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1

Student medical education with the real orthopedic case presented as interactive computer simulation

Dygut J., Płonka S.

Bio-Algorithms and Med-Systems

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2015

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Vol. 11, no. 1

59--67

EN

This article presents an example application of an e-learning tool for presenting cases with the aim of acquainting medical students with the procedures performed by a court expert in assessing causes and effects of an accident at work. Methods: The present publication is based on medicolegal expertise dealing with the case of a 51-year-old manual worker of a carpentry company who, due to lack of proper training in handling the machine, severely injured his hand. The main advantage of this publication is the presentation of a series of cause-effect events at every stage of the patient’s treatment that led to minor and major complications and adverse effects. Their starting point was the employer’s evident error, i.e., failure to provide the worker with proper training in handling the machine. Results and conclusions: The discussed orthopedic case has been implemented in the CASUS base (mainly using the program “Virtual Patients” as tool for case presentation) in the form of a description of a properly carried out diagnostic procedure and equipped with the expert’s opinion and explanation of possible inappropriate decisions.

2

Development and evaluation of a virtual patient-based exam in occupational medicine

Hege I., Schröpfer I., Radon K.

Bio-Algorithms and Med-Systems

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2015

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Vol. 11, no. 2

101--105

EN

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.

3

Using electronic virtual patients and collaborative groups for problem based learning

Aarons R., Albright S. S.

Bio-Algorithms and Med-Systems

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2010

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Vol. 6, no. 11

127--132

EN

TUSM has had a PBL course for decades. New LCME standards for accreditation call out PBL as an important tool in a medical curriculum. First year cases had been paper-based and second year cases have used a complex card-deck trying to simulate the clinical experience. We have now had two years of experience with paperless PBL. Collaborative groups were used for first year PBL and for second year the TUSK electronic virtual patient creator was used to create electronic versions of the card-deck. Transforming the paper cases was a simple task. The virtual patients were more difficult involving rethinking how the cases would work using the rules of the electronic virtual patient authoring tools. Facilitators, who had worked with the program, some for decades are slowly accepting this change. After the first year the virtual patient creator was reworked to make it more appropriate for PBL. The tool within TUSK, Tufts University Sciences Knowledgebase, now has more appropriate navigation and tracks the group’s clinical reasoning path and associated costs. We will report on student satisfaction as compared to first year as well as an analysis of clinical paths traveled by the groups and associated costs.

4

Towards the development of a gold standard for authoring, introducing and sustaining virtual patients in multi-campus clinical education environments

Vassiliou D., Arnrup K., Broström O., Evans M., Ruiz M., Hagwall K., Henriksson P., Sköld M., Sejersen R., Zary N

Bio-Algorithms and Med-Systems

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2010

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Vol. 6, no. 11

35--38

EN

The use of Virtual Patients (VPs) in medical education is increasing but they tend to become author-dependent. Research about the usual context of clinical courses distributed over several hospitals and with several teachers has not been addressed. The purpose of the study was therefore to develop a model for authoring, implementing and sustaining the use of VPs in a multi-campus clinical educational environment.

5

To start from scratch or to repurpose: that is the question

Kononowicz A. A., Stachoń A. J., Guratowska M., Krawczyk P.

Bio-Algorithms and Med-Systems

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2010

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Vol. 6, no. 11

57--63

EN

The high cost of authoring e-learning resources is a well-known problem when introducing and using virtual patients in medical schools. A method investigated by the European eViP project for reducing these expenses involves “repurposing” existing cases from a common database in order to fit them into new learning environments and scenarios. The goal of this study was to collect opinions on repurposing as a method of authoring educational cases. A questionnaire was sent to subject matter experts and learning technologists working on the eViP project at Jagiellonian University Medical College. The staff members had experience both in repurposing cases and creating virtual patients from scratch. A five-point scale for recording their preferences in the adaptation of virtual patients was introduced. By using open-ended questions the respondents had an opportunity to freely give their personal opinions on the pros and cons of adapted cases. For the majority of staff members polled the repurposing of existing cases was a great chance to start introducing virtual patients at a university with no previous experience in using this method of teaching. However, limitations of repurposing were also detected which consequently caused some of our specialists to prefer the creation of new cases rather than repurposing.

