Improving Student Improving Student Learning Through a Case-Learning Through a Case-Based Virtual Healthcare Based Virtual Healthcare Education Resource: A Education Resource: A Three Campus ProjectThree Campus Project

Jaishree Jagirdar, M.D. and Kristin Jaishree Jagirdar, M.D. and Kristin Fiebelkorn, M.D.Fiebelkorn, M.D.

Co-Principal Investigators Co-Principal Investigators

Department of PathologyDepartment of Pathology

Work in Progress

                        

                     

How it all began…How it all began…

• Virtual slideVirtual slide

• Virtual Information System (VIS) for Virtual Information System (VIS) for training training medical medical students grewstudents grew

• Imagine VIS as an enormous Imagine VIS as an enormous Wikipedia of virtual patient Wikipedia of virtual patient information which could be accessed information which could be accessed by any faculty member in by any faculty member in any schoolany school and individually by students from and individually by students from home home

How it all began…contd.How it all began…contd.• What better way to present this than a case based (patient centered) What better way to present this than a case based (patient centered)

format complete with progress notes and virtual tests used to diagnose format complete with progress notes and virtual tests used to diagnose patients diseases in an easily accessible interactive web databasepatients diseases in an easily accessible interactive web database

• The idea was that VIS would be valuable to The idea was that VIS would be valuable to allall faculty and would faculty and would encourage anencourage an interdisciplinary interdisciplinary approach to studying health care ― the approach to studying health care ― the preferred model of practice.preferred model of practice.

• For example, diabetes is a major issue in South Texas. Patient cases For example, diabetes is a major issue in South Texas. Patient cases related to related to diabetes diabetes and it’s ramifications could be used to specifically and it’s ramifications could be used to specifically target and enhance learning for graduate student researchers, dental target and enhance learning for graduate student researchers, dental students, dental hygienists, medical students, nursing students and students, dental hygienists, medical students, nursing students and others.” others.”

• Cost containment, ethical issues, end of life care, and competenciesCost containment, ethical issues, end of life care, and competencies

•To implement all this To implement all this needs money and needs money and manowermanower

Quality Enhancement Quality Enhancement ProcessProcess

• All Universities in Texas for the first All Universities in Texas for the first time are required to have a QEP as time are required to have a QEP as part of the part of the accreditation processaccreditation process by by the Southern Association of Colleges the Southern Association of Colleges and Schools (SACS), the regional and Schools (SACS), the regional accrediting agency operating under accrediting agency operating under the auspices of the Department of the auspices of the Department of Education. Education.

How it all began..contd..How it all began..contd..

• Academic Center for Excellence in Academic Center for Excellence in Teaching, put out a request for Teaching, put out a request for education project proposals for the education project proposals for the QEP. QEP.

• Our proposal was considered Our proposal was considered outstanding by stakeholders outstanding by stakeholders including the leaders of the Student including the leaders of the Student Government Association, the Faculty Government Association, the Faculty Senate and the Executive Committee Senate and the Executive Committee who reviewed it. who reviewed it.

GoalsGoals• ModularModular• ReliableReliable• ScalableScalable• SimpleSimple• ExtensibleExtensible• Seamless integration of different media Seamless integration of different media

and and different different learning object repositories learning object repositories (federated system)(federated system)

• Conform to INFOSEC mandatory Conform to INFOSEC mandatory guidelines.guidelines.

• Conform to UTHSCSA and UHS policies Conform to UTHSCSA and UHS policies and procedures including HIPPAand procedures including HIPPA

““Build it they will come” Build it they will come” philosophy does not work philosophy does not work

unless…!unless…!• Assemble an advanced, flexible, and robust online platform to deliver case-Assemble an advanced, flexible, and robust online platform to deliver case-based learning exercises to health professions learners ranging from based learning exercises to health professions learners ranging from beginners to advanced practitioners.beginners to advanced practitioners.

• Educate faculty on the campus about the strengths Educate faculty on the campus about the strengths and weaknesses of case-based teaching/learning.and weaknesses of case-based teaching/learning.

• Organize and manage centralized support units on Organize and manage centralized support units on the campus to assist faculty with developing, the campus to assist faculty with developing, implementing, and evaluating online case-based implementing, and evaluating online case-based teaching/learning.teaching/learning.

• Conduct formative evaluations of the project’s Conduct formative evaluations of the project’s information technology and faculty support information technology and faculty support services.services.

• Conduct Scholarship of Teaching projects to Conduct Scholarship of Teaching projects to evaluate case-based learning outcomes.evaluate case-based learning outcomes.

Deliverables from the Deliverables from the projectproject

• searchable electronic repositorysearchable electronic repository of of clinical images (clinical images (patient data setspatient data sets) for ) for constructing future teaching casesconstructing future teaching cases

• Library of electronic Library of electronic teaching casesteaching cases for health professions education with for health professions education with evaluation data regarding their evaluation data regarding their effectivenesseffectiveness

• Peer-reviewed presentations and Peer-reviewed presentations and reports on Scholarship of Teaching reports on Scholarship of Teaching studies using data from this project.studies using data from this project.

