Link

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Linköping UniversityOne university two cities
Linköping
Norrköping

• Norrköping

Håkan Hanberger prof, Div Infect Diseases,
coordinator clinical stadium medical
school Anne-Christine Persson coordinator web
scenarios Bjorn Bergdahl prof, Dept
Cardiology Faculty of Health Sciences and
University Hospital, Linkoping, Sweden
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Web scenarios - building on reality and
supporting the problem-based learning structure
of an undergraduate medical programme
Håkan Hanberger prof, Div Infect Diseases,
coordinator clinical stadium medical
school Anne-Christine Persson coordinator web
scenarios Bjorn Bergdahl prof, Dept
Cardiology Faculty of Health Sciences and
University Hospital, Linkoping, Sweden
3
Web scenarios - building on reality and
supporting the problem-based learning structure
of an undergraduate medical programme

• 1986, Faculty of Health Sciences (FHS) at
  Linköping University, Sweden, introduced
  problem-based learning (PBL) as the main
  educational philosophy for all undergraduate
  study programmes.

Web scenarios - http//www.hu.liu.se/lakarprogr/om
_lakarprogrammet
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Web scenarios - building on reality and
supporting the problem-based learning structure
of an undergraduate medical programme

• 1986, Faculty of Health Sciences (FHS) at
  Linköping University, Sweden, introduced
  problem-based learning (PBL) as the main
  educational philosophy for all undergraduate
  study programmes.
• 2001, web-based PBL scenarios introduced by the
  EDIT project (Educational Development using
  Information Technology).

Web scenarios - http//www.hu.liu.se/lakarprogr/om
_lakarprogrammet
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Web scenarios - building on reality and
supporting the problem-based learning structure
of an undergraduate medical programme

• The main aim of our project was to use
  information and communication technology (IT) and
  multimedia in scenarios to improve students
  learning.

Web scenarios - http//www.hu.liu.se/lakarprogr/om
_lakarprogrammet
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Web scenarios - building on reality and
supporting the problem-based learning structure
of an undergraduate medical programme

• The main aim of our project was to use
  information and communication technology (IT) and
  multimedia in scenarios to improve students
  learning.
• Another objective was to familiarise students
  with handling computers and accessing information
  from the Internet, thereby preparing them for the
  use of IT in health care.

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Web scenarios - building on reality and
supporting the problem-based learning structure
of an undergraduate medical programme

• The main aim of our project was to use
  information and communication technology (IT) and
  multimedia in scenarios to improve students
  learning.
• Another objective was to familiarise students
  with handling computers and accessing information
  from the Internet, thereby preparing them for the
  use of IT in health care.
• Today patient records, lab systems, diagnostics
  are on intranet in most hospitals

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• Revised curriculum
• subjects are integrated into mainly organ-based
  themes
• Within such themes, everyday situations or
  problems are selected as scenarios
• The theme groups are producing the web scenarios

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Immune-dermathology-infection and
microbiology
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30 EDIT scenarios per semester. 9
EDIT-scenarios per semester
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Role of scenarios in clinical semesters is to
complement the clerkships and to focus on
Basic science Pathophysiological
mechanisms Epidemiology Prevention Ethics
30 EDIT scenarios per semester. 9
EDIT-scenarios per semester
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The EDIT group room computer (cordless mouse and
keyboard) with internetaccess projector, screen,
whiteboard.
Web scenarios - http//www.hu.liu.se/lakarprogr/om
_lakarprogrammet
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Guided Tour EDIT-scenario
Web scenarios - http//www.hu.liu.se/lakarprogr/om
_lakarprogrammet
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Maj-Britt 80 years EDIT scenario, semester 8
(medicine surgery integrated)
Web scenarios - http//www.hu.liu.se/lakarprogr/om
_lakarprogrammet
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A scenario starts with a short and open review of
a patients complaints and background to
encourage a broad discussion
Maj-Britt Liljegren, 80 years old, arrives at the
Emergency department because of severe abdominal
pain for the last three hours. During the last
six months she has experienced intermittent
discomfort in the upper part of the abdomen
particularly in relation to meals. However, this
time the abdominal pain, which radiates to her
back, is much more severe.
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Maj-Britt sees her GP once a year because of
hypertension. Last year she had a TIA, with
temporary weakness in her right arm.
Maj-Britts husband died three years ago. She
lives alone and has no children. She is a former
office clerk and has never smoked. She consumes
one or two glasses of wine at weekends.
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Medication Trombyl (acetyl salicylic acid) 75
mg once daily, Atenolol 50 mg once daily,
Simvastatin 20 mg once daily.
Web scenarios - http//www.hu.liu.se/lakarprogr/om
_lakarprogrammet
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Scenarios develop gradually without exposing all
the information at once
Web scenarios - http//www.hu.liu.se/lakarprogr/om
_lakarprogrammet
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The EDIT base-group 1st meeting

