Case Study: University of Warwick

David Davies from The University of Warwick describes how VPs have been used at this institution.

Background

The VP system used at Warwick is the IVIMEDS system. This is a web-based Adobe Flex VP authoring and delivery system. IVIMEDS VPs are XML-based and include multimedia resources and a study guide. There is also an offline authoring tool created using Adobe AIR. VPs created offline may be uploaded to either the Warwick e-learning platform for delivery to students (using SiteBuilder – a custom built content management system) or to the IVIMEDS repository for sharing with IVIMEDS partners. Currently there are 28 medical schools using the IVIVMEDS VP system.

All of our students are enrolled on an undergraduate MBChB degree. Warwick students have a prior biological sciences degree prior to entering medical school. The course is split into two phases: Phase I is medical school based with some exposure to primary care, and Phase II is hospital based with further primary case work-based learning. Virtual patients and other forms of case-based learning are used across the course.

The IVIMEDS VPs are non-linear, that is students are fere to explore any aspects of the patient case depending upon their learning outcomes. Each VP is a multi-visit just as with real primary or secondary care patients, each VP may visit their doctor or clinic several times. As new visits unfold then the learning opportunities increase.

Particular patient visits emphasise one or more learning outcomes. For example, in a VP with stroke, an early visit might allow the students to better understand the cerebrovascular anatomy of the brain, while a later visit will help the students understand diagnostic radiology imaging, diagnosis, treatment and patient management.

VPs contain embedded narrative text, Flash-based interactive media, images, videos, and multiple-choice questions.
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Educational Scenarios

VPs come with optional study guides. A student studying in a problem-based learning mode will likely not use a study guide because he/she will have their own learning outcomes to fulfill. Other students may choose to use the study guide as this helps the student get the most out of each VP case depending upon the module in which the VP is used.

We have piloted the use of virtual patients in inter-professional learning, where medical students learn alongside students from other professions, e.g., nursing. As this is a small component of the course, we are evaluating the relative merits of further developing an inter-professional VP approach.
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Curricula Integration

VPs and indeed all e-learning at Warwick, complements more traditional forms of teaching. We have not yet totally replaced sections of the curriculum with e-learning or VP-only approaches: hoever we are considering this, especially for formative assessment.

The Warwick curriculum is heavily biased towards group work, and tends to have fewer lectures. The curriculum is not strictly problem-based and a subject expert facilitates group work.

In Phase II students have a learning outcomes framework to fulfill but they undertake less structured clinical rotations. It is up to each student to find his/her way through the clinical learning opportunities.

Consequently different students experience a different case mix. We are potentially looking at using VPs to provide a consistent baseline of case mix. We are potentially looking at using VPs to provide a consistent baseline of case mix that all students eperience, complemented by access to real patients during rotations.
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Integration With Other e-Learning Opportunities

In addition to what has been mentioned above, we are also trying to integrate more e-learning into VPs through their study guides and are increasingly looking at how VPs can form the front-end to clinical simulation scenarios, either acted out by simulated patients or with some form of technology-based simulation.

We are also planning formative assessment using VPs and digital clinical simulations. We also continue to invest in simulation centre training.
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Technical Integration

Warwick does not have a traditional VLE as such, instead opting for a more open content management system using a home-built system called SiteBuilder. Warwick also emphasises so-called Web 2.0 technologies and we have created Warwick blogs, with over 4000 active blogs across campus.

VPs are currently linked to each relevant module’s web site, although we are exploring taking a more competency or outcomes-based framework context rather than focus on arbitrary modules.
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VPs For Assessment

We don’t use our VPs formally in assessment although this is something we are interested in. There is formative MCQ-based assessment built into some VP study guides although this is not consistently applied across the course.
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Evaluation of VPs

We have yet to fully evaluate the VP approach at Warwick because we have only been members of IVIMEDS since August 2007. However we will be evaluating both student and teacher experience later in the year.
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Future Plans

We are building a competency framework based around our course’s learning outcomes matched against the General Medical Council’s ‘Tomorrow’s Doctors’ outcomes. This competency framework will be closely aligned to Foundation training competencies, not least because medical schools will be taking on responsibility for Foundation Year 1 training.

We are currently the only UK medical school evaluating the Map of Medicine, a web and evidence based clinical decision support system.

We are planning to use clinical guideline algorithms to create the scripts for new VPs aligned to postgraduate training needs.

In turn IVIMEDS is ensuring that its VPs tools are compliant with MedBiquitous technical format, and will continue to develop teacher-friendly editing tools.
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Any Advice?

Involve your teachers, especially clinical teachers as early as possible. A sense of shared ownership of VPs in particular, but e-learning in general is vital to successfully embedding new technologies in the curriculum.

Don’t underestimate the technical support needed to help teachers achieve successful e-learning.

Be clear about your learning outcomes so that it is clear to both teachers and students how e-learning and VPs complement other forms of teaching.
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