1. KE9 Curriculum Integration Design: Virtual Patient Year 2 Learning in context Dr Nicola Englyst, Dr Kirsten Poore, Dr Claire Smith 24 th March 2011

2. 2 Project overview: Year 2: 'Preclinical' Medical Education Spiralling Curriculum Semester 3 Gastrointestinal Nervous and Locomotor 2 Semester 4 Respiratory, Cardiovascular and Renal 2 Endocrinology and the Life Cycle

3. 3 Our challenges when teaching medicine…

4. 4 How do we make learning facts interesting?!! Lecture Practical LecturePractical Symposium Feedback –Basic sciences + basic clinical information –Lectures, tutorials, practicals and symposia 1 case per week throughout semester

5. 5 Different learning styles and preferences. “Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand" –Confucius Kolb: Experiential Learning Cycle Our students are all individuals! feeling watching doing thinking tactile visual auditory

6. 6 Feedback Students want more feedback! Can we provide instant individualised feedback for 250 students?

7. 7 Continuity in teaching and learning Our educators come from a variety of backgrounds. Can we find a way to provide continuity of teaching?

8. 8 KE9 Curriculum Integration Design Our challenge: To present basic scientific facts necessary to build a medical career on, in a way that is relevant, interesting and educational.  Integration of eLearning, either materials or technology, need to be designed as part of the curriculum, just like other curriculum activities. 8

9. 9 The aim of this project: To develop a series of interactive Virtual Patients to reinforce the links between science and students' future medical careers.

10. 10 VP Year 2: Curriculum Integration Design needs and requirements of the various stakeholder groups were initially assessed: –liaison with curriculum management groups and students –consulting the GMC guidelines published in Tomorrow’s Doctors –review of available literature concerning interactive multimedia, learning theories, Human Computer Interaction (HCI) and medical education 10

11. 11 VP Year 2: Curriculum Integration Design 11 Virtual Patients must be integrated into existing teaching –redevelopment of Endocrinology and Life Cycle Course (2008) specifically included incorporation of Virtual Patients Virtual Patients must be aligned with Learning Outcomes

12. 12 VP Year 2: Curriculum Integration Design 12

13. 13 Lecture Practical LecturePractical Symposium Feedback Direct access VP Year 2: Curriculum Integration Design 08:00 Virtual Patient

14. 14 Year 2: Six Virtual Patients developed In Semester 3, Gastrointestinal Course: –Mr Andrew King with reflux disease –Mikey Botley with infectious diarrhoea –Mikey Botley with Hemolytic-Uremic Syndrome (HUS) https://www.som.soton.ac.uk/learn/bm/bmgastro/patient/ In Semester 4, Endocrinology and the Life Cycle Course: –Mr and Mrs Andrews with infertility problems –Rachel Denver with type 1 diabetes –Mrs Jane Rice with type 2 diabetes https://www.som.soton.ac.uk/learn/bm/bmendocrinologylifecycle/patient/ 14

15. 15 Year 2: Virtual Patient content Clinical scenario laid out: 3D animations or videos interactive tasks basic science-related quizzes embedded learning materials –links to lectures –patient information sheets –external websites Helps students to: test basic science understanding in a clinical context develop clinical skills by taking the role of a doctor interacting with a patient think from a patient’s perspective 15

16. 16 Year 2: expected level integrative learning: anatomy, histology, physiology, pharmacology more diagnostic more discussion of treatment options  gateway into clinical Years 3 onwards 16

17. VP Year 2: Examples 17

18. 18 The scene is set: eg. video of an initial consultation

19. 19 links to other relevant teaching and learning resources Interactive quizzes based on information presented

20. 20 student's completed work student inputs, answers to questions and summary medical notes are stored –enables students to resume a Virtual Patient at a later date

21. recorded data are used to analyse students’ performance –offers individualised feedback for poorly understood topics

22. 22 Year 2: Teacher access teaching staff can also monitor Virtual Patient usage and students’ performance for each learning outcome associated to the case 22

23. 23 Year 2: Evaluation Student evaluation ratings at end of Semester: Overall Virtual Patient ratings for Year 2 were 3.6 (2010) and 3.9 (2009) out of 5 User tracking data: usage numbers 23 Academic year ELC Infertility ELC Diabetes 1 ELC Diabetes 2 GI Reflux GI Diarrhoea GI HUS 2008N/A 116N/A 20092001532161099022 2010178262230814424

24. VP Year 2: Evaluation Focus groups: Students rated Virtual Patients highly, particularly liking the formative feedback they provided Informal discussions: Semester coordinators reported that students who failed the semester were also frequently failing to use the Virtual Patients –engaged student understand that full use of course material enables an ability to understand the subject especially since the Virtual Patients are linked to assessments! 24

25. 25 VP Year 2: Evaluation Online questionnaires: Pre-questionnaires (80 completed): >50% cited importance of clinically relevant and realistic case scenarios, 23% wanted VPs to be constructive and integrated Post-questionnaires (35 completed): generally very positive. Eg. meeting expectations was rated above 4 (5 = very much); features most liked were clinically relevant and realistic clinical scenarios, and instant and individualised feedback –most wanted more Virtual Patients in their curriculum! –would use the Virtual Patients for assessment revision –recommend them to their fellow students 25

26. 26 Spread the word! (to students and teaching staff) Incorporate the VPs into your timetable Course coordinators provide a demonstration to students –Where to find the VPs –How to use the VPs –Benefits of using VPs –Outlining link with learning outcomes and assessments KE9 Curriculum Integration Design: our handy tips for getting your VP noticed!

27. 27 KE9 Curriculum Integration Design: our handy tips for getting your VP noticed! Key staff were reminded about VPs Case history 3 years on: Rachel is now 25 years old Diagnosed with type 1 diabetes 3 years ago Relatively well controlled Studying for her finals Hormones in diabetic ketoacidosis Increased catabolic hormones Glucagon Catecholamines Cortisol Growth hormone Absolute or relative insulin deficiency What are the physiological changes causing Rachel’s initial symptoms? Thirst –Excess peeing- reduce glucose and KBs –Vomiting & dehydration Nausea & vomiting –Toxic ketoacid elimination, hyperglycemia Breathlessness –Kussmaul’s respiration- deep breaths to decrease CO 2 to raise pH

28. 28 VP Year 2: Future work For the remaining weeks of each course, ‘Paper-based Virtual Patients' enable weekly case-based learning to continue throughout Year 2 28

29. 29 discussed in Friday feedback sessions as for online Virtual Patients will form framework for future Virtual Patients will require further funding

30. 30 VP Year 2: Conclusion a successful model of curriculum integration ongoing refinement to ensure students make full use of Virtual Patients' potential 30

31. 31 VP Year 2: Acknowledgements Project leader: Dr Sunhea Choi Content authors: Dr Myron Christodoulides, Dr Claire Smith, Dr Nicola Englyst, Dr Ying Cheong, Dr Kirsten Poore Learning designer: Dr Sunhea Choi eLearning Developer: Matt Hammerton Multimedia Developer: Mimi Lee Funding: Faculty of Medicine with match funding from NHS Education South Central. 31