iCoViP multiplier event with a Bavarian-Ukrainian flavor

by Daloha Rodriguez-Molina and Anja Mayer

On November 16th 2022, iCoViP project partners organized a multiplier event, framed within the “Ukraine digital: Ensuring academic success in times of crisis” project organized by the Institute of Medical Education of the University Hospital of Munich (LMU Klinikum). The event took place during one afternoon on the beautiful island of Frauenchiemsee, located in the lake of Chiemsee, about 2 hours east of the city of Munich.

It was organized and imparted by Daloha Rodriguez-Molina from LMU Klinikum in Munich and Anja Mayer from the University of Augsburg. A total of 25 medical educators from all over Ukraine and one specialist from the University of Munich (LMU) took part the event, in which we communicated a bit of the work that we have been doing within the iCoViP project. In the event, we presented the project and its intellectual outputs as well as the progress that we have made so far. Moreover, we talked about clinical reasoning, contextual factors to consider when creating virtual patients (VPs), how we developed the VP blueprint within iCoViP, the CASUS platform, our VP integration guidelines, and VP pilot examples from iCoViP and from the University of Chernivtsi in Ukraine.

Additionally, in a hands-on session, participants had the opportunity to work on one of iCoViP’s VPs on the CASUS platform. The whole event was carried out interactively and we believe that the exchange and knowledge between event organizers and facilitators from iCoViP and event participants was highly satisfactory. From this multiplier event, we at iCoViP learned that there is a high interest in using iCoViP’s VP collection within medical education at many Ukrainian universities.

Finally, we would like to thank the Institute of Medical Education of the University Hospital of Munich, and especially Karolin Dospil and Martin Fischer for the invitation and interest in our project, as well as for the logistic and technical assistance during the event. We would also like to thank all participants for their active participation and the fruitful exchange!

