Martin Haag

Design principles for virtual patients: a focus group study among students

Objectives  This study aimed to examine what students perceive as the ideal features of virtual patient (VP) design in order to foster learning with a special focus on clinical reasoning.

Can design principles of traditional learning theories be fulfilled by computer-based training systems in medicine: The example of CAMPUS

PURPOSE Computer-based training (CBT) systems offer the potential to efficiently support modern teaching and learning. However, it is still unknown if a similar efficient learning experience built on sound learning theories and corresponding design principles can be created in the complex health care environment. The purpose of this paper is to analyse to what extent learning theories and corresponding design principles are relevant and can successfully be applied in computer-based training in medicine. METHODS We use the case-based CBT system CAMPUS as an example for a CBT system currently used to enhance the medical teaching and learning experience. We apply two well-accepted learning theories (Blooms taxonomy and practice fields) and related design principles to determine to what extent they are relevant and fulfilled in the context of CAMPUS. RESULTS We demonstrate that in principle these learning theories and design principles can be implemented using computer-based training. However, not all design principles can be fulfilled by the system alone; rather the integration of the system into adequate -- traditional or virtual -- teaching and learning environments is essential. CONCLUSIONS Traditional learning theories and design principles are a valuable means in designing adequate CBT systems in medicine. They can be successfully implemented in CBT systems for medical education if the system itself is adequately integrated into teaching and learning environments.

Learner preferences regarding integrating, sequencing and aligning virtual patients with other activities in the undergraduate medical curriculum: A focus group study

Context: E-learning resources, such as virtual patients (VPs), can be more effective when they are integrated in the curriculum. To gain insights that can inform guidelines for the curricular integration of VPs, we explored students’ perceptions of scenarios with integrated and non-integrated VPs aimed at promoting clinical reasoning skills. Methods: During their paediatric clerkship, 116 fifth-year medical students were given at least ten VPs embedded in eight integrated scenarios and as non-integrated add-ons. The scenarios differed in the sequencing and alignment of VPs and related educational activities, tutor involvement, number of VPs, relevance to assessment and involvement of real patients. We sought students’ perceptions on the VP scenarios in focus group interviews with eight groups of 4–7 randomly selected students (n = 39). The interviews were recorded, transcribed and analysed qualitatively. Results: The analysis resulted in six themes reflecting students’ perceptions of important features for effective curricular integration of VPs: (i) continuous and stable online access, (ii) increasing complexity, adapted to students’ knowledge, (iii) VP-related workload offset by elimination of other activities, (iv) optimal sequencing (e.g.: lecture – 1 to 2 VP(s) – tutor-led small group discussion – real patient) and (V) optimal alignment of VPs and educational activities, (vi) inclusion of VP topics in assessment. Conclusions: The themes appear to offer starting points for the development of a framework to guide the curricular integration of VPs. Their impact needs to be confirmed by studies using quantitative controlled designs.

Electronic assessment of clinical reasoning in clerkships: A mixed-methods comparison of long-menu key-feature problems with context-rich single best answer questions

Abstract Background: It remains unclear which item format would best suit the assessment of clinical reasoning: context-rich single best answer questions (crSBAs) or key-feature problems (KFPs). This study compared KFPs and crSBAs with respect to students’ acceptance, their educational impact, and psychometric characteristics when used in a summative end-of-clinical-clerkship pediatric exam. Methods: Fifth-year medical students (n = 377) took a computer-based exam that included 6–9 KFPs and 9–20 crSBAs which assessed their clinical reasoning skills, in addition to an objective structured clinical exam (OSCE) that assessed their clinical skills. Each KFP consisted of a case vignette and three key features using a “long-menu” question format. We explored students’ perceptions of the KFPs and crSBAs in eight focus groups and analyzed statistical data of 11 exams. Results: Compared to crSBAs, KFPs were perceived as more realistic and difficult, providing a greater stimulus for the intense study of clinical reasoning, and were generally well accepted. The statistical analysis revealed no difference in difficulty, but KFPs resulted more reliable and efficient than crSBAs. The correlation between the two formats was high, while KFPs correlated more closely with the OSCE score. Conclusions: KFPs with long-menu exams seem to bring about a positive educational effect without psychometric drawbacks.

