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Objectives: Concept maps are a learning tool that fosters clinical reasoning skills in healthcare education. They can be developed by students in combination with virtual patients to create a visual representation of the clinical reasoning process while solving a case. However, in order to optimize feedback, there is a need to better understand the role of connections between concepts in student-generated maps. Therefore, in this study we investigated whether the quality of these connections is indicative of diagnostic accuracy.Methods: We analyzed 40 concept maps created by fifth-year medical students in the context of four virtual patients with commonly encountered diagnoses. Half of the maps were created by students who made a correct diagnosis on the first attempt; the other half were created by students who made an error in their first diagnosis. The connections in the maps were rated by two reviewers using a relational scoring system. Analysis of covariance was employed to examine the difference in mean connection scores among groups while controlling for the number of connections.Results: There were no differences between the groups in the number of concepts or connections in the maps; however, maps made by students who made a correct first diagnosis had higher scores for the quality of connections than those created by students who made an incorrect first diagnosis (12.13 vs 9.09; p=0.03). We also observed students’ general reluctance to use connections in their concept maps.Conclusion: Our results suggest that the quality, not the quantity, of connections in concept maps is indicative of their diagnostic accuracy.

Aims and objectives: Digital teaching, learning and assessment have been part of medical education and continuing education for decades. The objective of this review paper is to highlight developments and perspectives in these areas in the GMS Journal for Medical Education (GMS JME). Methodology: In the spring of 2020, we conducted a systematic literature search of the Journal for Medical Education (JME) and analysed the articles with regard to different categories such as article type, digital tools used or mode of data collection. Results: Of the 132 articles analysed, 78 were digital interventions (53 of which were exploratory-descriptive), 28 were project descriptions, 16 were surveys of needs or equipment and 10 were concept papers. About one-third of the studies and project reports each dealt with virtual patients or case-based learning, whereas no articles were published on trends such as serious games or virtual reality. Overall, our analysis shows that in many respects, the studies on digital teaching were more broadly based, especially between 2006 and 2010, after which this trend tended to decline again.Conclusions: Our analysis shows that publications in the JME consider some key aspects of digital teaching in medical education and continuing education, such as educational videos or virtual patients. The variability of information and methods of presentation advocate the use of guidelines to optimise the quality of scientific papers. Furthermore, clues for future research topics and experimental study designs are identified.

In Germany, about two thirds of students and doctoral candidates in medicine are female. The proportion is only about 35% for post-doctoral degrees and much lower for many leadership positions at medical schools and on medical education committees. Although reasons for this have long been known, changes are slow in coming. Therefore, with this commentary, we would like to shed light on the current situation regarding gender equality in Germany in medical education and identify and discuss measures. These include, for example, mentoring and networking programs as well as greater consideration of women in committees.

The COVID-19 pandemic posed new global challenges for teaching. We met these challenges as an international collaboration by adapting a collection of virtual patients for clinical reasoning training to this novel context.

The increasingly digitized healthcare system requires new skills from all those involved. In order to impart these competencies, appropriate courses must be developed at educational institutions. In view of the rapid development of new aspects of digitization, this presents a challenge; suitable teaching formats must be developed successively. The establishment of cross-location teaching networks is one way to better meet training needs and to make the necessary spectrum of educational content available. As part of the Medical Informatics Initiative, the HiGHmed consortium is establishing such a teaching network, in the field of medical informatics, which covers many topics related to the digitization of the health care system. Various problem areas in the German education system were identified that hinder the development of the teaching network. These problem areas were prioritized firstly according to the urgency of the solution from the point of view of the HiGHmed consortium and secondly according to existing competencies in the participating societies. A workshop on the four most relevant topics was organized with experts from the German Society for Medical Informatics, Biometry and Epidemiology (GMDS), the Society for Medical Education (GMA) and the HiGHmed consortium. These are:For all subject areas, existing preliminary work was identified on the basis of working questions, and short- and long-term needs for action were formulated. Finally, a need for the redesign of a technologically supported syntactic and semantic interoperability of learning performance recording was identified.

