Blended-Learning in medical education enhancing clinical expertise Workshop 4: Implementation of sustainable elearning at Berlin's Universities 29. November 2006 Kai Sostmann, Tina Fix, Gerhard Gaedicke, Manfred Gross U N I V E R S I T Ä T S M E D I Z I N B E R L I N
Structure Project aims and project-structure ELWIS- MED etrainer sustainibility macro-level Curricular integration - sustainibility Micro-level Bedside-teaching Discussion
ELWIS-MED - Aims Development of a set of: Tools Good practice examples Services, Infrastructure Templates for a sustainable facultywide elearningimplementation
Competence-transfer elearning etrainer Financial support elearning Didactic training Distribution into faculty Incentives = Blackboard introduction (Achievement-oriented resources) Medical training for 6000 students Teaching coordinators Teaching staff 120 clinical departments Continuing medical education for 3000 MDs
etrainer as nomads Multiplication of developed elearning scenarios: Based on best-practice solutions Introduction of Blackboard as LMS (FUcooperation) Sustainability = curricular integration Interdisciplinary Into as many departments as possible
etrainer - Tasks Consulting departments (120) SWOT- analysis: teaching organisation, curricular-needs, learning-goals Assessment types Interdisciplinary teaching elearning content www at present (emphasis on consulting content production
etrainer - Tasks Identification of potential needs for elearning-implementation: didactical surplus modular development lifelong-learning staff development continuing medical education Multiplication into other departments
Curricular implementation 1. What does UaK mean? 2. What does curricular implementation mean? 3. How does curricular implementation support development of clinical expertise?
Paediatric-UaK-Course UaK= Unterricht am Krankenbett = Bedside- Teaching: Since Oct. 2005 curriculum has been adopted to the new licensing rules for medical doctors: 5th clinical semester approx. 300 students Bedside-teaching: Max. 3 students at a patient s bed instructed by one teacher Patient presentation: Max. 6 students instructed by one teacher
UaK-Course-Structure Students Bedside -Teaching 1st week (4h) Selfstudies Bedside Teaching 2nd week Selfstudies Bedside Teach. 3. Week ecase 1 Part 1 ecase 1 Part 2 OnlinesupporteTutorIn ecase 2 Part 1 ecase 2 Part 2 Online-MC-Test with integrated feedback Lecture Lecture Lecture Lecture Lecture Lecture Lecture Lecture
elearning Case-based-teaching Aims: - Improved preparation for presence teaching based on defined learning cases and online tasks - Supplementation of the real patients by virtual patients - Individualized success feedbackto learners and teachers
elearning Case-based-teaching - CAMPUS-Authoring system - Building complete clinical pathways - Didactical reduced - Main symptoms (Audio, Video etc.) - Laboratory findings - Diagnostic and therapeutic procedures - Expert commentary - Coding - Assessment player
elearning Case-based-teaching - Obligatory solution of six online cases - Problembasedlearning with online discussion in Blackboard - Paediatric tutors guiding the discussion - Assessment: MC-test online Dept. Medical informatics FH Heilbronn
Theories By using Blended-Learning scenarios combined with online discussion, students can be enabled to differentiate more precisely on special clinical situations Future research will include content analysis of the single levels of knowledge There is strong evidence that online collaboration fosters clinical thinking and problemsolving skills De Wever et al. Discussing Patient Management Online: The Impact of Roles on Knowledge Construction for Students Interning at the Paediatric Ward, Advances in Health Sciences Education (2006)
UaK- Online Question: Are asynchronous discussion groups useful for the development of clinical expertise? 6 Students could work together online as a group Online-moderation by paediatric-residenttutors Students could develop their thoughts an specific clinical tasks for 6 cases over 12 weeks
Online-task-structure 1.Describe the main clinical symptoms! 2.Name the main differential diagnoses for the symptoms listed above! 3.Define the next diagnostic and therapeutic steps!
Curricular implementation Operationalized learning-goals: Assessing what is taught = "Assessment drives the curriculum " Introduction of practical and theoretical learning goals Content specifity/eligibilty criteria for the teaching cases: Commonness, importance, relevance of the disease entities on clinical or ambulatory medicine.
Curricular implementation Typical learning-goals (2/14): 1. "Being able to recognize the clinical signs and symptoms of meningitis for different age groups. " 2. " Being able to differentiate the clinical signs of Measles, Scarlet fever, Chickenpox on the basis of exanthema, enanthmema and laboratory findings. "
Clinical expertise 1. Recognizing and differentiating the clinical signs of meningitis Preparation: Selfstudies Limited teaching: Severe illness Life-threatening Intensive care unit Ethical implications WLAN-Intranet, Blackboard, Bibliothek, E-cases Critical symptoms disappeared Concise History taking
Clinical expertise REAL-PATIENT = Gold-standard of practical medical teaching. Decreased hospital stays Acuity of illness Blended-Learning-Scenario: Supplementation of reallife patient-experiences with virtual patients Limited patient access: Grade of severeness Acuity Ambulatory care
Clinical expertise Individualized Learningfeedback: Postprocessing on Blackboard Knowledge consolidation Online tests Reworking Virtual Patients Differential diagnosis clusters
Conclusion The real problem is the matter of selection, and the tenacity of the complaint serves to remind teachers of our poor performance in the first and probably hardest role of the teacher helping students to learn how to separate the wheat from the chaff. Daniel J Klass director of the quality management division College of Physicians and Surgeons of Ontario, Will e-learning improve clinical judgement? BMJ 2004;328:1147 8
Thank you for your attention! Charité Universitätsmedizin Berlin Prodekant für Studium und Lehre Projekt ELWIS-MED: elearning- Wissensvermittlung in der Medizin Stellvertretende Projektleitung Klinikleitung/Lehrkoordinator Tina Fix Prof. G. Gaedicke tina.fix@charite.de gerhard.gaedicke@charite.de Tel: 030 450 576 004 Tel.: 030 450 566 292 Arzt/ Integrationsbeauftragter Prodekan Lehre Kai Sostmann Prof. M. Gross Klinik f. Allgemeine Pädiatrie manfred.gross@charite.de Tel.: 030 450 576 166 Tel.: 030 8445 6812 kai.sostmann@charite.de manfred.gross@charite.de
Links: www.charite.de/lehre www.charite.de/elearning www.charite.de/ohc-lehre