MEDEV

School of Medical Sciences Education Development

Introduction

G4 is a JISC-funded project, under the Transforming Curriculum Delivery strand. G4 will replace paper problem-based learning (PBL) cases with online interactive virtual patient (VP)1 cases that allow students to make patient management decisions and see the consequences of their actions.The cases are livered in the transition year (T -year) of the MBBS medical course (T-year is second year for four year graduate entry students, and third year for fifth-year entry stream). Students will experience 18 clinical cases during three 6-week blocks of integrated learning. 

The generations

Over the years, the way in which medicine has been taught has evolved and this is largely due to the variety oft eaching and learning styles. These 'generations' of teaching and learning styles, as implemented at SGUL, can be described as:

G1 'Traditional' subject or discipline teaching. 

G2 'System-based teaching', e.g. respiratory, cardiovascular.

G3 'Scenario' based learning e.g. PBL, case based learning.

G4 'Interactive PBL': virtual patients with options and consequences.

The transformation

The project started in November 2008, and the first case was delivered in September 2009. Thereafter, a case has been delivered each week to 18 groups comprising eight students and a facilitator each. Each group's base room has a computer with internet access, smart board, and wireless mouse.

Students access the cases via the institutional Virtual Learning Environment VLE), Moodle.2 Within the course, students have an area for each learning week, here the links to the cases are provided, along with resources to supplement hte case, including web links around the subject, 'Key Topics 3 – resources developed in-house in the subject area, lecture notes, formative assessments and links to iTunes U resources. The case is played in  OpenLabyrinth,4 our VP delivery platform. The case isdelivered to the group via the smart board.

The students work though the case in a conventional style of PBL where each section of information is analysed, discussed and key points identified. At decision points a 'stop and discuss' prompt is added, allowing the facilitator to encourage active discussion before the choices are made available to the students. Once the facilitator believes the group is ready, the options are made available. Students then discuss the given optionsi n more detail and make a group informed decision.

Depending on their chosen option, the case will lead them down different paths. The order of tests or findings may be different depending on the choice. Whichever route students take, the same learning will be provided, in order to cover the same weekly learning objectives. For example; if students choose to do a set of blood tests that are not relevant they may be prompted by the nurse as to whether all the tests are needed, and to narrow them down.

Each case is written in the first person to set the scene, and to allow the students to take on the role of the doctor. As students progress through the case they generate learning objectives to investigate for the next session.

In the original trials of the VP/PBL,5 students regretted the absence of paper handouts of the case, which they had previously used for additional note-taking. To counter this, each PBL group was assigned to a wiki in Moodle called Notepad'. Use was voluntary and no restrictions were applied to its use. Any group member could edit the wiki at any point after the PBL session, or add notes and links to useful resources.

More groups used these wikis than anticipated, even though they were given little training or encouragement.The groups used them to list the learning objectives of the week, provide links to websites, and upload documents. They also used them as a repository for groupwork saved on the smart board during the session.

Each group was provided with a wireless mouse to be controlled by the group at the table (rather than at the computer) to retain as much as possible the round-able discussion element of PBL.

In addition to the 18 PBL VPs cases, the G4 team is developing 36 formative assessment cases - two cases for each learning week - to support the topics and themes of the PBL case. Students can play these scenarios in their own time. 

The tools

The VP cases were authored using a web based VP authoring system called VPSim', a tool developed by the University of Pittsburgh in the USA. Its easy-to-use authoring interface allows the subject matter expert to develop and preview the case as it progresses, without requiring any web authoring or programming skills.

Once complete, the case is imported into Open Labyrinth to be delivered to the students. Each case is enriched withr esources where possible. These may include images to set the scene, X-rays, graphs, images of medical equipment, and videos 

Initial feedback

The project has an extensive evaluation plan. Our findings from the first term suggest that students appreciate using VPs in the PBL sessions, and can understand how they relate to clinical practice. 

Students

The T year is the merging of the separate graduate (four year) and school leaver (five year) streams of the course, and their prior experiences differ. The 5 year MBBS students have a shorter, less problem-based version of PBL in the first two years of the course – case based learning(CBL). They are less familiar with discussion and problem solving in the small group setting, and it takes a few weeks before they are comfortable with the process. The four year MBBS students have PBL (paper based cases) from the start of their course, and are thus more familiar with the discussion and problem solving approach. 

Tutors

Initially, less experienced tutors found the new-style PBL challenging, but even so have noticed an increase in student discussion and problem solving. Implementation of the VPs in the curriculum has progressed well thus far and is seen by the institution as a potentially valuable learning experience for students who are moving into full time clinical attachments, allowing them to learn clinical decision making in a safe environment. 

Next steps

The last of the 18 cases will be delivered in Second Life,6 to explore how whether the increased functionality and immersiveness of a virtual world can improve the student experience.

G4 will be continued to be delivered beyond the life of the project, and further evaluation will be carried out to look at the impact of G4 on student knowledge retention. 

What are year 1 virtual patients?

At the University of Southampton Medical School virtual patients are the key to delivering its patient centred curriculum. In year 1, the aim of the virtual patients is to present a realistic clinical scenario from which students can experience a patient journey and the clinical processes involved. The virtual patients consist of interactive linear animated clinical scenarios with interactive tasks and embedded guided learning materials. They are designed to guide year 1 students through each clinical process whilst helping them apply and integrate their knowledge of the basic sciences in a clinical context. 

Roles of the year 1 virtual patients

Year 1 virtual patients are designed to support student learning throughout the course. For example,the Nervous and Locomotor 1 virtual patient, Mr Tim Brown, is divided into four weeks and based around the weekly topics of the course. Each week follows a different stage in the clinical process, and the clinical scenario encompasses basic science and clinical knowledge relevant to that stage of the course. The virtual patient, Mr Tim Brown, includes:

• The interpretation of radiological and histological images. 
• The description of pathological processes such as fracture healing.
• The identification of anatomical structures and knowledge of their function(s).
• The application of clinical skills such as the Glasgow coma scale.
• Familiarisation of clinical settings and processes.

Key features

The key features of the year 1 virtual patients include interactive animated clinical scenarios, interactive tasks and feedback, embedded interactive Learning objects and materials, and data retrieval.

Interactive animated clinical scenario

The Nervous and Locomotor 1 course follows on from the Foundations of Medicine course. At this stage, students are yet to be introduced to the clinical processes involved in specific medical specialities.

Interactive animated scenarios redesigned to provide students with an opportunity to experience clinical processes in a realistic environment. To achieve this for the Nervous and Locomotor 1case, Mr Tim Brown, the team conferred with consultants in emergency medicine and neurology. In addition, photos of the Emergency Department at Southampton General Hospital were taken and animated illustrations were created based on these photos.

Interactive tasks and feedback

Interactive tasks are embedded into the animated scenario. Where appropriate students are presented with interactive basic and clinical science related quizzes and tasks. For each activity students are presented with feedback. Furthermore, at the end of each weekly case they receive individualised feedback on their performance with the case.

Embedded learning objects and materials

Interactive learning objects and materials are embedded in the animated scenarios. At certain points students can interact with embedded objects graphics or illustrations) to obtain further information about specific medical equipment, medical images or members of hospital staff in the relevant clinical setting. Interactive learning materials embedded in the virtual patients are guided learning materials and with them students can learn and test their knowledge int he topic areas. For example, withint he Tim Brown case, students can access an interactive learning material that contains 3D animations, xeplanations and quizzes related to the Glasgow Coma Scale and Score.

Data retrieval

Student data gets stored in a database to enable them to access a virtual patient at any time and continue from the point at which they left. The data is also used to analyse each student's performance, generate individualised feedback and produce reports on virtual patients to improve the virtual patients design and learning and teaching with them in the curriculum. 

Virtual patients in the curriculum

Virtual patients in year 1 are delivered on a weekly basis. The case is introduced during the Monday morning lecture.After which students can explore and use the material in their own time during the week. The case is then summarised during the Friday symposium. Students have the virtual patients available to them throughout the remainder of the course to use as a revision tool andf or their assessment preparation. 

Pilot study

The virtual patient case, Tim Brown with a motorbike accident, designed for the year 1 Nervous and Locomotor1 course, was used as a pilot study. It integrates the four weeks of studentl earning in the course and tells Tim's story from his admittance to the emergency department through to his eventual rehabilitation and recovery with related basic and clinical sciences. The case was implemented for the first two weeks and integrated into the course curriculumin January 2009. To evaluate its learning effects, weekly pre- and post-tests for the first three weeks, pre- and post- questionnaires and focus group interviews were conducted. One hundred and eightys tudents took both tests in week one and 174 in weeks two and three. Two hundred and two and 138 students, respectively, participated in pre- andpost- questionnaires and 12 students were interviewed. The findings suggested that the students, who had used the Tim Brown case between the pre- and post- tests performed significantly better in the post- test in weeks one and two than students who had not used the virtual patient. However, between the pre- and post- tests in week three, there was no significant difference between the two groups. The key features that students liked most included the contextualised learning of basic sciences and the provision of immediate feedback. In addition, students' comments during interviews indicated that as a result of following the patient journey with an animated scenario, students perceived Tim Brown to be morethan 'just a case.'