6

Simulation of a virtual patient with cranial nerve injury augments physician-learner concern for patient safety

Kotranza A, Cendan J. C., Johnsen K, Lok B

Bio-Algorithms and Med-Systems

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2010

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Vol. 6, no. 11

25--34

EN

We have created the Neurological Exam Rehearsal Virtual Environment (NERVE), a virtual patient based simulation targeted to train medical students in the diagnosis of abnormal findings in the neurological examination. In NERVE, a learner communicates with and performs a physical examination of a life-sized virtual character experiencing double vision as a result of a cranial nerve palsy. NERVE affords verbal communication through natural speech and gestures, and affords physical interaction through manipulation of virtual tools such as an ophthalmoscope. Creation of NERVE is motivated by the limited quantity and depth of current medical education and simulation approaches to providing learners with exposure to abnormal physical findings in the context of a doctor-patient interaction. NERVE not only provides an immersive and on-demand learning opportunity, but provides students with the opportunity to experience the patient’s double vision in the first person in a “Patient Vision Feedback” (PVF) session. PVF allows the learner to experience how the world looks to the virtual patient, providing an opportunity for enhanced perspective taking and empathy. Thirty-two medical students have examined a virtual patient in NERVE. Twenty-nine of these students were able to correctly diagnose the virtual patient’s cranial nerve palsy, demonstrating content validity of NERVE. A subset of eight medical students experienced Patient Vision and, as a result, demonstrated improved concern for the patient’s wellbeing. NERVE is able to augment a neurology curriculum by providing increased exposure to abnormal findings and providing students with a unique insight into how the disease affects the patient’s wellbeing.

7

How dungeons & dragons made us better VPS: randomizing physiological data to rapidly produce 97 clinically realistic VPS

Tworek J., Pagetti M., McLaughlin K., Wright B.

Bio-Algorithms and Med-Systems

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2010

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Vol. 6, no. 11

41--45

EN

Creating multiple clinically realistic virtual patients (VPs) is a daunting, time-consuming process whereby time saved with a basic template still requires the end-user to populate physical exam, laboratory investigations and physiological data specifically to the nuances of each case. Within the gaming domain, it is common to populate multiple characters within a game by randomizing a range of values or characteristics (e.g. eye colour, height, weapons). Transferred to the clinical context, the ability to randomize all laboratory and other investigation results to default within the range of accepted physiological parameters for each finding allowed the University of Calgary to rapidly create ninety-seven VPs with clinically appropriate alphanumeric normal values. Using spreadsheet and database software, randomization was achieved by establishing the range of normal laboratory results. In addition, patient background, such as marital status, occupation, and so forth were also generated for each VP. These data-populated VPs were then imported into Open Labyrinth, where Subject Matter Expert time was condensed to providing abnormal findings to fit the context of the clinical presentation and desired diagnosis. The combination of common office productivity software and an open source VP platform allows others to leverage the same process for local curricular VP-based programs. This technique also optimizes programmer, instructional designer and subject matter expert time commitments to the project.

8

Evaluation of different designs of virtual patients: first results using the eVIP evaluation instruments

Oberle S., Huber S., Nawrotzki R., Harter C., Schönit E., Schäfer N., Tönshoff B., Huwendiek S.

