title: Problem-based learning in internal medicine: virtual patients or paper-based problems?
abstract: BACKGROUND
  Teaching using paper problem-based learning (p-PBL) sessions has left some students fatigued with the learning process. Therefore, attempts have been made to replace p-PBL with digitally enhanced, decision-making PBL in the form of virtual patients (VP). Student enthusiasm for substituting p-PBL with VP has not been quantitatively evaluated on the intended educational effects.
  
  
  OBJECTIVE
  To determine the educational effects of substituting p-PBL sessions with VP on undergraduate medical students in their internal medicine course.
  
  
  METHODS
  We conducted a randomised controlled study on 34 third-year undergraduate medical students in the academic year 2015-2016. Student performance after an intervention substituting p-PBL sessions with VP was analysed. The educational outcomes were measured with knowledge exams and the Diagnostic Thinking Inventory.
  
  
  RESULTS
  There was no difference in exam performance between groups (P > 0.833) immediately after the intervention, or in long term. Nor was there a significant difference in improvement of diagnostic thinking between groups (P > 0.935 and P > 0.320).
  
  
  CONCLUSIONS
  Our study showed no significant improvement in diagnostic thinking abilities or knowledge exam results with the use of VP. Educators can add VP to sessions to motivate students, but a significant improvement to educational outcome should not be expected.
authors: Faculty of Medicine, University of Maribor, Maribor, Europe.
authors: Monika
authors: http://orcid.org/0000-0003-1384-9487
authors: M
authors: Sobocan
authors: Faculty of Medicine, University of Maribor, Maribor, Europe.
authors: Neja
authors: N
authors: Turk
authors: Faculty of Medicine, University of Maribor, Maribor, Europe.
authors: Dejan
authors: D
authors: Dinevski
authors: Faculty of Medicine, University of Maribor, Maribor, Europe.|Department of Internal Medicine, University Clinical Center Maribor, Maribor, Slovenia, Europe.
authors: Radovan
authors: R
authors: Hojs
authors: Faculty of Medicine, University of Maribor, Maribor, Europe.
authors: Breda
authors: B
authors: Pecovnik Balon
mesh_terms: D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D007388:Internal Medicine / Q000379:methods*; D009042:Motivation; D018794:Problem-Based Learning / Q000379:methods*; D011446:Prospective Studies; D017524:Slovenia; D013337:Students, Medical; D013850:Thinking
keywords: clinical reasoning; curriculum development; education technology; health education