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Presence mode

Guiding questions:

  1. Should students work on VPs in a computer lab, shared space, seminar room or at homes?
  2. If working at distance should it be synchronous or asynchronous?
  3. If a mix of those modes is recommended what should guide the selection of the mode?

When preparing integration of VPs into the curriculum, another important aspect to consider is the presence mode, namely what are the differences (and potential advantages and disadvantages) between working on the VPs on-line or in-person, during classes or  using a blended strategy.

In face-to-face settings, students physically are present on the campus to work on the VPs. One of the advantages of this approach is for participants to get to know the computer program they intend to use, for the teacher to introduce important or complex topics [Fischer 2008]. Also specialized solutions such as virtual patients in virtual reality or in combination with other forms of simulation (e.g. standardized patient, patient simulator etc.) can be implemented that way. Solving VPs cases in the presence of a tutor gives the students higher motivation, especially when content is related to the exam material [Hege 2007], and less distraction when they work the VP cases in the classroom. Students also can receive immediate feedback or guidance when encountering problems during case solving. In interprofessional groups, the learners appreciate face-to-face form as an efficient tool to enrich the discussion and get a meaningful value in the encounter with the other profession [Edelbring 2022]. In the literature, different formats are indicated, depending on the level of curriculum, rooms availability etc. VPs can be introduced as an individual or group laboratory exercise. 

Regarding the on-line setting, working on the cases at home allows for self-directed learning at the student’s own pace, and deeper reflection on the material covered during small-group practicals [Riedel 2003]. Depending on the learner’s needs, students can fill in their own knowledge gaps (by reading additional resources) and organise their thoughts (e.g. in the form of a concept map); in this way, learning can be personalised, related to the individual needs rather than the needs of the group.

The online setting can also be used in situations of limited access to learning spaces or restrictions on contact hours [Johnson 2014] as happened during the COVID-19 pandemic or during individual illness, family situation, course of study or more logistic-based problems like conflicts in the study programs for interprofessional training. In this case students prefer an on-line encounter due to flexibility in time and space [Edelbring 2022].

If you are just starting with an on-line learning environment, we need to bear in mind that getting the tutors trained will take some time and this strategy might not be readily available. You can read more about teachers’ training in this section.

A compromise that combines the above techniques is blended learning. VPs may be featured in the both face-to-face, synchronous online (collaborative) and asynchronous online (independent study) elements of an activity [Ellaway 2015]. 

VPs can aid the delivery of additional content or introduction of a new material in an asynchronous way [Geha 2018]. It has also proven to be a successful theoretical, but practice-oriented preparation before practical implementation of the acquired knowledge (also known as flipped-classroom) [Huwendiek 2008], which allows students to learn in an environment similar to real practice, reducing the stress and a “culture shock” between university and clinical setting [Morrissey 2014].

Blended learning using VPs, however, can also proceed first in face-to-face mode – e.g. during a problem-based learning session – and then on-line as a repetition before an exam or as a reflection after an in-person encounter. It was shown by Kononowicz et al. that students using VPs together with face-to-face sessions were able to gain more from the course and scored better in the knowledge post-test than the control group [Kononowicz 2012].

There is a recommendation that the new curricula should include VPs, because of their utility in distributed learning environments as well as their ability to meet learners’ requirements for asynchronous as well as synchronous on-line learning [Posel 2012]. According to Ellaway et al., VPs have been successfully used as the integrating or scaffolding medium for distributed teaching. In that case, different groups at different sites work first independently, and then come together for collaborative VPs tasks [Ellaway 2015].

The conclusion is that face-to-face and on-line modes can be flexibly and deliberately selected according to the learning objectives and teaching constraints.

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