2013; 35: 251–253

SHORT COMMUNICATION

Pharmacases.de – A student-centerede-learning project of clinical pharmacology

BARBARA ZOLLNER1, MICHAEL SUCHA1, CHRISTOPH BERG1, NADINE MUß1, PETER AMANN1,BERNADETTE AMANN-NEHER1, DOROTHEE OESTREICHER2, STEFAN ENGELHARDT1

& ANTONIO SARIKAS1

1Technische Universitat Munchen, Germany, 2University of Erlangen-Nuremberg, Germany

Abstract

Aim: The aim of the project Pharmacases.de was to develop an innovative concept for creating high-quality e-learning content

which integrates and promotes the theoretical and cooperative skills of final-year medical students and is easily adoptable by

cooperating institutes and hospitals.

Methods and results: A peer-teaching concept was developed in which final-year medical students with the elective

pharmacology independently researched and wrote e-learning cases of clinical pharmacology (‘‘pharmacases’’). Subject-specific

expertise was acquired by consulting a peer network of elective students of other disciplines. The created material was subjected

to a multi-step peer review and published on the open-access internet platform http://www.pharmacases.de. At present, the

website contains 45 e-learning cases, 27 quizzes, and a student-managed discussion forum. Each month, approximately 1200

students access the e-learning content on the website with above-average evaluation results.

Summary and conclusion: The didactic concept of Pharmacases.de enabled the efficient generation of high-quality e-learning

content in a student-centered and interdisciplinary manner and was well received by the students. It will likely facilitate the transfer

of theoretical pharmacological knowledge into clinical practice.

Introduction

e-Learning, commonly defined as the use of information

technology in education (Masters & Ellaway 2008), is increas-

ingly implemented in undergraduate medical curricula (Ward

et al. 2001). While it offers a number of advantages in

comparison to traditional face-to-face teaching, such as inde-

pendence of place and time, adaptability to diverse learning

styles and paces of the students or scalability to rising student

numbers (Masters & Ellaway 2008), several challenges remain.

These include economic factors such as high costs and time

requirements for the generation of e-learning content (Masters

& Ellaway 2008). In pharmacology, a number of e-learning

resources exist that are mainly created by faculty or profes-

sional authors (Maxwell & Mucklow 2012). Another trend in

medical education is the shift from teacher-oriented to more

student-centered and self-directed learning environments,

which is exemplified by the emerging prevalence of peer

teaching at medical schools (Ten Cate & Durning 2007).

In Germany, undergraduate medical training lasts 6 years

which are divided into a 2-year pre-clinical phase and a 4-year

clinical phase, concluding with a year of practical training

(Nikendei et al. 2009). The latter consists of two mandatory

rotations in surgery and internal medicine in addition to an

elective, each lasting 16 weeks. Despite these efforts, a recent

survey by Ochsmann et al. (2010) showed that the majority of

first-year doctors in Germany feel ill-prepared for patient care,

in particular with pharmacotherapy.

In this article, we present Pharmacases.de, a novel student-

centered e-learning resource of clinical pharmacology that

combines both e-learning and peer-teaching concepts in

undergraduate medical education.

Methods

Final-year medical students with the elective pharmacology at

Technische Universitat Munchen (TUM) researched and wrote

e-learning cases (‘‘pharmacases’’) that present clinically rele-

vant aspects of pharmacology and toxicology in an interactive

and multi-medial manner. All cases were written with standard

office software (Microsoft PowerPoint, Microsoft, Redmond)

and converted to a flash-based format with a software package

for web-presentation (Articulate, New York, USA) that enabled

interactive elements (e.g., different question types for self-

assessment) and multi-media content (e.g., movie clips or

audio files). At the beginning of the elective, a brief instruction

on literature research and basic didactic principles was given

by faculty and written protocols were provided.

A network of elective students of other medical disciplines

was set up to exchange subject-specific expertise amongst the

peers (Figure 1). The cooperation within the network ranged

from phone or email consultations to on-site patient rounds by

the peers, with minimal faculty supervision.

The e-learning cases were made freely available on an

open-access website (http://www.pharmacases.de) that also

Correspondence: Antonio Sarikas, Institute of Pharmacology and Toxicology, Technische Universitat Munchen, Biedersteiner Strasse 29, 80802

Munich, Germany. Tel: 49 89 41403298; fax: 49 89 41403261; email: sarikas@ipt.med.tum.de

ISSN 0142–159X print/ISSN 1466–187X online/13/30251–3 � 2013 Informa UK Ltd. 251DOI: 10.3109/0142159X.2013.759642

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contained other peer-network generated or managed content

such as online quizzes and an online discussion forum.

To ensure high quality standards and up-to-date content,

all peer-created e-learning material underwent a multi-step

review process. Before publication on the website, each case

was presented in a weekly seminar at the Institute of

Pharmacology and Toxicology and reviewed by the peer

network. After publication on the website, all e-learning cases

were open to anonymous evaluation via an online question-

naire. Finally, faculty or specialists on the subject bi-annually

reviewed selected cases.

To evaluate user frequency, student perception, and

learning benefit, a representative survey of fifth-year

medical students at TUM was conducted. Of the 325 students,

a total of 264 participated in the survey (81%). Informed

consent and approval by the ethics committee of TUM was

obtained.

Results

Elective students of 11 clinical and theoretical disciplines

(pathology, microbiology, radiology, internal medicine, sur-

gery, dermatology, urology, neurology, psychiatry, ophthal-

mology, and pediatrics) at TUM participated in the

Pharmacases.de network that was coordinated by pharmacol-

ogy elective students. Participation in the network was

voluntary and depended on student or patient availability.