In January 2010 week three of the virtual patient was integrated into the course. Pre and post tests were embedded within the case online.The database results showed that 216 students used the week one case compared to 160 and 170 students in weeks two and three, respectively. Further analysis is scheduled and the findings will be reported at a later date. 

Progress to date

Weeks one, two and three of a virtual patient in the Nervous and Locomotor1 course have been implemented and integrated into the curriculum. They have proved to be both successful and popular with students. 

Work planned

Work on week four has begun and the entire four week case will be integrated into the course curriculum in January 2011, when the student learning experience will be investigated. 

Introduction

Over the last 12 months, a team of Public Health specialists has been investigating the enablers and barriers to the release of open educational resources (OER) to the University sector. 

Funded by the JISC Open Educational Resources Programme and focused on public health, PHORUS is led by the Health Sciences and Practice Subject Centre working with the Royal Society for Public Health, Bournemouth University and other partners.It is one of thirty projects across the countries of the UK in an initiative designed to test practical considerations and benefits of providing open educational resources (OER) in Higher Education. One of the early findings from the project is that OER attracts strong views from the academic community. It became apparent that OER may not be as well-developed in the range of public health disciplines as in other areas, and there are still concerns amongst individuals and institutions about some of the fundamental concepts. For example:16

Who owns the educational resources: the academic who produced them or the University as their employer? 

How can the quality of resources be assessed and then maintained? This is a crucial issue in health related topics.

How could the release of OER affect an academic's reputation?

And finally, will students still sign up for courses if the materials are freely available on-line? 

A review of the Public Health resources already available gave some interesting insights into these concerns. It seemed initially that very little Public Health material was available as OER. But as the project developed, it became clear that the problem lay in tagging and classification, rather than in availability. One of the key recommendations relates to the importance of accurate tagging of resources so that students and practitioners can find what they need.

The next observation was that some of the most active participants in OER were very successful institutions such as MIT, who regarded it as a key part of their appeal to students, who were assessing the quality of teaching materials as part of their decision to enrol.

The question of ownership and use of resources lies in defining clearly who owns the rights to the material through contracts of employment and the appropriate use of Creative Commons licences.

In conducting a Delphi Study with a group of active Public Health academics the project identified key issues of importance in enabling the release of OER, which are represented in the Context Diagram (see below) which starts to illustrate their relationship.

This Study has been through three iterations in a process designed to measure consensus around the key themes relating to the release of OER in Public Health. These are now being used to develop a conceptual framework and flow chart to assist OER development and use, to provide guidance for educators and practitioners.

The final part of the project has been to encourage organisations and individuals to provide resources which can be developed into an appropriate format for release as OER, and deposited in Jorum Open, for Public Health students, educators and professionals to draw on and reuse. The process as been a slow one, due to the reasons already outlined, but some very valuable and effective resources have already been made available as a result of his project.

Although the project officially finishes as the end of April, project activities will continue until the end of June. We are still welcoming learning resources that have been developed for accredited Public Health programmes in Higher Education institutions and we are also keen to hear about learning resources used with Public Health practitioners in other settings. Our project team will work with you to repurpose your resources as open educational content and to ensurethat your contribution is recognised. The resources will be stored in a repository with a web interface that allows users to search in various ways. You an help decide how your OER are made accessible (through keywords); you can choose the licence structure options you think most appropriate, and you will receive feedback on the resources as well. Learning resources can include lecture notes and handouts, reading lists, case studies,assessment questions and criteria, module handbooks, discussion material and questions, illustrative material and podcasts, webcasts and online discussion forums.There is a limited amount of funding for this project which will pay for staff time spent in developing your resources as open educational content (though note that this funding is not available to develop new resources).  

Introduction

Between April 2009 and April 2010, JISC and the Academy funded pilot projects and activities that support the open release of learning resources OER); for free use and repurposing worldwide. These projects were intended to inform a larger programme covering a significant portion of the HE Sector. Here Patricia McKellar of the UK Centre for Legal Education (UKCLE) discusses their contribution to the OER movement in a cross disciplinary project on simulation  learning. 

The benefits of simulation learning are well documented by the SIMPLE project1 however the full-scale development of widely shareable and re-urposable content amongst simulation designers and users has been almost non-existent. This has had serious consequences for the uptake of simulation as a form of situated learning.

Our project Simshare 2 aims to release a wide range of existing simulation learning resources by supporting the release of open educational simulation resources under a Creative Commons licence and collating and repurposing existing simulation materials for use by the higher education community. Simshare project webinfrastructure encourages simulation learning by helping staff to create, use, evaluate and re-purpose simulations as OER.

We also hope to encourage the wider education community to contribute and se simulation resources (these do not have to be highly sophisticated). By working with you, to repurpose resources for the Simshare website, to showcase your work.

Resources may include:

Content resources; for example, statements, scenarios, character roles,‘real life’ artefacts to produce authentic environments, photographs, videos,a witness statement for a role play.

Information from websites on which you may run the simulation.   

Student and staff resources to support the simulation.

Assessment criteria and other assessment guidelines.

Web 2.0 technologies; for example, podcasts, webcasts, online discussion forums.

Evaluation materials.

Academic papers about (or presentations on) the simulation, including PowerPoint presentations.

Useful web links.

Guidelines on integrating your simulation into a module, including transcripts of lectures relating to the simulation.

The Simshare site, which is currently being populated,will contain a significant amount of useful information about how simulations are used and the pedagogy supporting them. Simshare will also introduce a sophisticated community of practice based on social networking technology. Through the community academics will be able to enter information about themselves and their work in the 'My profile' space whilekeeping up to date with what others are doing on the site.

If you, or any of your colleagues, are considering using simulations in your learning and teaching practice, or want to see what others are doing, then we can run a Simshare workshop where you will:

Learn about OER, and how to be a part of it.

Have access to a wealth of free resources for teaching.

Have help in getting started in using simulation as aformof teaching, learning and assessment.

Practise assembling a simulation on paper and haveaccess to online resources to help you do this.

Learn how to download and upload resources to our OER website.

We hope that you will want to be part of the growing movement in OER. Please do consider contributing to the ever-increasing numbers of resources already being shared.

Introduction

The graduate entry programme in medicine started in 2004 as collaboration between Cardiff and Swansea Universities. The first two years are based at Swansea University and consist of a series of integrated learning weeks based round a clinical case and include lectures and practical clinical skills training. Formal ward based teaching is limited to the last nine weeks of year two, although students experience primary care through regular attachment at a GP buddy practice and complete a one week nursing attachment. It was recognised early in the course development that there were few clinical learning opportunities in these first two years and that a new method of delivering this experience was equired. 

Method

The LOCS (Learning Opportunities in the Clinical Setting) system consists of almost 300 half day clinical learning opportunities that are listed in a database accessible through the administrative offices of the three local hospitals of our partner NHS Trust. Each has details of the speciality, clinical area, likely clinical exposure and days and times available. They range from out-patient clinics, theatre lists, post-take ward rounds, multi disciplinary meetings, community drug clinic or prison visit. All LOCS allow students to observe clinical practice but, active student participation is possible. Each session is strictlyl imited to one or two students to ensure individual attention and feedback.

Students are able to read through the database, choose an activity and complete a paper request. The administrative staff then contact the relevant health professional to confirm that the LOCS is available and the student is sent an email to confirm the booking.

Although there is no upper limit to the number of LOCS an individual student can complete (provided other teaching is not missed), students are required to complete 12 LOCS in the first year and 8 in their second year. In addition, LOCS on the labour ward, accident and emergency department, general medicine, general surgery and elderly care are compulsory for every student.

LOCS are recorded by students via the BlackBoardTM virtual learning environment. Each page allows the student to enter the code number of the LOCS, to enter their reflections and to rate the session on a 3 point scale of "very useful", "useful" and "not useful". An administrative screen shows each year group of students in order of the number of LOCS completed and highlights those who have failed to complete the required number. Completion of the required number of LOCS is part of the assessment of professionalism and an incomplete record results in failure to progress to the next year of the course. Failure is redeemed by completion of the missing LOCS.