Online Educational Online Educational Resource SystemResource System

• Templates Templates will be developed for simplified will be developed for simplified

construction of different case types construction of different case types appropriate to different learners types and appropriate to different learners types and levels, mimicking a hospital information levels, mimicking a hospital information system. system.

• The VIS will be The VIS will be interactiveinteractive, allowing students , allowing students to to order diagnostic testsorder diagnostic tests and other and other interventions and to view results, including interventions and to view results, including laboratory tests, written reports and pertinent laboratory tests, written reports and pertinent virtual images from pathologic, radiologic, virtual images from pathologic, radiologic, endoscopic, and other evaluations. endoscopic, and other evaluations.

• The system will accommodate a The system will accommodate a rich, rich, multimediamultimedia approach, including audio approach, including audio (e.g., heart sounds), video (e.g., (e.g., heart sounds), video (e.g., simulated patient interview, physical simulated patient interview, physical exam, endoscopy), and images (e.g., exam, endoscopy), and images (e.g., photographs, radiographs, diagrams) via photographs, radiographs, diagrams) via a a novel flexible multimedia platform. novel flexible multimedia platform.

• The VIS will have the potential to The VIS will have the potential to integrate advanced resources such as integrate advanced resources such as virtual microscopy and three-virtual microscopy and three-dimensional graphics plusdimensional graphics plus links to links to supplemental filessupplemental files

More on on-line resourceMore on on-line resource• Cases will be accessed by students via the Cases will be accessed by students via the

BlackBoard course management system or the UTMB BlackBoard course management system or the UTMB Design A CaseDesign A Case system system http://http://www.designacase.orgwww.designacase.org

• A repository of de-identified, patient-derived A repository of de-identified, patient-derived materials will be available for use in teaching cases. materials will be available for use in teaching cases. An unique feature of this repository is the An unique feature of this repository is the linking linking togethertogether of all materials and information relating to of all materials and information relating to a single, real patient (for example, the radiograph, a single, real patient (for example, the radiograph, virtual microscopy slide, laboratory data, and clinical virtual microscopy slide, laboratory data, and clinical course will be linked, and will match); course will be linked, and will match);

• They will be able to They will be able to download filesdownload files for use in their for use in their teaching activities, and in turn, they will also be able teaching activities, and in turn, they will also be able to contribute teaching material and finished cases to to contribute teaching material and finished cases to the repository while maintaining copyright and the repository while maintaining copyright and intellectual property rightsintellectual property rights. .

Searchable Fields at Searchable Fields at Slide LevelSlide Level

• Pt namePt name• Medical record #Medical record #• Accession #Accession #• Organ/siteOrgan/site• DiagnosisDiagnosis• Key wordsKey words• DescriptionDescription

• AuthorAuthor• Date submittedDate submitted• Size Size • FormatFormat• Peer evaluation Peer evaluation

statusstatus

Specimen/Pt Data set Specimen/Pt Data set levellevel

• Type of media and formatType of media and format• Size and duration of mediaSize and duration of media• Suggested useSuggested use• School School • Copyright codeCopyright code

Searchable fields at Searchable fields at project/complete casesproject/complete cases

• Suggested moduleSuggested module• Copyright codeCopyright code• Peer review evaluation statusPeer review evaluation status

Searchable fields at Searchable fields at Module levelModule level

• SchoolSchool• Organ systemOrgan system• Suggested useSuggested use• Student evaluations if availableStudent evaluations if available

AddendumAddendum

• Recently we have expanded the Recently we have expanded the UTHSCSA QEP by providing online case-UTHSCSA QEP by providing online case-based education support to UT Medical based education support to UT Medical Branch and UTHSC Houston and by Branch and UTHSC Houston and by adding support staff at UTHSCSA by adding support staff at UTHSCSA by getting another grant.getting another grant.

• The integrated project will expand the The integrated project will expand the project so that enhanced support for project so that enhanced support for online case-based teaching/learning will online case-based teaching/learning will be available to over 9,000 students and be available to over 9,000 students and residents on three campuses. residents on three campuses.

Three Campus ProjectThree Campus Project

• University of Texas at Houston University of Texas at Houston

• University of Texas Medical Branch at University of Texas Medical Branch at GalvestonGalveston

• University of Texas Health Science University of Texas Health Science Center at San AntonioCenter at San Antonio

Academic CoordinatorEmily Iverson!

