KE9 Curriculum Integration Design: Virtual Patient Year 2Learning in context

Dr Nicola Englyst, Dr Kirsten Poore, Dr Claire Smith24th March 2011

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Project overview: Year 2: 'Preclinical' Medical EducationSpiralling CurriculumSemester 3

Gastrointestinal

Nervous and Locomotor 2

Semester 4

Respiratory, Cardiovascular and Renal 2

Endocrinology and the Life Cycle

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Our challenges when teaching medicine…

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How do we make learning facts interesting?!!

Lecture

Lecture

Lecture

Lecture

Lecture

Practical

Lecture Practical

Practical

Symposium

Symposium

Feedback

– Basic sciences + basic clinical information

– Lectures, tutorials, practicals and symposia1 case per

week throughout semester

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• Different learning styles and preferences.

• “Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand"

– Confucius

• Kolb: Experiential Learning Cycle

Our students are all individuals!

feeling

watchingdoing

thinking

tactilevisual

auditory

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Feedback• Students want more feedback!

• Can we provide instant individualised feedback for 250 students?

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Continuity in teaching and learning

• Our educators come from a variety of backgrounds.

• Can we find a way to provide continuity of

teaching?

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KE9 Curriculum Integration DesignOur challenge:

• To present basic scientific facts necessary to build a medical career on, in a way that is relevant, interesting and educational.

Integration of eLearning, either materials or technology, need to be designed as part of the curriculum, just like other curriculum activities.

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The aim of this project:

• To develop a series of interactive Virtual Patients to reinforce the links between science and students' future medical careers.

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VP Year 2: Curriculum Integration Design• needs and requirements of the various stakeholder

groups were initially assessed:

– liaison with curriculum management groups and students

– consulting the GMC guidelines published in Tomorrow’s Doctors

– review of available literature concerning interactive multimedia, learning theories, Human Computer Interaction (HCI) and medical education

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VP Year 2: Curriculum Integration Design

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• Virtual Patients must be integrated into existing teaching

– redevelopment of Endocrinology and Life Cycle Course (2008) specifically included incorporation of Virtual Patients

• Virtual Patients must be aligned with Learning Outcomes

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VP Year 2: Curriculum Integration Design

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Lecture

Lecture

Lecture

Lecture

Lecture

Practical

Lecture Practical

Practical

Symposium

Symposium

Feedback

Direct access

VP Year 2: Curriculum Integration Design

08:00Virtual Patient

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Year 2: Six Virtual Patients developed• In Semester 3, Gastrointestinal Course:

– Mr Andrew King with reflux disease

– Mikey Botley with infectious diarrhoea

– Mikey Botley with Hemolytic-Uremic Syndrome (HUS)https://www.som.soton.ac.uk/learn/bm/bmgastro/patient/

• In Semester 4, Endocrinology and the Life Cycle Course:

– Mr and Mrs Andrews with infertility problems

– Rachel Denver with type 1 diabetes

– Mrs Jane Rice with type 2 diabeteshttps://www.som.soton.ac.uk/learn/bm/bmendocrinologylifecycle/patient/

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Year 2: Virtual Patient content

Clinical scenario laid out:

• 3D animations or videos

• interactive tasks

• basic science-related quizzes

• embedded learning materials

– links to lectures

– patient information sheets

– external websites

Helps students to:

• test basic science understanding in a clinical context

• develop clinical skills by taking the role of a doctor interacting with a patient

• think from a patient’s perspective

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Year 2: expected level

• integrative learning: anatomy, histology, physiology, pharmacology

• more diagnostic

• more discussion of treatment options

gateway into clinical Years 3 onwards

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VP Year 2: Examples

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The scene is set: eg. video of an initial consultation

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links to other relevant teaching and learning resources

Interactive quizzes based on information presented

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student's completed

work

• student inputs, answers to questions and summary medical notes are stored

– enables students to resume a Virtual Patient at a later date

• recorded data are used to analyse students’ performance

– offers individualised feedback for poorly understood topics

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Year 2: Teacher access

• teaching staff can also monitor Virtual Patient usage and students’ performance for each learning outcome associated to the case

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Year 2: EvaluationStudent evaluation ratings at end of Semester: Overall

Virtual Patient ratings for Year 2 were 3.6 (2010) and 3.9 (2009) out of 5

User tracking data: usage numbers

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Academic year

ELC Infertility

ELC Diabetes 1

ELC Diabetes 2

GI

Reflux

GI

Diarrhoea

GI

HUS

2008 N/A N/A N/A 116 N/A N/A

2009 200 153 216 109 90 22

2010 178 262 230 81 44 24

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VP Year 2: EvaluationFocus groups:

• Students rated Virtual Patients highly, particularly liking the formative feedback they provided

Informal discussions:

• Semester coordinators reported that students who failed the semester were also frequently failing to use the Virtual Patients

– engaged student understand that full use of course material enables an ability to understand the subject

• especially since the Virtual Patients are linked to assessments!

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VP Year 2: EvaluationOnline questionnaires:

• Pre-questionnaires (80 completed): >50% cited importance of clinically relevant and realistic case scenarios, 23% wanted VPs to be constructive and integrated

• Post-questionnaires (35 completed): generally very positive. Eg. meeting expectations was rated above 4 (5 = very much); features most liked were clinically relevant and realistic clinical scenarios, and instant and individualised feedback

– most wanted more Virtual Patients in their curriculum!

– would use the Virtual Patients for assessment revision

– recommend them to their fellow students25

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• Spread the word! (to students and teaching staff)

• Incorporate the VPs into your timetable

• Course coordinators provide a demonstration to students

– Where to find the VPs

– How to use the VPs

– Benefits of using VPs

– Outlining link with learning outcomes and assessments

KE9 Curriculum Integration Design:our handy tips for getting your VP

noticed!

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KE9 Curriculum Integration Design:our handy tips for getting your VP

noticed!• Key staff were reminded about VPs

Case history 3 years on:

• Rachel is now 25 years old

• Diagnosed with type 1 diabetes 3 years ago

• Relatively well controlled

• Studying for her finals

Hormones in diabetic ketoacidosis•Increased catabolic hormones

•Glucagon•Catecholamines•Cortisol•Growth hormone

•Absolute or relative insulin deficiency

What are the physiological changes causing Rachel’s initial symptoms?

• Thirst

– Excess peeing- reduce glucose and KBs

– Vomiting & dehydration

• Nausea & vomiting

– Toxic ketoacid elimination, hyperglycemia

• Breathlessness

– Kussmaul’s respiration- deep breaths to decrease CO2 to raise pH

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VP Year 2: Future work• For the remaining weeks of each course, ‘Paper-based Virtual

Patients' enable weekly case-based learning to continue throughout Year 2

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• discussed in Friday feedback sessions as for online Virtual Patients

• will form framework for future Virtual Patients

• will require further funding

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VP Year 2: Conclusion• a successful model of curriculum integration

• ongoing refinement to ensure students make full use of Virtual Patients' potential

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VP Year 2: Acknowledgements• Project leader: Dr Sunhea Choi

• Content authors: Dr Myron Christodoulides, Dr Claire Smith, Dr Nicola Englyst, Dr Ying Cheong, Dr Kirsten Poore

• Learning designer: Dr Sunhea Choi

• eLearning Developer: Matt Hammerton

• Multimedia Developer: Mimi Lee

• Funding: Faculty of Medicine with match funding from NHS Education South Central.

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