Blended learning is a meaningful combination of online and face-to-face teaching and learning. In this article we summarize relevant aspects of this format and provide ten tips for educators and curriculum developers on implementing a blended learning curriculum in healthcare education. These general tips are derived from our experience and the available literature and cover the planning and implementation process.

Objective: ECG interpretation is prone to errors that can lead to relevant misdiagnoses and incorrect treatment. Prompts are one way in lectures to encourage learning from one’s own mistakes and to reduce error rates. Prompts are measures such as questions, hints, and suggestions of content-related or metacognitive nature, which can lead to self-explanation in the learner and thus to a deeper understanding of an issue. The aim of the study was therefore to investigate whether the use of prompts can reduce the error rate in ECG interpretation among students.Method: In a 2x2 experimental test and control group design, =100 final year medical students carried out ECG interpretation tasks in the form of online case vignettes in CASUS. In these tasks, justification prompts (B) and error analysis prompts (F) were systematically varied in four groups and the learning success was measured using a knowledge test. In addition, prior knowledge in ECG interpretation, motivation, interest in the topic, subjective confidence in ECG interpretation, and cognitive load was collected.Results: Neither error analysis prompts nor justification prompts had a significant effect on the correct ECG interpretation by students, (1,96)=1.03, =.31. Justification prompts seemed to have a positive effect on the confidence of answering the questions, (1,96)=10.15, =.002, =.10; and a negative effect on student motivation, (1,96)=8.13 , =.005, =.08; but both with comparable diagnostic accuracy.Conclusion: The present study could not confirm the positive effects of prompts on the error rate in ECG interpretation reported in the literature but showed significant effects on subjective confidence and motivation which should be investigated in further studies.

Background: Clinical reasoning is a complex skill students have to acquire during their education. For educators it is difficult to explain their reasoning to students, because it is partly an automatic and unconscious process. Virtual Patients (VPs) are used to support the acquisition of clinical reasoning skills in healthcare education. However, until now it remains unclear which features or settings of VPs optimally foster clinical reasoning. Therefore, our aims were to identify key concepts of the clinical reasoning process in a qualitative approach and draw conclusions on how each concept can be enhanced to advance the learning of clinical reasoning with virtual patients. Methods: We chose a grounded theory approach to identify key categories and concepts of learning clinical reasoning and develop a framework. Throughout this process, the emerging codes were discussed with a panel of interdisciplinary experts. In a second step we applied the framework to virtual patients. Results: Based on the data we identified the core category as the "multifactorial nature of learning clinical reasoning". This category is reflected in the following five main categories: Psychological Theories, Patient-centeredness, Context, Learner-centeredness, and Teaching/Assessment. Each category encompasses between four and six related concepts. Conclusions: With our approach we were able to elaborate how key categories and concepts of clinical reasoning can be applied to virtual patients. This includes aspects such as allowing learners to access a large number of VPs with adaptable levels of complexity and feedback or emphasizing dual processing, errors, and uncertainty.

In describing the inverted classroom model (ICM), the following paper is meant to provide an introduction to the subject matter and to serve as a practical guide for those wishing to employ its methods in basic and advanced medical training and education. The ICM is a blended-learning method in which a self-directed learning phase (individual phase) precedes the classroom-instruction phase. During the online phase, factual knowledge is imparted that serves as a basis for the classroom phase. The classroom phase should subsequently be used to assimilate and implement the previously gained knowledge. In contrast, traditional course concepts impart factual knowledge in lectures, for example, or in other face-to-face teaching formats and are followed by the students’ self-instruction in order to assimilate this knowledge. The goal of the ICM is the shift from passive learning to accelerated learning in order to foster learning at cognitively demanding levels such as analysis, synthesis and evaluation. The concurrent increase in production and use of screencasts and educational videos, the Open Educational Resources “movement” and the widespread use of Massive Open Online Courses (MOOCS) have contributed to the increased dissemination of the inverted-classroom method. The intention of the present paper is to provide an introduction to the subject matter and simultaneously to offer a short overview of important projects and research results in the field of medical education and other health professions. Furthermore, an outline is given of the advantages and disadvantages of the model as well as its potential benefit to the future of medical education and training.

