Get students comfortable talking with their peers, you, and the TA(s) (as applicable) from the start of the course. Create opportunities for students to have pair or small group conversations to get to know one another and connect as a community. Regardless of your class size or context (i.e.: seminars, large-lecture classes, labs), for discussions to become a norm in your course, you will need to build community early on in the course.
How will you make peer-to-peer engagement an integral part of your class? How can you get students talking to each other?
To encourage student participation and peer-to-peer interaction, create early and frequent opportunities for students to share and talk with each other. These opportunities can help make students more comfortable with participating in discussion, as well as help build rapport and foster trust amongst class members. Icebreakers and small group discussion opportunities provide great ways to get students talking, especially in large-enrollment classes where students may feel less connection with their peers (see sample icebreakers below ). For additional support with building community in your course, see the CTL’s Community Building in Online and Hybrid (HyFlex) Courses resource. (Although this resource emphasizes online and hybrid/HyFlex modalities, the strategies provided are applicable across all course modalities.)
How can you communicate class norms around discussion and participation on day one?
The first class meeting is an opportunity to warm students up to class discussion and participation from the outset. Rather than letting norms of passivity establish over the first couple of weeks, you can use the first class meeting to signal to students they will be expected to participate or interact with their peers regularly. You might ask students to do a welcoming icebreaker on the first day, or you might invite questions and syllabus discussion. No matter the activity, establishing a norm around discussion and participation at the outset will help warm students up to participating and contributing to later discussions; these norms can also be further supported by your discussion guidelines . Icebreakers: Icebreakers are a great way to establish a positive course climate and encourage student-student, as well as instructor-student, interactions. Some ideas for icebreaker activities related to discussion include:
With all of your preparation and planning complete, there are some important considerations you will need to make with both your students and yourself in mind. This section offers some strategies for engaging in classroom discussion.
How will you engage all of your students in the discussion? How will you make discussion and your expectations about student participation explicit and integral to the class?
Involving your students in class discussion will allow for more student voices and perspectives to be contributed to the conversation. You might consider leveraging the time before and after class or office hours to have informal conversations and build rapport with students. Additionally, having students rotate roles and responsibilities can keep them focused and engaged.
Student roles: Engage all students by asking them to volunteer for and rotate through roles such as facilitator, summarizer, challenger, etc. In large-enrollment courses, these roles can be assigned in small group or pair discussions. For an asynchronous discussion, roles might include: discussion starter / original poster, connector to research, connector to theory. Additional roles might include: timekeeper, notetaker, discussion starter, wrapper, and student monitor:
Student-generated questions: Prepare students for discussion and involve them in asking and answering peer questions about the topic. Invite students to post questions to a CourseWorks Discussion before class, or share their questions during the discussion. If students are expected to respond to their peer’s questions, they need to be told and guided how to do so. Highlight and use insightful student questions to prime or further the discussion.
Student-led presentations: In smaller seminar-style classes or labs, invite students to give informal presentations. You might ask them to share examples that relate to the topic or concept being discussed, or respond to a targeted prompt.
How will you facilitate discussion? What will your presence be in asynchronous discussion spaces? What can students expect of your role in the discussion?
Make your role (or that of your co-instructor(s) and/or TA(s)) in the discussion explicit so that students know what to expect of your presence, reinforcement of the discussion guidelines, and receipt of feedback.
Actively guide the discussion to make it easy for students to do most of the talking and/or posting. This includes being present, modeling contributions, asking questions, using students’ names, giving timely feedback, affirming student contributions, and making inclusive moves such as including as many voices and perspectives and addressing issues that may arise during a conversation.
Manage the discussion and intervene when necessary : Manage dynamics, recognizing that your classroom is influenced by societal norms and expectations that may be inherently inequitable. Moderate the ongoing discussion to make sure all students have the opportunity to contribute. Ask students to explain or provide evidence to support their contributions, connect their contributions to specific course concepts and readings, redirect or keep the conversation on track, and revisit discussion guidelines as needed.
For large-enrollment courses, you might ask TAs or course assistants to join small groups or monitor discussion board posting. While it’s important for students to do most of the talking and posting, TAs can support students in the discussion, and their presence can help keep the discussion on track. If you have TAs who lead discussion sections, you might consider sharing some of these discussion management strategies and considerations with them, and discuss how the discussion sections can and will expand upon discussions from the larger class.
Thinking time will allow students to prepare more meaningful contributions to the discussion and creates opportunities for more students, not just the ones that are the quickest to respond, to contribute to the conversation. Comfort with silence is important following a posed question. Some thinking time activities include:
Ensure that the discussion meets the learning objectives of the course or class session, and that students are leaving the discussion with the knowledge and skills that you want them to acquire. Give students an opportunity to reflect on and share what they have learned. This will help them make connections between other class material and previous class discussions. It is also an opportunity for you to gauge how the discussion went and consider what you might need to clarify or shift for future discussions.
