Search

There is a need for culturally competent health care providers (HCPs) to provide care to deaf signers, who are members of a linguistic and cultural minority group. Many deaf signers have lower health literacy levels due to deprivation of incidental learning opportunities and inaccessibility of health-related materials, increasing their risk for poorer health outcomes. Communication barriers arise because HCPs are ill-prepared to serve this population, with deaf signers reporting poor-quality interactions. This has translated to errors in diagnosis, patient nonadherence, and ineffective health information, resulting in mistrust of the health care system and reluctance to seek treatment. Sign language interpreters have often not received in-depth medical training, compounding the dynamic process of medical interpreting. HCPs should thus become more culturally competent, empowering them to provide cultural- and language-concordant services to deaf signers. HCPs who received training in cultural competency showed increased knowledge and confidence in interacting with deaf signers. Similarly, deaf signers reported more positive experiences when interacting with medically certified interpreters, HCPs with sign language skills, and practitioners who made an effort to improve communication. However, cultural competency programs within health care education remain inconsistent. Caring for deaf signers requires complex, integrated competencies that need explicit attention and practice repeatedly in realistic, authentic learning tasks ordered from simple to complex. Attention to the needs of deaf signers can start early in the curriculum, using examples of deaf signers in lectures and case discussions, followed by explicit discussions of Deaf cultural norms and the potential risks of low written and spoken language literacy. Students can subsequently engage in role plays with each other or representatives of the local signing deaf community. This would likely ensure that future HCPs are equipped with the knowledge and skills necessary to provide appropriate care and ensure equitable health care access for deaf signers.

Objectives: This study examined trainer perceptions of simulation-based learning for Continuing Professional Development in international settings.Methods: A qualitative research methodology was used to gain insight into trainer perceptions. Seventeen international physician trainers involved in simulation training in cardiovascular catheterization and intervention were interviewed. An inductive thematic analysis was performed following steps described by Braun and Clarke; researchers inductively approached, and then carefully dissected the transcripts into individual stories, grounded the problems, and explored themes.Results: Trainer perceptions are largely aligned with learning theories, even though they were not specifically educated in simulation-based learning and program design principles in advance. Trainers perceive their primary role as facilitators to be most important and consider structuring sessions, facilitating group learning, and stimulating reflection to be crucial themes in simulation-based learning. They believe that building trust is an underlying principle to function in their role and feel responsible for being prepared to improve trainee satisfaction as adult learners. Trainers believe that learning from making mistakes is an important mechanism in simulation-based learning, but they give less attention to giving feedback.Conclusions: Trainers with basic training in facilitation skills in a classroom may unconsciously follow teacher-student instructional models with which they are familiar. This study confirms that trainers in simulation-based learning need pedagogical and facilitating skills to guide trainees and facilitate group processes. Educational training for trainers should include building trust and giving feedback in a more explicit place. In future studies, a mixed-method methodology is suggested to evaluate multi-layered complexities of educational practices.

Introduction: There are certain factors in exam preparedness that are not well studied in the postgraduate medical education context. Non-academic predictors have been extensively researched but usually in isolation. Methods: The study involved a sequential explanatory mixed methods research design. The study was conducted among anaesthesia postgraduates appearing for high-stake nation-wide primary examination. Data obtained by a questionnaire assessing pre-examination attributes were compared with the students’ reflections through focus group discussions (FGD) after the formal declaration of results. The examination had an overall pass rate of 42.9% (18 out of 42). Results: The study showed that pre-examination questionnaire could identify attributes and study behaviours in the postgraduates who passed. Passers procrastinated three times lesser, pursuing a timetable-based study (conscientiousness); had higher metacognitive self-regulation (p value

BackgroundPalliative care is gaining importance within the physician’s range of duties. In the undergraduate medical curriculum, education on the four dimensions of care is insufficient. The spiritual dimension is hardly addressed. Therefore, we developed a coherent set of learning tasks targeted at learning to communicate about the spiritual dimension. The learning tasks are based on educational principles of authentic learning, reflective learning and longitudinal integration in the curriculum. This article reports on the feasibility of using these learning tasks in the medical curricula.MethodsTeachers and educational scientists were interviewed and students were asked to evaluate the learning tasks in focus groups. Interview transcripts were analysed by three independent researchers.ResultsThe learning tasks encourage the students to reflect on the four dimensions of palliative care and their personal values. Learning was clearly organised around authentic learning tasks relevant to the later profession, using paper, video cases, as well as simulations and real patients. Participants suggest giving more attention to cultural diversity. As palliative care is an emotionally charged subject, the safety of both student and patient should be guaranteed. All participants indicated that the program should start in the bachelor phase and most agreed that it should be integrated vertically and horizontally throughout the undergraduate program, although there is some debate about the optimal moment to start.ConclusionThe tasks, are authentic, encourage the students to reflect on the spiritual dimension of palliative care and are suitable for integration in the undergraduate medical curriculum.