Bio-Algorithms and Med-Systems

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2010

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Vol. 6, no. 11

15--19

EN

Introduction: Application of electronic virtual patients (VPs) is not only restricted to the clinical part of medical education. VPs can be used in preclinical years as well as in advanced trainings for physicians. The presented study overviews and compares different designs of VPs in different educational scenarios and summarizes their evaluations. Methods: Due to the needs of each scenario the design of VPs got adjusted. The range of preclinical and clinical subjects comprised anatomy, biochemistry, child and youth psychiatry, paediatrics and others. In addition to the online evaluation through the students at the end of each VP, checklists completed by the VP designers got evaluated and compared due to each type of design using the eViP evaluation instruments. Results: Evaluation results will be presented in detail including weaknesses and strengths of design with respect to the scenario made for. Allover the feedback was encouraging and positive. A descriptive comparison of each type of design will be discussed including feedback of students and VP designers. Conclusions: VPs can be adjusted in design to suit different educational scenarios. The eViP design evaluation instruments proved to be helpful to further optimize VP design according to the scenarios used in.

9

Collaborative development of virtual patients in clinical education

Berman N., Fall L.

Bio-Algorithms and Med-Systems

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2010

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Vol. 6, no. 11

65--67

EN

We have developed virtual patients in three medical disciplines (pediatrics, internal medicine, family medicine) that have achieved a very broad level of use in the US and Canada. We believe that the collaborative development and maintenance model is the key to success of these projects. This model recognizes that incorporating technology in medical education is primarily an educational, not a technological, challenge. The collaborative model incorporates six key components: 1) multi-institutional authoring to achieve comprehensive coverage of a nationally accepted curriculum, 2) a consistent pedagogical approach within and across disciplines, 3) instructors resources for integrating the program in the curriculum, 4) maintenance of the content with nationally representative editorial boards, 5) support for the academic needs of medical educators, and 6) a stable support infrastructure that is financially sustainable. The broad acceptance of these virtual patients achieves the goals of sharing of content, elimination of redundant work, and improved medical education. We believe that the collaborative development and maintenance model can and should be advanced in other areas of e-Learning.

10

Repurposing virtual patients for the preclinical years - a pilot study

Oberle S., Huber S., Tönshoff B., Nawrotzki R., Huwendiek S.

Bio-Algorithms and Med-Systems

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2009

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Vol. 5, no. 9

79--82

EN

Introduction: Electronic virtual patients are becoming increasingly more popular in medical education. These interactive clinical scenarios seem to be well suited to integrate clinical case examples into preclinical education, thereby demonstrating relevance of the subjects studied and fostering transfer between theoretical and clinical subject matter. We report on a pilot study dealing with the repurposing of an existing clinical virtual patient to the preclinical part of medical education, with an assessment of the associated effort. Methods: For this pilot study, a CAMPUS virtual patient (www. campusvirtualpatients.com), originally created and implemented for teaching and assessment within the regular pediatric curriculum, was taken and repurposed for the preclinical part of medical education. According the preclinical learning objectives, this virtual patient was redesigned and the clinical level of difficulty was simplified. For the first time interactive graphics were used in the CAMPUS system. 26 second year medical students voluntarily worked through the virtual patient as self study, then completed a questionnaire. Results: 26 students took part in this pilot study. The results indicate a very high acceptance of virtual patients as learning tools and attest to a successful combination of clinical and preclinical elements. Students wish to have more virtual patients like the one presented, with cases in different preclinical subjects. The level of difficulty with respect to clinical features and the required knowledge needed to successfully complete the virtual patient is rather sophisticated for the preclinical part of medical education. The calculated associated effort for repurposing was 68 hours. Conclusions: This pilot study indicates that students appreciate using virtual patients as a part of their preclinical education. It seems worthwhile to repurpose clinical virtual patients for the preclinical years. However, confirmation with a larger student population is needed and studies higher up within the Kirkpatrick levels would be beneficial.

11

Repurposing virtual patients for clinical reasoning: development of a guideline and assessment of time and effort

Hanebeck B., Tönshoff B., Huwendiek S.

