"The Virtual Teaching Hospital" (VTH) was developed to enable academic staff without formal training in programming or instructional design to produce integrated interactive multimedia learning modules based on patient case studies. These case studies are presented within the graphic environment of a hospital to promote the integration of basic science and clinical disciplines and to illustrate the relevance of the basic sciences to the various health professionals. Students can view patient profiles to observe the clinical reasoning process and the range of professional activities which draw on the knowledge base of the basic sciences to solve real problems. A sample module based on a stroke patient has been developed.
Black et al (1994) identified six principles of constructive design, ranging across student generation of knowledge, authentic situations, cognitive apprenticeship, the use of multiple contexts, cognitive flexibility of multiple perspectives, and student collaboration. Cognitive apprenticeship embeds learning in an activity and makes deliberate use of social and physical contexts. If the situated nature of cognition is ignored, the education system provides academic decontextualised knowledge which may not be robust (Brown, Collins and Duguid, 1989).
The complex and ill structured knowledge domain which must be accessed by a range of health professionals in dealing with patients in a hospital provides a situation where much of this theory can be tested in the design and functionality of an interface for learners across a range of disciplines. Hypercourseware (Siviter and Brown, 1992) is a conceptual framework for developing computer based flexible learning material on a large scale. The principle of the browser, which can cater for flexible needs, and which can be managed and updated, relinquishes the concept of fixed products, and places the emphasis on an ongoing and evolving process of organising educational resource material.
Advanced knowledge domains should not be presented as well structured, linear, compartmentalised, simply hierarchical and rigidly pre-packaged entities (Spiro and Jehng, 1990). Cognitive Flexibility Theory enables the student to learn by criss-crossing a conceptual landscape, and the instruction involves providing learning materials the student can actively explore under expert guidance. By crossing the landscape many different ways, knowledge to be used in many ways is taught in many ways. Learning complex content material requires multiple explanations, analogies and dimensions of analysis.
Two attempts were made to overcome these perceived difficulties in Biological Science subjects. Firstly, various disciplines were included within the one subject. Secondly, case studies were introduced either as an integral part of subjects with small student numbers, or as tutorial sessions for large groups. Feedback from students indicated that this approach enhanced motivation and learning, but the limited availability of contact hours and appropriately skilled tutors restricted the use of case studies.
The development of computer based case studies offered a potential solution to these problems, and also the opportunity to enhance the nature and quality of the learning experience for staff and students. While staff had expertise in clinical and basic sciences, teaching, and support for case based learning, they did not have sufficient programming skills or awareness of recent applications of information technology to learning. The aim of the Virtual Teaching Hospital (VTH) project was to develop a courseware browser which would provide appropriate information access for students in a range of health professional courses, and a case study template which would enable academic staff to produce integrated interactive multimedia learning modules based on patient case studies. The ability to include multimedia resources to facilitate explanation, analogy, modelling of activities, and tap into the social, emotional and contextual aspects of cases was a bonus.
The design team moved to rapid prototyping of the browser interface and patient profile in HyperCard. As the case study material was compiled, the structure of its presentation unfolded. The patient was the central focus of the profile, and numerous views of the patient could be provided by a range of health professionals dealing with the case. This would give the students a range of perspectives on the one set of patient data. Teams of health professionals frequently work on cases, but it is not common for one health professional to have access to the thought processes of another. As the case material was compiled from the clinician in charge of the case, certain decisions of this medical expert were not clear to team members who were relative novices in the subject domain. This prompted the development of pre- and post-thoughts of the clinician, and a unique opportunity to tap the expert's thought processes on why certain questions were asked or tests ordered, and what the response was to certain results. This was tapping into the process of hypothesis formulation and self questioning which is often automatic, and not shared by experts in such situations as clinical rounds. By exposing this process, the relevance and scope of the required content knowledge to formulate such hypotheses was naturally shown. This material was presented in the student challenges.
Such case study profiles do not place the learner in a simulation situation. They present the time frame of the case in a retrospective fashion. The student is not selecting the interview question or test they wish performed. This program does not aim to replace the real case with an extremely complex simulation. The student can, however, explore the case at their own pace as often as they like with or without the expert guidance and thought processes. Students within one health profession can gain insight into the way other colleagues may approach the patient, and why certain pieces of information are vital to fellow health professionals. The opportunity is also there to involve the family of the patient, and to let health professionals consider the emotions and thoughts of patient, family and friends.