Introduction While the popularity of international care is rising, the complexity of international care compromises patient safety. To identify risks and propose solutions to improve international care, this study explores experiences of healthcare workers with international handovers in a European border region. Methods A cross-sectional survey design was used to reach out to 3000 healthcare workers, working for hospitals or emergency services in three neighboring countries in the Meuse-Rhine Euregion. In total, 846 healthcare workers completed the survey with 35 closed- and open-ended questions about experiences with international patient handover. Results One-third of respondents had been involved in international handover in the previous month. The handovers occurred in planned and acute care settings and were supported by numerous, yet varying standardized procedures. Healthcare workers were trained for this in some, but not all settings. Respondents mentioned 408 risks and proposed 373 solutions, which were inductively analyzed. Six identified themes classify the level on which risks and accompanying solutions can be found: awareness, professional competencies, communication between professionals, loss of information, facilities and support, and organizational structure. Discussion This study gives insight in international patient handovers in a European border region. Among the biggest risks experienced are procedural differences, sharing patient information, unfamiliarity with foreign healthcare systems, and not knowing roles and responsibilities of peers working across the border. Standardization of procedures, harmonization of systems, and the possibility for healthcare workers to get to know each other will contribute to reach common ground and move towards optimized and patient-safer cross-border care.

BackgroundCross-border healthcare is complex, increasingly frequent and causes potential risks for patient safety. In this context, cross-border handovers or the transfer of patients from one country to another deserves particular attention. Although general handover has been the topic of extensive research, little is known about the challenges of handover across national borders, especially as perceived by stakeholders. In this study, we aimed to gain insight into healthcare professionals’ perspectives on cross-border handover and ways to support this.MethodsWe conducted semistructured interviews with healthcare professionals (physicians, nurses, paramedics and administrative staff) in a European border region to investigate their perspectives on cross-border handover. The interviews were aimed to investigate settings of acute and planned handover. Informed by the theory of planned behaviour (TPB), interviews focused on participant perspectives. We summarised all interviews and inductively identified healthcare professionals’ perspectives. We used elements of the TPB as sensitising concepts.ResultsForty-three healthcare professionals participated. Although respondents had neutral to positive attitudes, they often did not know very well what was expected of them or what influence they could have on improving cross-border handover. Challenges covered five themes: information transfer, language barriers, task division and education, policy and financial structures and cultural differences. To overcome these challenges, we proposed strategies such as providing tools and protocols, discussing and formalising collaboration, and organising opportunities to meet and get to know each other.ConclusionHealthcare professionals involved in cross-border handovers face specific challenges. It is necessary to take measures to come to a shared understanding while paying special attention to the above-mentioned challenges. Meeting in person around meaningful activities (eg, training and case discussions) can facilitate sharing ideas and community building.

SUMMARY Currently, higher education institutes are urged to adapt their education programmes rapidly to online courses. This toolbox article provides recommendations for optimising collaborative learning in online courses from the perspective of course design, and the roles of teachers and students, all illustrated in our example. With regards to course design, it is recommended to construct learning tasks for which students need to collaborate to reach a shared goal, use collaboration scripts to structure activities and communication, manage expectations about collaboration, provide room for discussion about the team process, facilitate autonomy and use existing communication tools. The presence of teachers online is essential, to provide feedback on the content and to guide team processes. Finally, students are recommended to get to know fellow students, to create a positive atmosphere and to reflect on the collaboration. We conclude that online collaborative learning can work well, but requires a balance between course structure and autonomy, and needs active monitoring during implementation. If this is done, it is perfectly possible to engage students and teachers, to support deep learning and to develop collaboration skills.

