Students Language Proficiency And Cross-cultural Use Of Virtual Patients. V. Muntean, U. Fors, N. Zary, T. Calinici

Students Language Proficiency and Cross-Cultural Use of Virtual Patients Valentin Muntean*, Uno Fors**, Nabil Zary**, Tudor Calinici* * “Iuliu Hatieganu” University of Medicine, Cluj-Napoca, Romania **Karolinska Institutet, Stockholm, Sweden

Email:[email protected]

Language Proficiency and Cross-Cultural Use of VP’s



Sharing educational resources, specifically virtual patients (VP’s), among medical schools, is a way to improve education. However, several cultural aspects may have an impact on the development and the use of VP’s.



This study focus on the influence of learners language proficiency on cross-cultural use of VP’s.

Language Proficiency and Cross-Cultural Use of VP’s



As a part of the eViP-project, 42 fifth year Romanian medical students from the Faculty of Medicine in Cluj, Romania, enrolled in the optional lecture “Methods of teaching and evaluation for medical students” were asked to participate in a pilot study with virtual patients.



The students’ previous training was exclusively in Romanian and none of them had worked with VPs before, however, a requisite for participation in the study was a good understanding of English.

Language Proficiency and Cross-Cultural Use of VP’s



Three cases developed by faculty in internal medicine, surgery and endocrinology were used. Every case had an English and a Romanian version. The content of the versions was identical and translation into English was performed by the case authors and reviewed by a native English speaker.

Language Proficiency and Cross-Cultural Use of VP’s



30 out of the 42 students considered themselves as having a good or very good understanding of English and agreed to participate in the study.



The identity of the students remained unknown for researchers throughout the study. Every student was given a code name (anonymous) and was randomly assigned two different cases, one in English and one in Romanian. The access to the cases was given for a twoweek period. The students logged to the cases through the Internet from home.

Language Proficiency and Cross-Cultural Use of VP’s

diagnostic corect (YES/NO)

tratament corect (YES/NO/INC OMPLETE)

raspun suri student date in ROM(R) sau ENGLl( E)

19

YES

INCOMPLETE

ROM

51

10

12

YES

YES

ROM

11

103

81

50

INCOMPLETE

YES

ROM

53

50

29

5

12

YES

INCOMPLETE

ENG

50

BT-ENG

90

98

31

43

YES

YES

ROM

37

student 9

BT-ENG

32

90

7

33

INCOMPLETE

INCOMPLETE

ROM

29

student048

BT-ENG

70

32

28

38

YES

INCOMPLETE

ROM

48

student054

BT-ENG

52

55

7

33

YES

INCOMPLETE

ROM

51

student055

BT-ENG

34

25

8

21

YES

YES

ROM

8

student 20

BT-ENG

75

97

99

19

INCOMPLETE

INCOMPLETE

ROM

57

student 26

D.R. ROM

52

141

118

25

INCOMPLETE

NO

ROM

36

student 27

D.R. ROM

120

131

158

28

NO

NO

ROM

84

student 29

D.R. ROM

42

117

27

38

INCOMPLETE

INCOMPLETE

ROM

31

student 41

D.R. ROM

46

119

39

37

YES

INCOMPLETE

ROM

31

student 5

D.R. ROM

35

135

15

19

YES

YES

ROM

75

student 9

D.R. ROM

52

117

20

46

INCOMPLETE

YES

ROM

40

student047

D.R. ROM

46

92

5

35

INCOMPLETE

INCOMPLETE

ROM

25

student056

D.R. ROM

60

123

64

50

NO

NO

ROM

51

student059

D.R. ROM

44

65

7

6

YES

YES

ROM

37

student046

D.R. ENG

30

93

36

32

NO

NO

ROM

31

timp/ca z (min)

nr.intre bari anamn eza

nr.de date de exame n obiecti v

nr.de examin ari de lab/radi ologice

NUME student / caz

caz ROMm(R) sau ENGgl(E)

student049

BT-ROM

40

48

11

student058

BT-ROM

25

21

student 23

BT-ROM

80

student 3

BT-ENG

student 57

nr de cuvinte in justific area diagno sticului

Language Proficiency and Cross-Cultural Use of VP’s



Of the 30 students enrolled in the study, 8 did not finalize both cases and were excluded from the final analysis of the results. The following criteria were analyzed:       