The website was launched on December 1, 2010. As of May

17, 2012, the website had been accessed by 19,548 visitors

(approximately 1200 visitors per month). The discussion forum

was frequented 3945 times. In May 2012, the website

contained 45 e-learning cases and 27 online quizzes with a

total of 500 multiple choice questions for self-assessment.

Depending on the complexity, difficulty level, and the

involvement of the peer network, the time required for the

generation of one e-learning case ranged from 1 to 2 weeks

(35–70 h) for the pharmacology elective student and 0.5–4 h

per case for the peer network student. In contrast, time for

supervision by faculty was 1–2 h (pharmacologist) and 15–

30 min (supervisors of the respective network peer) per case,

respectively.

Evaluation results

Most students (95%, n¼ 250) studied more than 10 pharma-

cases during the last semester. The majority of students stated

that the learning benefit of the e-learning cases was ‘‘good’’ or

‘‘excellent’’ (94%; n¼ 248) and classified the additional learn-

ing benefit in comparison to textbooks or faculty lecture notes

as ‘‘high’’ or ‘‘very high’’ (88%; n¼ 232; Figure 2). Most

students (97%; n¼ 256) would appreciate a similar e-learning

project in other disciplines. The majority (59%; n¼ 156) were

interested in participating in the pharmacases.de network as

Figure 2. Evaluation results. A representative survey of fifth-year medical students at TUM was conducted to evaluate user

frequency, student perception, and learning benefit of the e-learning cases. The response rate was 81% (264 of 325 students).

Figure 1. Pharmacases.de peer network. Elective students

of 11 clinical and theoretical disciplines at TUM participated in

the peer network that was coordinated by the pharmacology

elective students. For clarity reasons, the figure depicts only

part of the network.

B. Zollner et al.

252

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peers and 17% (n¼ 44) indicated to choose the elective

pharmacology to actively create new e-learning cases.

Discussion

In this article, we presented a novel teaching project of clinical

pharmacology that combines both e-learning and peer teach-

ing strategies to create high-quality e-learning content for

undergraduate medical education. In comparison to other

e-learning resources in pharmacology, both generation and

quality surveillance of the e-learning material was peer-driven

and -managed, with minimal supervision by faculty.

Ten Cate and Durning (2007) distinguished several modal-

ities of peer teaching that mainly differ in the educational

distance between teacher and student and the formality of the

learning environment. For instance, ‘‘collaborative or cooper-

ative learning’’ is characterized by a minor or non-existent

cognitive distance and informal learning environment. In

contrast, the setting in ‘‘peer teaching,’’ and to a higher

extent in ‘‘near-peer teaching’’ becomes more formal and the

cognitive distance increases. The Pharmacases.de project

engaged students in all modalities described above and is

thus likely to yield the learning benefits that were shown by

recent studies in educational research (Ten Cate & Durning

2007). In contrast, in the context of e-learning, the term

‘‘collaborative learning’’ is often used for the use of wiki-type

open architecture software (Wheeler et al. 2008).

The Pharmacases.de peer network was primarily based on

student–student interaction without intermediation by faculty

and thus provided almost non-hierarchical communication

structures between the elective students, which is likely to

impact learning efficacy. Cornwall (1979) postulated in his

‘‘cognitive congruence hypothesis’’ that a teacher with a

knowledge base close to that of the learner may be more

efficient. Also, it was shown that congruent teachers under-

stood the problems of students better and addressed these

problems in a more appropriate fashion (Bulte et al. 2007).

In addition to assessment, teaching can be a powerful

motive force for learning (Ryan & Deci 2000). Thus, an aspect

that should not be underestimated is the impact of ‘‘role

modeling’’ as powerful intrinsic motivation for the learner. The

high popularity of the elective pharmacology since the

inception of the Pharmacases.de project as documented by

the survey (Figure 2) may be explained by this phenomenon.

A frequently raised concern in higher education is the

assumption that teaching by students may be inferior to faculty

teaching. Although several studies had rejected this concern

(Tolsgaard et al. 2007), we decided to implement a multi-step

quality surveillance that included review by peers (e.g.,

collaborating students within the network), near-peers (e.g.,

feedback and evaluation by junior students on the website or

in the discussion forum), and faculty (e.g., supervision and

biannual review by external experts). Apart from quality

assurance, this peer-led review process also served

educational purposes to raise student awareness for the critical

interpretation of scientific data and drug information.

It will be interesting to investigate in future studies if the

Pharmacases.de peer teaching project will enhance and

facilitate the transfer of theoretical knowledge and cooperative

skills to the professional career of the participating students.

Acknowledgment

The authors thank Andreas Fleischmann, Pascal Berberat, and

Allison Murawski for critical reading of this article.

Declaration of interest: The authors report no declarations

of interest. The authors alone are responsible for the content

and writing of the article.

Notes on contributors

BARBARA ZOLLNER, MICHAEL SUCHA, CHRISTOPH BERG, NADINE

MUSS, PETER AMANN, and BERNADETTE AMANN-NEHER are sixth-year

medical students with the elective pharmacology at TUM, Munich,

Germany.

DOROTHEE OESTREICHER is a sixth-year medical student at the

University of Erlangen-Nuremberg, Erlangen, Germany.

STEFAN ENGELHARDT, MD, PhD, is the Director of the Institute of

Pharmacology and Toxicology at TUM, Munich, Germany.

ANTONIO SARIKAS, MD, is the Principal Investigator at the Institute of

Pharmacology and Toxicology at TUM, Munich, Germany and Founder of

Pharmacases.de.

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