Centre for Virtual Patients
Evaluation of curricular integration of virtual patients:
Development of a student questionnaire and a reviewer checklist within the
electronic virtual patient (eVIP) project
Sören Huwendiek, Helen Rani Haider, Burkhard Tönshoff, Bas de Leng
ICVP’09 conference
Krakow, Poland
Centre for Virtual Patients
Introduction
The curricular integration of virtual patients is essential for their success
To date there are no standardized instruments available to evaluate the
curricular integration of virtual patients
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Aim of the Project
Development of a student questionnaire and reviewer checklist
to evaluate the curricular integration of virtual patients with the primary aim of
fostering clinical reasoning
which is employable in different kinds of didactic scenarios using virtual patients
 offers the opportunity to compare different integration modes and
elucidate strategies of effective curricular integration
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Literature review
• Systematic literature review: Medline, ERIC, Google Scholar
• Search terms included: Blended Learning, Flexible Learning, Constructive
Alignment, Curricular Integration, E-Learning and Virtual Patients
 no standardized instrument to evaluate the curricular integration of virtual
patients could be found
 theoretical frameworks supporting the development and design of the
questionnaire
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Literature informing the theoretical framework of the questionnaire (1)
The Community of Inquiry Model by Garrison et al. as a general framework
for the questionnaire:
 learning occurs through the interaction of 3 core components:
- cognitive presence
- social presence
- teaching presence
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Literature informing the theoretical framework of the questionnaire (2)
• Octagonal Framework of Blended Learning by Badrul Khan (2000)
• Criteria categorizing didactic scenarios by Heyer (2006)
• Principles of curricular integration of virtual patients, a focus group study
among students at the University of Heidelberg (2009)
• Literature concerning educational strategies to promote clinical diagnostic
reasoning (Bowen 2006)
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The questionnaire (1)
• 20 questions, clustered in 5 main categories:
(A) Teaching presence
(B) Cognitive presence
(C) Social presence
(D) Learning effect
(E) Overall judgement
• Additionally:
(F) 3 Open ended questions
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The questionnaire (2)
5-Point-Likert-Scale:
(1) strongly disagree
(2) disagree
(3) neutral
(4) agree
(5) strongly agree
(6) not applicable
After each question free text field: briefly reasons for answer (optional)
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“Corresponding teaching event”
• to describe teaching and learning activities which go along with virtual patients
• definition of “corresponding teaching event” according to educational scenario
(e.g. virtual patients used during problem-based learning, small-group-discussions after working with virtual
patients)
 In this manner questionnaire employable for different kinds of
educational scenarios using virtual patients
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The reviewer checklist
• to characterize the curricular integration scenario of virtual patients in detail by teacher
• 12 items describing the educational scenario in detail
• 24 items clustered in the same 5 subsets used in the student questionnaire
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Process of refinement by eVIP experts
• first draft reviewed by eVIP-partners, refined, tested on target group and again
refined
• final review through eVIP-partners
• Translation in local partners language and tested with students, refined and
retranslated into English
• Final student instrument, translated in 6 languages , available on eVIP-website
• Final reviewer checklist in English, available on eVIP-website
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Study among 5th year medical students
Educational scenarios:
- VPs integrated into the Paediatrics Course at Heidelberg
Medical School using small group discussion after VP-Work
- VPs as preparation for skills lab training (Paediatrics)
Results:
the questionnaire and checklist proved to be very helpful in identifying strong areas and
areas with need of improvement concerning the curricular integration of VPs
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Conclusion
A multi-lingual student questionnaire and checklist to analyse and compare virtual
patient curricular integration scenarios is now available
First studies evaluating virtual patient integration scenarios at the University of
Heidelberg proved the instruments to be helpful to optimize the educational
scenarios
 We hope the instruments will be widely implemented around the globe
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Bibliography
Rourke, L., Anderson, T., Garrison, D.R., Archer, W.: Assessing Social Presence In
Asynchronous Text-based Computer Conferencing, Journal of Distance Education, ISSN: 08300445, 2001.
•Rourke, L., Anderson, T., Garrison, D.R., Archer, W.: Assessing Social Presence In Asynchronous 2003.
• Khan, B.H.: A Framework for Open, Flexible and Distributed Learning, Proceedings of the Technological
Education and National Development Conference, “Crossroads of the New Millenium” (2nd , April 8-10,
2000, Abu Dhabi, United Arab Emirates)
• Heyer, S. : Didaktische Szenarien und deren Verhältnis zu Lernmaterialien, Forschungsberichte des
Fachbereichs Elektrotechnik & Informationstechnik, ISSN 0945 0130, Fernuniversität Hagen, 2006
(www.fernunihagen.de/etit/fachbereich/forschung/index.html)
• Huwendiek, S. et al.: Curricular integration principles of virtual patients: a focus group study among
students, 2008. Manuscript in preparation.
• Bowen, J.L.: Educational Strategies to Promote Clinical Diagnostic Reasoning, N Engl J Med, 355: 221725, 2006.
• Ark, T. K., Brooks, L. R., Eva, K. W.: The benefits of flexibility: the pedagogical value of instruction to
adopt multifaceted diagnostic reasoning strategies, Medical Education, 41:3, 281-287, 2007.
• Gruppen, L.D., Frohna, A.Z.: Clinical Reasoning. In: Norman, Geoffrey R. International handbook of
research in medical education. Kluwer Academic Publishers, Dordrecht 2002.
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Thank you for your attention!
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Study among 5th year medical students
Work with VPs
Centre for Virtual Patients
Study among 5th year medical students
Work with VPs
Tutor moderated small
group discussion
Centre for Virtual Patients
Introduction
Campus-Lernprogramm,
Zentrum für virtuelle Patienten (ZVP),
Heidelberg
(for further information see: www.medicase.de)
eVIP Electronic Virtual Patients,
Co-funded by the European Union
(for further information see:
www.virtualpatients.eu)
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