Time per case (average +/-SD) No. of history questions asked (average +/-SD) No. of tests ordered for physical examination (average +/SD) No. of lab or imaging tests ordered (average +/-SD) Correct diagnosis and treatment (Yes, Incomplete or No) Student answer (in English or Romanian) No. of words in diagnosis justification (average +/-SD)

Language Proficiency and Cross-Cultural Use of VP’s

diagnostic corect (YES/NO)

tratament corect (YES/NO/INC OMPLETE)

raspun suri student date in ROM(R) sau ENGLl( E)

19

YES

INCOMPLETE

ROM

51

10

12

YES

YES

ROM

11

103

81

50

INCOMPLETE

YES

ROM

53

50

29

5

12

YES

INCOMPLETE

ENG

50

BT-ENG

90

98

31

43

YES

YES

ROM

37

student 9

BT-ENG

32

90

7

33

INCOMPLETE

INCOMPLETE

ROM

29

student048

BT-ENG

70

32

28

38

YES

INCOMPLETE

ROM

48

student054

BT-ENG

52

55

7

33

YES

INCOMPLETE

ROM

51

student055

BT-ENG

34

25

8

21

YES

YES

ROM

8

student 20

BT-ENG

75

97

99

19

INCOMPLETE

INCOMPLETE

ROM

57

student 26

D.R. ROM

52

141

118

25

INCOMPLETE

NO

ROM

36

student 27

D.R. ROM

120

131

158

28

NO

NO

ROM

84

student 29

D.R. ROM

42

117

27

38

INCOMPLETE

INCOMPLETE

ROM

31

student 41

D.R. ROM

46

119

39

37

YES

INCOMPLETE

ROM

31

student 5

D.R. ROM

35

135

15

19

YES

YES

ROM

75

student 9

D.R. ROM

52

117

20

46

INCOMPLETE

YES

ROM

40

student047

D.R. ROM

46

92

5

35

INCOMPLETE

INCOMPLETE

ROM

25

timp/ca z (min)

nr.intre bari anamn eza

nr.de date de exame n obiecti v

nr.de examin ari de lab/radi ologice

NUME student / caz

caz ROMm(R) sau ENGgl(E)

student049

BT-ROM

40

48

11

student058

BT-ROM

25

21

student 23

BT-ROM

80

student 3

BT-ENG

student 57

nr de cuvinte in justific area diagno sticului

Language Proficiency and Cross-Cultural Use of VP’s Case (ROM or ENG)

Time/case (min)

SD

 

 

 

BT-ROM

48,3

28,4

DR-ROM

55,2

25,21

SV-ROM

59,3

19,3

ROM

55,7

21,3

 

 

 

BT-ENG

57,56

21,6

DR-ENG

38.0

11,3

SV-ENG

46,9

19,6

ENG

48,2

18,8

 

 

 



Interestingly, the average time per case was longer for the Romanian versions of VPs (55.7 +/- 21.3 min) versus English versions (48.2 +/- 18.8).



When comparing individual cases, students working with the Romanian version used more time per case than for the English version in two of the cases and less in one.

Language Proficiency and Cross-Cultural Use of VP’s Case (ROM or ENG)

No. question/histo ry

SD

 

 

 

BT-ROM

57,3

41,7

DR-ROM

115,6

23,5

SV-ROM

64,2

26,7

ROM

84,4

36,7

 

 

 

BT-ENG

60,8

33,4

DR-ENG

74.0

52,1

SV-ENG

70,4

33,5

ENG

68,1

35,1

 

 

 



There were more history questions asked for Romanian VPs (84.4 +/- 36.8) when compared with English versions (68.1 +/- 35.1).



In two cases, the students asked more questions for the English VPs and in one many more questions for the Romanian cases.

