Reflections from the Medical Education Forum 2021

The 2nd Medical Education Forum (MEF) hosted from 4 to 6 May 2021 as a virtual meeting was an opportunity to review and summarise current research outcomes in medical education. It was organised by Jagiellonian University Medical College, McMaster University and Polish Institute for Evidence-Based Medicine. The live event had five speakers from the DID-ACT project (Samuel Edelbring, Inga Hege, Sören Huwendiek, Małgorzata Sudacka & me) and had 110 participants from 24 countries, most of them from Canada, Poland and Ukraine.

During the MEF conference, I took on the task of reviewing the most recent systematic reviews of virtual patients effectiveness. A review of reviews is called an umbrella review. Effectiveness of virtual patients is an important topic for the DID-ACT project because we use this type of education resources as a vehicle to deliver interactive exercises to practice clinical reasoning in the designed DID-ACT curriculum. To see how effectiveness is measured of clinical reasoning outcomes is also important to inform the DID-ACT project pilot evaluations. 

I have identified in the recent three years five systematic reviews of virtual patients effectiveness. This included a systematic review I completed with my colleagues from the Digital Health Education collaboration in 2019. For me personally, preparation of the MEF presentation was an interesting exercise that gave an opportunity to see how much the results obtained in our former review align with the outcomes reported in other reviews published afterwards. To check it makes sense as systematic reviews often have unique scopes defined by the selected inclusion criteria, data extraction and synthesis methods and therefore may differ. 

The reviews published after 2019 were carried out by international teams from France, New Zealand, South Korea, UK and USA. Only one, similar as we, included all health professions; the remaining focused on particular health professions: nursing, medicine, pharmacy. The studies either included all possible outcomes or selected a particular skill. It was interesting to see that the skill that was in particular in the scope of interest in syntheses in the recent years were communication skills. The conclusions of the studies were consistent across the different professions and topics. The studies reported benefits of application of virtual patients in education with hardly any exceptions. As Lee and colleagues (Med Educ, 54(9), 2020) concluded in their systematic review, the effectiveness of virtual patients can be even more improved when their use is preceded or followed by reflection exercises and human-teacher provided feedback. The technological features of virtual patient platforms were less important. 

You may learn more about the result of my umbrella review, presentation of the other DID-ACT project speakers and the follow-up Question & Answers sessions as video recording.

Leave a Reply

Your email address will not be published.

How to teach synchronously in a virtual setting

  • You need a reliable camera, microphone, and virtual platform and be familiar with its features, such as whiteboard, chat, polling, breakout rooms, etc.
  • At the beginning establish communication rules, e.g. whether participants should raise their (virtual) hand, use the chat, and/or just speak. Also, we recommend asking participants to turn on their camera
  • For small group work break out rooms work very well, just be clear about the tasks the groups should work on prior to dividing them into the groups.
  • For collaboration the use of integrated virtual whiteboards or other platforms such as Padlet are very useful. Just make sure prior to the session that you have everything setup and the links at hand, e.g. to post them in the chat.
  • Allow a bit more time for starting the session and the group works as there might be participants who are not familiar with the platform or technical problems might occur.

How to motivate unprepared participants

  • Make clear that the asynchronous assignments are a core part of the course and that its content will not be repeated. Even if it is difficult, stick to that when starting the synchronous teaching session.
  • If you expect unprepared participants, you can start the session with a student-centered group exercise mixing prepared and unprepared students to increase peer-pressure and make them realize that being unprepared does not feel good.  
  • Use the introductory or closing quizzes / tests so that participants can self- assess whether they have the required knowledge and you as a facilitator can see the level of knowledge and preparation of your participants.

Further recommended reading:

How to involve participants with different levels of experience

  • To account for such different levels, we recommend making use of the asynchronous preparatory phases which also include introductory quizzes in which participants can self-assess their prior knowledge and you as a facilitator can assess the differences within your group. Participants with less prior experience can also be guided to additional preparatory resources.
  • Encourage participants to work in pairs or small groups when preparing so that they can help and learn from each other. You could even facilitate this by dividing them into groups with different levels of experience.
  • Similarly, during the synchronous phases, we recommend forming groups with participants different levels of experience and emphasize the peer support aspects of such group activities.
  • We also recommend starting with rather smaller groups and allow more time than stated in the course outlines, if you expect a heterogenous level of experience. This way you can better manage this challenge.
  • Encourage your participants to ask questions, emphasizing that nobody knows everything and that it is important for learning to ask questions.  
  • Especially in the train-the-trainer course you might have to deal with over-confident participants, who especially in an interprofessional setting can dominate the group. This is a complex cultural challenge, but you could try to establish (and follow) communication rules at the beginning of a session.  

How to address potential overlaps or redundancies

  • Identify what is already included and what is missing in your curriculum related to clinical reasoning outcomes and compare it to the DID-ACT blueprint. Prioritize learning outcomes that are not yet covered but regarded as important.
  • Identify activities, resources, or teaching sessions with similar learning outcomes that might be in need for change anyway because of low evaluation results, teachers or students struggle with it. These could be suitable for adding or replacing parts with DID-ACT activities.
  • Ask teachers and students about overlaps and gaps they see in their teaching / learning of clinical reasoning and where they struggle. This could also be done by a reflection round after related teaching activities in the curriculum
  • Although ideally a longitudinal integration is aimed at, we recommend to starting small with a pilot implementation to gain experience and develop a show case.

How to teach in an interprofessional setting

  • Allow for enough time prior to the teaching for the organization and motivation / encouragement of stakeholders and participants
  • Allow for enough time and guidance during the course so that the participants from the different professions can get to know each other and their professions and discuss their different perspectives. This might mean that you need to calculate some extra time in addition to the suggested duration of the learning unit.
  • There may be a different understanding of clinical reasoning in the different health professions, so we recommend making participants aware of this. You could for example use and adapt activities from the learning units on the health profession roles to facilitate this.
  • Courses in an interprofessional setting should not come too early in the curriculum (not before professions have formed their own professional identity - however, this also depends on the aim of the course). 
  • Make sure you have enough participants from different professions. If possible, the facilitator could divide the participants in smaller groups with an equal distribution of professions. 
  • Similarly, you need an equal distribution of facilitators / facilitators from different professions.
  • Develop customized learning materials considering the different professions. If needed you can adapt the material and activities provided in the DID-ACT curriculum.

Further recommended reading:

van Diggele, C., Roberts, C., Burgess, A. et al. Interprofessional education: tips for design and implementation. BMC Med Educ 20, 455 (2020). (Link)

Skip to content