key: cord-0895573-qa49r2cn authors: Wagner-Menghin, Michaela; Szenes, Victor; Scharitzer, Martina; Pokieser, Peter title: Designing virtual patient based self-study quizzes covering learning goals in clinical diagnostic sciences for undergraduate medical students – the radiology example date: 2020-12-03 journal: GMS J Med Educ DOI: 10.3205/zma001384 sha: a972fdc1f6473619fb9f47f75e4ea3af015f74fd doc_id: 895573 cord_uid: qa49r2cn Background: Diagnostic tests and examinations inform clinical decision making. Thus, an essential part of medical students’ workplace-based training is dedicated to core skills in clinical diagnostic sciences. Due to a reduction of clinical internships for fifth-year students in the wake of COVID-19 learning activities replacing this aspect of training were needed. Project description: Virtual Patient online learning materials addressing clinical diagnostic sciences, specifically, radiology, were developed to prepare students for the transition to workplace-based learning. Three types of activities related to interprofessional patient treatment, showing how radiology knowledge improves the diagnosing and treatment of patients, were used to design the narrative of each virtual patient. The materials also showed students “how to learn” in the clinical workplace while showing “what to learn”. Students complete relevant tasks and compare their approach with experts’ approach in a self-directed way. Results: Twenty self-study quizzes, accompanied by nine interactive Webinars were developed, providing 13% of the overall available replacement learning materials for the summer term 2020. In June 2020, 486 students completed the program and collected a mean share of 16% (SD=10) of their required credits by choosing to learn with these materials. Conclusion: Developing virtual patients based on three types of clinical activities to prepare students for the transition to workplace based learning proved successful and allowed rapid development of learning materials. The presented online quiz format and webinar format showed high acceptance and interest among students. During clinical decision making primary care physicians or medical specialists of various disciplines compile information from the patient's history, the physical examination, and diagnostic procedures, which are performed and appraised by medical specialists. To make the best use of diagnostic procedures, all practising physicians should rely on skills related to clinical diagnostic sciences (CDS) as specified for undergraduate medical education [1] , [2] , [3] . Due to the outbreak of COVID-19 Austrian hospitals reduced the number of internships for fifth-year medical students, thus canceling their workplace-based learning of CDS. The Learning Development Team of the Teaching Center was approached -more than ten teams from dif-ferent departments of the Medical University were approached -by the Director of the Curriculum to create replacement learning scenarios, covering some KLZÖ learning goals (Austrian National Learning Objectives Catalogue for Undergraduate Medical Education) with the following specifications: 1. Online activities: to comply with COVID-19 measures 2. Self-directed learning: to facilitate the transition to workplace-based learning The last author's rich archive of radiological cases made it feasible to focus the development of virtual patient learning materials (VPs) on CDS related to radiology. During workplace-based learning students observe the decision making of senior doctors. Students participate in this process in a self-directed way by attempting problem solving and by reflecting on work practices between together with the supervisor, creating knowledge as a shared activity. Since the transition to workplace-based learning is difficult for undergraduates [4] , we propose VPs to show them "how to learn" in a self-directed way while showing them "what to learn". While students complete relevant tasks with authentic patient information [5] , [6] , they compare their approach with the approach of experts using four categories ranging from 0% (no concordance, different approach) through 40% or 80% to 100% (similar approach) to self-score the quiz. Including an appropriate basic science question together with a clinical application question, activates the students' basic sciences knowledge. A short teaching summary promotes learning. Self-Study Quizzes were presented using Moodle, or in interactive webinars (without concordance rating). To evaluate we prompt students to comment on each quiz freely; we also compare the mean share of credits earned by students choosing to participate in our learning activities with the share of credits provided by our learning materials within the overall replacement program. Twenty self-study quizzes and nine interactive live webinars were developed, covering 16 KLZÖ-objectives (up to five objectives per VP). Three learning activity types highlighted the learner's perspective during the development of the quizzes' content. By participating in all available replacement activities, one could overfulfill the requirements by about 75 percentage points. As our learning activities accounted for 13% of available credits, nobody was obliged to participate