O5. A Multi-Centre Study Showing the Utility and Flexibility of Virtual Patients to Teach Musculoskeletal Medicine

Abstract

Background: Virtual patients (VPs) are web based representations of realistic clinical cases that can be used to teach medical students musculoskeletal medicine. Whilst they are used in up to one third of US medical schools, evidence to support their integration into undergraduate education remains limited. This research intends to support the adoption of a set of freely available open access VPs to teach medical students in the UK. Methods: This is a multi-centre randomized 2x2 factorial study exploring two independent design variables of VPs in MSK medicine, conducted to an established protocol. Participants were medical students from a year group at three UK medical schools from 2011-12: Warwick (WMS); Birmingham (UBMS); and Keele (KMS). We authored a series of open-access 30 minute long VPs on four clinical topics: large joint arthritis, polyarthritis, multi-system disease and back pain. Each VP had a structured 15-item assessment of clinical reasoning. Each school had different pattern of VP integration and delivery. All students gave informed consent following an introductory talk, video and written participant information. We collected automated case metrics recording performance, patterns of use, and summative assessment data from WMS. Each VP was followed by an established self-reported VP evaluation score (European Virtual Patients Questionnaire). We used a pre-planned statistical analysis. Our institution research committee approved the research. Results: We invited 718 students to participate (WMS 231, UBMS 354, KMS 133). From this 591 consented, completing 1774 VPs, with 296 students completing all four VPs. Students spent a mean of 28.6 min per case (S.D. 13.6). The students returned 1229 complete evaluations (70.8%). Cases were positively evaluated by all three schools with overall scores of 44.9/55 on the EViP for global satisfaction in all four questionnaire domains. Student's performance in the VPs correlated with summative assessment results from WMS. Of the 136 students from WMS who completed all four cases, VP performance scores correlated significantly with a summative written end of year examination (P<0.001, R=0.38), and a 3 station MSK OSCE (P<0.001, R=0.20). These correlations were also significant with all students from WMS who completed 1 or more cases (all P<0.05). Flexibility in timetabling at UBMS was successful, students completed 19.8% of cases at the weekend (147/741, 19.8%), spending significantly more time per VP (35.8 min, P<0.05). They completed 35.1% of cases out of hours 0800-1800 (260/741, 35.1%). Conclusion: These data support the use of VPs, which are positively evaluated by students, and correlate with other written and clinical assessment metrics. These open access cases, validated in three UK medical schools could help students and faculty integrate cases into established MSK teaching sessions either as an additional resource or part of structured teaching. The cases are freely available from the website http:www.go.warwick.ac.uk/msk.