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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 ICVP09 conference Krakow, Poland
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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 0830-0445, 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/e
  tit/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
  2217-25, 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, 413,
  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
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Study among 5th year medical students  
Tutor moderated small group discussion
Work with VPs
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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)