Implementation of the MedBiquitous Standard into the

learning system CASUS Inga Hege – LMU MunichAndrzej Kononowicz - Jagellonian UniversityMichael Pfähler – LMU MunichMartin Adler - Instruct AG

• CASUS• MVP standard• Implementation in CASUS• Challenges• Scenarios• Conclusions

Overview

• Developed at LMU since 1993, distributed by instruct • Linear case-based learning system• 9 different question types with quantitative and qualitative feedback• Optional Expert comments and Hyperlinks for additional content• Player in 6 languages• Reporting and analysis of students results• Currently about 1000 VPs (in 8 languages) in database• About 1000 cases session daily, 130 faculties• SingleSignOn to other systems (e.g. LMS) via AICC, Shibboleth

CASUS

CASUS Player

MVP standard

VPD: provides the personal and clinical data relevant to the clinical scenario being simulated.

VPD: provides the personal and clinical data relevant to the clinical scenario being simulated.

Media Resources: all of the images, animations, videos, audio files and any other digital objects

Media Resources: all of the images, animations, videos, audio files and any other digital objects

DAM: expresses the aggregation of VPD and MR elements for exposure through the AM.

DAM: expresses the aggregation of VPD and MR elements for exposure through the AM.

AM: encodes what the learner can do and how they engage with the virtual patient.

AM: encodes what the learner can do and how they engage with the virtual patient.

[MVP 09]

MVP standard

linear Case progress

DAMNode

ActivityModelDataAvailabilityModel

ActivityNode

ActivityNode

ActivityNode

ActivityNode

VPDText

VPDText

VPDText

Xtensibleinfo/VPDText

VPDText

VirtualPatientData

No specialized fields are used, only VPDText

Metadata

CASUS VP metadata (authoring view)

LOMLearning ObjectsMetadata

Metadata – provides information about, other data managed within an application or environment (e.g. name, author, size, data type)

Challenges

• Implementation of questions– important component of a Casus VP

• Example: case of Mr. Angermeier

– 47,69% on text content (this case contains with questions 22.730 characters {without spaces} after removing questions 11.889)

– 8 out of 29 cards ceased to exist

Almost 50% of the case is lost after removing questions and their feedback

-> Assessment items are not supported in the MVP standard-> but two solutions ...

• 9 different question types• Multiple/Single Choice (MC)• Freetext (rated and non-rated), Cloze• Sorting, Mapping• Lab values• Underline• Long Menu• Differential diagnostic network tool

•-> Implementation of QTI in MVP by

the XtensibleInfo element in VPD

Questions in CASUS

Differential diagnostic network

Long-Menu Questions

Correct answers

Distractors

Schuwirth LW, van der Vleuten CP, Stoffers HE, Peperkamp AG. Computerized long-menu questions as an alternative to openended questions in computerized assessment. Med Educ.1996;30(1):50-5.

>500

• = Question and Test Interoperability specification• Defines an information model and associated binding that can be used to represent and exchange assessment items.• Limitations:

• QTI > 1.2 unstable (QTI 2.1 withdrawal/reposted)• Lack of standard support for specific question types (e.g. Long Menu) Extension proposals: M.Pfähler, M. Holzer, An extension to the QTI standard to support long menu items and specific metadata in QTI 2.1, GMS Medizinische Informatik, Biometrie und Epidemiologie 2009, Vol. 5(1), ISSN 1860-9171

-> VPs for assessment can be shared using QTI

IMS QTI

Import/Export of QTI questions in CASUS is optional

CASUS’ QTI questions in Heidelberg’s CAMPUS system

• Implementation of Answers • Import of branched VPs• Import of highly structured VPs

Challenges

NodeNode

NodeNode NodeNode

NodeNode NodeNodeNodeNode

NodeNode

NodeNode

NodeNode

NodeNode

NodeNode

NodeNode

Branched VP Linear VP

NodeNode

Challenges -Import of branched VPs

Our solution: •Import of all nodes in a linear order• Display of available next nodes and marking of start node and end nodes.-> Author can decide how to re-structure VP

Challenges – Import of highly structured VPs

WEB-SP VP

• Implementation of Answers • Import of branched VPs• Import of highly structured VP• Tracking of changes in VPs • Textstyles need filtering to exchange correctly and match the standard• Image maps with Hyperlinks -> XtensibleInfo• Hyperlinks to text elements/images/movies

Challenges

Challenges

VPDText

• Exchange and communication between systems• Access to teaching resources in different systems• Use of learning resources independently from the original system• Content is still accessible if a system is not supported any longer or in case of system change

Why Standards?

Scenarios

Wiki systemWiki system

- Printing- Backup- Standalone/local VP

Casus Exam toolCasus Exam tool

Assessment Item DatabaseAssessment Item Database

QTI

Other systems implementing MVP

Other systems implementing MVP

VP duplication

• MVP and other standards can be more than an exchange format for VPs• QTI is a good starting point to exchange assessment items • Import from branched and highly structured systems needs further improvement (e.g. a graphical interface)• CASUS does not fit 100% into the MVP Standard -> didactical value preserved?

Conclusions

More information:

www.casus.eu

www.virtualpatients.eu

Thank you!