Uta-Maria Waldmann

Virtual patients for assessing medical students–important aspects when considering the introduction of a new assessment format

Background: A case-based online assessment tool has been accomplished at the University of Ulm by simulating consultations with virtual patients in General Practice setting. After a successful pilot study, more data on validity were needed as one important step when considering introducing this assessment format to replace the regular written course exam. Methods: Five distinct sources of validity evidence are addressed: content, response process, internal structure, relationship to other variables and consequences. An examination simulation was conducted including all students (147) of the General Practice course, scores of three virtual patient cases compared with the written course exam and data gathered regarding usability, acceptance, content and structural characteristics, and consequences. Results: All five aspects were supported by collected data. Correlation to the written exam was moderate with r = 0.36, correlation between the cases higher with r = 0.50–0.56. Conclusion: Although a direct comparison of written course exams and dealing with virtual patients is difficult in many aspects and the study setting as an exam simulation caused confounders, this new assessment format is supported by many aspects of validity evidence. Solving virtual clinical scenarios addresses other abilities, skills and knowledge than traditional written exams and since “assessment drives learning” it could have positive implications on teaching and learning alike.

E-learning for education in primary healthcare--turning the hype into reality: a Delphi study.

Objective: E-learning has the potential to provide effective education for general practice, but there are significant difficulties that must be overcome. Design: We initiated a two-round Delphi study, aiming to identify expectations and barriers to e-learning in primary healthcare education. Methods: We distributed questionnaires to 60 primary care experts who are also experts in the field of e-learning. Their responses were independently analysed by two of the authors (J.G., H.C.V.) and were clustered to form 32 themes. These were fed back to the participants in a second postal questionnaire with the objective of reaching agreement or disagreement, with a cut-off of 80%. Results: The response rate was 67% (n=40) in the first and 60% (n=36) in the second round. The extent of agreement reached ranged from 8% (“e-learning is displacing practical teaching and learning”) to 97% (“e-learning needs convincing didactical concepts”). Agreement was high with the themes “e-learning gets a new focus by mixed learning concepts” and “users will have a higher level of media competence 5 years from now” (94% each). There was a positive attitude to e-learning, but there was concern about the lack of orientation towards users’ needs and the poor development of innovative didactical concepts. In implementing e-learning in primary care, education should be independent of financial influence from the healthcare industry in order to eliminate conflicts of interest. Conclusion: The experts’ responses show that e-learning in primary healthcare education can contribute substantially to undergraduate, graduate, and continuing medical education, and should therefore be evaluated in systematic studies.