Pharmacases.de – A student-centered e-learning project of clinical pharmacology
Post on 08-Dec-2016
2013; 35: 251253
Pharmacases.de A student-centerede-learning project of clinical pharmacology
BARBARA ZOLLNER1, MICHAEL SUCHA1, CHRISTOPH BERG1, NADINE MU1, PETER AMANN1,BERNADETTE AMANN-NEHER1, DOROTHEE OESTREICHER2, STEFAN ENGELHARDT1
& ANTONIO SARIKAS1
1Technische Universitat Munchen, Germany, 2University of Erlangen-Nuremberg, Germany
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.
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.
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: email@example.com
ISSN 0142159X print/ISSN 1466187X online/13/302513 2013 Informa UK Ltd. 251DOI: 10.3109/0142159X.2013.759642
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
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
(3570 h) for the pharmacology elective student and 0.54 h
per case for the peer network student. In contrast, time for
supervision by faculty was 12 h (pharmacologist) and 15
30min (supervisors of the respective network peer) per case,
Most students (95%, n 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%; n 248) and classified the additional learn-ing benefit in comparison to textbooks or faculty lecture notes
as high or very high (88%; n 232; Figure 2). Moststudents (97%; n 256) would appreciate a similar e-learningproject in other disciplines. The majority (59%; n 156) wereinterested 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.
peers and 17% (n 44) indicated to choose the electivepharmacology to actively create new e-learning cases.
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
studentstudent 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.
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,
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
Bulte C, Betts A, Garner K, Durning S. 2007. Students views of near peer
teaching. Med Teach 29(6):583590.
Cornwall MG. 1979. Students as teachers: Peer teaching in higher
education. Amsterdam: Centrum voor Onderzoek van
Wetenschappelijk Onderwijss, University of Amsterdam. Technical
Masters K, Ellaway R. 2008. e-Learning in medical education, Guide 32. Part
2: Technology, management and design. Med Teach 30(5):474489.
Maxwell S, Mucklow J. 2012. e-Learning initiatives to support prescribing.
Br J Clin Pharmacol 74:621631.
Nikendei C, Weyrich P, Junger J, Schrauth M. 2009. Medical education in
Germany. Med Teach 31(7):591600.
Ochsmann E, Drexler H, Schmid K. 2010. Berufseinstieg bereitet vielen
Absolventen Probleme. Dtsch Arztebl 107(14):A654655.
Ryan RM, Deci EL. 2000. Self-determination theory and the facilitation of
intrinsic motivation, social development, and well-being. Am Psychol
Ten Cate O, Durning S. 2007. Peer teaching in medical education: Twelve
reasons to move from theory to practice. Med Teach 29(6):591599.
Tolsgaard MG, Gustafsson A, Rasmussen MB, Hoiby P, Muller CG, Ringsted
C. 2007. Student teachers can be as good as associate professors in
teaching. Med Teach 29(6):553557.
Ward JPT, Gordon J, Field MJ, Lehmann HP. 2001. Communication and
information technology in medical education. Lancet
Wheeler S, Yeomans P, Wheeler D. 2008. The good, the bad and the wiki:
Evaluating student-generated content for collaborative learning. Br J
Educ Technol 39(6):987995.