Twelve tips to support the development of clinical reasoning skills using virtual patient cases.

Clinical reasoning is a critical core competency in medical education. Strategies to support the development of clinical reasoning skills have focused on methodologies used in traditional settings, including lectures, small groups, activities within Simulation Centers and the clinical arena. However, the evolving role and growing utilization of virtual patients (VPs) in undergraduate medical education; as well as an increased emphasis on blended learning, multi-modal models that include VPs in core curricula; suggest a growing requirement for strategies or guidelines that directly focus on VPs. The authors have developed 12 practical tips that can be used in VP cases to support the development of clinical reasoning. These are based on teaching strategies and principles of instructional design and pedagogy, already used to teach and assess clinical reasoning in other settings. Their application within VPs will support educators who author or use VP cases that promote the development of clinical reasoning.

The Virtual Pathology Instructor: a medical student teaching tool developed using patient simulator software.

Virtual microscopy has been adopted by many medical schools but often without addressing the need for students to understand how to integrate slide observations with other diagnostic information. The goal of this study was to develop an innovative tool for teaching pathology to medical students that presents a variety of virtual materials necessary for a complete pathology evaluation. The Virtual Pathology Instructor (V-PIN) is patient simulation software (vpSim) created and supported by the University of Pittsburgh School of Medicine, Laboratory for Educational Technology, and allows students to assume the role of a diagnostic pathologist. V-PIN utility was demonstrated by educationally significant improvement between pretest and posttest scores for 2 cases (mean, 3.8 versus 4.2; P = .0007; 1.9 versus 3.0; P = .0001). A third case did not perform as well (mean, 2.5 versus 2.3; P = .12) but detailed evaluation of the performance of the case identified possible improvements. Maximum posttest performance was seen following both the traditional workshop and the V-PIN case as compared to the case alone (posttest 4.2 versus 3.0; P < .0001). No significant difference was identified in student progress through V-PIN cases taken before or after the related traditional workshop, as demonstrated by total time on task, number of steps to complete, total score, number of incorrect answers, and number of requests for V-PIN help. Patient simulation software is an effective tool for teaching pathology to medical students and can provide individual instruction and immediate feedback as well as identify opportunities to refine and enhance the educational experience.

How we develop and sustain innovation in medical education technology: Keys to success.

The use of information technology to support the educational mission of academic medical centers is nearly universal; however, the scope and methods employed vary greatly (Souza et al. 2008 ). This article reviews the methods, processes, and specific techniques needed to conceive, develop, implement, and assess technology-based educational programs across healthcare disciplines. We discuss the core concepts, structure, and techniques that enable growth, productivity, and sustainability within an academic setting. Herein are specific keys to success with examples including project selection, theory-based design, the technology development process, implementation, and evaluation that can lead to broad participation and positive learning outcomes. Most importantly, this article shares methods to involve students, faculty, and stakeholders in technology design and the development process that fosters a sustainable culture of educational innovation.

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.

Building a virtual patient commons.

Virtual patients as a form of educational intervention can take many forms and can provide highly effective ways of addressing reduced student access to real patients, the need for standardised and well-structured educational patient encounters, and opportunities for students to practice in safe and responsive environments. However, virtual patients can also be complicated and costly to develop. As a result collaborative and distributed development is best suited to their widespread take up. This paper considers the development and use of virtual patients and the steps that have been taken to support authors in making this approach more sustainable and adaptable. In particular, this has involved the development of a common data interoperability standard, which in turn has engaged a number of communities that have developed, or are developing, virtual patient commons, consisting of shared resources, tools and knowledge for mutual benefit. The paper illustrates how innovative and otherwise difficult to sustain models for supporting and extending healthcare education, such as virtual patients, can be supported using a commons approach with commonly agreed data standards and specifications at their core.

Teaching internal medicine residents to care for reproductive-age and pregnant women: an effective Web-based curriculum.

BACKGROUND: We sought to determine whether a Web-based curriculum could improve internal medicine residents' perceived preparedness and knowledge in the areas of preconception care, infertility evaluation, and management of medical conditions during pregnancy. Training in these areas has been previously identified as inadequate. DESCRIPTION: Three Web-based modules were developed to teach these topics. Seventy residents at one institution were invited to complete the modules and to participate in the curriculum's evaluation over 6 months. EVALUATION: Paper questionnaires assessed preparedness and comfort level among all participants. Web-based surveys that assessed pre/postknowledge and satisfaction among module completers accompanied each module. Ninety-seven percent completed paper questionnaires, and 59% completed 1 or more modules. At the end of the study period, module completers felt significantly more prepared than noncompleters, and improvement in comfort level was strongly associated with the number of modules completed. Knowledge improved significantly with module completion and curricular satisfaction was high. CONCLUSIONS: A Web-based approach to teaching these topics to internal medicine residents increased knowledge and perceived preparedness and was well received.

An XML standard for virtual patients: exchanging case-based simulations in medical education.

Virtual Patients are computer-based simulations of a clinical encounter where the user plays the role of a healthcare provider while receiving in-context instruction. This unique pedagogical approach enables active case-based learning for learners. Academic institutions around the world have developed high-quality virtual patients using many different authoring and playback technologies. However, sustainability and scalability have proved challenging due to the number of cases needed and production costs. In an effort to promote sharing of Virtual Patients and broader adoption into medical education at all levels, MedBiquitous organized an international working group to create an XML-based "MedBiquitous Virtual Patient Standard" (MVP) describing a common structure for virtual patient content and activities. The MVP enables virtual patient exchange across systems, modification, and display within conformant player software.

Development and successful pilot of a web-based scaleable, distributed curriculum development and management system for medical education.

In response to a need for a comprehensive online curriculum development and management system for medical education at the University of Pittsburgh the author, the Lab for Educational Technology (the Lab), students and faculty developed the Pitt Med Navigator website (Navigator). This completely web-based, distributed, personalized application is used by students and faculty to: 1) create, manage, and rapidly access online course resources; 2) author teaching cases, interactive multimedia presentations, and quizzes; and 3) manage a personal education portal. Four pilot courses and objective evaluations have revealed high student and faculty utilization and a high degree of perceived educational value.

A web and handheld based diagnosis & procedure tracking system.

Personal computing devices such as personal organizers, handheld PC's, and tablet PC's are becoming common tools in clinical care and medical education. There is an increasing need for these devices to track various tasks students and medical trainees perform. In particular, in undergraduate medical education, there is a need for tracking the depth and breadth of each student's clinical encounters over the course of his or her education. The authors have developed an application which allows for easy and rapid deployment of a tracking system for medical students' experiences during their clinical training years.