title: Virtual patients on the semantic Web: a proof-of-application study.
abstract: BACKGROUND
  Virtual patients are interactive computer simulations that are increasingly used as learning activities in modern health care education, especially in teaching clinical decision making. A key challenge is how to retrieve and repurpose virtual patients as unique types of educational resources between different platforms because of the lack of standardized content-retrieving and repurposing mechanisms. Semantic Web technologies provide the capability, through structured information, for easy retrieval, reuse, repurposing, and exchange of virtual patients between different systems.
  
  
  OBJECTIVE
  An attempt to address this challenge has been made through the mEducator Best Practice Network, which provisioned frameworks for the discovery, retrieval, sharing, and reuse of medical educational resources. We have extended the OpenLabyrinth virtual patient authoring and deployment platform to facilitate the repurposing and retrieval of existing virtual patient material.
  
  
  METHODS
  A standalone Web distribution and Web interface, which contains an extension for the OpenLabyrinth virtual patient authoring system, was implemented. This extension was designed to semantically annotate virtual patients to facilitate intelligent searches, complex queries, and easy exchange between institutions. The OpenLabyrinth extension enables OpenLabyrinth authors to integrate and share virtual patient case metadata within the mEducator3.0 network. Evaluation included 3 successive steps: (1) expert reviews; (2) evaluation of the ability of health care professionals and medical students to create, share, and exchange virtual patients through specific scenarios in extended OpenLabyrinth (OLabX); and (3) evaluation of the repurposed learning objects that emerged from the procedure.
  
  
  RESULTS
  We evaluated 30 repurposed virtual patient cases. The evaluation, with a total of 98 participants, demonstrated the system's main strength: the core repurposing capacity. The extensive metadata schema presentation facilitated user exploration and filtering of resources. Usability weaknesses were primarily related to standard computer applications' ease of use provisions. Most evaluators provided positive feedback regarding educational experiences on both content and system usability. Evaluation results replicated across several independent evaluation events.
  
  
  CONCLUSIONS
  The OpenLabyrinth extension, as part of the semantic mEducator3.0 approach, is a virtual patient sharing approach that builds on a collection of Semantic Web services and federates existing sources of clinical and educational data. It is an effective sharing tool for virtual patients and has been merged into the next version of the app (OpenLabyrinth 3.3). Such tool extensions may enhance the medical education arsenal with capacities of creating simulation/game-based learning episodes, massive open online courses, curricular transformations, and a future robust infrastructure for enabling mobile learning.
authors.affiliation: Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Eleni
authors.identifier: http://orcid.org/0000-0002-2439-090X
authors.initials: E
authors.lastname: Dafli
authors.forename: Panagiotis
authors.identifier: http://orcid.org/0000-0003-2650-9529
authors.initials: P
authors.lastname: Antoniou
authors.forename: Lazaros
authors.identifier: http://orcid.org/0000-0003-1613-2852
authors.initials: L
authors.lastname: Ioannidis
authors.forename: Nicholas
authors.identifier: http://orcid.org/0000-0001-9952-6712
authors.initials: N
authors.lastname: Dombros
authors.forename: David
authors.identifier: http://orcid.org/0000-0003-3593-544X
authors.initials: D
authors.lastname: Topps
authors.forename: Panagiotis D
authors.identifier: http://orcid.org/0000-0002-9936-5805
authors.initials: PD
authors.lastname: Bamidis
mesh_terms: D003198:Computer Simulation; D004501:Education, Medical / Q000379:methods*; D006282:Health Personnel; D006801:Humans; D020407:Internet; D016544:Patient Simulation; D010865:Pilot Projects; D012660:Semantics; D012984:Software; D013337:Students, Medical; D014584:User-Computer Interface
keywords: data sharing; educational assessment; medical education; patient simulation; problem-based learning; semantics