ABSTR A C T Objective: To improve our understanding of patients' needs in cross-border healthcare, with a specific focus on handover. Methods: In this qualitative study, we conducted narrative interviews with 8 patients who had experienced cross-border healthcare, including handover. Based on an inductive analysis, we crafted stories representing participants' perspectives. Crafted stories attend to the personal character of patients' experiences. Results: We crafted 3 stories relating patients' cross-border healthcare pathways. We identified 3 recurring issues in these stories: (1) Patient involvement in the decision-making process regarding their healthcare; (2) Communication with their healthcare providers; and (3) Information throughout the healthcare process. Conclusion: The said issues, albeit no novelty in healthcare, seem to be amplified by cross-border barriers, such as system, language, and cultural differences. To empower patients to be involved in their own healthcare process, these issues should become a topic of conversation between patients and healthcare professionals. Practice implications: The patient stories in this article could help raise awareness among professionals and patients about the issues patients face in cross-border healthcare. Awareness is a first step in overcoming these issues. (c) 2021 The Authors. Published by Elsevier B.V.

The study aims to find the factors hindering the implementation of surgical site infection control guidelines in the operating rooms of low-income countries. The design of the study is a mixed-method sequential explanatory study. The setting is Shifa International Hospital and Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Participants are health care workers. A questionnaire and structured key informant interviews probed the perspectives and perceptions of different stakeholders regarding the factors which hinder the implementation of surgical site infection control guidelines. Two-hundred fifty-two health care workers took part in the survey. The response rate was 90%. The majority of the participants was based in private teaching hospitals (63.9%) and 36.1% in the public sector teaching hospitals. The factors of surveillance, knowledge, education, and culture had low scores. Qualitative data analysis revealed the hindering factors in the implementation of surgical site infection control guidelines in the operating rooms of low-income country. The important one are lack of a surveillance system, education, and culture of infection control. This study identified hindering factors regarding implementation of surgical site infection control guidelines in the operating rooms at the institutional and individual level involved in patient care. The identification of these hindering factors may help politicians, policy makers, and institutions to identify the strategies for overcoming these hindering factors. Education is the key factor for success. By offering training to health care workers, we significantly contribute to decrease the incidence of SSIs in the low-income country.

PurposeTo analyze educators' experiences of facilitating cultural discussions in two global health professions education programs and what these experiences had taught them about critical consciousness.MethodA multicultural research team conducted in-depth interviews with 16 faculty who had extensive experience facilitating cultural discussions. They analyzed transcripts of the interviews thematically, drawing sensitizing insights from Gramsci's theory of cultural hegemony. Collaboration and conversation helped the team self-consciously examine their positions toward the data set and be critically reflexive.ResultsParticipant faculty used their prior experience facilitating cultural discussions to create a "safe space" in which learners could develop critical consciousness. During multicultural interactions they recognized and explicitly addressed issues related to power differentials, racism, implicit bias, and gender bias. They noted the need to be "facile in attending to pain" as learners brought up traumatic experiences and other sensitive issues including racism and the impact of power dynamics. They built relationships with learners by juxtaposing and exploring the sometimes-conflicting norms of different cultures. Participants were reflective about their own understanding and tendency to be biased. They aimed to break free of such biases while role modeling how to have the courage to speak up.ConclusionsExperience had given facilitators in multicultural programs an understanding of their responsibility to promote critical consciousness and social justice. How faculty without prior experience or expertise could develop those values and skills is a topic for future research.

The aim of this study is to compare the role of the tutor in an online and a face‐to‐face problem‐based learning (PBL) session to shed light on potential differences of the tutor role in both settings. In this practice‐based study we compared the two groups with the same tutor undertaking the same module. Students completed questionnaires about tutor performance, student characteristics and the module. Marks on the end‐of‐module test were analysed. The tutor was interviewed about his expectations and experiences. One session of each group was recorded and analysed qualitatively. Results show tutor tasks appeared to be comparable in both settings with regard to “content and pedagogical content knowledge,” “group dynamics,” “process instruction” and “intermediary between faculty and students.” The face‐to‐face group rated tutor performance lower than the online students. Students and tutor identified the absence of nonverbal cues as a limitation of online PBL. In online sessions the tutor additionally provided technical support and moderated the chat box. It is recommended to involve an extra person in online sessions who is responsible for technical issues. This person could also check the chat box for messages of students. Future research should focus on the necessity of an extra tutor training for online sessions. [ABSTRACT FROM AUTHOR]