Health professionals are not reimbursed for LOCS and clinical workload is unaffected. This limits many of the LOCS to observation rather than active participation or the provision of any teaching for the students.

Although it is difficult to quantify the administrative workload due to the distributed nature of the work, it probably equates to a full time member of staff. 

Results

The system has run successfully for the last four years. There are currently 297 LOCS available in the database leading to 1,555 LOCS per year with an average 1 (range 8-27) LOCS per student completed each year.

All students complete a survey at the end of the year. Ratings have been positive, with 55% "very useful", 42%"useful" and only 3% "not useful". Negative comments usually relate to the personal interaction between the clinician and student. Although rated as "not useful" byt he students, these may nevertheless provide students with valuable experiences of day-to-day health care delivery as provided by NHS staff.

Problems have occurred early in each year as students have failed to complete either their Hep B vaccination programme or criminal records check, both of which preclude clinical contact.

There has been a small but persistent proportion of LOCS that fail to happen, or example, due to a cancelled theatre list. However, staff can usually find a replacement at short notice. Changes to timetabled lectures are a persistent rpoblem as the new time frequently clashes with previously booked LOCS.

We were initially concerned that the LOCS system did not allow all students to attend sessions appropriate to the case of the week. For example, in the stroke' week, there would not be enough places for all the students to attend neurology or rehabilitation related sessions. However, students seem entirely capable of attending, for example, labour ward in the middle of a week studying pneumonia and vice versa. 

A further problemis that the structure of the learning weeks means that certain sessions are almost always occupied by large group teaching, for example, Monday mornings. This means that the uptake of LOCS during those sessions is extremely low. For the opposite reasons, LOCS on a Wednesday faternoon (when lectures cannot be scheduled) are often heavily over subscribed.

The recorded student reflections indicate a generally excellent educational experience, with students being able to interact with both patients and staff. Feedback from clinicians is generally very positive, although there have been a few instances of clinicians telling students that theycan see no point in first year tudents coming to clinical areas because they don't know enough basic science.

The LOCS systemf eatures many highly desirable educational features, in that the learning is active, student led and based entirely in the clinical environment. Although it is difficult to map such learning to formal learning objectives, students appear to find them valuable to consolidate their theoretical knowledge, practice clinical skills and to learn about the wider aspects, such as exposure to role models and identifying possible career choices. 

Further developments

We feel that these sessions have potential as formal assessment tools .Many students are already performing clinical activities in a clinical area observed by clinicians.The addition of a formalised marking scheme and recording system could onvert the existing process into an efficient summative assessment. Although it would require major investment in the training of clinicians, a series of "assessment OCS" could provide a highly valid assessment of the ability of individual students in the clinical environment. 

Introduction

The Joint Information Systems Committee (JISC) and the Higher Education Academy collaborated on phase one of the Open Educational Resources (OER) Programme. The Higher Education Funding Council for England (HEFCE) provided an initial £5.7 million of funding for 29 pilot projects (April 2009 to March 2010) which explored how we can expand the open availability and use of free, high quality online educational resources. This pilot programme was intended to stimulate activity in British higher education institutions (HEIs) and establish a national repository called Jorum Open. 

OER was coined in 2002 to describe shared electronic learning and teaching materials which (typically) have clearly identifiable Creative Commons licensing arrangements indicating how they can be repurposed in teaching and learning.  The eMassachusetts Institute of Technology (MIT) has publicly released at least 1950 courses under the Open CourseWare (OCW) initiative since their announcement in the NewYork Times in 2001. In the UK the Open University's OpenLearn project had over 5,400 hours of content available for repurposing by 2008, and currently has 13,500 hours of content available in their OpenLab area where content can be disaggregated and rebuilt. Both have millions of users worldwide.

Resources may be anything used in teaching and learning such as individual images; illustrations; reading lists; URL bookmarks; videos; audio resources and podcasts; presentations; lectures; lecture notes; cases; module and degree programme specifications; and possibly whole courses. 

Benefits of OER

These resources showcase the high quality of UK higher education and the vision is that they will be used, reused and repurposed globally. It is believed that making educational resources ‘open’ broadens their use and enables them to be repurposed. Through OER students gain access to a broader range of materials to suit different learning styles and obtain a range of perspectives on individual topics. Staff can reuse and repurpose materials rather than needing to develop them from scratch. This potentially frees up time to work on aspects of their work where they can truly add value, such as furthering their research and effectively tutoring their students. Sharing quality learning materials in this way can enhance the institution’s international reputation and provide prospective students with a taste of what to expect – a ‘shop window’.

What we are doing

The Organising Open Educational Resources project (OOER) was awarded £249, 960 to a consortiumof 17 partners based in UK Higher Education Institutions to carry out work relating specifically to our disciplines and focussing on clarifying the process for openly releasing or publishing learning and teaching resources as OER.

We concentrated on bringing together existing expertise, sharing policies and good practice in the areas of intellectual property rights (IPR), patient and non-patient consent, institutional policies and procedures relating to
releasing or publishing teaching content openly, and how making a large number of educational resources into OER might affect existing business models and collaborations. 

The partners

• University of Warwick
• University of Southampton
• University of Oxford
• University of Nottingham
• University of Liverpool
• University of Edinburgh
• University of Bristol
• University of Aberdeen
• St George's, University of London
• Royal Veterinary College
• Queen's University Belfast
• Newcastle University
• London School of Hygiene and TropicalMedicine
• Keele University
• Imperial College
• Cardiff University ( joined us as an unfunded partner after the project started)
• University of Bedfordshire 

What we did

Partners signed up to areas of work where they had recognised expertise, via a series of 12 work packages. Or they signed up to contribute resources with the potential to go forward as OER. We wanted representation from a wide range of HEIs, with diverse resources, created by a variety of different kinds of teachers contributing to medicine, dentistry and veterinary medicine programmes in UK HEIs.

The Subject Centre co-ordinated the work, and facilitated a series of project meetings under the auspices of the Executive Group which had representation from all partners.

The work packages produced a series of toolkits. Case studies are being written to test and refine the toolkits in an iterative development cycle that continue until the end of the project. 

The outputs

The toolkits will be amalgamated into a set of easy to use web based tools to help you navigate your way through the process of taking resources from your institution and releasing them as OER. There will be an upload page too, which will facilitate distribution and syndication on an educational resource.

They are available from

www.medev.ac.uk/oer

Acknowledgements

Many thanks must go to all of the project partners and Subject Centre colleagues for their diligence and enthusiasm in executing this project. 

Introduction

The OOER project(1) was funded by HEFCE and administered by the Academy and JISC. One of the recommendations was that people considering releasing or publishing their learning and teaching resources should use Creative Commons(2) licences to clarify the conditions for use and re-use of those resources. 

This article explores the concept of open licensing and examines the range of licences offered by Creative Commons 

What is open licensing?

Open Definition has a simple guide to open licensing.(3) Basically, by applying an open licence to your work, you make specific what can and cannot be done to your work, you grant permissions and state restrictions.

There are many different forms of open licensing, but the most commonly used for content is the set of licences offered by Creative Commons. 

But I'll be giving away copyright/IPR?

You retain the copyright and simply licence works under your own conditions (or those specified by your employer). Creative Commons licences apply in addition to existing copyright. 

Why bother?

It makes use, re-use and re-purposing of your work by others really clear. You may already have materials available in a repository or on a website, such as a VLE, for others to download and use but you should still think about clarifying the licence to use material clear for others. 

• Sharing teaching resources is a good thing, and the right thing to do.
• It is a philanthropic way to demonstrate good use of public money.
• It can help sell your institution to prospective students and staff.
• It is a way of showing off the quality of your work.
• You can state that you want to be attributed by any people re-using your IPR.

The Frequently Asked Questions section of the Creative Commons website has a great deal of useful easily digested information.(4) And the OOER project has developed a value statement(5) to help those interested in Open Educational Resources.

Applying Licences

Creative Commons offers six basic licences(6), starting with the most accommodating licence type and ending with the most restrictive.7  You choose a combination of up to four that you wish to apply to your work.

Attribution
This is usually abbreviated to by

You let others copy, distribute, display, and perform your copyrighted work—and derivative works based upon it—but only if they give credit the way you request.

Share alike
This is usually abbreviated to sa

You allow others to distribute derivative works only under a licence identical to the licence that governs your work.

Non-commercial
This is usually abbreviated to nc

You let others copy, distribute, display, and perform our work—and derivative works based upon it—but for non-commercial purposes only.

