eDrugCalc: an online self-assessment package to enhance medical students' drug dose calculation skills.

AIMS: Dose calculation errors can cause serious life-threatening clinical incidents. We designed eDrugCalc as an online self-assessment tool to develop and evaluate calculation skills among medical students. METHODS: We undertook a prospective uncontrolled study involving 1727 medical students in years 1-5 at the University of Edinburgh. Students had continuous access to eDrugCalc and were encouraged to practise. Voluntary self-assessment was undertaken by answering the 20 questions on six occasions over 30 months. Questions remained fixed but numerical variables changed so each visit required a fresh calculation. Feedback was provided following each answer. RESULTS: Final-year students had a significantly higher mean score in test 6 compared with test 1 [16.6, 95% confidence interval (CI) 16.2, 17.0 vs. 12.6, 95% CI 11.9, 13.4; n= 173, P < 0.0001 Wilcoxon matched pairs test] and made a median of three vs. seven errors. Performance was highly variable in all tests with 2.7% of final-year students scoring < 10/20 in test 6. Graduating students in 2009 (30 months' exposure) achieved significantly better scores than those in 2007 (only 6 months): mean 16.5, 95% CI 16.0, 17.0, n= 184 vs. 15.1, 95% CI 14.5, 15.6, n= 187; P < 0.0001, Mann-Whitney test. Calculations based on percentage concentrations and infusion rates were poorly performed. Feedback showed that eDrugCalc increased confidence in calculating doses and was highly rated as a learning tool. CONCLUSIONS: Medical student performance of dose calculations improved significantly after repeated exposure to an online formative dose-calculation package and encouragement to develop their numeracy. Further research is required to establish whether eDrugCalc reduces calculation errors made in clinical practice.

Online virtual patients - A driver for change in medical and healthcare professional education in developing countries?

The development of online virtual patients has proved to be an effective vehicle for pedagogical and technological skills transfer and capacity building for medical and healthcare educators in Malawi. A project between the University of Edinburgh and the University of Malawi has delivered more than 20 collaboratively developed, virtual patients, contextualised for in-country medical and healthcare education and, more significantly, a cadre of healthcare professionals skilled in developing digital resources and integrating these into their emerging curricula. The process of engaging with new approaches to teaching and delivering personalised, context sensitive content via a game-informed, technology-supported process has contributed to the ability of healthcare educators in Malawi to drive pedagogical change, meet the substantial challenges of delivering new curricula, cope with increasing student numbers and promote teacher professional development. This initial phase of the project has laid the foundation for a broader second phase that focuses on promoting curriculum change, developing educational infrastructure and in-country capacity to create, and integrate digital resources into education and training across multi-professional groups and across educational levels.

Leveraging game-informed healthcare education.

The perceived potential of computer games to afford healthcare teachers new, innovative approaches to designing compelling experiential learning activities continue to grow apace. This paper considers the current 'state of play' with regards to the introduction of game-based learning activities into healthcare education. Game-based learning invites opportunities for richly immersive learning activities, but is expensive to implement, and time consuming to develop. There are also significant risks inherent in attempting to embed learning activities within recognizable game frameworks and genres. This work, therefore, attempts to establish a clear differentiation between game-based and game-informed learning. Where game-based learning attempts to situate learners as players and provide learning activities within a recognisable game delivery model, game-informed learning suggests that it is possible to make teaching practices more game-like by applying the principals of game play without necessarily having to be committed to developing a game to produce the same compelling, immersive learning experiences.

What medical educators need to know about "Web 2.0".

"Web 2.0" describes a collection of web-based technologies which share a user-focused approach to design and functionality, where users actively participate in content creation and editing through open collaboration between members of communities of practice. The current generation of students in medical school made Web 2.0 websites such as Facebook and MySpace some of the most popular on the Internet. Medical educators and designers of educational software applications can benefit from understanding and applying Web 2.0 concepts to the curriculum and related websites. Health science schools have begun experimenting with wikis, blogs and other Web 2.0 applications and have identified both advantages and potential problems with these relatively open, student-focused communication tools. This paper reviews the unique features of Web 2.0 technologies, addresses questions regarding potential pitfalls and suggests valuable applications in health science education.