Background The need for palliative care is increasing. Since almost every junior doctor will come across palliative care patients, it is important to include palliative care in the undergraduate curriculum. The objective of this research is to gather undergraduate students’ views on palliative care in terms of its importance, their confidence in and knowledge of the domain. Methods Final-year medical students at four Dutch medical faculties were surveyed. The questionnaire measured their views on the education they had received, their self-reported confidence in dealing with palliative care patients and their knowledge of palliative care. Results Two hundred twenty-two medical students participated in this study. Students considered palliative care education relevant, especially training in patient-oriented care and communication with the patient. Students felt that several topics were inadequately covered in the curriculum. Overall, the students did not feel confident in providing palliative care (59.6%), especially in dealing with the spiritual aspect of palliative care (77%). The knowledge test shows that only 48% of the students answered more than half of the questions correctly. Conclusion The students in this study are nearly junior doctors who will soon have to care for palliative patients. Although they think that palliative care is important, in their opinion the curriculum did not cover many important aspects, a perception that is also in line with their lack of confidence and knowledge in this domain. Therefore, it is important to improve palliative care education in the medical curriculum.

Item does not contain fulltext

Jamiu O Busari,1,2 Huriye Yaldiz,3 Daniëlle Verstegen4 1Pediatric Residency Program, Department of Pediatrics, Zuyderland Medical Center, Heerlen, the Netherlands; 2Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands; 3Faculty of Medicine, Radboud University, Nijmegen, the Netherlands; 4Health Professions Education Program, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands Background: Previous research has shown that medical residents are in need of additional training in management and leadership skills. One of the possible ways of teaching this competency is the use of a serious game. This study explores residents’ views of the potential use of a serious game to teach a module on negotiation in practice management and leadership curriculum. Method: The aim of this study was to identify the features required to design a serious game for management and leadership education, including potential scenarios for such a game. Qualitative interviews were conducted with six medical residents. After transcription and coding of data, thematic analysis was used to group the data into four themes, namely: 1) CanMEDS leader competency, 2) personal views about negotiation, 3) views about serious games, and 4) educational needs in a serious game. Results: Our findings revealed that leadership and negotiation were two domains where residents felt they needed additional training. Those who were already familiar with medical applications and had them installed on their smartphones or tablets had a more positive attitude toward gaming than those who did not. The residents were mostly interested in how realistic the content of a serious game was and its ability to combine management and leadership skills with medical knowledge and clinical expertise. Conclusions: The findings in this study demonstrate that serious games have the potential to teach certain aspects of management and leadership. The study shows that residents are receptive to the use of serious games and, if well designed, believe that it can be used to improve their management and leadership competencies. Keywords: serious games, postgraduate medical education, medical residents, management, leadership

This case-study compared traditional, face-to-face classroom-based teaching with asynchronous online learning and teaching methods in two sets of students undertaking a problem-based learning module in the multilevel and exploratory factor analysis of longitudinal data as part of a Masters degree in Public Health at Maastricht University. Students were allocated to one of the two study variants on the basis of their enrolment status as full-time or part-time students. Full-time students (n = 11) followed the classroom-based variant and part-time students (n = 12) followed the online asynchronous variant which included video recorded lectures and a series of asynchronous online group or individual SPSS activities with synchronous tutor feedback. A validated student motivation questionnaire was administered to both groups of students at the start of the study and a second questionnaire was administered at the end of the module. This elicited data about student satisfaction with the module content, teaching and learning methods, and tutor feedback. The module coordinator and problem-based learning tutor were also interviewed about their experience of delivering the experimental online variant and asked to evaluate its success in relation to student attainment of the module's learning outcomes. Student examination results were also compared between the two groups. Asynchronous online teaching and learning methods proved to be an acceptable alternative to classroom-based teaching for both students and staff. Educational outcomes were similar for both groups, but importantly, there was no evidence that the asynchronous online delivery of module content disadvantaged part-time students in comparison to their full-time counterparts.

Introduction: Maastricht University has been actively exploring blended learning approaches to PBL in Health Master Programs. Key principles of PBL are, learning should be constructive, self-directed, collaborative, and contextual. The purpose is to explore whether these principles are applicable in blended learning.Methods: The programs, Master of Health Services Innovation (case 1), Master Programme in Global Health (case 2), and the Master of Health Professions Education (case 3), used a Virtual Learning Environment for exchanging material and were independently analyzed. Quantitative data were collected for cases 1 and 2. Simple descriptive analyses such as frequencies were performed. Qualitative data for cases 1 and 3 were collected via (focus group) interviews.Results: All PBL principles could be recognized in case 1. Case 2 seemed to be more project-based. In case 3, collaboration between students was not possible because of a difference in time-zones. Important educational aspects: agreement on rules for (online) sessions; visual contact (student-student and student-teacher), and frequent feedback.Conclusion: PBL in a blended learning format is perceived to be an effective strategy. The four principles of PBL can be unified in PBL with a blended learning format, although the extent to which each principle can be implemented can differ.