PlayersPlayers

SystemsSystems• AperioAperio• BlackBoard CE 6BlackBoard CE 6• UHS systemsUHS systems• Sharepoint Portal Sharepoint Portal

ServerServer• Learning Objects Learning Objects

RepositoryRepository

TechnologiesTechnologies• .NET framework.NET framework• C#/C++C#/C++• Java/JSPJava/JSP• Struts frameworkStruts framework• SQLServerSQLServer• OracleOracle• BEA WeblogicBEA Weblogic• Apache WebServerApache WebServer• IISIIS• HTML/JavaScriptHTML/JavaScript• Win 2003/Linux/SolarisWin 2003/Linux/Solaris• Win Media ServerWin Media Server

ObjectiveObjective

TiersL

ay

ers

Sca

lab

ility

Ava il a b

i li t y

Oth

er

Application

Platform

Infrastructure

Virtual Information Virtual Information SystemSystem

• PatternPattern– Craig Larman’s Design PatternsCraig Larman’s Design Patterns

• ExpertExpert

– Blackboard Architecture PatternBlackboard Architecture Pattern• Model-View-ControllerModel-View-Controller

– Gang of four Design patternsGang of four Design patterns• Façade Façade

BlackBoard ArchitectureBlackBoard Architecture

VIS-Extension of this MVC 2 architecture-Incorporates other patterns

Virtual Information System: Virtual Information System: Structure ViewStructure View

Physical ViewPhysical View

Clinical DataBackup Server

UHS System

File Server Streaming Media & IIS

SAN (RAID 5)

Clinical Data ServerAperio File Server

Aperio App ServerTeaching Data Server

Oracle(BlackBoard)

WebLogic(BlackBoard)

UHS

PATHOLOGY – DEVELOPMENT ARENA

UTHSCSA CR

Backup Server

LDAP Server

LEGEND

UHS servers

QEP VIS servers

UTHSCSA CR servers

Please note: Not all servers shown here are physical servers. Some are virtual servers. The

virtual servers are highlighted in yellow.

Student Perspective 1 – Student Perspective 1 – Conceptual ModelConceptual Model

VIS System : Draft 1.2

Stu

dent

P

ersp

ectiv

e 1

This is the student perspective for the VIS system from Blackboard CE 6 front-end. This diagram is a draft and is intended to evolve on further discussions.

Student

Blackboard CE 6

Login1. Student: AccessBB() 2: BB: OpenStudentProfile()

Blackboard CE 6Student Profile

Blackboard CE 6BB Operations

-Quiz, Discussions, Evaluations

3: Student: UseBBfunctions()

Blackboard CE 6FACADE

4: Student: UseBBfacade()

Aperio Browser5b: Student: AccessAperio()

5b1: Aperio: accessZoomify()

5b2: Aperio: allowAperioFunctions()

nMiscellanousDatasets

On other servers

5c: Student: AccessData()

StreamingMedia

5d: Student: AccessStreamingContent()

FileServer

5e: Student: AccessFileServer()

Check for Single-SignonOption

Student Perspective 2 – Student Perspective 2 – Conceptual ModelConceptual Model

VIS System : Draft 1.2

Stu

den

t P

ersp

ectiv

e 2

This is the student perspective for the VIS system from Microsoft SharePoint front-end. This diagram is a draft and is intended to evolve on further discussions.

Student

SharePoint

Login(ActiveDirectoryAuthentication)

1. Student: AccessSP() 2: SP: OpenStudentProfile()SharePoint

Student Profile

SharePointSP Operations

-Document Repository,

Forums, Surveys

3: Student: UseSPfunctions()

SharePointFACADE

4: Student: UseSPfacade()

Aperio Browser5b: Student: AccessAperio()

5b1: Aperio: accessZoomify()

5b2: Aperio: allowAperioFunctions()

nMiscellanousDatasets

On other servers

5c: Student: AccessData()

StreamingMedia

5d: Student: AccessStreamingContent()

FileServer

5e: Student: AccessFileServer()

Check for Single-SignonOption

Faculty Perspective 1 – Faculty Perspective 1 – Conceptual ModelConceptual ModelVIS System : Draft 1.2

Clin

ical

Fac

ulty

P

ersp

ectiv

e 1

This is the faculty perspective for the VIS system from Aperio front-end. This diagram is a draft and is intended to evolve on further discussions.

Faculty

Aperio

Login(Aperio

Authentication)

1. Faculty: AccessAP() 2: Aperio: OpenFacWorkArea()Aperio

Faculty Work Area

AperioFACADE

3: Faculty: UseAperioFacade

UHS 4a:Faculty: AccessUHS() Aperio Browser4b: Faculty: AccessPublishView()

4b1: Aperio: accessZoomify()

4b2: Aperio: allowAperioFunctions()

nMiscellanousDatasets

On other servers

4c: Faculty: AccessData()

StreamingMedia

4d: Faculty: AccessAndEditStreamingContent()

FileServer

4e: Faculty: AccessFileServer()

3: Faculty: UseAperioFunctions

TEACHINGAREA

Aperio Sample FlowsAperio Sample Flows

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