How will you know the discussion has met the learning objectives of the course or class session? How will you ensure students make connections between broader course concepts and the discussion?
Set aside time to debrief the discussion. This might be groups sharing out their discussion take-aways, designated students summarizing the key points made and questions raised, or asking students to reflect and share what they learned. Rather than summarizing the discussion yourself, partner with your students; see the section on Student Roles above for strategies.
How will you determine the effectiveness of class discussion? How can you invite students into creating the learning space?
Feedback: Student feedback is a great way to gauge the effectiveness and success of class discussion. It’s important to include opportunities for feedback regularly and frequently throughout the semester; for feedback collection prompts and strategies, see the CTL’s resource on Early and Mid-Semester Student Feedback . You might collect this through PollEverywhere, a Google Form, or CourseWorks Survey. Classes of all sizes and modalities can benefit from collecting this type of feedback from students.
Reflect: Before you engage with your students’ feedback, it’s important to take time and reflect for yourself: How do you think the discussion went? Did your students achieve the learning goals that you had hoped? If not, what might you do differently? You can then couple your own reflection with your students’ feedback to determine what is working well, as well as what might need to change for discussions to be more effective.
Iterate: Not all class discussions will go according to plan, but feedback and reflection can help you identify those key areas for improvement. Share aggregate feedback data with your students, as well as what you hope will go differently in future discussions.
Asynchronous discussion spaces are an effective way for students to prepare for in-class discussion, as well as expand upon what they have already discussed in class. Asynchronous discussion boards also offer a great space for students to reflect upon the discussion, and provide informal feedback.
There are a number of Columbia tools that can support asynchronous discussion spaces. Some options that instructors might consider include:
Anderson, L. W., & Krathwohl, D. R. (2001). A taxonomy for learning, teaching, and assessing: A revision of Bloom’s taxonomy of educational objectives. New York: Longman.
Armstrong, B. (2020). To Spark Discussion in a Zoom Class, Try a ‘Silent Meeting .’ The Chronicle of Higher Education. November 18, 2020.
Barkley, E.F. (2010). Student Engagement Techniques: A Handbook for College Faculty . Jossey-Bass.
Barkley, E.F.; Major, C.H.; and Cross, K.P. (2014). Collaborative Learning Techniques: A Handbook for College Faculty . Second Edition. Jossey-Bass.
Barnard Center for Engaged Pedagogy. (2021). Crafting community agreements .
Brookfield, S. D., & Preskill, S. (2016). The Discussion Book: 50 Great Ways to Get People Talking . Wiley.
Cashin, W.E. (2011). Effective Classroom Discussions . IDEA Paper #49. Retrieved from www.ideaedu.org
Center for Research on Teaching and Learning. Guidelines For Classroom Interactions. Retrieved from http://www.crlt.umich.edu/examples-discussion-guidelines
Davis, B.G. (2009). Tools for Teaching , 2 nd Edition.
Hancock, C., & Rowland, B. (2017). Online and out of synch: Using discussion roles in online asynchronous discussions. Cogent Education, 4(1).
Howard, J.R. (2015). Discussion in the College Classroom: Getting Your Students Engaged and Participating in Person and Online . Wiley.
Howard, J.R. (2019) How to Hold a Better Class Discussion: Advice Guide. Chronicle of Higher Education. https://www.chronicle.com/interactives/20190523-ClassDiscussion
The K. Patricia Cross Academy. Making Good Use of Online Discussion Boards. Retrieved from https://kpcrossacademy.org/making-good-use-of-online-discussion-boards/
Read more about Columbia undergraduate students’ experiences with discussion
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Effective facilitation of a discussion involves the recognition and employment of different perspectives and different skills to create an inclusive environment. In order to do so, it is important to consider the features of effective discussions, and conditions that promote small group interaction and engagement. Discussion is a powerful mechanism for active learning; a well-facilitated discussion allows the participant to explore new ideas while recognizing and valuing the contributions of others.
adapted from Handelsman et al. 2006
Opportunities for reflection.
What do I bring to the group? What surprises or challenges me?
What behaviors am I most familiar or comfortable with?
What behaviors challenge me?
Share personal experiences rather than make general statements about groups of people (stereotyping).
Ask dominant participants to allow others to speak.
Give all participants a voice- at the start highlight the value of a diversity of perspectives as an essential part of the process.
Go over constructive and destructive group behaviors at the start of the course / workshop.
Request that if participants challenge others’ ideas, they back it up with evidence, appropriate experiences, and/or appropriate logic.
Encouraging participation can be accomplished by:
adapted from: Center for Integration of Research, Teaching and Learning Handbook, accessed July 2008
Maintaining discussions often means dealing as smoothly as possible with the problems that arise. Here are some common problems with suggestions for how to deal with them.
