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

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  • 2013; 35: 251253

    SHORT COMMUNICATION

    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

    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 0142159X print/ISSN 1466187X online/13/302513 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

    (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,

    respectively.

    Evaluation results

    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.

    252

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  • peers and 17% (n 44) indicated to choose the electivepharmacology 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

    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.

    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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    Pharmacases.de

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