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Background: The Bavarian Virtual University (BVU) offers resources to develop and implement e-learning courses and allows open access to information and provides the capacity to share information. Students of Bavarian universities can participate easily in these courses. Thus, the barriers to enter a university are now much lower. E-learning will be supported by the use of the learning and authoring software CASUS®. It optimises the creation of virtual patients and guarantees a common standard and a high quality throughout the whole e-learning course. Methods: This paper describes the application process of proposals at BVU and the development process of online courses with CASUS® using the example of "General Practice". The conceptual structure of the program and its specific rationale is presented herein. In addition, the number of participating students is analysed when the online course is integrated in the curriculum or when it is not. Results: The e-learning course General Practice includes a total of 48 scenarios. They focus on the heuristics in General Practice of prevention and primary care. If the online courses are integrated in the curriculum, the number of students participating in e-learning courses increases. The integration of virtual patients (VPs) into practical training may improve the perceived benefit. Probably, there is no need for examinations to prove students' knowledge if they can apply contents in the practical training. To answer this question, an evaluation of students' and teachers' perspective is needed. In addition, it is challenging to define one level of education for students of different universities. Hence, new methods are needed to develop and evaluate generally accepted standards that fit all participating universities and their students. Conclusions: The application of proposals at BVU and creating VPs with the learning and authoring system CASUS® can be highly recommended to other universities, as well as the establishment of organisations like BVU in other countries. Keywords: e-learning; general practice; medical education; online courses. Introduction New communication systems, data delivery, and social networking have widely spread into students' daily routine. The permanent availability of the Internet via laptops, tablets, and smartphones has increased access to Internet tools, including e-learning tools. Medical education has been affected by this process. The Institutes of General Medicine at the Ludwig-Maximilians-University Munich (LMU) and Technical University Munich (TUM) are interested in developing and implementing e-learning methods in order to improve students' medical education and to support the teaching staff. E-learning can be defined as "the delivery of learning via any form of electronic media" . There are different technologies that are used in learning and teaching: students use websites, podcasts, mobile applications, blogs, discussion boards or Internet forums, interactive online tutorials, and virtual learning environments. E-learning courses are usable if *Corresponding author: Barbara Vogel, Klinikum der Universität München, Insitut für Allgemeinmedizin, Pettenkoferstr. 8a, 80336 Munich, Germany, E-mail: email@example.com Christina Kormann and Jörg Schelling: Klinikum der Universität München, Institut für Allgemeinmedizin, Munich, Germany Michael Mehring and Antonius Schneider: Technische Universität München, Institut für Allgemeinmedizin, Munich, Germany Martin Offenbächer: Klinikum der Universität München, Institut für Allgemeinmedizin, Munich, Germany; and Hochschule für angewandte Wissenschaften Coburg, Bereich Gesundheitsförderung, Coburg, Germany Niko Kohls: Hochschule für angewandte Wissenschaften Coburg, Bereich Gesundheitsförderung, Coburg, Germany 108Vogel et al.: E-learning innovations they are effective, are efficient, and improve students' and teachers' satisfaction and benefit . Students' perspective The students are already familiar with the use of PCs and the social network during their leisure time. Nowadays, the Internet is an integral part of students' social life and interaction. Using the Internet for communication and learning can improve a student's motivation. There is a person available for technical problems and student questions. As a result of student feedback and of the peer evaluation by experts from outside Bavaria, the courses are updated on a regular basis. To ensure the high quality of the courses, virtual patients (VPs) encourage students' problem-solving and judgement-making skills . The e-learning courses support and supplement traditional teaching forms such as lectures, practicums, discussion groups, and seminars. Evidence-based educational guidelines recommend this mixed approach . The combination of guidelines and problem-based e-learning plus interaction with the computer increases knowledge and results in change in practice . Schneider et al. stated that students using the learning and teaching platform CASUS® for preparing lectures of VPs lead to improved outcomes . The students perceive the e-learning courses as very useful if the access is simple and the contents are meaningful with assessments and feedback. Furthermore, the program is cost-effective and saves time [10, 11]. E-learning has positive effects on the students' learning of clinical skills and on improving their performance of clinical skills . Internet-based methods seem to generate similar learning effects as traditional methods . Using multimedia and multiple teaching methods is generally effective in changing performance . Bavarian Virtual University The Bavarian Virtual University (BVU) funds the development and implementation of online courses. In total, 30 universities participate in this network [2, 3]. BVU enables flexibility of time and location. Therefore, it has become much easier for students to work alongside their studies or combine their learnings with their social tasks, for instance bringing up children. The geographical distance between the students and the university is no longer a real barrier. E-learning packages can be used efficiently, anytime and anywhere. Another advantage is that learners can also receive immediate feedback on their performance. Online courses with immediate feedback for case-based teaching are as efficient as continuing medical education . Students can attend online courses at BVU equivalent to two to six credit points by the European Credit Transfer System (ECTS). Written examinations are accepted by several universities. Students are