The Virtual Patient for Education and Training: A Critical Review of the Literature

Abstract Nowadays, virtual patients are becoming increasingly essential for high-quality medical education since there are not enough actual patients available for educational and training purposes. However, development and curricular integration of virtual patients is challenging and time consuming. This review gives an overview on relevant aspects of development and usage of virtual patients and shows the current state of development. The included information is sourced from relevant literature of the last 15 years and the longstanding experience of the authors in the relevant fields. Zusammenfassung Virtuelle Patienten werden in der modernen Medizinerausbildung immer wichtiger, weil nicht in ausreichendem Umfang “echte” Patienten für die Ausbildung zur Verfügung stehen. Die Entwicklung und curriculare Integration von virtuellen Patienten ist allerdings sehr anspruchsvoll und zeitaufwändig. Dieser Artikel gibt einen Überblick über relevante Aspekte der Entwicklung sowie der Nutzung von virtuellen Patienten und stellt den aktuellen Entwicklungsstand, unter Berücksichtigung der relevanten Literatur der letzten 15 Jahre und der langjährigen Erfahrung der Autoren dar.

User-Centred Design and Usability Evaluation of a Heart Rate Variability Biofeedback Game

Reduced heart rate variability (HRV) is an indicator of a malfunctioning autonomic nervous system. Resonant frequency breathing is a potential non-invasive means of intervention for improving the balance of the autonomic nervous system and increasing HRV. However, such breathing exercises are regarded as boring and monotonous tasks. The use of gaming elements (gamification) or a full gaming experience is a well-recognised method for achieving higher motivation and engagement in various tasks. However, there is limited documented knowledge on how to design a game for breathing exercises. In particular, the influence of additional interactive elements on the main course of training has not yet been explored. In this paper, we evaluated the satisfaction levels achieved using different game elements and how disruptive they were to the main task, i.e., paced breathing training. An Android flight game was developed with three game modes that differ in the degrees of multitasking they require. Design, development, and evaluation were conducted using a user-centred approach, including context analysis, the design of game principle mock-ups, the selection of game principles through a survey, the design of the game mechanics and GUI mock-up, and icon testing, and the performance of a summative study through user questionnaires and interviews. A summative evaluation of the developed game was performed with 11 healthy participants (ages 40-67) in a controlled setting. The results confirm the potential of video games for motivating players to engage in HRV biofeedback training. The highest training performance on the first try was achieved through pure visualisation rather than in a multitasking mode. Players had higher motivation to play the more challenging game and were more interested in long-term engagement. A framework for gamified HRV biofeedback research is presented. It has been shown that multitasking has considerable influence on HRV biofeedback and should be used with an adaptive challenge level.

Computer-Supported Teaching and Learning Systems in Medicine

In 1999, the scenario University in the Year 2005 predicted that by 2005 half of all students would be studying at virtual universities, while there would be only a small core of traditional universities left. Obviously, this prediction did not come true, and the scenario is far from being realized, even today (Sects. 64.1–64.3). However, there is a visible trend towards using computer-supported teaching and learning systems in medical studies at traditional universities within blended learning (BL) concepts (Sect. 64.5). A meta-analysis by Cook et al. showed that studying supported by internet-based learning is at least equal to traditional forms of teaching [64.1]. In German-speaking countries, the term computer-based training (CBT) is frequently used for computer-supported training, but there are a plethora of other English-derived terms that are also in use, such as computer-assisted instruction (CAI), computer-assisted learning (CAL) and computer-based instruction (CBI). The term web-based training (WBT) [64.2] is used if the applications are based on web technology and accessed via the web. The term e-Learning [64.3] (electronic-learning) is somewhat broader, and — aside from CBT and WBT — also includes other forms of digital learning such as computer-supported cooperative/collaborative learning (CSCL) (Sects. 64.5 and 64.6). Against the backdrop of the historical development and moves toward reforming the medical curriculum, an overview over the relevant aspects of CBT/WBT systems in medical studies are presented in this chapter; in particular, questions regarding the integration of the curriculum and the sustainability of reforms.