No derivative works
This is usually abbreviated to nd

You let others copy, distribute, display, and performonly verbatim copies of your work, not derivative works based upon it. Everyone should use Creative Commons open licences on their work

The Licences

Attribution cc: by

This licence lets others distribute, remix, tweak, and build upon your work, even commercially, as long as they credit you for the original creation. This is themost accommodating licences, in terms of what others can do with your works licenced under Attribution. 

Attribution share alike cc: by-sa

This licence lets others remix, tweak, and build upon your work even for commercial reasons, as long as they credit you and licence their new creations under the identical terms. Thisl icence is often compared to open source software licences. All new works based on yours will carry the same licence, so any derivatives will also allow commercial use. 

Attribution no derivatives cc: by-nd

This licence allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged, with credit to you. 

 Attribution non-commercial cc: by-nc

This licence lets others remix, tweak, and build upon your work non-commercially, and although their new works must also acknowledge you and be non-commercial, they don't have to licence their derivative works on the same terms.

Attribution non-commercial share alike cc: by-nc-sa

This licence lets others remix, tweak, and build upon your work non-commercially, as long as they credit you and licence their new creations under the identical terms. Others can download and redistribute your work just like the by-nc-nd licence, but they can also translate, make remixes, and produce new stories based on your work. All new work based on yours will carry the same licence, so any derivatives will also be non-commercial in nature.

Attribution non-commercial no derivatives cc: by-nc-nd

This licence is the most restrictive of the six main licences, allowing redistribution. This licence is often called the "free advertising" licence because it allows others to download your works and share them with others as long as they mention you and link back to you, but they can't change them in any way or use them commercially. 

Case studies

wiki.creativecommons.org/Case_Studies/OpenLearn 

What does a Creative Commons licence look like?

The Creative Commons website, has images that you can use and generates the following code for you to embed in your works.(6)

The CC licence (an attribution-non-commericial-share alike for this article) might look like any of these: 

Important!

One final thing you should understand about Creative Commons licences is that they are all non-exclusive. This means that you can permit the general public to use your work under a Creative Commons licence and then enter
into a separate and different non-exclusive licence with someone else, for example, in exchange for money.

Acknowledgements

The content for this article has been derived with permission from Creative Commons original content at creative commons.org and Open Definition at

www.opendefinition.org 

Introduction

We all regularly use visual evidence in our teaching and dissemination. Indeed, the sciences as a whole are largely dependant on visual means of communication: imagine trying to describe the circulatory system using words alone, and consider how those words stack up next to the visual representation of Vesalius' 'the VeinMan' or consider how both the oral description and the historical depiction compare to complex forms of modern imaging. 

Here we see a high amount of stimulating and intricate information delivered in a comprehensive manner by pictorial evidence. Indeed, the value of visual evidence is seen equally in both classroom and clinical settings: videos, models, microscopic work, ECG readings, and lab imaging all deliver specific, meaningful information in a direct, succinct format designed to convey the highly complex nature of information needed. It is vitally important that we know how to both find and use appropriate visual evidence. 

For example, if I describe to you the delicate lace network of blood vessels surrounding and perfusing the lungs, it is entirely possible that you have an almost kinaesthetic appreciation for what those words refer to: you may be able to outline the basic shape and size of this networ kusing your hands, or be able visualize the interweaving of arterioles and capillaries in relation to the main branches,and so on. This is because the visual representation itself is so familiar to you: my words relate back to what you already know as a complex set of visual information. Now look at the opposite: assuming that you do not immediately know what Taraxacum officinale is, and are therefore unable to draw up a visual reference for it (please bear with me, those of you who are familiar with this particular plant). Let's see what you gather from the following description: 

Leaves are long (5-40cm), narrow and lobed, with the lobes pointing backwards towards the base and only in abasal rosette. The succulent hollow (poisonous) stems (also 5-40cm) are never branched and bear the solitary terminal capitulum (2.5-7.5 cm diameter). The clock is made by the pappus of straight, not feathery hairs which are joined to the fruit by a thin stalk.

Imagine you are holding this plant in your hand. What is it? Does it help if I say that this plant has a yellow flower? That it is common? Perhaps the problem lies with the language: I could describe the leaves as being long, narrow and tapered, with serrated edges, and ending in a point, all growing from a single central root at the base of the plant, with flowers coming up on single stalks filled with a milky sap. Do you know what the plant is now? Undoubtedly, a picture would convey this information more completely and readily: apart from the verbosity of the above descriptions, we need to remember that language itself is complex, and communicates very little unless the vocabulary is familiar and shared. 

Yet despite the wide usage of visual evidence in the sciences, we still retain a vague sense that it is somehow a 'lesser' form of evidence to that of the written word. For example, we worry about the concept of stealing another's ideas when it comes to referring to books and journal articles, and yet generally feel free to use images which we have not created ourselves (check back over your PowerPoint presentations and make a mental note of how many pictures exist without reference attached to them). This is a serious omission on our part. 

Images, whether from physical or digital sources, fall into a number of categories, including copyrighted material, ‘morgue’ material, royalty free images, and ‘free to use ’material. Look for images with Creative Commons licences cc:by-nc-sa (or similar) on which you must acknowledge the copyright owner but is free for non commercial reuse. Copyright considerations are fraught with a host of problems, but as it is your responsibility to ensure that any visual evidence which you use is not owned by any individual or institution (this may be the original artist, or the owner of the image in the case of historical artefacts, amongst others!), it is in your interest to ensure, as far as possible, that the image you use is not in copyright.

Orphaned works or 'morgue' artefacts are those where no provenance can be found: that is to say, they are images, usually photographs, where the original artist is unknown, and the picture is perhaps perceived to exist within the common realm of usage, and therefore available to all. However, unless the material is clearly out of copyright date (say, a Renaissance wood cut), or there is express authorial clearance ofc opyright, there is no guarantee that an image is free of copyright. Typically images which either the original artist (for example, the photographer) has licenced as 'free to use', or those historical images which are being made freely available by the owner or repository are considered royalty or copyright free. Alas, copyright, or royalty, free images may not always be free to use – when you buy access to a digital library, you are in effect buying the right to use those images under the terms of the purchase. Similarly there are websites which offer the use of images for sale. 'Free to use', on the other hand, suggests that the use of an image is just that, entirely free of any charge to you. Many sites offer 'free to use 'with a range of stipulations attached (ie. free to use for educational but not commercial purposes, free to use with authorial acknowledgment, and so on). Lists of both royalties-free and 'free to use' internet sites may be found at the end of this article. 

However, even when using 'free to use' material, we remain subject to the same rules of acknowledgement that we would be if we were quoting another's words: we may be free to use those words or images,  but we must as ethical professionals acknowledge them. Even in cases where copyright is not an issue, this question of acknowledgement is itself relatively complex. Supposing you found a photograph of a model of a lung that you wanted to use: who should you acknowledge as author? The individual whose body the lung was modelled on; the individual who created the model; the institution producing the model; the photographer who took the picture we're looking at; or the magazine or book publisher presenting the photograph? Or all of these? Generally speaking, those rules applying to bibliographic referencing apply also to visual evidence: information on the primary author or artist (of the photograph, picture, or model), editor (or compiler) of the resource where the image was found (if applicable), publisher, date and location should be included in your reference list. 

Once you've found an image, you will need to consider attaching meaningful metadata in order to tag and catalogue it for future use – this is the key tool for users. How are these images to be used, and by whom, and in what context? Is your teaching absolute (undergraduate medical pedagogy), or culturally relative (medicine in the humanities)? Are you are looking at providing images solely for the teaching of anatomy, for example, where the tags 'venous system' or 'pulmonary blood supply 'might suffice, or might you also use them for considering historical context, where you will also include tags relevant to the artist, the date, and perhaps the medium as well as the theory or practice? 'Tagging' or determining what metadata will be of use to your end user will most likely benefit from a series of consultation, feedback, and analysis. 

As with all things, the proper use of visual evidence becomes easier with practice, and it is no longer enough for us to simply use these images; it is now time to use them wisely.

Current 'Free To Use' Sources (always check the terms of the licence):

www.flickr.com

www.freefoto.com

www.freeimages.co.uk

www.freedigitalphotos.net

www.imageafter.com

www.healthcarefreeware.com/photo.htm

(this is a good source site) 

Morgue (free to use, but check the provenance)and Royalty Free Images (which you can purchase to use):

en.fotolia.com

www.morguefile.com 

Specialist libraries with large databases of general medical or historical medical images:

www.imaios.com/en/e-Anatomy

www.mediscan.co.uk

images.wellcome.ac.uk

special.lib.umn.edu/swha/IMAGES/home.htm

www.fromoldbooks.org

www.springerimages.com

And the plant in question: the humble dandelion. 