Cross-cultural education is thought to develop critical consciousness of how unequal distributions of power and privilege affect people’s health. Learners in different sociopolitical settings can join together in developing critical consciousness – awareness of power and privilege dynamics in society – by means of communication technology. The aim of this research was to define strengths and limitations of existing cross-cultural discussions in generating critical consciousness. The setting was the FAIMER international fellowship program for mid-career interdisciplinary health faculty, whose goal is to foster global advancement of health professions education. Fellows take part in participant-led, online, written, task-focused discussions on topics like professionalism, community health, and leadership. We reflexively identified text that brought sociopolitical topics into the online environment during the years 2011 and 2012 and used a discourse analysis toolset to make our content analysis relevant to critical consciousness. While references to participants’ cultures and backgrounds were infrequent, narratives of political-, gender-, religion-, and other culture-related topics did emerge. When participants gave accounts of their experiences and exchanged cross-cultural stories, they were more likely to develop ad hoc networks to support one another in facing those issues than explore issues relating to the development of critical consciousness. We suggest that cross-cultural discussions need to be facilitated actively to transform learners’ frames of reference, create critical consciousness, and develop cultural competence. Further research is needed into how to provide a safe environment for such learning and provide faculty development for the skills needed to facilitate these exchanges.

Item does not contain fulltext OBJECTIVES: To obtain the views of vascular surgeons about online resources in their specialty as a guide to future e-learning development. DESIGN: A focused questionnaire regarding e-learning resources in vascular surgery was circulated online. A combination of structured and open-ended questions addressed users' ranking of various resource types, examples of presently used websites, suggestions for future growth, and the opportunity to become actively involved in e-learning development. The responses were collected over a 4-week period and remained anonymous. SETTING: The study was conducted online at http://www.vasculareducation.com as part of an ongoing project on e-learning for vascular surgeons by the Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. PARTICIPANTS: The survey population consisted of vascular surgeons and surgical trainees in Europe. The participants were contacted via their membership of the European Society for Vascular Surgery and national academic or administrative vascular surgical organizations. Demographic information was collected about clinical seniority and country of work. RESULTS: In all, 252 responses were obtained. Respondents favored the development of a variety of online resources in vascular surgery. The strongest demand was for illustrations and videos of surgical techniques, followed by an interactive calendar and peer-reviewed multiple-choice questions. Overall, 46% of respondents wished to contribute actively toward e-learning development, with consultants being more willing than trainees to do so. CONCLUSIONS: Members of the vascular surgical community value online resources in their specialty, especially for procedural techniques. Vascular surgeons would like to be actively involved in subsequent development of e-learning resources. 01 juli 2012

Designing specifications for technically advanced instructional products, such as e-learning, simulations or simulators requires different kinds of expertise. The SLIM method proposes to involve all stakeholders from the beginning in a series of workshops under the guidance of experienced instructional designers. These instructional designers ensure that specifications are designed in a systematic, iterative, way based on instructional design and development models. The workshop participants, however, bring in all the necessary information and they take all the decisions. The SLIM method is geared towards the first phase of the instructional design process: designing a needs statement in the form of a first set of global user requirements. It has been used in eight case studies. The results of these case studies have led to improvements to the method and suggestions for further research.

This paper describes a MOOC about PBL which is designed –as far as possible in the setting of a MOOC- in line with modern learning principles that are also at the basis of PBL: constructive, contextual, collaborative and self-directed learning: Problem-Based Learning: Principles and design. Students at the centre! The course is centred around a set of authentic ‘problems’ organized in three different tracks (tutoring, designing, and implementing PBL) targeted at different types of participants. Small group work is essential in this MOOC. Students can either form teams themselves or be assigned to a team automatically. Each team has team space with chat facilities, file exchange, and facilities to schedule online meetings. However, teams can decide themselves how they want to collaborate and communicate, synchronously or asynchronously. A pilot study brought forward strong and weak points, which were used to further improve the design. This paper describes the pilot study, the changes made in the design and some first impressions of the first run of the MOOC. Preliminary conclusions are that MOOCs require careful instructional design. Stimulating online small group learning in a MOOC, i.e. following PBL learning principles to an extent but without tutors for each team, is possible, but not easy.