Bio-Algorithms and Med-Systems

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2009

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Vol. 5, no. 9

69--72

EN

Introduction: Fostering clinical reasoning is considered to be one of the major learning goals in medical education. However, there is only limited access to real patients to learn clinical reasoning. This deficiency can be overcome by providing virtual patients as an adjunct to real patient encounters. Research has been carried out on design features for virtual patients, especially to improve clinical diagnostic reasoning skills. However, developing new virtual patient cases from scratch is costly, making it reasonable to repurpose existing cases. Efforts to apply these to already existing virtual patients are, as yet, unreported, but are considered to be considerably lower than creation of new cases. Methods: We established a guideline for repurposing virtual patients for fostering clinical reasoning, which was developed from the literature and from our own experiences in repurposing 15 virtual patients. Furthermore, we documented the associated effort in terms of work hours. Results: The established guideline for repurposing virtual patients for clinical reasoning includes the following six major steps: (1) Case selection and initial check; (2) Literature review; (3) Development of a repurposing concept; (4) Enrichment for fostering clinical reasoning; (5) Reduction of cognitive load; (6) Final checks including review by expert and completion. The six steps are described in detail. The associated time and effort were calculated on average by 33 hours per case. Conclusion: We describe a guideline for repurposing virtual patients for clinical reasoning and its associated time and effort. We hope that others planning to repurpose virtual patients for clinical reasoning find this guideline helpful.

12

Repurposing existing virtual patients; an Anglo-German case study

Balasubramaniam C., Poulton T., Huwendiek S.

Bio-Algorithms and Med-Systems

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2009

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Vol. 5, no. 9

91--98

EN

Virtual Patients (VPs) are expensive to make from scratch. An attractive solution is to take those from one institution and transfer them to another. However, is it educationally feasible to simply translate the language of a VP from one country to another? The Repurposing Existing Virtual Patients (REViP) project between St George's, University of London and the University of Heidelberg has repurposed and content-enriched existing German VPs to English language, culture and pedagogy. These VPs were then embedded, tested and evaluated as core components within the paediatrics module and then ultimately made open to the wider community for free. The project has confirmed that repurposing and enriching is an effective way to share and reuse VPs as opposed to creating from scratch. However, much care should be taken to make the VPs suitable for the educational needs of the student, in their local context. This case study explores how the project was implemented and highlights the key outputs and conclusions.

13

Needs analysis for virtual patients: a report from the eVIP project

Davies D. A., Balasubramaniam C., Huwendiek S., de Leng B.

Bio-Algorithms and Med-Systems

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2009

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Vol. 5, no. 9

29--34

EN

The eViP Programme has conducted a survey on the current use of virtual patients across the EU and the wider global community. A total of 216 respondents have given feedback on the current and potential future use of virtual patients, including different educational settings and scenarios within which virtual patients have been used. Data has been gathered on different business models for access to a repository of virtual patients. The broad demographic profile of respondents has been gathered to help analyse these data in context. This report will be of use to those considering a virtual patient approach in their curricula, as well as providing a snap-shot of the current good practice in this area. It is planned to release an updated version of this survey in 2010 towards the end of the eViP Programme so that changes in opinion and implementation of a VP approach can be reviewed.

14

Maryland virtual patient: a knowledge-based, language-enabled simulation and training system

McShane M., Nirenburg S., Jarrell B., Beale S., Fantry G.

Bio-Algorithms and Med-Systems

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2009

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Vol. 5, no. 9

57--63

EN

Maryland Virtual Patient (MVP) is system aimed at training medical personnel in certain aspects of clinical medicine. The user plays the role of attending physician and is tasked with diagnosing and treating virtual patients (VPs), with or without the help of a virtual tutor. Each VP is composed of both a realistically functioning physiological side and a reasoning - and language-enabled cognitive side. The former permits the VP to undergo the physiological states and changes associated with diseases, their treatments, and even unexpected external stimuli, such as clinically counterindicated interventions. The latter permits the VP to consciously experience and reason about its disease state, make decisions about its lifestyle and medical care, and discuss all of these with its attending physician (the user). This paper provides a brief overview of core aspects of MVP.