* 2008-Jun-23. For the first time, a computer tomograph (CT) can be used to automatically differentiate various tissue types in one scan. That's because the Somatom Definition from Siemens features two X-ray tubes that work in parallel at different energy levels. Thanks to the syngo Dual Energy software, the tomograph can detect vessels and bones and display them in clear contrast to one another. Until now, using CTs without the Dual Energy feature, two scans were needed to do this. The breakthrough enables physicians to diagnose their patients' conditions faster and more accurately. 

Introduction

In order to meet the educational challenges of Modernising Medical Careers (MMC) and the European Working Time Directive (EWTD) the Postgraduate Deanery Wales set up a single eLearning platform Postgraduate Learning and Teaching Online (PLATO) for all trainee doctors and dentists in Wales and their trainers. PLATO was launched in Wales in 2008 and provides a one stop shop approach for the delivery of high quality training for medical and dental trainees and their trainers in Wales. PLATO delivers a range of clinical educational resources across a wide variety of specialties in addition to corporate and professional development modules. 

PLATO principles include:

• Sharing and reusing of resources.
• Multidisciplinary coursemembership.
• Blended approach to learning.
• Easily customizable courses.
• Authenticated access controlledby course leaders.
• Flexible learning.
• Signposting of quality assuredexternal resources.
• Accessible learning. 

As a part of the strategy to meet the educational challenges posed by MMC, EWTD and the rurality of Wales, the Deanery has adopted a technology enhanced learning approach. The Deanery's eLearning Unit (ELU) was set up PLATO. The aim is to develop and signpost high quality e.resources to meet local and national training needs in Wales. A vital element in achieving this has been to signpost external resources that have been through the ELU's quality assurance process. This avoids any unnecessary duplication of resources and effort. Thi aspproach allows the ELU to focus on identifying gaps in training provision and creating materials or courses to fill those gaps.

A platform for providing eLearning in Wales, Learning@NHSWales, was already in existence and available to the wider NHS. This platform is based on Moodle1 and contained an array of features specifically for Learning and blended learning. Learning@NHSWales led to the development of PLATO, a platform with all the functionality of Moodle with intuitive navigation, inbuilt support systems, flexible page layouts, enhanced reporting and fully customizable design.

Learners

Medical and dental trainees in the NHS and their educational supervisors. The reality is that training for trainees is multidisciplinary and PLATO reflects this in the enrolment strategy. Registration to the platform currently allows for all NHS employees and some undergraduate medical schools. Enrolment onto any given course is at the discretion of course leaders. This allows inter-professional education and ensures that courses and the learning material developed for them is suitable for all relevant clinical staff. 

PLATO approach to eLearning development

ELU educationalists and learning technologists work with content experts to form teams to design and develop materials for courses to meet local and national needs. A range of appropriate learning activities are included in the design from an arly stage. These activities range from simple MCQs through to custom drag-and-drop exercises.

PLATO courses are designed with the objective and desired outcome for each activity defining the form of that activity. For each activity we aim to use Ally's approach2 of employing behaviourist strategies for teaching the 'what' (facts), cognitive strategies to teach the 'how' (processes and principles), and constructivist strategies to teach the 'why' (higher level thinking that promotes personal meaning and situated and contextual learning). However, this ideal is tempered with the realities of differing levels and types of resources vailable to specialties in Wales and the NHS as a whole.

Assessments and other activities are recorded to provide course performance data and to allow a record of training to be kept. Certificates are automatically generated when a certain combination of activities are completed successfully, this combination is determined by the course leader and can be different for each course. This allows the educational supervisors and others managing the trainee's education to simply ask to see the certificate as evidence of course or module completion.

PLATO resources fall into three broad categories:

• Clinical.
• Corporate.
• Professional development. 

Clinical modules

Examples of clinical modules include:

• Rheumatology.
• Sexual health.
• ENT.
• Minimental state examination.
• Safeguarding children.
• Acute pain management. 

Cervical screening Wales (CSW)

This module is part of an accredited programme which includes face to face training and practical sessions for the procedures. The module comprises a series of case based scenarios with an online assessment. This is an integral part of CSW three year up-date to ensure clinical competence in the field of smear taking. The learners are general practitioners, GP trainees and practice nurses across Wales.

• Corporate modules.
• Fire safety.
• Wales Junior Medical Staff handbook.
• ABMU West Junior Medical Staff induction.
• Cardiff & Vale NHS Trust Induction.
• Royal Glamorgan Postgraduate Centre: Foundation programme.

Cardiff & Vale induction

This course is designed to improve access and streamline the induction of new medical staff into Cardiff and Vale NHS Trust hospitals. The materials are in two sections, the core section includes materials that need to be covered in the first weeks of arrival. The comprehensive section covers materials that need to be reviewed before completion of the trainee's rotation. Both core and comprehensive sections provide evidence of completion via assessment and certification. 

Professional development

Professional development in education (PDE) for supervisors:

• MSc medical education. 
• Planning your medical career.
• Applying for specialist training.
• NHS reflective practice modulefor NES ePortfolio.

professional development in education for supervisors

Developed in collaboration with the London Deanery, four modules are now available to all consultants in Wales. Subject areas include equality and diversity, feedback, careers support and work place based assessments. PLATO has extended the scope of the original London Deanery materials by adding formative and summative assessments. A score of 80% or higher for the summative assessments makes a personalised certificate available for downloading, printing, and saving. All scores and activity are logged in a grade book allowing reporting against PMETB standards.3 

Future developments

PLATO is currently being developed to allow automated importing of summative assessments into a database (Intrepid) allowing course pass marks to be stored and reported on in relation to the rest of the Deanery data. The CSW module is being enhanced in collaboration with Swansea Metropolitan University using 3D resources, progressing from the correct method of taking a swab sample through to screening cellular samples.

Chemotherapy administration module is under development. The learner group is nurse practitioners and the module is interactive case based with assessments. This has been driven by UK and Wales reports on patient safety in this area. 

Introduction

The UK Centre for Bioscience is one of 17 subject centres involved in the subject strand of the Open Educational Resources (OER) phase 1 pilot programme. 

Our approach

In the ten years since the UK Centre for Bioscience was established, the bioscience learning and teaching community has produced many educational resources which have been made available through the Centre website for the benefit of the academic community.1  Many of these have been supported with individual or departmental grants to encourage wider adoption in other institutions and a community perspective. This support also provides a means for recognition of good practice in teaching and learning. The impact and further development of such resources depends upon others individuals, who will report the outcomes through our publication routes; principally reports, bulletin articles2 and our e-journal.3

The recent rise of the OER approach towards learning resource development and release presents opportunities and challenges to explore: in preparing resources or a worldwide audience a number of issues emerge including licensing, discovery, distribution mechanisms and building support for further development.

For our pilot project we put out a call to the bioscience learning and teaching community for examples and collections of resources on a key aspect of curricula in the biosciences – laboratory and fieldwork practical classes.We sought resources which had successfully been deployed within the originating institution but, with the aid of a further funding could be prepared for open release and widespread use. Although the project was very much a pilot to discover the barriers and issues to the OER approach across the biosciences, it was important from the Centre perspective to deliver tangible outputs which could immediately be useful to our community. As such the project was to mark a significantstep towards the development of an Interactive laboratory and Fieldwork Manual for the biosciences.

We selected ten partner bioscience departments from across the UK who offered examples that addressed common areas in practical teaching and also encompassed various delivery solutions – from stand-alone to web applications. The key concepts of OER are that the community can not only easily adopt Creative Commons licenced resources in whole or in part for immediate benefit, but also adapt the resources, for with these being returned back to the community for further use or enhancement. Our range of delivery solutions allows us to discover more about the portability and adaptability of a range of resource types in a bioscience context. 

The resources

Our Interactive laboratory and Fieldwork Manual for the Biosciences is comprised of:

Cancer Biology (Dr Momna Hejmadi, University of Bath): an interactive online eLearning tutorial on cancer biology, designed using Adobe Flash software to help conceptualise complex cellular processes in DNA replication, damage and repair. Supported by formative quizzes, references and printer-ready notes. 

Medical Microbiology (Dr Sue Bickerdike and Dr JohnHeritage, University of Leeds): a set of resources designed to support mainly first-year modules, and comprising the teaching of core knowledge with respect to microbiology. They consist primarily of Articulate presentations and Articulate Engage interactions demonstrating both theoretical and practical aspects of common undergraduates modules.

Virtual Biochemistry Laboratories (Professor David Male, The Open University): three virtual laboratories on Molecular and Cell Biology. Each laboratory is supplemented with background reading material to provide a complete self-contained teaching package.

