1. The Trial: The replacement of ‘paper’ cases by interactive online Virtual Patients (VP) in Problem-Based Learning (PBL) Terry Poulton, Trupti Bakrania, Sheetal Kavia, Jonathan Round, Emily Conradi & Sean Hilton The e-Learning Unit 1

2. Problem-Based Learning …a type of Virtual Patient
The conventional Well this i skin of virtual patient
The case you use in tutorials for problem based learning
They are scenarios,
They take you through the virtual environment of a case
There s only one strange thing about it
You are supposed to be supporting the idea of clinical reasoning , ability to diagnose, investigate, to manage, to understand the clinical situation
Its called clinical reasoning
But the paradox
tradition format, the paper case
Has only one way through the case! And we have come to accept this one right answer. There’s the paradox.
Up until now learning has given a tool to supplement other tools. Some like it, most accept it. But the virtual patient suddenly produced something that nothing else could do , it could train clinical reasoning, because it gave choice!
Flight simulators
The next case
…a type of Virtual Patient 2

3. What we wanted from A Virtual Patient… Scenario..
Ability to take decisions
Explore the consequences of those decisions …
Immediate feedback to the student…
We want the type of virtual patient virtual that’s online and has choices and consequences. …two provides feedback to the students and adds value to taking PBL online. 3

4. Linear PBL
And here we are this is one day tutorial stretched out showing all the pages and this is a real tutorial under what we’ve done Is taken this program that makes all these boxes and put the header of each of the pages in their an includee in their remote the text of each page
If this was a conventional tutorial we would just print off each of those pages to go to the student but it’s not conventional 4

5. Branched PBL
This is actually one of the new tutorials. And this is the normal of brown and tutorial and hear what you see is what we added a series of options ,,Here here and here are these provide that are listed as routes to the case celeron so there are ideal pathways and the brown pathways was represents the ideal of one of the roles are wrong, pathways which one should not go down, and some one of those are in that grayer of being at gray area being 5

7. Problem-based Learning

10. VP/PBL TRIAL
Year 1 students mini-trial (1 case)
Year 2 students whole module trial
Groups
Type of VP
Case 1
Case 2
Case 3
Case 4
Case 5
1-5
Linear
Branched
6-10

11. 1st yr Students (first term):
Which method of PBL would you prefer to undertake in the future:
1st yr Students (first term):
Paper 22%
Online with decisions (branched) 74%
Online without decisions (linear) 4%
2nd yr Students (last term):
Paper 42%
Online with decisions 56%
Online without decisions 2%
2nd yr Tutors (last term):
Paper 25%
Online with decisions 63%
Online without decisions 12%

12. Students Tutors I learnt more from having choices to make 4.0
I found the online decision cases more engaging 3.9
I found the non-linear cases frustrating 1.8
1 = strongly disagree, 5 = strongly agree
Tutors
Students found the decision cases more interesting 4.2
It is easier to tutor paper-based cases 3.0
Online PBL makes it harder to meet the LOBs 2.5
Students spent more discussion time on the option steps 4.3
“Students slowed down to discuss options ,
instead of rushing through the early parts of the case “

13. Comments about ‘Decision-Making’
Non-linear cases were definitely more stimulating.
More than once we deliberately went down the 'wrong' track to see what happened. Very useful to do this on a paper patient …
The biggest benefit I believe is the decision making.
Its not the decisions, it’s the consequences!
Comments About ‘Paper’
I was dreading this as I am used to scribbling all over the notes as we talk…Actually I found this OK.
Not having a paper copy of the tutorial makes everyone in the group look at the screen rather than at each other..
I think probably as a year we are just used to the paper version!

14. Summary
The use of VPs in PBL was supported by students and tutors who believed the options created a more engaging session, and that students learned more
They disliked the absence of a paper handout.
They saw no value ‘in simply putting cases online!’ (the linear cases)
A re-run of the trial would relate linear/branching to exam performance

15. Outcome-
A new programme
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

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