Definitely both. There was a small number of students with a high student-teacher ratio, with much exposure to practical training. So there was cleary a question of added value of e-learning in the curriculum.

Martin: Recently student numbers have doubled from 42 to 84 students per year at this university. Also, there is quite a heterogeneous cleckship training. Do you see a place in the clinical years for e-learning to establish a common standard for case discussions?

Marzellus: There is definitey an advantage in that. We have started to show the CASUS system to clinicians and introduce the idea of e-learning. Also, they are involved in reviewing the content of cases before these are offered as additional learning tools to students.

Martin: We have also recently introduced clinical skills e-learning cases. What do you think about computer assisted examinations? So far, key examinations are paper-based.

Marzellus: Yes, this is correct, and it means an immense amount of work can be significantly reduced through computer assistance. So far this discussion has focused on ensuring data protection in computer-based learning.

Martin: Through eViP we have the opportunity to use an international pool of virtual patient cases. What is your view on the necessity of integrating Englaish cases?

Marzellus: I think the need is growing. We now offer a program to achieve the German and US medical examinations. The more English learning tools we can offer the greater the acceptance of this program will be among the students.

Martin: We do need to address certain challenges in the future: Clinical clerkships, clinical skills, assessment and internationalisation. This will take up to two years.

Marzellus: e-learning can only work if it is really integrated into the curriculum.

Martin: We have to get the teachers on board, which is not always easy. But we will succeed!

My name is Sian Owen and I work with Dr David Davies at The University of Warwick Medical School in Coventry, UK. Part of our role within eViP is to raise awareness and disseminate information about the programme.

At the moment I am traveling across Germany visiting our German Partner Institutions: Witten/Herdeke University, Heidelberg University and the Ludwig Maximilians University in Munich to meet with other eViP members and to interview students, academics and learning technologists about their work with e-learning and VPs, and of course any eViP-related activities!

Over the course of the next week I’ll be blogging about my experiences and publishing interviews where you will be able to find out information on e-learning projects that are taking place in these institutions.

The first batch of interviews will be from staff and students at Witten/Herdecke. Stay tuned for more info…

Chara Balasubramaniam and Steve Malikowski from St George’s University of London e-Learning Unit talk to eViP about their award-winning poster presentation “Google, Wikipedia or Tutors: What to the students choose?”

More students than ever are accessing web pages, but how do they source this information? Do they use Google, Wikis, or to they listen to their tutor’s recommendations? This was the question that Steve Malikowski and Chara Balasubramaniam asked a cohort of 94 medical students, with surprising results!

As they explain, students were more likely to follow their tutor’s recommendation – with straight Google searches being the least popular method of accessing information. Is this the case in your institution? We would love to hear what you think!

The PREVIEW project takes problem based learning into the virtual world, by creating PBL scenarios in Second Life. This project is coordinated by Emily Conradi at St George’s University of London, and is run in collaboration with The University of Coventry and the Kingston University in London.

The project uses eight paramedic scenarios in Second Life to help students develop their clinical decision-making skills in various emergency scenarios. The paramedic students can access these environments remotely, whilst communicating with each other in real time.

You can tour PREVIEW in Second Life via the Preview Project’s You Tube channel here, and you can visit the PREVIEW website here.

Listen to Emily Conrandi and Sheetal Kavia talk to eViP about the PREVIEW project.

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Wired Science recently wrote an interesting overview of how virtual simulations are increasingly being used to prepare future surgeons before they get given the knife and let loose on their patients. The article is well worth a read.

The use of virtual simulations for health care professionals has often been compared to the use of flight simulations in aviation, as was the case in this article. This echoes the sentiment of Dr Terry Poulton from St George’s University of London at the recent International Conference on Virtual Patients (ICVP) 2009 held in Krakow, Poland. You can listen to Terry talk about the state of Virtual Patient technology here.

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But back to the article – it makes perfect sense for budding surgeons to hone their skills before they perform surgery on their patients, and evidently more institutions are embracing this technology in their curricula.

Here you can watch the Wired Science video of how researchers at Stanford University use a virtual reality simulator for sinus surgery.

Of course eViP is focused on virtual patient scenarios that are used to help the students develop their clinical reasoning skills, rather than virtual simulation technology. However, they form part of the broad spectrum of e-learning technology.

If you are interested in how people use virtual patients, then you can read the results of the eViP 2008 survey, and you can watch Dr David Davies from the University of Warwick discuss the results here.