Influenza outbreak (iCases) (Dr Vivien Sieber,University of Oxford): iCases give students the opportunity to interact with experimental data in a realistic context. With limited time and money, students must decide what tests are needed to resolve a complex situation typical in biomedical sciences. 

Genetic Analysis virtual laboratory Scenarios (Mr Ian Miller, University of Manchester): a set of scenarios designed to support an undergraduate course in Genetics. In the scenarios the student plays the role of a genetics researcher, and performs simulated experiments to reinforce concepts taught in lectures.

Virtual Analytical Laboratory(VAL) (Dr Vivien Rolfe, DeMontfort University):Resources to help bioscience students gain essential laboratory skills, including pipetting, microscopy and basic microbiological techniques.

Virtual Education Resource for the Biosciences(VERB) (Dr Helen Chatterjee and Alex Lee, University College London): an online teaching and learning resource designed to accompany and enhance undergraduate degrees in the biosciences, focused around UCL's extensive zoological collections. Contains web books and associated quizzes outlining the diversity of the animal kingdom from an evolutionary perspective, plus an associated glossary with hyperlinked entries. 

Biodiversity (Dr Kevin Caley, University of Nottingham): part of the Biodiversity Consortium's"...World" suite. Includes an aerial survey of mammalsin Kruger National Park (fieldwork regarded as 'exotic' and 'expensive'), surveys of a set of gravestones in North Yorkshire (and therefore an example of sampling sessile populations, alongside more general information on lichens) and a more theoretical unit that examines biodiversity indices and models.

Virtual Field Ecology (Dr Ross MacLeod, University ofGlasgow): a collection of resources designed to supplement lecture and field courses in ecology by providing a level of detail that goes beyond what can be presented n  lecture or learnt at a single field site in the short space of time available on  field course.

Virtual Rocky Shore(VRS) (Dr Richard Stafford, University of Gloucestershire): The VRS is a computer simulation of grazing snails on a rocky shore, and allows an open, enquiry-based approach to experimental design. The simulation allows data to be rapidly collected and analysed in a short space of time. 

 These resources are all available from Jorum Open4 or perhaps more conveniently through an alternative interface in the UK Centre for Bioscience project pages within our Centre's website.5 We look forward to your visit. 

Introduction

This project brings together clinical and non-clinical researchers to map the operating theatre (OT) as a multi-professional site of teaching and learning. Alongside the observation of educational activities, high fidelity simulation is used to distill key elements of clinical pedagogy for faculty development. Workplace-based learning plays a key role within postgraduate clinical education. Dwindling opportunities for clinical exposure highlight the growing role of simulation in postgraduate training. Developing a robust evidence base to support the use of simulation is a pressing need. To maximize the benefits which simulation offers to theatre staff, it is essential to identify the teaching and learning that takes place in the OT. 

We adopt a social-interactional and multi modal perspective on learning and teaching. This perspective brings out issues which tend be overlooked when education is constructed as the transmission and processing of information, which sees teaching and learning as coding/sending and decoding/receiving a body of knowledge (a 'curriculum') through talk. It brings into focus the complexity of the operating theatre as a site where curriculum entities are constructed and socially/pedagogically framed in a range of interactional modes, including and movements, gaze and talk. Such a detailed mapping of the operating theatre provides an empirical basis for critical reflection on current practice and explorations of ways to improve clinical education. 

Main findings

Observations were carried out in a major teaching hospital in London. In total 25 operations in general surgery were observed, involving a pool of 40 surgeons, anaesthetists, nurses and ODPs and five medical students. The operations over eight different general surgical procedures, lasting between 45 minutes and six hours (totalling approximately 60 hours). The key findings are summarized below. 

The OT is a vibrant site of learning and teaching

When walking into the operating theatre, any time before, during or after an operation, one can always see and hear people engaged in activities from which they are likely to learn: nurses explaining to other nurses what new instruments are for, what the preferred plug point is for the diathermy machine, or how to use the whiteboard; nurses telling medical students where to stand in the theatre or teaching them how to scrub; medical students doing their first catheter, senior house officers(SHOs) doing their first central line, consultants consulting other consultants when doing their first single incision cholecysectomy, specialist SpRs (SpRs) receiving instructions from the consultant while showing the SHO how to place a port; anaesthetists doing case based assessments with their SHO, et etera. Recognition of this every day learning by all staff, experienced and inexperienced, may have a positive effect on the pedagogic framework. 

Teaching and learning in the OT not only involves talk

Here are two examples of typical interactional exchanges in the OT.

Example 1:

Cons: What's this?

MedStud: No idea.

Cons: I'll give you a clue, this[sic] is the liver.

Example 2:

MedStud: The ovary.

Cons: Yes.

Cons:Holds tissue up.

SpR:Operates diathermy on tissue.

In (1) teaching and learning takes place in and through talk and pointing to / out. In (2) different modes of communication are used, notably hand and arm gestures. Example (2) is often not described as teaching, whereas (1) is, since theuse of talk is seen to be more 'explicit'. We argue instead that teaching in (1) and (2) are equally explicit and should both be recognized as teaching episodes. By holding the tissue up the consultant indicates to the SpR precisely where she/he needs to dissect. Using multiple 'modes of interaction' also allows a trainer to teach multiple trainees at the same time: Examples (1) and (2) could well have enfolded simultaneously. 

Teaching and learning through 'dialogue' is rare

Examples (1) and (2) demonstrate 'vertical' participation structures –from the more to the less experienced, from the more to the less powerful. An example of a horizontal participation structure would be a consultant asking the SpR after a staging laparoscopy, "So,what do you think?" In the vertical structures the trainer asks a question to which she or he knows the answer, and the trainee is allowed to do something she or he knows how to do him or herself. In the situation of the horizontal structure an 'issue 'which is open' leads to thef ormulation of an 'open question' ;the trainer is inviting the SpR to give his or her opinion, thus setting up a dialogue in which they jointly construct an account of what they just saw. Such horizontal structures appear to be less common than the vertical structures, not only when they involve medical students, but also when they involve rather senior SpRs.We want to explore what the potential of more dialogic talk in the operating theatre might be, both within and across professions. 

Nurses teaching compared with doctors

Having looked at teaching andl earning among nurses, anaesthetists and surgeons, some differences emerge between these professional groups. It appears that horizontal participation structures are more common among nurses than among surgeons and anaesthetists. Another difference is the educational activity among anaesthetists and surgeons. During operations, anaesthetists seem to have more opportunity to attend to their trainees, of which there is usually only one (rather thant wo-three in surgery). Their activities during operations also tend to involve a lot more talk than those of surgeons. 

Distributed simultation

Our observations have led us to develop new application models for Distributed Simulation (DS), a portable, contextualized and patient safe learning environment see picture). DS is aimed at widening access to clinical training in a realistic simulation environment at a fraction of the costs of fully equipped simulation suites.1  We can use the DS to investigate teaching models. Some of these models are based on the potential of the DS as an additional site of teaching and learning alongside, e.g., a clinical skills classroom, the OT, the ward), others may eventually be transferrable to the environment that is being simulated. 

Acknowledgements

The research reported here is funded by the London Deanery (Simulation and Technology-enhanced Learning Initiative (STeLI) grant) and the Royal College of surgeons (2009 Research Fellowship). 

On behalf of the mEducator consortium

The widespread use of the Internet in medical and healthcare education has resulted in the development of different types of web-based educational resources and in turn has revitalised the teaching and learning process.The potential benefits for the community are clear provided there are common ways of sharing these resources among different academic institutions, not just in the UK but across the world.

Many academic institutions use their own virtuall earning environments (VLEs) and learning content management systems (LCMSs) in order to deploy educational resources in their curricula. These resources can be of various formats, such as clinical/non-clinical images, text, video, podcasts, virtual patients, serious games scenarios etc. However, there is no standardised way of sharing these resources so that institutions can make use of the current worldwide open educational resource (OER) initiatives to transform and enrich their respective curricula.

An attempt to solve this problemis now underway as part of the mEducator best practice network (BPN), a European Union co-funded project under the eContentplus programme, which aims at implementing and critically valuating existing standards and reference models in the field of eLerning in order to nable specialised state-of-the-art medical educational content to be iscovered, retrieved, shared and re-used across world wide higher education nstitutions.

The mEducator project places an emphasis on current day practices with educational resources, primarily focussed on repurposing (i.e. to convert a resource created for one purpose into a resource fit for another purpose), and seeks to include this as extensions to existing standards.The project also seeks to implement and compare two alternative solutions for educational content discovery and retrieval on the web as part of its best practice nature. 

mEducator partners

Aristotle University of Thessaloniki, Greece.

University of Cyprus, Cyprus.

