1. Towards The Development of a Gold Standard for Authoring, Introducing and Sustaining Virtual Patients in Multi-campus Clinical Education Environments Vassiliou et al

2. Context of the study Karolinska Institutet, Medical programme Preparation for clinical rotations Four hospitals, 30-35 students/hospital

4. Participants All course directors All clinical assistants Learning technologists/expertise on VP- systems

5. How to introduce and maintain the use of VPs: Aim

6. Readiness phase Disease & Illness (7 weeks) End of 2nd year Medical imaging Anatomy Microbiology/ Bacteriology Pathology Immunology Pharmacology Clinical chemistry Physiology Clinical examination CLINICAL PRACTICE

7. Choice of VP system

8. Initiation phase Teachers from all four teaching hospitals meet November 2007 – agree on using the system Project presented to departments of subjects to be integrated (microbiology, pharmacology etc) Need for healthy template around which all cases will be created – first version ready April 2008

9. Initiation phase – healthy template An extensive selection of laboratory and imaging diagnostics: Clinical chemistry Immunology Transfusion medicine Hereditary metabolic diseases Bacteriology/Virology Biopsies for cytopathology Common endoscopic procedures Radiologic imaging techiques Clinical physiology Neurophysiology Bedside testing

10. Introduction phase All four hospitals assigned the creation of a case Autumn 2008; two cases (Chrohn’s disease and multiple myeloma) Spring 2009; four cases Spring 2010; six cases

11. Maintenance phase Clininal assistants responsible for introducing students to the VPs and creating new cases. Teacher turnover: one to four terms Challenge: introducing new teachers in four different hospitals, editing existing cases, creating new cases, improving the healthy template

12. Maintenance phase First consensus: September 2009; teachers accept editing of their VP by peers. Case format altered: both the original authors and those having revised the case will be evident to the student working with the case. New teachers are encouraged to improve the cases they “inherit” since their contribution can be tracked. Incentive for all teachers to create cases as their legacy will still be alive and cared for long after they had left the course.

13. Maintenance phase The role of the learning technologist re- assessed Even though the Web-SP system does not require extensive computer skills, an introduction is needed before the new teachers start using it and the learning technician is involved right from the start to prevent unnecessary problems.

14. Discussion Regular meetings Support by learning technican, particularly in creating the healthy platform, acting as a link between users and software developers Cases should be created by clinical teachers – and revised by teachers Author contribution, as well as editing, should be evident when working with a case – as an incentive to create and improve VP cases

15. Conclusions It is crucial for the continued use of VPs that issues of authoring and sustainability are addressed at an early stage. The aim of the proposed model is to systematically ensure that all issues are addressed in a timely fashion so that the teaching team feel shared ownership and responsibility for the VPs. Nov 2007 Teacher consensus on using VPs Introducing the system to other departments Apr 2008 First healthy template Autumn 2008 Spring 2009 Spring 2010 Two VP cases Four VP cases Six VP cases Sept 2009 Maintenance plan

16. Collaborators Course directors: Olle Broström, Christer Sylvén, Peter Henriksson, Magnus Sköld, Thomas Nyström Clinical assistants: Katarina Arnrup, Eva Sjöblom, Caroline Holmin, Mini Ruiz, Marie Evans, Eli Westerlund, Jonas Spaak, Kristina Hagwall, Stephanie Mindus, Åsa Derolf, Mohana Alawi, Karolina Nowinski, Daniel Richter, Hanna Lenhoff Members of VP core facility: Nabil Zary, Ronny Sejersen, Uno Fors, Samuel Edelbring Course administrators, clinical teachers in Physiology, Chemistry, Radiology