since there were alternatives available. In June 2020, 486 fifth-year students completed the replacement program and earned a mean share of credits by participating in our quizzes and webinars of 16% (standard devi-ation±10). Students chose our activities as compared to the alternatives with a similar preference. Students' selfscoring resulted in a mean concordance score of 81% (SD=10%). On average 10% (SD=3%) of students commented per quiz, expressing predominately satisfaction (e.g. great case, ☺ ) or neutrality (e.g. "thanks", "nothing in particular"). Defining three types of clinical activities helped in guiding the development of VPs requiring CDS skills related to radiology, which have previously been proposed for medical undergraduates [7] . The VP-based quizzes and webinars showed high acceptance among the students and can be improved based on the provided comments. Our approach in guiding the development of online VPs to improve the transition of students to workplace-based learning demonstrates high acceptance among students. As such, the second edition for all quizzes is currently under preparation. Besides working on covering more of the KLZÖ learning goals, development has to focus on systematically describing how CDS knowledge is needed in varying clinical settings to systematically prepare students for the challenges they face related to learning in the clinical workplace. Alle Ärzte/Ärztinnen, die bildgebende Diagnostik in die Entscheidungsfindung einbeziehen, benötigen detailliertes Wissen über Indikationen und Schwierigkeiten bei der Durchführung radiologischer Untersuchungen. Obwohl Radiologen/Radiologinnen den Befund erstellen, benötigen alle Ärzte/Ärztinnen Fähigkeiten zur Erkennung von Pathologien auf radiologischen Bildern. Alle Ärzte/Ärztinnen müssen auf verständliche Weise mit den Patienten/Patientinnen über die Bildgebung kommunizieren (Beispiele in Tabelle 1). Beim arbeitsplatzbasierten Lernen beobachten Studierende die klinische Entscheidungsfindung der verantwortlichen Ärzte/Ärztinnen. Selbstgesteuertes Erlernen erfolgt, indem Studierende versuchen, ein beobachtetes klinisches Problem zunächst selbstständig zu lösen und dann die eigenen Entscheidungen mit denen des Supervisors/der Supervisorin zu vergleichen bzw. gemeinsam zu diskutieren. Da der Einstieg ins arbeitsplatzbasierte Ler-nen für Studierende schwierig ist [4] , schlagen wir vor, Studierenden anhand der VP Lernszenarien nicht nur zu zeigen, "was sie lernen sollen", sondern auch, "wie man selbstgesteuert am Arbeitsplatz lernt". Im Quiz erarbeiten Studierende zunächst für einen Patienten/eine Patientin, dargestellt durch authentische medizinische Informationen (=VP), eine klinisch relevante Entscheidung [5] , [6] . Die Definition der drei typischen klinischen Aktivitäten erleichterte die Entwicklung von VP-Lernszenarien für radiologische KDiWi Lernziele, die in der Literatur für Medizinstudierende vorgeschlagen wurden [7] . Die VPbasierten Quizze und Webinare zeigten eine hohe Akzeptanz unter den Studierenden und können anhand der freien Kommentare verbessert werden. Unser Ansatz, die Entwicklung von Online-Lernszenarien mit VPs durch Definition prototypischer klinischer Aktivitäten zu steuern, um Studierende auf späteres Lernen am Arbeitsplatz vorzubereiten, zeigt eine hohe Akzeptanz bei den Studierenden. Daher wird derzeit die zweite Ausgabe für alle Quizze vorbereitet. Neben der Arbeit an der Abdeckung weiterer Lernziele des KLZÖ muss systematisch beschrieben werden, welche KDiWi-Kenntnisse in verschiedenen klinischen Situationen benötigt werden. Dadurch wäre es möglich, Studierende gezielt auf die Herausforderungen beim Lernen am klinischen Arbeitsplatz vorzubereiten. Die Autor*innen erklären, dass sie keinen Interessenkonflikt im Zusammenhang mit diesem Artikel haben. Klinischer Lernzielkatalog Österreichs [Austrian National Learning Objectives Catalogue for Undergraduate Medical Education Graz: Eigenverlag der Medizinischen Universität Graz National Competency-Based Learning Objective Catalogue for Dental and Human Medicine Swiss Catalogue of Learning Objectives for Undergraduate Medical Training Klinischer Lernzielkatalog Österreichs [Austrian National Learning Objectives Catalogue for Undergraduate Medical Education Graz: Eigenverlag der Medizinischen Universität Graz National Competency-Based Learning Objective Catalogue for Dental and Human Medicine Swiss Catalogue of Learning Objectives for Undergraduate Medical Training Opportunity or threat: the ambiguity of the consequences of transitions in medical education A qualitative analysis of virtual patient descriptions in healthcare education based on a systematic literature review Do virtual patients prepare medical students for the real world? Development and application of a framework to compare a virtual patient collection with population data An Internet-Based Radiology Course in Medical School: Comparison of Academic Performance of Students on Campus Versus Those With Absenteeism Due to Residency Interviews Designing virtual patient based self-study quizzes covering learning goals in clinical diagnostic sciences for undergraduate medical students -the radiology example The authors declare that they have no competing interests.