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      Effects of introducing a voluntary virtual patient module to a basic life support with an automated external defibrillator course: a randomised trial

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          Abstract

          Background

          The concept of virtual patients (VPs) encompasses a great variety of predominantly case-based e-learning modules with different complexity and fidelity levels. Methods for effective placement of VPs in the process of medical education are sought. The aim of this study was to determine whether the introduction of a voluntary virtual patients module into a basic life support with an automated external defibrillator (BLS-AED) course improved the knowledge and skills of students taking the course.

          Methods

          Half of the students were randomly assigned to an experimental group and given voluntary access to a virtual patient module consisting of six cases presenting BLS-AED knowledge and skills. Pre- and post-course knowledge tests and skills assessments were performed, as well as a survey of students' satisfaction with the VP usage. In addition, time spent using the virtual patient system, percentage of screen cards viewed and scores in the formative questions in the VP system throughout the course were traced and recorded.

          Results

          The study was conducted over a six week period and involved 226 first year medical students. The voluntary module was used by 61 (54%) of the 114 entitled study participants. The group that used VPs demonstrated better results in knowledge acquisition and in some key BLS-AED action skills than the group without access, or those students from the experimental group deliberately not using virtual patients. Most of the students rated the combination of VPs and corresponding teaching events positively.

          Conclusions

          The overall positive reaction of students and encouraging results in knowledge and skills acquisition suggest that the usage of virtual patients in a BLS-AED course on a voluntary basis is feasible and should be further investigated.

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          Most cited references22

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          Virtual patients: a critical literature review and proposed next steps.

          The opposing forces of increased training expectations and reduced training resources have greatly impacted health professions education. Virtual patients (VPs), which take the form of interactive computer-based clinical scenarios, may help to reconcile this paradox. We summarise research on VPs, highlight the spectrum of potential variation and identify an agenda for future research. We also critically consider the role of VPs in the educational armamentarium. We propose that VPs' most unique and cost-effective function is to facilitate and assess the development of clinical reasoning. Clinical reasoning in experts involves a non-analytical process that matures through deliberate practice with multiple and varied clinical cases. Virtual patients are ideally suited to this task. Virtual patients can also be used in learner assessment, but scoring rubrics should emphasise non-analytical clinical reasoning rather than completeness of information or algorithmic approaches. Potential variations in VP design are practically limitless, yet few studies have rigorously explored design issues. More research is needed to inform instructional design and curricular integration. Virtual patients should be designed and used to promote clinical reasoning skills. More research is needed to inform how to effectively use VPs.
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            Computerized virtual patients in health professions education: a systematic review and meta-analysis.

            Educators increasingly use virtual patients (computerized clinical case simulations) in health professions training. The authors summarize the effect of virtual patients compared with no intervention and alternate instructional methods, and elucidate features of effective virtual patient design. The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, and Scopus through February 2009 for studies describing virtual patients for practicing and student physicians, nurses, and other health professionals. Reviewers, working in duplicate, abstracted information on instructional design and outcomes. Effect sizes were pooled using a random-effects model. Four qualitative, 18 no-intervention controlled, 21 noncomputer instruction-comparative, and 11 computer-assisted instruction-comparative studies were found. Heterogeneity was large (I²>50%) in most analyses. Compared with no intervention, the pooled effect size (95% confidence interval; number of studies) was 0.94 (0.69 to 1.19; N=11) for knowledge outcomes, 0.80 (0.52 to 1.08; N=5) for clinical reasoning, and 0.90 (0.61 to 1.19; N=9) for other skills. Compared with noncomputer instruction, pooled effect size (positive numbers favoring virtual patients) was -0.17 (-0.57 to 0.24; N=8) for satisfaction, 0.06 (-0.14 to 0.25; N=5) for knowledge, -0.004 (-0.30 to 0.29; N=10) for reasoning, and 0.10 (-0.21 to 0.42; N=11) for other skills. Comparisons of different virtual patient designs suggest that repetition until demonstration of mastery, advance organizers, enhanced feedback, and explicitly contrasting cases can improve learning outcomes. Virtual patients are associated with large positive effects compared with no intervention. Effects in comparison with noncomputer instruction are on average small. Further research clarifying how to effectively implement virtual patients is needed.
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              Applying the science of learning to medical education.

              OBJECTIVE The goal of this paper is to examine how to apply the science of learning to medical education. SCIENCE OF LEARNING The science of learning is the scientific study of how people learn. Multimedia learning - learning from words and pictures - is particularly relevant to medical education. The cognitive theory of multimedia learning is an information-processing explanation of how people learn from words and pictures. It is based on the idea that people have separate channels for processing words and pictures, that the capacity to process information in working memory is limited, and that meaningful learning requires appropriate cognitive processing during learning. SCIENCE OF INSTRUCTION The science of instruction is the scientific study of how to help people learn. Three important instructional goals are: to reduce extraneous processing (cognitive processing that does not serve an instructional objective) during learning; to manage essential processing (cognitive processing aimed at representing the essential material in working memory) during learning, and to foster generative processing (cognitive processing aimed at making sense of the material) during learning. Nine evidence-based principles for accomplishing these goals are presented. CONCLUSIONS Applying the science of learning to medical education can be a fruitful venture that improves medical instruction and cognitive theory.
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                Author and article information

                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central
                1472-6920
                2012
                18 June 2012
                : 12
                : 41
                Affiliations
                [1 ]Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Lazarza 16, Krakow, 31-530, Poland
                [2 ]Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kopernika 17, Krakow, 31-501, Poland
                Article
                1472-6920-12-41
                10.1186/1472-6920-12-41
                3408380
                22709278
                07cb839e-3fe6-4707-a1e1-bfa7dce79584
                Copyright ©2012 Kononowicz et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 December 2011
                : 18 June 2012
                Categories
                Research Article

                Education
                blended learning,voluntary participation,virtual patient,bls-aed training
                Education
                blended learning, voluntary participation, virtual patient, bls-aed training

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