Virtual patients: practical advice for clinical authors using Labyrinth.

BACKGROUND: Labyrinth is a tool originally developed in the University of Edinburgh's Learning Technology Section for authoring and delivering branching case scenarios. The scenarios can incorporate game-informed elements such as scoring, randomising, avatars and counters. Labyrinth has grown more popular internationally since a version of the build was made available on the open source network Source Forge. This paper offers help and advice for clinical educators interested in creating cases. CONTEXT: Labyrinth is increasingly recognised as a tool offering great potential for delivering cases that promote rich, situated learning opportunities for learners. There are, however, significant challenges to generating such cases, not least of which is the challenge for potential authors in approaching the process of constructing narrative-rich, context-sensitive cases in an unfamiliar authoring environment. This paper offers a brief overview of the principles informing Labyrinth cases (game-informed learning), and offers some practical advice to better prepare educators with little or no prior experience. INNOVATION AND IMPLICATIONS: Labyrinth has continued to grow and develop, from its roots as a research and development environment to one that is optimised for use by non-technical clinical educators. The process becomes increasingly iterative and better informed as the teaching community push the software further. The positive implications of providing practical advice and concept insight to new case authors is that it ideally leads to a broader base of users who will inform future iterations of the software.

Can medical students from two cultures learn effectively from a shared web-based learning environment?

OBJECTIVE: This study aimed to establish whether medical students from 2 different cultures can learn effectively from a shared web-based learning environment. METHODS: Students from the College of Medicine, Edinburgh, UK and the Medical School, Gifu, Japan shared 2 weeks of teaching and learning in clinical genetics, using problem-based learning in a web-based application (WBA). Questions about language, time zone, agreement about the curriculum (learning outcomes, tutor activity and assessment) and specific pedagogical issues about the educational effectiveness of students' learning were considered. RESULTS AND CONCLUSIONS: The evidence indicates that a shared WBA is practical where the learning outcomes and problem scenarios are common and students are fluent in the same language. Problem-based learning transfers itself best to online discussion boards when the numbers in the group are 16 or more. Students do not use the WBA as a primary source of resource material, and they augment the discussion boards with face-to-face meetings with peers and tutors.

Soluble LDL-R are formed by cell surface cleavage in response to phorbol esters.

A 140-kDa soluble form of the low density lipoprotein (LDL) receptor has been isolated from the culture medium of HepG2 cells and a number of other cell types. It is produced from the 160-kDa mature LDL receptor by a proteolytic cleavage, which is stimulated in the presence of 4beta-phorbol 12-myristate 13-acetate (PMA), leading to the release of a soluble fragment that constitutes the bulk of the extracellular domain of the LDL receptor. By labeling HepG2 cells with [35S]methionine and chasing in the presence of PMA, we demonstrated that up to 20% of LDL-receptors were released into the medium in a 2-h period. Simultaneously, the level of labeled cellular receptors was reduced by 30% in those cells treated with PMA compared to untreated cells, as was the total number of cell surface LDL-receptors assayed by the binding of 125I-labeled antibody to whole cells. To determine if endocytosis was required for cleavage, internalization-defective LDL-receptors were created by mutagenesis or deletion of the NPXY internalization signal, transfected into Chinese hamster ovary cells, and assayed for cleavage in the presence and absence of PMA. Cleavage was significantly greater in the case of the mutant receptors than for wild-type receptors, both in the absence and presence of PMA. Similar results were seen in human skin fibroblasts homozygous for each of the internalization-defective LDL receptor phenotypes. LDL receptor cleavage was inhibited by the hydoxamate-based inhibitor TAPI, indicating the resemblance of the LDL receptor cleavage mechanism to that of other surface released membrane proteins.