EARMA 2001 Presentation

9.00 – 10.30 THEME C:

New ways of international interaction between learners - a possible tool for benchmarking? (Lecture Hall Adam)

Moderator:

Senior Lecturer Jan-Olov Höög, Dept of Medical Biochemistry and Biophysics, KI

The Swedish Learning Lab: New methods in E-learning

Speaker:

Professor Ulf Gyllensten, University of Uppsala, Sweden

Two examples of international student interaction - the ISP-VL and the PharmaPac projects

Speaker:

Dr. Uno Fors, Director, KI Learning Lab, Karolinska Institutet, Sweden

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Benchmarking can mean a number of things, for example a comparison of one student group against another, or a comparison of a result or procedure against some type of standard. In education, the general idea is often to investigate if a certain educational activity or programme meets preset quality goals or standards. This is most often also performed by special benchmarking experts or educational assessment teams, which implies a top-to-bottom approach, where the students seldom are directly involved.

Within the medically related projects in the Swedish LearningLab, we use international interaction between students not only for letting the faculty test if the student’s results can meet a preset standard, but for letting the students to more or less benchmark themselves against their fellow students from other countries, which means a more bottom-to-top approach.

This is done because of a number of reasons. First, it is very hard, if not impossible, to tell that a certain way of diagnosing a patient or treat an illness is better than another. This has led to a great number of differences between different medical programs in different countries. But great differences also exist within countries, like in Sweden, where we know that for example the students are taught different procedures for diagnosis or treatment, depending where they study medicine.

An other reason for this is the fact that the very nature of medicine implies that every new patient is unlike the last, which means that stereotype facts and strict procedures seldom are the best way to solve a medical problem, instead we try to train the problem-solving capacity of our students. One way to do this is to let the students meet as many medical problems (cases) as possible another way is to let both the faculty and the students understand that there are more than one good way to solve a problem.

The two projects that I will describe in a minute, will show how this is done in the fields of medical diagnosis and pharmacological therapy.

The ISP-VL project…

A central issue in the learning process in medicine is how to learn not only facts and data, but also to learn how to deal with new problems and tasks, something that might be described as "soft" or “tacit” knowledge. This Swedish Learning Lab project is using the clinical learning situation of health care professionals as the model for exploration of the possibilities of virtual meeting spaces and computer assisted collaboration as a tool for facilitating our type of benchmarking needs.

The ISP-VL experiment deals with real time simulated patients, trans-Atlantic virtual collaboration spaces and high-speed networking, incorporating all three Swedish LearningLab universities (KI, KTH, UU) and also Stanford University School of Medicine.

The project is designed for a collaborative student activity, in which the student is "in charge" of defining and finding adequate knowledge. There is furthermore an ambition of getting the students emotionally involved as an emotionally based learning has a high degree of retention.

The students interact using real-time video conferencing at the same time as they are working with a computer based simulated patient case. By means of this set-up, they can discuss and work through a case together with student colleagues anywhere in the world. In our case, from three different universities at Karolinska Institute and Uppsala University in Sweden and at Stanford University in the USA.

After finishing the pilot course in April this year, the thoughts of the students from KI, Uppsala and Stanford, were very positive. Most of the students reported that they would like more courses and collaboration tools like this in the future. They also said that it was interesting and stimulating to work with problem solving around patient case problems with student fellows at other universities. Although some students reported that it was a little confusing to try to solve a patient case together with international student colleagues, most of them said that they liked the possibility to see and discuss different approaches to medical problem solving.

The faculty involved was also positive to the pilot course, and reported that it was interesting to see how the different groups of students worked with the case problems using different strategies, but still could collaborate.

A new course with more students and with more elaborated collaboration tools will be used in the fall 2001 and the final full-scale course will be held in spring 2002.

PharmaPac…

This SweLL project is a joint effort of Karolinska Institutet and Stanford University. In this project, is also the Janus Telepharmacology project, Umeå University and SUMMIT, School of Medicine, Stanford University participating.

The background is this: With drug costs rising, the advances in drug development and information technology, and the increased marketing efforts of the pharmaceutical companies, it is imperative that students are exposed to the reasoning process in patient treatment, and that they experience a high level of teaching in clinical pharmacology that is firmly grounded in the adherence to scientific principles and to the concepts of evidence based medicine. Along with the increased knowledge demands, students need to become global in their approaches to assessing and treating patients.

To deal with this, we have created a teaching system in Pharmacology and Clinical Pharmacology that is based on clinical problems and presented as WEB-based interactive patient-cases. Each case is linked to several sites, providing additional information about the patient. This approach was tested in a two-week clinical clerkship pilot, that run between April 9th - 20th.

The general aims of the course are:

To increase the rational use of drugs

To understand the concept of individualized pharmacotherapy

To evaluate and anticipate drug interactions and adverse effects

To increase the awareness of international differences in drug therapy guidelines

The Swedish group, six medical students and one professor, were on the Stanford campus April 8-13 collaborating with a group of six Stanford students and one professor on medical cases with an emphasis on clinical pharmacology. The cases varied widely, from questions of what type of anesthesia to prescribe before operating on a badly sprained ankle, to the proper response to certain lung disorders. This initial week was followed by a week where the Swedish students were back home, chatting online with their Stanford teammates at designated times to discuss and resolve cases before review by their respective instructors.

Besides learning more about pharmacology, the project also highlighted the differences and similarities in pharmacological approaches between the two countries. One of the major differences revealed involves the treatment of infectious diseases. Swedish tradition has been to narrow the use of different antibiotics, even though they are available, the first-line treatment for upper airway infection is still penicillin-based. Because of this policy the number of resistant strains in Sweden is quite low, whereas the United States has seen the development of more resistant strains and other infections as well.

Another item discussed by the students and the faculty is that first-line treatment for asthma also included some differences; the Swedes primarily use a powder inhaler instead of an aerosol inhaler.

Within most of the cases presented during the course, students reported only minor differences in approach, suggesting that access to the same journals and resources has caused the world of pharmacology to shrink. "There aren't very important differences in the treatments," said a Swedish student, "but when you find a difference, it really stimulates you to look for why."

The next step in this project is to perform more full-scale courses during the fall this year.

Uno Fors