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Implementation of the MedBiquitous Standard into the learning system CASUS Inga Hege – LMU Munich Andrzej Kononowicz - Jagellonian University Michael Pfähler – LMU Munich Martin Adler - Instruct AG

Overview • • • • • •

CASUS MVP standard Implementation in CASUS Challenges Scenarios Conclusions

CASUS • 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 Player

MVP standard

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

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

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.

[MVP 09]

MVP standard

ActivityModel DataAvailabilityModel linear Case progress DAMNode ActivityNode ActivityNode ActivityNode ActivityNode

VirtualPatientData No specialized fields are used, only VPDText

VPDText

VPDText VPDText Xtensibleinfo/VPDText

VPDText

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

LOM Learning Objects Metadata

CASUS VP metadata (authoring view)

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

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

Questions in CASUS Correct answers

• 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

>500

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. Long-Menu Questions

•-> Implementation of QTI in MVP by the XtensibleInfo element in VPD

Differential diagnostic network

IMS QTI • = 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

Import/Export of QTI questions in CASUS is optional

CASUS’ QTI questions in Heidelberg’s CAMPUS system

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

Challenges Import of branched VPs Branched VP

Linear VP

Node

Node

Node

Node

Node

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 Node

Node

Node

Node Node

Node

Node Node

Challenges – Import of highly structured VPs

WEB-SP VP

Challenges • 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

VPDText

Why Standards? • 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

Scenarios Other systems implementin g MVP Casus Exam tool

Wiki system

QTI Assessment Item Database

VP duplication - Printing - Backup - Standalone/local VP

Conclusions

• 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?

Thank you! More information: www.casus.eu www.virtualpatients.eu