Democritus University of Thrace, Greece.

Medting, Ireland and Spain.

Technical University of Cluj-Napoca, Romania.

Universite Nice, Sophia Antipolis, France.

Medical University Plovdiv, Bulgaria.

Universita degli studi Catania, Italy.

University of Helsinki, Finland.

St George's, University of London, UK.

Succubus Interactive, France.

The Open University, UK.

The Serious Games Institute Coventry University, UK.

European Cervical Cancer Association, Belgium.

Objectives

The following objectives have been set to collect and repurpose a critical mass of different types of health educational material such as:

Conventional educational content types : lecture notes, books, lecture presentations, exam questions, practicals, scientific papers, graphs, images/videos, algorithms and simulators. 

Educational content types unique in medical education: teaching files, virtual patients, evidenceb ased medicine forms, objective standard clinical examinations, clinical guidelines, anatomical atlases and electronic traces of images.

Alternative educational content types: active learning techniques and problem/case based learning sessions via web 2.0 technologies, serious games (2D/3D), webtraces, wikis and blogs/discussion forums.

Analyse the suitability of existing metadata standards like Healthcare LOM3 to address all types of health educational material listed above and to make respective recommendations for standards extensions.

Analyse the suitability of existing standards like SCORM for Healthcare to support the packaging and seamless delivery of all these types of educational material.

Communicate and interact with standardisation bodies like MedBiquitous Europe,3 IEE,4 IMS5, CEN,6 Health On the Net,7 HL&,8 etc to ensure adoption of standards recommendations/extensions.

Analyse policies andmechanisms for content providers, peers (academic educators) and final users (medical students) to evaluate, rate, contribute to, and renew content in repositories/VLEs/LCMSs.

Elaborate on issues relating to intellectual property rights (IPRs) of educational resources, based on current practices, and propose best practice guidelines for IPR management.

Outline methodology

mEducator's project plan is of high complexity including interdependencies between its different subtasks. In order to accomplish the aforementioned objectives thefollowing methodology is being followed:

Content preparation: at this initial phase of the project, all content providing partners have provided the consortium with the various types of educational resources used in its institution. In mEducator, educational resources must have a registered history of creation, be linked with specific educational goals and objectives, have established learning outcomes, have defined educational contexts/settings, and be recommended with certain teaching methods & strategies types, while assessed/evaluated by certain means to accomplish the fulfilment of its predefined learning outcomes. 

Content integration: after defining each partner's responsibility regarding the type of educational material they provide to the consortium, the next phase of the project is the representation of the material by means of a common metadata content description scheme. The first version of this scheme is now defined and available with appropriate conformance metrics. The scheme will be used for the creation of XML files that would store important information about an educationa resource and would be transferred between different systems/VLEs/LCMSs.

Repurposing: repurposing in mEducator is defined as the transformation of a learning resource initially created for a specific educational purpose and context into a resource fit for a different purpose in the same or different educational context. This process is of crucial importance within mEducator and reflects current OER practice, since the interaction between institutions includes the reuse of educational resources and repurposing to new needs. So far, the following repurposing types have been defined by the mEducator project to:

Different languages. 

Different cultures.

Different pedagogical approaches.

Different educational levels.

Different disciplines or professions.

Different content types.

Different technologies.

People with different abilities.

Part of this phase takes place simultaneously with the standardisation phase since the repurposing procedures will also be captured in the metadata content description scheme.

Content discovery and retrieval

During the last phase of the project, the discovery and retrieval of medical education resources will be implemented and evaluated using the agreed metadata content description scheme. As a result, two alternative solutions for educational content discovery and retrieval on the web will be developed:

The first solution will be based on a traditional isolated repository with enhanced web 2.0 functionality technologies enabling repurposing in a mash-up environment. 

The second solution will be based on a semantic webservice architecture lending itself to dynamic retrieval of resources from individual partner VLEs/LCMSs/systems.

Introduction

In September 2005, the Royal Veterinary College welcomed the first group of students on the Widening Participation Gateway course which has been a huge success. The Gateway course is the first year of an extended six-year veterinary degree programme, created for students who are part of our UK widening articipation cohort.1  It is designed to widen the opportunities to students who went to a non-selective state school, were eligible to receive the education maintenanc eallowance (EMA) and who's parents have not been to university. 

Successful completion of the programme does not give a qualification in itself, but does lead on to a guaranteed place on our five year BVetMed programme. We are also now able to offer students the chance to study for their veterinary degree elsewhere. The Universities of Liverpool, Bristol and, as of last year, Glasgow will guarantee an interview for a place on a five year clinical veterinary degree. In September 2009, 34 students joined the current Gateway year and have all passed their first in course assessment. Feedback from students is already very positive.

"The lectures have been structured very well, and the pace has always been just right. Very amazing course and would not be here without it!" Gateway student

Students who have passed the year are now in a variety of different places. The majority are in Years 1, 2 and 3 of the BVetMed. Some are at Bristol University and some at Liverpool, and a few are spending the year intercalating with a BSc in another discipline. Two students from the original intake have returned to the RVC having successfully graduated with a BSc biomedical sciences & infection from University College London and from University of Liverpool with a BSc veterinary conservation medicine. This year, even more students have shown an interest in intercalation and are applying right now for courses around the country.

The first group of students are now in Year four at the RVC. They have been visiting practices and farms to observe and learn from practitioners. They need to complete 26 weeks of extra mural studies (EMS) over the last three years of the course and have become ambassadors for the Gateway programme across the country. As they spend time with vets, vet nurses (and sometimes secondary students), doing work experience, they are spreading the message that it is possible to get into vet school from a non traditional route and succeed whilst you are there.

Stephanie Edwards is one of those students who is in her fourth year of the VetMed course at the RVC. She has excelled in the degree, receiving merits in all years and a distinction in Year 3 of the BVetMed, and tells her story. 

I achieved average GCSE grades and A levels and when applying to universities or veterinary degrees I got straight rejections. My options were limited but I was determined to achieve my goals so I returned to school tor esit my A levels and, upon my return, the new Gateway course was brought to my attention. I fulfilled the requirements for entry so applied and, after a successful interview, was given an unconditional offer. I found the Gateway year an excellent opportunity to integrate into a new environment and develop my learning skills and also to make some close friends within the 20-something sized group. Having not come from a farming background I had little experience handling large animals and found that the structured animal husbandry classes we were given during the Gateway year gave me more confidence. When doing practical lessons, EMS and SCE exams on the BVetMed course I felt I was not behind in this area. I believe it helped me develop a good work ethic and basic practical skills to build on later on the course, and this has enabled me to progress well with the degree. I have a favourite EMS placement with a farm practice locally which I continue to return to. They have helped me build on the theory and improvemy practical skills in an area of the profession which I take a deeper interest in and intend to progress into a career in large animal practice after graduation.

"Steph has now done two periods of EMS with MacPherson O'Sullivan Ltd, a farm animal practice based in Shrewsbury, Shropshire.We were the first EMS she had undertaken where we have done a lot of routine fertility work with her, some perations and some clinical work. I have been very impressed with her grasp of the practical work we have undertaken, her keenness to learn and to participate in our day to day work. Her knowledge is good and she would seem to have an aptitude for this side of veterinary practice. Her practical ability I would put above most of the students I have dealt with in the past for where she has got in the course so far. As a Gateway entrance student, I would have no qualms about her and at present would rate her beyond normal entrance students I have helped to train on EMS."

RodWood. BVSc,MRCVS.MacPherson O'Sullivan Ltd 

When the RVC first developed the Gateway course Professor Lance Lanyon, then Principal of the RVC, said:

"The veterinary profession has long been recognised as one of the most difficult to enter. The odds are stacked against young people from the inner cities who do not have easy access to animal experience, and who often attend schoolsw here students do not outinely achieve the high A-gradesr equired. The Gateway Programme will help the veterinary profession to become more representative of the society it serves."

Our original Gateway entry will be applying for their first jobs in one year's time, and we know that they will be just the first cohort of successful vets who found a way into vet school that accounted for their circumstances. 

Introduction

This article summarises a study on exploring a different approach to traditional pedagogy by evaluating the use of mobile learning in medical and healthcare education. 

Rapid developments in information and communications technologies (ICT) and evolving learner behaviours require institutions to continuously revaluate their approaches to pedagogy, both in physical and virtual' classroom' spaces. The increasing availability of low-cost mobile and wireless devices and associated infrastructure heralds both opportunities and challenges for educational institutions and their teachers and learners.1

The eLearning Unit at St George's carried out a comprehensive survey to find out the latest activities in this changing landscape and also the likely impact on teaching, learning and information service provision. In addition to the student survey, a mobile learning system had been implemented which can be integrated with the University's existing virtual learning environment. 