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Phase of the curriculum4th year of medical school
Goal in the curriculumThe iCoViP collection was implemented to practice selected VPs in the subject of Occupational Medicine (a voluntary subject in the University of Zaragoza in the 4th year of medical school).
Effective use of resourcesThe collection was used asynchronously so it was not necessary to have a computer infrastructure or a specific room and all students in Spain have laptops or access to the medical school computers. However, issue of updating content not yet solved.
VP alignmentThe collection is used  while students are doing their clinical placements having a teacher revising the responses and explaining to students most frequent mistakes.
Prioritization/relevanceFor Occupational Medicine, the use of the iCoViP collection was a mandatory assignment needed to pass, but did not add points to the final grade.
Relation to other learning activitiesNone
Time allocationOne week was given to complete the assignment but more time was available for those who wanted to do the activity remote from home.
Group allocationStudents worked alone at home, when the educator discussed the solution of the VP, it was allocated in class (face-to-face or online).
Presence modeAsynchronous
Technical IntegrationIt was integrated into Moodle.
VP use orientation/trainingVPs were related to a specialty of medicine, but were randomly assigned to students regardless of where in the specialty they were rotating at the time.
Technical infrastructureWe used the technical infrastructure of the iCoViP project without any additions at the University of Zaragoza.
Learning activities around VPsThe teacher explained each VP and how to resolve them after getting the responses of all the students.
AssessmentStudents had to complete the VPs, but there was no grade at the end. Only credit (pass/fail).
Quality assurance, maintenance, and sustainabilityFrequent revision of the VPs by medical doctors.
Phase of the curriculumYear 3 and 4 of medical school
Goal in the curriculumStudents learn basic steps of clinical reasoning including identifying relevant findings, developing differential diagnoses, deciding about a final diagnosis, ordering tests to rule out / confirm differentials, and suggesting treatment options.
Effective use of resourcesCourse tutors needed time to familiarize themselves with the VPs and time had to be planned during the synchronous meetings to discuss the VPs
VP alignmentVPs were part of the modules (e.g. Abdomen, cardiovascular system, pulmonary system, etc.) in year 3 and 4 of medical school and aligned with the objectives of these modules based on key symptoms. In addition a pool of 41 VPs was available for deliberate practice across key symptoms and diagnoses.
Time allocation5 VPs / module
Group allocationStudents could choose whether to work in groups or individually.
Presence modeStudents could decide when and where to work on the VPs during the period of the module.
Technical IntegrationVPs were integrated into the school's learning management system Moodle via a SingleSignOn interface.
VP use orientation/trainingNo specific familiarization, but general introduction at the beginning of year 3.
Learning activities around VPsDepending on the modules other learning activities were embedded.
AssessmentThe topics of the VPs were part of modules assessment.
Quality assurance, maintenance, and sustainabilityWe used the built-in feedback functionality to receive qualitative feedback from students and VPs were part of the regular evaluation activities of the medical school.
Phase of the curriculumYear 1 and 2 of medical school
Goal in the curriculumStudents learn basic steps of clinical reasoning such as identifying & prioritizing findings and composing a summary statement. They also can follow the reasoning process of the VP author concerning differential diagnoses, ordered tests, and treatments.
Effective use of resourcesCourse tutors needed time to familiarize themselves with the VPs and time had to be planned during the synchronous meetings to discuss the VPs.
VP alignmentVPs were part of the longitudinal clinical course and aligned with the other modules in year 1 and 2 (In case of Augsburg this was Contact, Movement, and equilibrium). We aligned the key symptoms of the VPs with these modules, so that students worked in parallel on these VPs and the corresponding module.
Time allocation15 VPs over two years / 5 VPs per module.
Group allocationStudents could choose whether to work in groups or individually.
Presence modeStudents could decide when and where to work on the VPs during the period of the module.
Technical IntegrationVPs were integrated into the school's learning management system Moodle via a SingleSignOn interface.
VP use orientation/trainingAt the beginning of year 1 students were introduced into clinical reasoning and how they can train this ability with VPs.
Learning activities around VPsDepending on the key symptoms during the longitudinal clinical course other learning activities were embedded.
AssessmentThe topics of the VPs were part of the clinical longitudinal course assessment.
Quality assurance, maintenance, and sustainabilityWe used the built-in feedback functionality to receive qualitative feedback from students and VPs were part of the regular evaluation activities of the medical school.
Phase of the curriculumBasic sciences/pre-clinical years:
- At Jagiellonian University Medical College in Kraków we have integrated it in the “Introduction to Clinical Sciences” course in 2nd year of medicine.
- At University of Porto in the “Propedeutics/Semiology” course in the 3rd year of medicine.
Goal in the curriculum- To provide the students with an opportunity to challenge their knowledge at home in between classes with an interactive, clinical-oriented task.
- To support learning by linking basic science knowledge with clinical reasoning. Students had the opportunity to practice on undiagnosed cases the skill of differentiating common symptoms, such as dyspnea, abdominal pain, headache.
Effective use of resourcesUse of iCoViP VPs in native language of the students. No extra cost needed.
VP alignment- In Kraków we have selected a few VPs (seven) with common diseases (e.g. pneumonia, pancreatitis, pulmonary embolism) with common symptoms.
- In Porto, VPs are chosen according to the common symptoms to promote clinical reasoning.
Prioritization/relevance- In Kraków the completion of all VPs is mandatory.
- In Porto, VPs are introduced on a voluntary basis and are available on demand.
Relation to other learning activitiesWe used the time students had at home between seminars (Kraków: between on-campus based PBL sessions). VPs were spaced-activated (a new VP appeared biweekly synchronized with changing topics of the PBL seminars that focus on different leading symptoms).
Time allocationAround 30 minutes biweekly, repeated 7 times in a semester. 
Group allocationStudents worked alone at home to reflect but could consult the VPs with their peers or instructors in small groups of the face-to-face PBL seminars.
Presence modeStudents worked on the VPs asynchronously and self-directed at home to have time to reflect and consult textbooks.
Technical IntegrationVPs were integrated with a course to which all students were enrolled on the official university learning management system Moodle using Learning Tools Interoperability (LTI) interface.
VP use orientation/trainingStudents were provided with an introductory email with instructions and had additionally the opportunity to technically practice using CASUS in a parallel “Telemedicine” (Medical informatics) course. Instructors received test-codes to practice the VPs at home.
Technical infrastructureStudents used their own computers from home. An email address was provided to a person responsible for technical support.
Learning activities around VPsStudents were asked to complete concept maps for all VPs they solve. Moreover, in Kraków students were provided with links to additional online articles to help them with topics difficult at this stage of education.
AssessmentStudents were asked to complete the cases prior to the end of the term. They were not given grades for the activity - just credit. Their answers were randomly inspected to see common mistakes and provide general feedback to all students.
Quality assurance, maintenance, and sustainabilityWe checked the diagnostic accuracy of individual cases (and detected one case with imprecise diagnosis). Students evaluated the course using the iCoViP case collection evaluation questionnaire.
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