15

Interprofessional cooperation for the cardiological patient benefits - planned course using a virtual patient's setting

Szot W., Kolarzyk E.

Bio-Algorithms and Med-Systems

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2009

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Vol. 5, no. 9

13--15

EN

Hygiene and Ecology Department UJCM took interest in courses regarding cardiovascular and metabolic disorders, due to nature of specialist working in Department and their research. Thanks to close collaboration between Hygiene and Ecology Department and Krakow's Cardiac Institute there is possibility to run course dealing with different types of cooperation in and among different medical professions. Since it is believed that medical students are aware of different specializations and the majority of them choose their areas of interest during the 3rd-4th year of studies, those courses were planned at the end of second semester of 4th year of medical education. To cooperate with these, students from other faculties (Nursery, Emergency Medicine, Medical Technicians etc) were invited to participate in course with using a virtual patient's setting. During the course it is being stressed upon the need of good practice and interprofessional cooperation between specialists from different professions during the process of proper management of the patient suffering from the leading cause of sudden death which is, nowadays, cardiac failure and all diseases leading to it (heart infarction, arrhythmia, high blood pressure etc). Using the virtual patient's setting and role-playing skills of doctors who moderate this course, several problem-based cases will be presented, each leading students to their own conclusion why this cooperation and trust in others abilities is so vital in patients management.

16

Integration of virtual patients into existing curricula of bh pediatric departments results of two evaluation studies

Bokonjic D., Petrov B., Masic S., Huwendiek S., Lozo S.

Bio-Algorithms and Med-Systems

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2009

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Vol. 5, no. 9

17--21

EN

Introduction: Virtual patients (VPs) are interactive computer programmes that simulate real-life clinical scenarios. We have identified pediatric departments at BH Medical faculties Foca and Mostar as suitable for introducing virtual patients due to the lack of training in patient management and clinical reasoning. Methodology: We have introduced three virtual patients of the CAMPUS system (www.campusvirtualpatients.com). Our tutors were trained by the staff of the Medical Faculty of Heidelberg University. We organized introduction sessions and then divided our students into small groups. Two studies were done using questionnaires, which measured students' satisfaction, learning outcomes, design of virtual patients and the perception of different integration scenarios. Results: In the study, students estimated virtual patients as a good tool for studying and fostering clinical reasoning. Average mark of each part of the programme measured by questionnaire and total mark of the whole programme was almost the same (Kruskal-Wallis=7,892; P=0,096). Students assessed the virtual patients as very stimulating for learning of pediatrics and emphasized that the experience they gained will help them in the continuation of their education. Students estimated the design and integration of virtual patients into the curriculum as fostering learning. Conclusion: We evaluated the use of VPs at two BH faculties. Results indicate that VPs were well integrated and will help our students to improve their clinical reasoning.

17

Implementation of the MedBiquitous standard into the learning system casus

Hege I, Kononowicz A. A., Pfähler M., Adler M., Fischer M R

Bio-Algorithms and Med-Systems

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2009

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Vol. 5, no. 9

51--55

EN

E-Learning applications such as electronic virtual patients (VPs) are an indispensable component of modern medical curricula. The eViP project is a 3-year programme co-funded by the European Union to create a bank of repurposed and enriched multicultural virtual patient cases from across Europe. One of the deliverables of this project is to implement the Med-Biquitous Virtual Patient (MVP) standard within the four included VP systems in order to support the exchange process. The linear learning system Casus® is part of eViP and has implemented an export and import functionality for MVP conformant VPs. The challenges we faced during implementation were the inclusion of assessment items - a crucial part of Casus cases - and the import of branched VPs without loss of information. The experiences and results of exchanging VPs based on the MVP specification will provide valuable information for future projects in this area.

