A virtual orthopaedic hospital: feedback on student acceptance


  • Markus Wünschel,

  • Nikolaus Wülker,

  • Torsten Kluba

Torsten Kluba, Department of Orthopaedics, University Hospital Tübingen, Hoppe-Seyler Strasse 3, 72076 Tübingen, Germany. Tel: 00 49 7071 298 7364; Fax: 00 49 7071 294091; E-mail: Torsten.kluba@med.uni-tuebingen.de

Context and setting

In 2003, a new licensing regulation for doctors (Approbationsordnung) came into force. This regulation is obligatory and applies at all medical schools in Germany. One of the important differences between it and the previous version of the licensing regulation is its mandatory requirement for case studies and problem-based learning (PBL) to be applied throughout medical school and in the two written board examinations. As a result, PBL has become a very important teaching method and has had huge impact on student performance on board examinations.

Why the idea was necessary

From our own teaching experience, we know that it is sometimes difficult to have educational patients available for structured lessons because hospitalisation times have become shorter and an increasing number of patients are treated on an out-patient basis. In such cases, virtual patients are used to fill the gap and to help maintain a broad spectrum of teaching that does not rely solely on textbook knowledge. Although web-based virtual patients are a well-known application in e-learning for medical students, it is only in the last few years that the Internet has become a popular platform for such education. Increases in bandwidth allow multimedia web applications to be used with a regular web browser and personal computer from the comfort of home.

What was done

Twelve virtual orthopaedic patients were created using the ‘Inmedea-Simulator’, a web-based virtual hospital environment integrating the complete orthopaedic curriculum. A script was composed for each patient, which listed his or her personal characteristics, including complaints, symptoms, social status, hobbies, etc., as well as the frequency and dates of clinical visits. All medical students taking part in the ‘interdisciplinary clinical curriculum’, a mandatory seminar in the 2006–2007 academic year, were informed beforehand (via e-mail) that they should complete at least 10 of 12 patient case studies. During the seminar, the virtual patients were discussed with the students as blended learning. At the end of the course week the students completed a questionnaire for subsequent analysis.

Evaluation of results and impact

A total of 170 students (100 female, 70 male) took part in the study. Overall, 94% of the students enjoyed dealing with the virtual patients and emphasised the diversity of patient cases, the artful graphic design and the utility of available expert comments; 71% of respondents graded the virtual orthopaedic clinic overall as being very good or good; 96% considered that orthopaedic disease patterns can be taught appropriately using this system, and 78% wanted the virtual patients to be a permanent element in the orthopaedic teaching concept. The implementation of the web-based virtual orthopaedic patients was well received by the medical students. Problem-based learning that uses materials that are as close to real cases as possible can only be implemented by using all available means of modern Internet and computer technology. Student acceptance of these modes of delivery is high, despite the fact that the orthopaedic teaching curriculum requires the teaching of an exalted contingent of psychomotor skills. Future research should focus on the learning success achieved with the virtual patients.