To complement the application of a complex network of knowledge within a case study, content resources were needed within the VTH for students to pursue material they perceived as clinically important. Here the browser nature of the general hospital interface provided the hooks for many types of content. Various rooms within the hospital would provide logical venues to seek out certain kinds of information, such as the laboratories or library, and the corridors could allow linkage of general material relevant to a hospital.
Staff within the faculty would be provided with the opportunity to develop material related either to a case study, or their content specialty. The classroom developed off the library as a logical place to find certain subject based content chunks. Staff could enter the multimedia construction process either at a familiar spot - presenting the content of their expertise, or they could tackle the more difficult task of re-structuring material to think of its relevance to specific cases. The browser also offered the opportunity to link content software already produced by other learning institutions.
The design of the VTH acknowledges the importance of the teaching staff not only in the production 6f learning material, but also in the support of this material when it is used with students. Process is the important keyword here, not product. This is an evolving design process within the Faculty, aimed at including staff in the technological innovations, rather than imposing change without consultation. The nature of the student tasks which drive them through the many resources of the Virtual Teaching Hospital will be determined and developed by staff members. Some of these tasks may be presented on computer, while other staff members may use case material as a stimulus for discussion, or content packages linked in the hospital as resource material for assignments. The wealth of possibilities will be unfolded through use and creative staff initiatives.
By selecting various objects in this graphic environment, students can get more information about various pieces of equipment or learn about various procedures. This informative hospital walk has great potential for development. Imagine the wall space for posters and equipment and floor space for a range of people. New innovations such as QuickTime VIZ will make the simulation more realistic.
A courseware browser for use by different schools has been realised, but this is just the beginning of a very long term process which seeks to skill and involve academic staff in the construction and use of information technology for learning. What many staff have yet to realise is the difficulty in presenting material from the varied perspectives of clinical relevance. The desire to highly structure content and merely map that to the learner's mind has to be overcome, and constructivist principles of learning acknowledged.
The patient profile structure offers a unique opportunity to tap into the metacognitive skills of planning, monitoring and self regulating carried on by a range of health professionals as they interact with the patient. Self questioning and reflection are two skills which all learners need to acquire, and which are often not highlighted by lecturers. The multiple perspectives on content afforded by the different health professionals is also unique, and will require the collaboration of a real team of health professionals. As the students criss-cross the patient landscape from the perspectives of these different people, a range of interpretations and analyses could be presented.
In the development and maintenance of a courseware browser and its many associated resource links, staff will come to appreciate the crucial role of resource management - not only its organisation, but also its coding for re-use. Whole faculties will come to appreciate the construction of large information systems, and the need to constantly update and restructure as understanding develops. By experiencing this process, they will share what the student must experience as they seek to build their own personal information system to deal with the complex and ill structured professional domain they have selected.
Hopefully, academic staff will come to appreciate the multiplicity of solutions to the wonderful process of learning, and thus create a range of learning task tools to support students in their difficult journey from novice to expert. The VTH design experience has already provided the Faculty of Health Sciences at the University of Sydney with a considerable challenge - to invest the effort required to move to a situated model of learning which capitalises on the new developments in information technology.
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|Authors: Mrs May Wong|
Lecturer, Department of Biomedical Science
Faculty of Health Sciences, The University of Sydney
PO Box 170, Lidcombe NSW 2141
Telephone: (02) 646 6289 Fax: (02 646 6520
Dr Edward Hettiaratchi
Dr Elizabeth Post
Dr Hoang Tran-Dinh
Ms Christine Anne Brown
Please cite as: Wong, M., Hettiaratchi, E., Post, E., Tran-Dinh, H. and Brown, C. A. (1996). The virtual teaching hospital. In C. McBeath and R. Atkinson (Eds), Proceedings of the Third International Interactive Multimedia Symposium, 426-430. Perth, Western Australia, 21-25 January. Promaco Conventions. http://www.aset.org.au/confs/iims/1996/ry/wong.html