Instructional design is not a linear process: designers have to weigh the advantages and disadvantages of alternative solutions, taking into account different kinds of conflicting and changing constraints. To make sure that they eventually choose the most optimal one, they have to keep on collecting information, reconsidering continuously whether their own decisions are still justified in the light of the latest insights. We have studied the role of iteration during instructional design. For our research, we have used an ISD-based method for the specification of training simulators. During our empirical evaluation study, we introduced five events that are likely to cause iteration. The results show that the quality of the designs is not directly related to the amount of iteration. We conclude that there are different kinds of iteration, triggered by different kinds of actions and events. We propose a list of triggers for iteration some of which originate from outside (new information, new opinions/arguments and acquisition procedures); others are caused by, or evolve from interaction with the design process itself (discovery of missing input, need to repair errors, new insights based on work later on in the design process, and new ideas of the designers).

Communities of Learning (CoL) kunnen het leerproces van deelnemers aan onlineleermodules bevorderen. Eerder onderzoek heeft echter nauwelijks aandacht besteed aan de invloed van hiërarchische posities binnen CoL op collaboratieve leerprocessen. In het proefschrift van Martin Rehm (2013) is op deze tekortkoming ingegaan. Rehm onderzocht in een aantal empirische studies de invloed van hiërarchische posities op de bijdragen aan discussies binnen CoL. Deze studies richtten zich op 25 CoL, die opgezet waren als onderdeel van postacademisch onderwijs. In totaal waren 249 medewerkers van een internationale organisatie met verschillende hiërarchische posities bij het onderzoek betrokken. Het doel van de CoL was om samenwerkend leren te bevorderen door discussieplatforms aan te bieden. De resultaten tonen duidelijk aan dat hoe hoger de hiërarchische positie is van deelnemers, hoe groter hun sociale en cognitieve communicatie, en hoe centraler hun positie binnen CoL. Daarnaast heeft Rehm ook een subgroep van ‘ Stars’ geïdentificeerd, die - ongeacht hun hiërarchische positie - hun collega’s overtroffen en in het centrum van hun CoL stonden. Uitgaande van deze bevindingen, heeft Rehm een aantal strategieën voor CoL geformuleerd die de leerprocessen en leerresultaten van alle deelnemers kunnen bevorderen.

Smartphones and Mobile Clinical Decision Support Systems (MCDSS) could help to overcome information overload and support physicians in providing up-to-date medical care. However, would smartphones and MCDSS also be useful for medical students during their clinical clerkships? In this prospective pilot study eight students were asked to use a smartphone during their daily clerkship activities and specifically to evaluate a basic MCDSS. Students were asked to fill out a short survey and exit interviews were conducted. Most students found the smartphone, especially access to the internet, a useful tool during their clerkship. Some students thought that the internet was an easier accessible information source compared to many applications. Several students were not aware of any high-quality applications and most students were not willing to pay more than ten Euros for such an application. In the opinion of most students smartphones should not be used in the presence of a patient. Students expressed a desire for more basic content in the tested MCDSS. In conclusion, smartphones can be a useful tool for medical students during their clerkship. MCDSS for medical students should be designed to their needs. Further research is needed to guide MCDSS development specifically targeted at medical students.

Blended learning in which online education is combined with face-to-face education is especially useful for (future) health care professionals who need to keep up-to-date. Blended learning can make learning more efficient, for instance by removing barriers of time and distance. In the past distance-based learning activities have often been associated with traditional delivery-based methods, individual learning and limited contact. The central question in this paper is: can blended learning be active and collaborative? Three cases of blended, active and collaborative learning are presented. In case 1 a virtual classroom is used to realize online problem-based learning (PBL). In case 2 PBL cases are presented in Second Life, a 3D immersive virtual world. In case 3 discussion forums, blogs and wikis were used. In all cases face-to-face meetings were also organized. Evaluation results of the three cases clearly show that active, collaborative learning at a distance is possible. Blended learning enables the use of novel instructional methods and student-centred education. The three cases employ different educational methods, thus illustrating diverse possibilities and a variety of learning activities in blended learning. Interaction and communication rules, the role of the teacher, careful selection of collaboration tools and technical preparation should be considered when designing and implementing blended learning.