Language Proficiency and Cross-Cultural Use of VP’s Case (ROM or ENG)

No. physical exam. ordered SD

No. lab./imaging ordered

SD

 

 

 

 

 



BT-ROM

34.0

40,7

27.0

20,2

DR-ROM

50,3

53,7

31,5

13,6

SV-ROM

40,5

26,3

38,4

18,1

ROM

43,5

38,2

33,6

15,7

 

 

 

 

 

BT-ENG

26,44

33,7

28,4

11,2

DR-ENG

61,2

65,7

27.0

16,9

SV-ENG

43,3

45,1

34,1

22,3

ENG

42,1

45

30,4

17

 

 

 

 

 

The number of tests ordered for physical examination and lab or imaging tests ordered was almost the same for Romanian and English cases.

Language Proficiency and Cross-Cultural Use of VP’s Case (ROM or ENG)  

Correct diagnosis (YES/INCOMPLETE/ NO)

BT-ROM

2/Y. 1/I

DR-ROM

3/Y. 4/I. 2/N

SV-ROM

8/Y. 2/I

We found high differences for correct diagnosis between Romanian and English VPs.

ROM

13/Y. 7/I. 2/N



 

 

BT-ENG

5/Y. 2/I

DR-ENG

1/Y. 3/I. 1/N

SV-ENG

3/Y. 4/I. 3/N

ENG

9/Y. 9/I. 4/N

 

 



The diagnosis was correct in 13 of the Romanian VPs and 9 of English VPs, incomplete in 7 Romanian and 9 English cases and wrong in 2 Romanian and 4 English cases.

Language Proficiency and Cross-Cultural Use of VP’s Case (ROM or ENG)  

Correct treatment (YES/INCOMPLETE/ NO)

BT-ROM

2/Y. 1/I

DR-ROM

3/Y. 3/Y. 3/N

SV-ROM

6/Y. 4/I

ROM

11/Y. 8/I. 3/N

 

 

BT-ENG

2/Y. 5/I

DR-ENG

1/I. 4/N

SV-ENG

2/Y. 45I. 3/N

ENG

4/Y. 10/I. 7/N

 

 



The differences between the two versions were even greater for treatment plan. 

The correct treatment plan was given in 11 Romanian and 4 English VPs, the answer was incomplete in 8 Romanian and 10 English and wrong in 3 Romanian and 7 English cases.

Language Proficiency and Cross-Cultural Use of VP’s Case (ROM or ENG)

Studnt answer

 

(ROM/ENGL)

BT-ROM

2/ROM

DR-ROM

9/ROM

SV-ROM

10/ROM

ROM

22/ROM

 

 

BT-ENG

6/ROM. 1/ENG

DR-ENG

4/ROM. 1/ENG

SV-ENG

9/ROM. 1/ENG

ENG

19/ROM. 3/ENG

 

 



The student answers were in Romanian in all Romanian cases and in Romanian for most English VPs (19 out of 22).

Language Proficiency and Cross-Cultural Use of VP’s Case (ROM or ENG)  

No.words in diagnosis justification



BT-ROM

38,3

DR-ROM

45,5

SV-ROM

51,3

ROM

46,7

 

 

BT-ENG

40.0

DR-ENG

45,8

SV-ENG

35,2

ENG

39,4

 

 

The number of words in diagnosis justification was larger for Romanian versions of VPs (46.7 +/- 4.6) when compared with English versions (39.4 +/- 2.0). 

The difference is due to only one of individual cases, in the other two the figures being almost the same.

Language Proficiency and Cross-Cultural Use of VP’s



We found unexpected high differences of student performance on Romanian and English versions of VP’s.



Further studies are necessary to refine those differences and to understand their significance.

Language Proficiency and Cross-Cultural Use of VP’s

      

Number of students Number of cases/student Student English proficiency Student training/experience with VP’s and diferent players Student experience for a specific domain of medicine Case difficulty/complexity Case cultural specificity

Language Proficiency and Cross-Cultural Use of VP’s



Planned future studies: 

Cultural/content 



Language 



English/Swedish versus Romanian

Students 



Cases from Karolinska, London, Munchn, Heidelberg versus “Home made cases” - Cluj

Romanian versus International students

Players 

Web-SP, Labyrinth, Casus, Campus

Language Proficiency and Cross-Cultural Use of VP’s



VP’s could play a role in addressing the cultural diversity that exists in the society and increased mobility of healthcare professionals, students and patients.

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