asked to inform themselves whether and how credit points or certificates of performance for the chosen course will be taken into account by their home university. In the summer semester of 2015, there are approximately 400 courses that are all free of charge to students from the 30 member universities. Additionally, students gain competence in the process of e-learning itself. Students from different Bavarian cities are able to take part in the courses . Accordingly, BVU seems to be an efficient tool for distributing medical education to several universities and their students. Virtual universities can enhance standardisation of medical education and can provide resources sharing . Another aim of BVU is to reinforce international cooperation and to strengthen courses in the English language . The learning and authoring system CASUS® CASUS® is a web-based learning and authoring system. It is based on an educational concept by the AG Medizinische Lernprogramme (medical teaching programmes) at the LMU started in 1993 [14, 15]. CASUS® is characterised by an intuitive functionality. Multimedia elements, such as graphics, photos, and films, can be integrated smoothly with a simple mouse click. Authors can easily create VPs and use many standardised interactive elements including a wide range of questions and answer types, references, and hyperlinks. Specific expert comments can be embedded in cases adding educational value . Virtual universities, such as BVU, allow open access to information and offer the capacity to share information. In addition, the barriers to attend a university are now lower than before . CASUS® optimises the creation of Teachers' perspective For teachers, the online courses offer more educational and didactical opportunities because of the use of multimedia teaching. By offering these courses at BVU, teachers can offer additional courses that might need to be held at the same time they would normally teach the e-learning course content. By offering workshops, BVU also enables collegial networking among teachers. Furthermore, the online courses are an effective and efficient solution for tackling the lack of space and rooms [2, 3]. Vogel et al.: E-learning innovations109 VP and guarantees a high level of quality management. The integration of a computer-based learning tool into the curriculum is as important as the optimisation of the software itself . The aim of this paper is to describe the application process of online courses at BVU. In addition, we want to show the developing process of problem-based cases with CASUS®, and its strength and weakness. Finally, in this paper, we want to analyse whether there is a difference between the number of participants if the online course is integrated in the curriculum or if it is not. Materials and methods The clinical centre of the university in Munich, especially the Institutes of General Practice, is engaged in various teaching activities. In cooperation with BVU, a doctor of medicine creates case- and competency-based problems using CASUS®. The course is called "General Practice." BVU finances the project, and the university in Munich provides the software CASUS® to create VPs. The online courses supplement and support conventional courses and students' practical training. Practice and were based on 16 units for each course. The third course included 16 topics of prevention in General Practice. In a first step, for all courses, the most important topics of General Practice were collected. After identifying the topics, a concept or dramaturgy was created for each topic. The didactic methods of the units were outlined, and a description of how the testing would be provided was added. The various media to be used, such as videos of doctor-patient consultations performed by actors, or instructional videos, photos, figures, or written teaching materials were explained in detail. Each unit was subdivided into six to 12 instructive parts (charts). The testing was implemented after each instructive part using multiple-choice questions. For creating VPs, we used the Webbased learning and authoring system CASUS®. How to implement the e-learning course "General Practice" into the curriculum For every TUM student, obligatory e-learning courses in "General Practice" are implemented as part of the curriculum. A total of eight units have to be passed successfully to obtain a certificate at the end of the session. A unit is passed successfully when at least 80% of the unit is completed correctly by the students with a minimum of 15 min expenditure of time. This certificate is required in order to obtain the certificate of the General Practice training. A further requirement for the certificate of General Practice is a training of 2 weeks under supervision by using an attendant logbook. The e-learning course is embedded into the practical training, and the students are given the advice to pass the e-learning course as a preliminary step before the practical training commences. During the entire term, the students are able to get in touch with the supervisor of the course, either by e-mail with questions about the course or via the feedback function. Suggestions for improvement of the course are also received in this way. Additionally, after completion of the course, each course has been evaluated during the test phase and revised if necessary. Students of other universities can participate voluntarily. They can also participate in the e-learning course and receive a certificate, if they have passed successfully. The certificate may be accepted by other universities. However, we cannot be sure. How to apply proposals at BVU Twice a year, the member universities of BVU are invited to submit proposals for new online courses. Initially, there must be a demand for the specific course by at least two universities. The universities must estimate how many students might participate in this course. Not only courses with a high number of participating students will be chosen, but BVU also wants to support universities by establishing new curricula even if only a small number of students apply for a course. After the decision of the board of presidents about which course will be financed, the universities have to present an exact description of the course. The included universities are responsible for the realisation and implementation of this course over the next 5 years. Till 2014, BVU paid on average 40,000 for the development of an online course with three ECTS [2, 3]. From 2015, BVU will pay 45,000 for comparable projects. How to create the e-learning course "General