Summary of work

The aim of the mobile learning project was to study the feasibility of mobile learning (mLearning) for mainstream teaching and learning. By doing so, to identify any developments which may benefit the institution, the project was carried out in the following phases. 

Phase 1: a comprehensive survey to evaluate the impact of mobile learning with students

An online survey was constructed in SurveyMonkey2 which was divided into five sections:

An introduction describing the purpose of the survey.

Questions relating to student's personal and course information.

Questions relating to phone characteristics.

Questions relating to general phone usage.

Questions relating to phone use for learning.

The survey was completed by 714 medical and healthcare students (424 females and 290 males with an average age of 21) across all the different years. 

Analysis and comments on some of the important questions

Survey questions from "phone characteristics" and "general phone usage" sections were as follows:

Q: "Please use the drop down list below to select your mobile phone brand (694 responses, 23 respondents skipped this question)"

The results show that most of the students own a smartphone withmultimedia apabilities. A quarter ofrespondents owned a Nokia mobile phone, 7 owned a Samsung with Sony Ericsson and Apple taking the third and fourth places respectively. 

Q: "Choose 5most important uses of your mobile phone? 671 responses, 46 respondents skipped this question)"

The most important uses of mobile phones were' Checking e-mail (43%)' and Recording video/audio/pictures (40%)', as shown in Figure 2. 'Browsing on the internet (34%)' was found to be the secon dmost important use of t hemobile phone which pointed out the importance of the internet.

Q: "How many mLearning applications/websites did you access last month? (668 responses, 49 respondents skipped this question)"

More than half of the students were already performing mLearning activities as shown in Figure 3. The St George's students are currently downloading over 1000 academic podcasts weekly and visiting over 1500 dedicated mLearning sites monthly. In the next year, about half of the students plan on using their mobile to watch educational videos and to view PowerPoint slides.

An analysis was carried out to study the challenges that might be faced when using mobile devices to learn. Some of the technical limitations were resource delivery,storage, data security, accessibility, etc.  

Phase II: Mobile Moodle was identified

Due to the overwhelming student response in favour of mobile learning, the Learning Unit had identified an open source project, called Mobile Moodle (MM)3 in response to the following requirements:

An open source project (free to download and install). 

Technically customisable.

Easy to implement.

Simple to use and manage.

MM Implementation

There are two ways by which MM can be used – an application version and a browser version. While the application version is dependent of the mobile phone, the browser version is independent and always has live streaming. Hence, the browser version was found to be more advantageous and was customised at St George's. 

How is Moodles content transferred to mobile phones?

MM transfers Moodle content to mobile phones through a mobile interface called MLE (Mobile Learning Engine).4  It plays an intermediate role between the mobile device and the Moodle System. Figures 4 & 5 show the difference in appearance of a Moodle Quiz through both desktopMoodle andMM. 

Phase III: MM Evaluation

The usability test

A MM usability test was carried out with 20 users (staff and students) who were asked to complete a few tasks using their own mobile handsets. The tasks included logging in to MM, accessing specific course materials, downloading learning resources, completing simple quizzes, etc. The time taken to complete these tasks was then compared to an expert user Figure 6).

The orange line represents the average time taken by the expert user and the red line represents the average of all the times taken by the first time users. The assumption is that once the users become familiar with the MM interface, the time taken to access and navigate the course materials and other resources would decrease. 

Conclusions

As mobile networks and infrastructure are uniformly upgraded to third generation (3G) and beyond, the current constraints of bandwidth will be relieved and mobile content will correspondingly increase in both quantity and quality.5  The public have grown to expect connectivity wherever and whenever. Subsequently, today's generation is becoming much more of a mobile society.6

The results of our survey show a direction of travel where MM can help us to explore mobile learning for mainstream teaching and learning. 

ICVP 2010 and MedBiquitous bringing minds together

This year the 2nd International Conference on Virtual Patients joined forces with the MedBiquitous Annual Conference to explore how virtual patients, eLearning resources and web 2.0 technologies can transform health education and assessment. Learning technologists and healthcare educators from around the world gathered to present their findings and learn from one another.

While virtual patients are an important component of healthcare education, other events have not focused on the diverse ways in which virtual patients can be implemented in the curriculum, their design implications, and virtual patient related research. The additional focus of eLearning and Web 2.0 built on the themes of collaborative development and participative learning.

This conference3 continued the exciting ideas that took place during the 1st international conference on virtual patients held in Krakow, Poland in 2009.2 By merging with the MedBiquitous Annual Conference, the conference scope expanded to include howt echnology standards could be used to facilitate collaboration and further enhance learning. The conference was also an opportunity to disseminate findings of the eViP3 programme, a collaboration of nine institutions co-funded by the European Commission to create a bank of over 300 repurposed and enriched virtual patients. 

Virtually there with virtual patients

The core of this conference focused on virtual patients. During the plenary session, Peter Greene (Executive Director of MedBiquitous)4 described how technology standards support collaboration around virtual patients – including both pedagogical innovation and educational research.

The conference provided ample opportunity to demonstrate pedagogical and technical innovations during the popular 'innovation demonstrations', where participants had the chance to attend small, short demonstrations of innovative learning technologies and ask questions of the presenters. The conference organizers compared this to 'speed dating' for learning technologies.

Highlights include demonstrations of the Pivote virtual patient platform for Second Life; mixed reality virtual patient breast simulator; and a programmable virtual patient platform where the virtual patients become more 'intelligent' as the case progresses.

Panels gave speakers the opportunity to present research related to virtual patients as well as providing food for thought and new ideas for the community. One notable panel focused on the implementation of virtual patients in the curriculum, an idea further explored by Trupti Bakrania's article on the G4 Project (see elsewhere in this newsletter).

Speakers discussed repurposing of paper cases for PBL, combining virtual patients with small group discussion, and evaluation of different curricular integration scenarios. It was impressive how many of the sessions focused on the reuse and repurposing of virtual patients afforded by the eViP programme. Truly a wealth of information is emerging from this project, and more research is likely to come. 

Web 2.0 and medical education

ICVP 2010 and MedBiquitous Annual Meeting5 included sessions that focused on web 2.0 and social networking, including a web 2.0 workshop and a panel of presentations. Furthermore, the conference exemplified how to use web 2.0 technologies in concert with a face-to-face meeting. Conference participants yweeted their thoughts on the sessions using the hash tag"#ICVP2010". The ViP website(www.virtualpatients.eu) providedf requent updates and feature articles from roving reporters Siân Claire Owen and Supriya Krishnan (SGUL).

These web 2.0 sessions gave us an exciting peek into the future. Terry Poulton set the stage in the plenary session by gives delegates a tour of the SGUL island in Second Life,6 an online virtual world. David Davies (University of Warwick) and BMcGee (University of Pittsburgh) then led an "Unconference"on web 2.0 and social networking that provided participants with an opportunity to discuss how social networking impacts healthcare education and practice.

Several participants provided examples of how they are using social networking and web 2.0, and a number of presentations highlighted how educators are using web 2.0 to change education, in particular for remote learners.

One interesting presentation from Hung The Nguyen of NorthernTerritory General Practice Education showed us how students use web 2.0t o reflect on the experience of being immersed in a different culture and to share those experiences with other students. Another from Eleni Kaldoudi (Democritus University ofT hrace) showed how social networks can be used to facilitate educational content retrieval. 

eLearning resources

Many presenters showed technical innovations in eLearning, including the integration of disparate systems and resources leveraging common standards, an idea demonstrated in Evangelia Mitsopoulou's article on the mEducator project. In addition, there were presentations on the delivery of student learning using mobile technologies, a concept explored by Narain Ramluchumun in his article on mobile learning (elsewhere in this newsletter).

The conference also included a review of the business issues relevant to Learning - certainly a pertinent issue in the era of Open Educational Resources and content sharing platforms such as the Association of American Medical Colleges MedEdPORTAL. Equally important were the presentations on sustainability and licensing of digital resources. If the licensing and business arrangements are not set appropriately formt he onset, sharing of educational resources is made even more difficult. 

Outcomes and future plans

Megan Quentin-Baxter gave an overview of open educational resources and UK programmes to promote sharing. Ronald Harden provided a challenge to the audience in the plenary session, emphasizing that eLearning must be adaptive, provide a real context for learning, enable remote collaboration, be outcome based, and unitary across all levels. Sean Hilton further emphasized his point in his closing plenary for the conference. All agreed that in the light of these exciting new technological developments, further research into the efficacy of virtual patients, web 2.0, and eLearning resources is warranted.