Case Studies: St George’s University of London

Terry Poulton and Chara Balasubramaniam write about how their institution has used their virtual patients.


St George’s University of London (SGUL) used the Labyrinth VP player, which was originally created by the University of Edinburgh and subsequently developed at the University of Northern Ontario in Canada by Dr Rachel Ellaway. Labyrinth creates branched-narrative virtual patients, allowing users to choose from a set of choices and examine the consequences of their decisions.

Multimedia content is added to enrich the VP scenario, and scoring systems are activated for formative assessment.

Students for a variety of levels and courses have used these VPs. From foundation years, pre-clinical and clinical undergraduate medicine, pre-registration nursing and paramedic foundation degrees to continuing professional development (nursing), psychiatric and mental health and learning disability.

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Educational Scenarios

The VPs used at SGUL are used in three main areas:

  1. In PBL tutorials – the branched-narrative VPs replace conventional paper-based linear scenarios, allowing the student tutorial group to decide on options and note the consequences.
  2. As supplementary resources for students to use as self-directed learning opportunities, with cases tailored to coincide with the core curriculum teaching of the period in question (e.g., paediatric cases, which are not only delivered during the paediatric attachment but will be closely tied to the theme of the individual week).
  3. Formative examination in the computer classroom, with tutorial feedback integrated with specific face-to-face clinical sessions during the clinical years of the course.

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Curricula Integration

In the first two years of medicine VPs are used as the core PBL learning ‘case of the week’, in a face-to-face tutorial session. These are the predominant bioscience years and are central to the core delivered curriculum.

They are also used as supplementary resources, online for self-directed learning, and during clinical attachments (as described above).
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Integration With Other e-Learning Opportunities

As self-directed resources, VPs are integrated with additional clinical science and skills resources, so in effect the case is expected to trigger as much as possible all other learning opportunities. As assessment VPs they are intended to trigger student revision.
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Technical Integration

All VPs are accessible through Moodle, which is the institutional virtual leaning enviroment (VLE).

Most are deposited in a designated VP area which is resstricted to staff access. Individual teachers make their own judgment as to which, when and where individual VPs are made available to ‘Open Labyrinth’ on the SGUL server, and will increase the range of options for VP availability.
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VPs for Assessment

Labyrinth has an in-built scoring system, and VPs are being used for formative assessment in the Paedistric attachment, in which all students, separately, complete the formative online. They then discuss the cases as a group with a facilitating tutor.
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Evaluation of VPs

In a recent study in our Graduate Entry to Medicine course, SGUL looked at the impact of adapting an existing PBL case for use online, in branching-format.

Students who had experienced formative testing using Assessment VPs were asked for their views on this form of assessment. Very few (1.5%) had any difficulty with the technology. Most found the cases realistic, fair and liked the method of assessment.

The most common complaint was that they were not allowed to go back to change an answer, or review information. One noted: “The more practical experience I have, the better I will perform.”
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Future Plans

VPs will replace paper-based cases in the curriculum. They will also replace mini-cases in assessment with formative and summative VPs.

We will extend VPs into various blended learning curricula for workplace learners as the SGUL Paramedic Foundation Degree.
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Any Advice?

When creating VPs, use a system which is seen by staff to be reasonable and not an excessive time investment. Try to identify where the calue of VP lies for students rather than the creators.

Target particular areas for VP production. Single VPs dotted around the curriculum are interested, they will have novelty value, but they may have very limited impact in the subject area, and therefore limited impact in the curriculum. The use of Vps will also be more difficult to evaluate.

Above all, try to share other people’s VPs!
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