1. Reading and understanding the vinjetto
2. Brain-storming on the principles hidden in the
   theme

Severe pain.. may be pancreatitis or
intraabdominal infection?
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The EDIT base-group 1st meeting

1. Reading and understanding the vinjetto
2. Brain-storming on the principles hidden in the
   theme

Severe pain.. may be pancreatitis or
intraabdominal infection?
We should brainstorm on different cause of pain
in upper part of abdomen
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The EDIT base-group 1st meeting

1. Reading and understanding the vinjetto
2. Brain-storming on the principles hidden in the
   theme

Severe pain.. may be pancreatitis or
intraabdominal infection?
We should brainstorm on different cause of pain
in upper part of abdomen
I heard that acute pancreatitis is the worst case
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The EDIT base-group 1st meeting

1. Reading and understanding the vinjetto
2. Brain-storming on the principles hidden in the
   theme

Severe pain.. may be pancreatitis or
intraabdominal infection?
We should brainstorm on different cause of pain
in upper part of abdomen
Which are the mechanisms behind pancreatitis?
I heard that acute pancreatitis is the worst case
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The EDIT base-group 1st meeting

1. Reading and understanding the vinjetto
2. Brain-storming on the principles hidden in the
   theme

Severe pain.. may be pancreatitis or
intraabdominal infection?
We should brainstorm on different cause of pain
in upper part of abdomen
Which are the mechanisms behind pancreatitis?
Obstruction of pancreatic outflow may be due to
alcohol or gallstone
I heard that acute pancreatitis is the worst case
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The EDIT base-group 1st meeting

1. Reading and understanding the vinjetto
2. Brain-storming on the principles hidden in the
   theme

I know Leakage of
enzymes into the pancreatic tissue causes release
of pro-inflammatory mediators from pancreatic
macrophages
release of pro-inflammatory mediators from
pancreatic macrophages is the mechanism
We should brainstorm on different cause of pain
in upper part of abdomen
Which are the mechanisms behind pancreatitis?
Obstruction of pancreatic outflow may be due to
alcohol or gallstone
Back to practice! What about
radiology which methods do you suggest CT,
Ultrasonography?
I heard that acute pancreatitis is the worst case
to encounter
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The EDIT base-group 1st meeting

1. Reading and understanding the vinjetto
2. Brain-storming on the principles hidden in the
   theme

I know Leakage of
enzymes into the pancreatic tissue causes release
of pro-inflammatory mediators from pancreatic
macrophages
release of pro-inflammatory mediators from
pancreatic macrophages is the mechanism
We should brainstorm on different cause of pain
in upper part of abdomen
Which are the mechanisms behind pancreatitis?
Obstruction of pancreatic outflow may be due to
alcohol or gallstone
Back to practice! What about
radiology which methods do you suggest CT,
Ultrasonography?
I heard that acute pancreatitis is the worst case
to encounter
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The EDIT base-group 1st meeting

1. Reading and understanding the vinjetto
2. Brain-storming on the principles hidden in the
   theme
3. Grouping suggested ideas into categories

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The EDIT base-group 1st meeting
3. Grouping suggested ideas into
categories Different cause of pain in upper part
of abdomen Acute pancreatitis Acute
cholecystitis - gallstones Mechanisms behind
pancreatitis? Obstruction of pancreatic outflow
may be due to alcohol or gallstone Leakage of
enzymes into the pancreatic tissue causes release
of pro-inflammatory mediators from pancreatic
macrophages Diagnosis Radiology which methods
do you suggest CT, Ultrasonography? Laboratory
tests
I know Leakage of
enzymes into the pancreatic tissue causes release
of pro-inflammatory mediators from pancreatic
macrophages
release of pro-inflammatory mediators from
pancreatic macrophages is the mechanism
We should brainstorm on different cause of pain
in upper part of abdomen
Which are the mechanisms behind pancreatitis?
Obstruction of pancreatic outflow may be due to
alcohol or gallstone
Back to practice! What about
radiology which methods do you suggest CT,
Ultrasonography?
I heard that acute pancreatitis is the worst case
to encounter
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• To stimulate discussions on a general and
  detailed level more information is added in a
  stepwise fashion about
• diagnostics
• treatments,
• mechanisms