18

Evaluation of curricular integration of virtual patients: development of a student questionnaire and a reviewer checklist within the electronic virtual patient (eVIP) project

Huwendiek S., Haider H. R., Tönshoff B., de Leng B.

Bio-Algorithms and Med-Systems

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2009

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Vol. 5, no. 9

35--44

EN

Introduction: The use of virtual patients in medical education is increasing rapidly. The curricular integration of the e-learning modules is essential for their success. To date, we are not aware of any published standardized instruments to evaluate the curricular integration of virtual patients. Methods: In a literature review, we searched for valuable frameworks for designing a student questionnaire and a teacher checklist concerning the curricular integration of virtual patients. The resulting instruments were reviewed by the electronic Virtual Patient project (eVIP) partners and accordingly refined. The resulting instruments were tested on the target groups and further refined. The resulting student questionnaire was translated into the 6 partner languages, again tested and refined. Results: Student questionnaires in six languages and a reviewer checklist concerning the curricular integration of virtual patients were developed based on a framework informed by the literature. The final student instruments consist of 20 questions, clustered in the following 5 main categories: teaching presence, cognitive presence, social presence, learning effect, and overall judgement. The final reviewer checklist consists of 12 questions characterizing the virtual patient scenario and 24 items around the same 5 main categories. Conclusion: We developed multi-lingual student questionnaires and a teacher checklist, in order to analyze and compare virtual patient curricular integration scenarios around the globe.

19

Enriching virtual patients with interactive images

Huber S., Hess F., Donkers J., Heid J., de Leng B., Huwendiek S., Haag M.

Bio-Algorithms and Med-Systems

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2009

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Vol. 5, no. 9

73--77

EN

Background: At the University of Heidelberg and Maastricht University, virtual patients are primarily used for training clinical reasoning. Adapting virtual patients for undergraduate students has included the realisation of new features for embedding applied knowledge besides the already existing knowledge questions. Methods: The literature related to interactive images was analysed and scenarios of the usage for various interactive image types were evaluated against the background of virtual patients. A template-based and easy-to-use animation editor was implemented to develop interactive images that were made available to undergraduate medical students. Using such interactive images can help students learning basic facts and fundamental concepts more efficiently. Actually, there are different types of interactive images available, e.g. mouse-over or drag-and-drop labelling images. These interactive images are realized in Adobe Flash and can either be used stand-alone or integrated as media files in CAMPUS virtual patients. The latter has the advantage of combining pre-clinical with clinical knowledge and providing students a consistent interface to E-Leaming content during their whole study. In a different scenario, the CAMPUS Animation Editor can be made available to the students to create their own interactive images and deepen their medical knowledge. Results: Currently, selected interactive images are used within virtual patients in an undergraduate course. While working through the virtual patient the students can take part in a survey for focus group analysing. Until now, the students are presented a standardized questionnaire for virtual patients containing only general questions about the strengths and weaknesses of the virtual patients and the used virtual patient system. Individual statements by students indicate the usefulness of interactive images especially for self-study. A questionnaire concentrating on the interactive images is planned for spring 2009. Conclusion: Interactive images are a valid tool for applied knowledge transfer. However, an easy-to-use editor for each interactive image type is required to lower the creation barrier.

20

E-learning with use of virtual patient in pharmacy education

Nesterowicz K., Polak S.

Bio-Algorithms and Med-Systems

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2009

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Vol. 5, no. 10

35--37

EN

E-learning is an approach to facilitate and enhance learning through, and based on both computer and communications technology. At first it is necessary to acknowledge an important growth of blended and collaborative learning applications. Many institutions try to make universal learning modules which promote cooperative methods of work. Other initiatives focus on the idea of building a common e-learning system. One of available distance learning techniques in studying pharmacy is a virtual patient application. The practical example of such educational attitude is presented based on the in-house developed patient case.