Volume 11, Issue 2 - Special issue: E-learning Techniques in Medicine / Guest Editors: Inga Hege and Andrzej A. Kononowicz

Following their introduction at the beginning of the 21st century, interactive or dynamic Virtual Patients are beginning to be used more widely in clinical education. They can be seen as being at the end of a continuum of simulation technical complexity, having been earlier developed on a wide range of “media”: human actors, paper, video, physical mannequins, etc. This paper focuses on the current emergent more complex Virtual Patients in three-dimensional (3D) immersive clinical environments. In these environments, in silico 3D patient avatars interact directly in response to virtual clinical interventions undertaken by avatars, each of which is controlled by one or more users. The paper explores the issues of authoring, deploying, and managing these real-time, dynamic Virtual Patients using as an example the immersive clinical environment CliniSpace. As clinician-accessible Virtual Patient authoring is now becoming available in immersive clinical environments, so these wider clinical and managerial non-technical issues are coming rapidly to the fore.

Background: Simulation training in medical education is a valuable tool for skill acquisition. Standard audio/video-feedback systems for training surveillance and subsequent video feedback are expensive and often not available. Methods: We investigated solutions for a low-budget audio/video-feedback system based on consumer hardware and open source software. Results: Our results indicate that inexpensive, movable network cameras are suitable for high-quality video transmission including bidirectional audio transmission and an integrated streaming platform. In combination with a laptop, a WLAN connection, and the open source software iSpyServer , one or more cameras represent the easiest, yet fully functional audio/video-feedback system. For streaming purposes, the open source software VLC media player yields a comprehensive functionality. Using the powerful VideoLAN Media Manager, it is possible to generate a split-screen video comprising different video and audio streams. Optionally, this system can be augmented by analog audio hardware. In this paper, we present how these different modules can be set up and combined to provide an audio/video-feedback system for a simulation ambulance. Conclusions: We conclude that open source software and consumer hardware offer the opportunity to build a low-budget, feature-rich and high-quality audio/video-feedback system that can be used in realistic medical simulations.

Occupational medicine (OM), especially the ability to recognize potentially workplace-related diseases or accidents, is important for medical students to learn. The assessment in OM at the Ludwig-Maximilians-University is implemented as a paper-based, multiple-choice question exam that does not assess the students’ ability to remember occupational aspects in clinical contexts. Therefore, the aim of this study was to create and evaluate an online exam based on 19 virtual patients to assess the aspects of OM in an interdisciplinary setting. Thirty-nine medical students participated in the exam with an average score of 65%. The score for freetext questions assessing OM aspects was low (39%). The study showed that the implementation of an interdisciplinary VP-based exam is feasible. The integration of such an interdisciplinary exam would be feasible, for example, as an open-book assessment.

Background: The Bavarian Virtual University (BVU) offers resources to develop and implement e-learning courses and allows open access to information and provides the capacity to share information. Students of Bavarian universities can participate easily in these courses. Thus, the barriers to enter a university are now much lower. E-learning will be supported by the use of the learning and authoring software CASUS ® . It optimises the creation of virtual patients and guarantees a common standard and a high quality throughout the whole e-learning course. Methods: This paper describes the application process of proposals at BVU and the development process of online courses with CASUS ® using the example of “General Practice”. The conceptual structure of the program and its specific rationale is presented herein. In addition, the number of participating students is analysed when the online course is integrated in the curriculum or when it is not. Results: The e-learning course General Practice includes a total of 48 scenarios. They focus on the heuristics in General Practice of prevention and primary care. If the online courses are integrated in the curriculum, the number of students participating in e-learning courses increases. The integration of virtual patients (VPs) into practical training may improve the perceived benefit. Probably, there is no need for examinations to prove students’ knowledge if they can apply contents in the practical training. To answer this question, an evaluation of students’ and teachers’ perspective is needed. In addition, it is challenging to define one level of education for students of different universities. Hence, new methods are needed to develop and evaluate generally accepted standards that fit all participating universities and their students. Conclusions: The application of proposals at BVU and creating VPs with the learning and authoring system CASUS ® can be highly recommended to other universities, as well as the establishment of organisations like BVU in other countries.

Background: Massive Open Online Courses (MOOCs) extended with Virtual Patients (VPs) may foster specific medical skills. In particular, three educational use cases have been proposed to enable interactivity and foster clinical reasoning skills training: collective evaluation of decision making in the context of uncertainty, collective repurposing of cases with division of discussion into subgroups, and computational models in short cases for flexible selection and adaptive learning with VPs. The aim of this study was to evaluate the educational strengths and weaknesses of the proposed use cases. Methods: We went through a two-round modified Delphi process. A panel of experts was formed and asked with open-ended questions to identify the strengths and weaknesses of each use case. The obtained responses were categorized thematically; four specific aspects of the use cases were isolated. In the second phase, the panel was asked to read the collected, categorized responses and prioritize the use cases focusing on each of the four identified aspects. Results: Six experts participated in the process. According to their opinion, decision making in uncertain context was the most feasible in implementation and in fostering clinical reasoning skills training; cultural repurposing was judged to leverage the MOOC potential the most; and computational models in short cases were considered the most interesting use case for the learners. Conclusions: The use cases were validated and prioritized; the Delphi approach brought insights into the use cases’ potential benefits, threats, and challenges.

Background: At Manchester Medical School, students enter the clinical environment having received only limited teaching of cardiovascular examination. This is delivered during a 1-h lecture and 1 h of clinical teaching. I thought this was an insufficient amount of teaching and decided to try and rectify this issue. Six months into year 1 of clinical teaching, the students complete a 4-week Personal Excellence Pathway project, which is designed to help students explore areas of interest to them. To rectify the perceived lack of teaching, I created an interactive iBook that demonstrates in a detailed way how to examine a patient’s cardiovascular system. Methods: The iBook was created using iBooks Author, a free Apple product. It is interactive and easy to use. I built it using free editing software such as iMovie and iPhoto. Full explanations and demonstrations of the examination itself and of the signs elicited were created using video, audio, clinical images, and links to a glossary. This core content was acquired by spending time in clinics, filming a consultant performing the examination, and acquiring images of clinical features on the wards. Results: Overall, given the breadth and depth of the subject covered, the iBook took less time to create than I had expected. Recording the video contents took far less time than expected. Obtaining the clinical images for the relevant signs took longer than expected. Conclusions: Many students now use iPads and Apple laptops as an integral part of their work. The creation of such an interactive iBook that is interesting and widely accessible by the students can be very beneficial to the medical student population. In this 4-week project, I showed that it is possible for a student to create an innovative learning tool in a short amount of time that can enrich the education of fellow students at medical school.