1. Implementing an Online Interactive Curriculum using Virtual Patients
Trupti Jivram, Terry Poulton
St George’s University of London

2. Problem-Based Learning
Conventional style of PBL
Sheets of paper handed out
There is only one way forward in the case – the correct way (the next steps will continue the scenario)
…and its limitations 2 2 2

3. Linear PBL
This shows one paper tutorial – each node represents one page of the paper case. One after the other. 3 3 3

4. Branched PBL
This shows how a PBL case branches out, providing options at different points in the case and then bought back into the correct path.
Yellow nodes show the idea pathway – yellow brick road 4 4 4

5. To change the existing PBL curriculum, to create a more interactive, personalised model of course delivery with virtual patients at its core
To be delivered in the Transitional year between campus-based learning and clinical attachments, as Clinical PBL
Based on18 adaptive and enriched interactive cases, with 36 formative assessments, integrated with social software/wikis for notes/reflections
Funded project – JISC (joint information systems committee)
Explain transition year
Aim of project 5

6. Why G(eneration) 4? G1 – Subject- or discipline-based
G2 - System-based
G3 - Case based, but linear
G4 – Interactive with options, consequences
Explain the generations 6 6 6

7. Case creation
Existing paper cases rewritten to fit the VP model by subject Matter Experts (SMEs)
Cases are authored using Decision Simulation (DSim developed by the University of Pittsburgh)
Cases reviewed by PBL VP experts
Resources added
Tutor notes created
Student notes created
Found that not all the original cases were suitable for the level they were aimed for. Some needed rewirtting
Some also needed rewritting to fit the vp model
This is done by subject matter experts – funded by the project to work on the cases some were part of the module teams
Once the case is ready it is reviewed by experienced VP writers, PBL tutors – suggestions of modifications , changes are made
Resources are added to the cases – these include xrays, images
The final stage is where the tutor notes are created – the SME checks the tutor notes
There are the text of the correct path given out at the end of each tutorial – back up notes are created as well in case the online versions do not work
Explain what tools were used 7

8. Case delivery Student access cases via Moodle Cases delivered in DSim
Groups discuss the options and consequences as they progress through the case
Outcome is dependant of the option chosen
Students can use the wiki ‘notepad’ to share resources during and after the session
How do student access the cases?
Students still in their PBL groups – sat around the table with a tutor
Moodle/ Dsim 8

9. Problem-based Learning
VPs being delivered online in a PBL session
Explain how PBL is still the same - snacks, tutor, discussion around the table 9

10. Example of a case 10

11. 11

12. Wiki – ‘Notepad’
Links to websites
Learning objectives 12

13. Assessment cases Optional formative VPs
Related to the topic of the week, delivered at the end of each week
Different styles
MCQ
Branching
Testing day with students
Each case has a mixture of both styles 13

14. Evaluation Pre and post questionnaires with students
Focus groups with case writers, tutors and students
Interviews

15. Students
Questionnaires (using 5-point Likert-scale statements) were distributed to approximately 200 students
Obtain indicators of their experience and perceptions before and after use of the virtual patient cases.
Pre and post test questionnaires
Of course memory retention tests would need to be done over a period of time and we hope to incorporate VPS as a formal part of student assessment

16. Quotes from Students
“...took the wrong path, and they end up in a disaster ...,”
“…but in a branched one, they have the choices to take it back and learn something new. I think that’s good.”
“…it is quite memorable, whereas in the paper case, you don’t have that. So, they just go to learn something in a very tedious way”
“It’s getting you to think more, because you’re making choices”...

17. Staff perspectives
“The feedback from the students seems to be incredibly positive”
“…it really does seem to take the PBL to another level that really mimics what they’re seeing when they go out into the clinical world.”
“So it really is a big educational step, and the students have said that they found that they’re on the wards, and then they go and do PBL, and the two are cementing each other”

18. Impact of change
“At this early stage the impact would seem to be completely positive, the cases were produced and delivered on time and were well received by students as shown above.”
“Students report that alternating placements with the G4 PBL helped them to draw information between placements. Enthusiasm extended throughout the year.”

19. Virtual worlds First tutorial was delivered in Second Life
Contained a GP surgery and a renal unit with objects that student can use to assess the patient
Renal case 19

20. GP Surgery 20

22. Please rank the following forms of PBL
Paper
Online
Virtual world

24. Key messages and recommendations
G4 demonstrated that branched virtual patients enhance the quality of the student learning experience in Problem-based Learning.
Virtual Patients change the dynamics of facilitation
Case Authors require specialised preparation / training and support
Second Life was not considered a suitable environment for PBL VPs at present

25. Curriculum Transformation Workshop 5-6 December 2011 at St George’s, University of London