Web scenarios - http//www.hu.liu.se/lakarprogr/om
_lakarprogrammet
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Elevated P-amylase Suspected pancreatitis !Confirm
ed!
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Yes! We should go a little deeper into radiology
and check the links CT, Ultrasonography!
Elevated P-amylase Suspected pancreatitis !Confirm
ed!
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Time for new brainstorming!!
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The EDIT base-group 1st meeting

1. Reading and understanding the vinjetto
2. Brain-storming on the principles hidden in the
   theme
3. Grouping suggested ideas into categories
4. Producing questions based on each category
5. Specifying study goals
6. Individual studies
7. Presenting acquired knowledge testing general
   level
8. Applying revised knowledge on the specific case

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The EDIT base-group 2nd meeting

1. Reading and understanding the vinjetto
2. Brain-storming on the principles hidden in the
   theme
3. Grouping suggested ideas into categories
4. Producing questions based on each category
5. Specifying study goals
6. Individual studies
7. Presenting acquired knowledge
8. Applying revised knowledge on the specific case

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The EDIT base-group 2nd meeting
7. Presenting acquired knowledge
release of pro-inflammatory mediators from
pancreatic macrophages is the mechanism
What did you learn about the mechanisms of
pancreatitis and how to prevent development of
pancreatic necrosis ?
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The EDIT base-group 2nd meeting
7. Presenting acquired knowledge testing
general level
release of pro-inflammatory mediators from
pancreatic macrophages is the mechanism
What did you learn about the mechanisms of
pancreatitis and how to prevent development of
pancreatic necrosis ?
I did a Medline search and I will summarise the
main message in 5 minutes based on a recent review
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The EDIT base-group 2nd meeting
7. Presenting acquired knowledge testing
general level
release of pro-inflammatory mediators from
pancreatic macrophages is the mechanism
OK, I found an algoritm for treatment of
pancreatitis with different severities scores on
the hospital intranet it is on your email..
What did you learn about the mechanisms of
pancreatitis and how to prevent development of
pancreatic necrosis ?
I did a Medline search and I will summarise the
main message in 5 minutes based on a recent review
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The EDIT base-group 2nd meeting
8. Applying revised knowledge on the specific case
I have checked why this patient was not accepted
for surgery,
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The EDIT base-group 2nd meeting
8. Applying revised knowledge on the specific case
Fine, and I can summarise the conservative
treatment she successfully responded to
I have checked why this patient was not accepted
for surgery,
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Each step meeting should be evaluated!
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EDIT- web scenarios

• Simple, robust technical solutions
• Integrated part of undergraduate education
  programmes
• Scenarios are easy to revise and reuse
• Well received by students and teachers
• About 600 regular users in medical school
• More than 150 teachers involved in scenario
  construction

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EDIT- web scenarios

• Powerful tool for change
• Review scenarios
• Review semesters
• Review programmes
• Use in other contexts
• Open source?

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Base Group appliedin Clinical clerkships

• Students are trained to be responsible for their
  own learning also in the clinical training

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Student education ward- first in the world
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Student education wards

• In 1996, the first student training-ward in
  Sweden started in Linköping.
• Several clinical education wards have later
  started both in Sweden and abroad.
• In Linköping, and later in Norrköping, students
  at the end of their education in the nursing,
  occupational therapy, medicine and physiotherapy
  programmes form inter-professional teams with 5-8
  members at orthopaedic wards and recently also at
  a geriatric ward.

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Student education wards

• Two or three teams are in charge of a ward, in
  alternating turns, and supported by clinical
  tutors.
• The teams organise and carry through care,
  rehabilitation and treatment within the expected
  level of competence.
• The majority of the patients are elderly having
  complicated medical records apart from their
  orthopaedic-surgical problems.

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Student education wards

• The two-week placement ends with a seminar.
• Reflecting on actual experiences, each team
  selects a problem, makes a presentation and leads
  a discussion for 30-45 minutes.
• Finally, they summarise the issue with special
  attention to differences and similarities between
  professions, and make conclusions relevant for
  their professional practice to come

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• EDIT - finalist in the European Academic Software
  Award (EASA) competition in Switzerland 2004.
• The medical program in Linköping has a top
  position in the national evaluation and was
  awarded for excellence in higher education in 2007

Håkan Hanberger, coordinator clinical education