AMEE 2009, Malaga, Spain. During this meeting eViP met with Caroline Rodgers and Emily Adams, both graduate entry medical students at The University of Oxford. Here they describe their experiences in creating virtual patients for use in the Year 5 Primary Care syllabus.
This project came about initially as Dr Richard Harrington from Oxford University had developed a substantial library of videos that ranged from patients talking about their experiences of hospitals and health care, to patients in acute situations. He approached Caroline and Emily to develop virtual patients using some of these videos combined with clinical decision trees.
As Caroline explained: “We decided to take some of the library videos and also some scenarios and patient histories to develop virtual patients which involve students making decisions about management, and also so we could learn more about how patients perceive clinical practice.”
Key topics from the Year 5 Primary Care syllabus at Oxford University were identified. Video clips from a bank of patient videos were added, and the virtual patients were enriched with hyperlinks to other relevant online resources.
Emily added: “We had this bank of videos, but what we discovered very quickly was we wanted to create a particular kind of patient which would be useful for the students. Clearly as far as the students were concerned they wanted resources that will help them pass their exams, and also in the long term will equip them to be better doctors.”
However, what became apparent was the existing videos were not specifically relevant to the Year 5 medical curriculum. As Emily explained: “Although we had this big video library, we actually needed to create more videos ourselves.”
This resulted in another hurdle, that being the issue of consent. “This has been a big issue with the project,” says Emily, “because the patients in the original video library had given their consent to be used on video, but not on the Web.”
At first, they obtained consent retrospectively from the patients in the original video library for use on video and also for use on the Web. “And now, looking at the eViP project, we’re thinking about using these resources worldwide,” said Emily. “Which is obviously a great feature with virtual patients. But in terms of consent it was back to the drawing board.”
Eventually they created new video clips from scratch and ensured that they had consent both for the video clips, and also for their use on the Oxford University Weblearn system.
So how did the students benefit from these virtual patient scenarios, once they were completed? The study is still in the early stages, however some key findings are already starting to emerge.
The main finding is that students value immediate feedback. “In the original design we had an obvious score tallying alongside each page,” Emily explained. “However the students didn’t know what they were getting the scores for. So we added an immediate feedback page which they could use as a learning experience.”
“Students also wanted to have a score all along so they knew how they were getting on. So we implemented those changes.”
Caroline added that: “We designed the questions so that you can’t just click on any old answer, you actually get penalized for making the wrong decisions. We also included different types of questions, some branched and some linear.”
This was clearly an important exercise, not only to find out how students get the most benefit from virtual patients, but how to tackle other issues such as obtaining valid patient consent for all types of media involved, not to mention evaluating the real value of using multi-media in virtual patients.
“We would really like to know whether the videos have added anything to these resources,” said Emily. “Given how time consuming they are to create, it’s certainly an important thing to find out.”
So far four scenarios: – 1. cardiovascular risk, 2.dyspepsia and dysphagia, 3. Low back pain, and 4. Urinary tract infection – have been launched and the next steps include collecting anonymous feedback from a cohort of 30 students, recording how a larger group of students use these resources over one year, and also to assess whether these virtual patients have an impact on performance in the written and practical exams.
Beyond this initial pilot study, the study coordinators would like to trial the same resource with and without the patient videos to assess their usefulness.
For further information, please visit the Oxford University medical school website.
