title: Embedding a Virtual Patient Simulator in an Interactive Surgical lecture.
abstract: BACKGROUND
  Lectures are traditionally used for teaching declarative knowledge. One established tool for clinical education is the demonstration of a real patient. The use of real patients in the daily clinical environment is increasingly difficult. The use of a virtual patient simulator (VPS) can potentially circumvent these problems. Unlimited availability and the opportunity of an electronic feedback system could possibly enrich traditional lectures by enabling more interactivity that meets the expectations of the current student generation. As students face the consequences of their own decisions they take a more active role in the lecture. VPS links declarative knowledge with visual perception that is known to influence students' motivation. Until now, there have been no reports covering the usage and validation of interactive VPS for supporting traditional lectures.
  
  
  OBJECTIVE
  In this study, we (1) described the development of a custom-made three-dimensional (3D) VPS for supporting the traditional lecture and (2) performed a feasibility study including an initial assessment of this novel educational concept.
  
  
  METHODS
  Conceptualization included definition of curricular content, technical realization and validation. A custom-made simulator was validated with 68 students. The degree of student acceptance was evaluated. Furthermore, the effect on knowledge gain was determined by testing prelecture and postlecture performance.
  
  
  RESULTS
  A custom-made simulator prototype that displays a 3D virtual clinic environment was developed and linked to a PowerPoint presentation. Students were able to connect to the simulator via electronic devices (smartphones and tablets) and to control the simulator via majority vote. The simulator was used in 6 lectures and validated in 2 lectures with 68 students each. Student acceptance and their opinion about effectiveness and applicability were determined. Students showed a high level of motivation when using the simulator as most of them had fun using it. Effect on knowledge gain was proven by comparison of chosen therapeutic workflow before and after the lecture. Students showed significantly (p < 0.05) more correct answers in determination of the therapeutic workflow after the lecture.
  
  
  CONCLUSIONS
  We successfully developed and evaluated a custom-made 3D VPS for supporting the traditional lecture. VPS is probably an effective instrument that might replace real patients in selected lectures and prepare students for bedside teaching.
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Kleinert
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Plum
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Heiermann
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: Roger
authors.initials: R
authors.lastname: Wahba
authors.affiliation: Department of Radiology, University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: De-Huan
authors.initials: DH
authors.lastname: Chang
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hölscher
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Stippel
mesh_terms: D002983:Clinical Competence; D000066491:Clinical Decision-Making; D005240:Feasibility Studies; D013502:General Surgery / Q000193:education*; D006801:Humans; D016544:Patient Simulation; D000066908:Simulation Training / Q000379:methods*; D012984:Software; D014584:User-Computer Interface
keywords: Medical Knowledge; Practice-Based Learning and Improvement; education; immersive; simulator; teaching talk; virtual