Practice" The creation of the e-learning course "General Practice" started in 2011. The first two courses covered the most common reasons for consultation issues in General Results We were able to evaluate the 4-year course. However, the first semesters were a testing phase, and we describe 110Vogel et al.: E-learning innovations below the analyses of the utilisation by winter semester 2012/2013. The course was designed for medical students in clinical semesters. However, the enrolment was enabled for all students of other universities and of any subjects. For the students of BVU, the course was free of charge, while students from other universities had to pay a participation fee. The one group identified TUM students and the other group students from other universities. For TUM students, the course is obligatory; however, for students from other universities, the course is voluntary. The project of General Practice includes a total of 48 scenarios. The courses focus on the heuristics in General Practice of prevention and primary care. The cases are based on medical guidelines and describe main symptoms such as tiredness or headache. The number of students who participate in e-learning courses increases every year, especially if the e-learning courses are obligatory as at TUM. Students at TUM need the certificate as a requirement for practical training. In 2012, they started with 165 TUM students. In 2014, the number of participants increased to 419. On average, 70.01% of the TUM students passed and obtained the certificate. If the course is voluntary, the number of students varies; 259 students took part in the course in the winter semester of 2012/2013, and the number of students decreased until there were 116 participating students in the summer semester of 2014. However, in the winter semester 2014/2015, a total of 169 students passed the course. In addition, the percentage of students who passed decreased from about 43% to 30% (Table 1). that refresh the contents of courses. Students of BVU do not have to pay fees. Thus, the courses are cost-effective. Especially, the number of TUM students participating increased as the course is mandatory there. TUM students need the course for practical training and examinations. Because the courses are combined with practical training, this teaching mix improves students' performance of clinical skills significantly. The aim of these online courses is to make the students ready for practical training. Hege et al.  state that the best practice for e-learning application is a voluntary integration strategy combined with the examination-relevance of the content. They did not discover the combination of voluntary integration strategy and relevance of the contents for practicum. Edelbring et al.  analysed the integration of VP into courses. A more intense follow-up pays off in terms of the benefit perceived by the students. Students' positive perception of integration directly affects their satisfaction and perception of the effectiveness of their learning progress . Thus, the integration of VPs into practical training may improve the perceived benefit. Probably, there is no need for examinations to prove students' knowledge if they can apply the contents in practical training. However, even if the number of participants increases, we cannot evaluate the gain of students' knowledge and skills. To answer this question, evaluation of students' and teachers' perspective is needed. The user-friendly software CASUS® makes it easy for authors to create cases. An author can create individual cases with the opportunity to use different media. In addition, the CASUS® authoring tool enables individual student support and guidance. Nevertheless, there are still challenges in developing interactive cases. One challenge is to create scenarios that show the entire context of a patient's problems. To make sure that the integrity and correctness of the units are fulfilled, recommendations of actual medical guidelines were included. Another challenge was how to design our e-learning cases as close as possible to Discussion An increasing number of students take part in the interactive e-learning course General Practice. In general, there are good reasons for all students of BVU to participate. The students can interact and receive immediate feedback. The contents are up to date because BVU supports projects Table 1:Number of students participating in the e-learning course "General Practice". All students TUM students (% all students) 165 (38.92) 181 (45.82) 216 (56.99) 305 (72.45) 419 (71.26) 1286 (58.27) TUM students with certificate (% students TUM) 102 (61.82) 129 (71.27) 163 (75.46) 209 (68.53) 300 (71.60) 903 (70.01) Other students (% all students) 259 (61.08) 214 (54.18) 163 (43.01) 116 (27.55) 169 (28.74) 921 (41.73) Other students, where required with certificate (% other students) 112 (43.24) 107 (50.00) 79 (48.47) 34 (29.31) 51 (30.18) 383 (41.59) WSa 12/13 SSb 13 WSa 13/14 SSb 14 WSa 14/15 Sum Winter semester. bSummer semester. Vogel et al.: E-learning innovations111 reality as a general doctor sees in daily work. To bring theoretical knowledge and practical application together is a very challenging task. However, the VPs help students learn and also prepare them for internship or first-year residency. Students of different universities can take part in the courses. Therefore, it is challenging to define one level of education for all. In general, it should be an ambitious level, but with a realistic opportunity to pass the course successfully. New methods are needed that develop and evaluate generally accepted standards that would be fit for all participating universities. Conclusions and perspectives The online courses are implemented successfully into the curriculum. Additional projects are planned. The LMU and the University of Applied Sciences Coburg with the faculty of "Integrative Health Promotion" will create the online courses "Health Promotion in a General Practice" and "Shared Decision Making as Part of Evidence-based Practice." The application of proposals at BVU and creating VPs with the learning and authoring system CASUS® can be highly recommended to other universities as well as the establishment of organisations like BVU in other countries. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. Research funding: None declared. Employment or leadership: None declared. Honorarium: None declared. Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Bio-Algorithms and Med-Systems – de Gruyter
Published: Jun 15, 2015
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