Since 2004 a commercial learning management system (LMS) was introduced at the Medical Faculty of LMU. During the following four years the platform was hardly used by staff members and students. Therefore, in 2009 it was replaced by the Open Sorce LMS Moodle. Reasons for this step were a better adaptability of the software and the possibility for teachers to upload their material themselves. Our aim was to enhance acceptance among both students and teachers. During the implementation special emphasis was laid on the integration of Moodle into the existing IT infrastructure of the faculty. After the introduction of Moodle the number of active users increased from 500 to 5,060 (students and teachers). The number of courses raised from 14 to 90 (summer term) and 125 (winter term). Mainly static documents such as scripts and lecture slides have been uploaded, but also a few interactive activities have been provided. The calculated costs for using Moodle added up to about 20 €/user/year. In comparison the commercial system cost about 100 €/user/year because of the low number of users. The high acceptance especially among teachers showed that decision to introduce Moodle was the right step at our faculty. Evaluation results show that despite many improvements users still rate Moodle as not very user friendly. At the end of the summer term we faced technical problems due to an unexpected peak of hits. An ongoing adaption of the platform is necessary to adress these issues. The aim for the coming terms are to support teachers to provide more high quality interactive learning activities.

Medical students often lack the ability to develop strategies for problem solving based on adequate diagnostic and therapeutic measures. Case studies are an appropriate learning as well as examining tool for this purpose. For in-house examinations new computer based examinations are playing an important role, because they permit a chronological approach to clinical cases. At the same time this method allows the use of new question and answer formats. Based on this background CASUS was introduced at the Heinrich-Heine-University of Duesseldorf as a mandatory case and computer-based learning system including an online computer-based exam for the first time in Germany. About 140 students participated in the examination which was held at the university’s computer centre. The introduction of the online examination led to a significant increase in the use of the CASUS study cases during the term. The study cases as well as the online examination were accepted very well among the students. Despite the cost-effective use of this multimedia method and its didactic advantages it currently requires more administrative efforts and is more interference-prone than traditional paper based examinations with multiple choice questions. Problems of justiciability and technological safety have to be solved first before a routine use in summative evaluation of learning. Therefore, at present online examinations can serve for the formative evaluation of learning.

Over the past years the rapid development of computer-based training in medicine has created a multitude of learning units, that are difficult to overview for the learners. We therefore suggest that good search facilities play key role in the curricular integration of e-learning. We will describe the two main strategies for a simple and efficient search in medical learning content: Indexing with selected terminologies and a free-text search. Indexing can overcome the problems with unexpected synonyms while the free text search also exposes detail that are not explicitly annotated by the author. Further we will report about our experiences with the case-based portal CASEPORT and the test item management system IMSm.

In undergraduate medical education virtual patients (VPs) are a suitable method to teach clinical reasoning and support the visualization of this thinking process in a safe environment. The aim of our study was to investigate differences in the clinical reasoning process and diagnostic accuracy of female and male medical students. During the summer term 2020, we provided access to 15 VPs for undergraduate students enrolled in a medical school in Bavaria, Germany. All interactions of the 179 learners within the VP system CASUS were recorded, exported, and analyzed. We found significant differences in the clinical reasoning of female and male learners. Female students documented more findings, differential diagnoses, tests, and treatment options and more often created a summary statement about the VP. Their overall performance was higher than those of their male peers, but we did not see any significant differences in diagnostic accuracy. The significant differences between male and female medical students should be considered when planning teaching and research activities. A future study should investigate whether these differences can also be found in physicians. [ABSTRACT FROM AUTHOR]