A way to approach the dominant participant and pull in non-participants is to redirect the discussion to another person or another topic. Alternatively, you may wish to reframe their comments, making them viable additions to the discussion. Facilitators might also ask one or more members of the group to act as observers for a few sessions, reporting back their observations to the group. Perhaps assigning the avid talker to the observer role would help the person develop sensitivity. Another approach is to break down the group into still smaller task groups.
A way to approach non-participants is to provide opportunities for smaller group discussions or pair-share discussions. Smaller groups may help put some students at ease. A second strategy is to ask opinion questions occasionally (e.g., “How do you feel about this?”). This may encourage participation by reducing participants’ fear of answering incorrectly. Another strategy is to have participants write out their answers to a question. Having the words written out may make it easier for a shy or fearful person to speak up.
In good discussions, conflicts will sometimes arise. If such conflicts are left ambiguous, they may cause continuing trouble. Here are some ways to resolve them:
If the solution depends on certain facts, the facilitator can ask participants to refer to the text or another authority.
If there is an experimentally verified answer, the facilitator can use the opportunity to review the method by which the answer could be determined.
If the question is one of values, the facilitator may use the occasion to help participants become aware of the values involved.
The facilitator can list both sides of the argument on the board.
The facilitator can take a strong position as moderator, preventing participants from interrupting each other or speaking simultaneously. She or he can lay ground rules for discussion, such as asking participants to focus conflict on ideas rather than people and to resist being judgmental.
The facilitator can encourage participants making unclear contributions to give examples and factual evidence of their points. The facilitator can also restate points for verification or rejection by the participants, or give enthusiastic nonverbal cues and patience.
Some facilitators keep discussions on track by listing the questions or issues they want to cover on the board or summarizing the discussion on the board as it proceeds. Stopping and asking a participant to summarize where the discussion is at the point it appears to go off track may also help.
When participants argue for the sake of argument, facilitators will usually lose if they take the bait. Participants or students who attack often want attention, so simply giving them some recognition while firmly moving on often takes care of the problem. If participants are simply trying to embarrass the facilitator, they may seek to make him or her defensive with such comments as, “How do you really know that…?” or “You’re not really saying that…?” Such questions can be handled by playing boomerang. The facilitator might say, “What I’m saying is…, but now I'd like you to share your perspective.” Turning the question back to the questioner forces him or her to take responsibility for his or her opinion. Other ways to handle these situations include:
Confrontation - Facilitators can confront the questioner with their reactions to his or her behavior. “I’m uncomfortable with the imprecision of your questions. What I really hear you saying is...”
Active listening - Facilitators can paraphrase the message they heard and check out the accuracy of their assumptions before responding.
Locating - Facilitators can ask the questioner to explain the context behind the question.
Reframing - The focus can be on clarifying the assumptions behind the person’s argument and then inviting her or him to see alternative possibilities.
Deferring - Often, the best strategy is to invite participants to come up after the session and arrange for a time to talk about the disagreement further, and then move the discussion on to another topic.
Boice, R. (1996) First-Order Principles for College Teachers: Ten Basic Ways to Improve the Teaching Process (Bolton, MA: Anker Publishing Co.)
Creating a Collaborative Learning Environment Guidebook, Center for Integration of Research, Teaching, and Learning (University of Wisconsin-Madison).
Feito, J. (2007) Allowing Not-Knowing in a Dialogic Discussion . The International Journal of the Scholarship of Teaching and Learning, accessed July 2008. http://academics.georgiasouthern.edu/ijsotl/v1n1/feito/ij_feito.htm
Gelula, M.H. (1997) Clinical discussion sessions and small groups . Surgical Neurology, 47:400-403.
Handelsman, J., Miller, S., & Pfund, C. (2006) Scientific Teaching: Diversity, Assessment, Active Learning (New York: W.H. Freeman & Co.)
Sellers, S.L., Roberts, J., Giovanetto, L., Friedrich, K. & Hammargren, C. (2007) Reaching All Students-A Resource for Teaching in Science, Technology, Engineering & Mathematics (Second Edition) (Madison, WI: Center for the Integration of Research, Teaching, and Learning)
Steinert, Y. (2004) Student perceptions of effective small group teaching . Medical Education, 38:286-293.
Tuckman, B. & Jensen, M. (1977) Stages of Small Group Development . Group and Organizational Studies, vol. 2, pp.419-427.
University of Queensland: Designing Culturally Inclusive Environments , accessed July 2008. www.tedi.uq.edu.au/cdip
Family and community engagement program.
Topics: Classroom Media & Tools Social & Emotional Learning Relationships & Communication Digital Citizenship
Creating a classroom community where meaningful conversations can happen isn't easy—it's an ongoing process that takes time. But using online discussion tools can be one great way to help your students build these skills. Plus, the ability to engage in online discussions responsibly is a great 21st-century skill in and of itself.
Online discussions often lead to better in-class discussions afterward—you know, the kind where students raise their hands and speak out loud. With online discussions, students have a chance to engage with each other virtually, often having their thoughts and opinions validated. Afterward, they're typically much more willing to share out loud in class and often share in thoughtful ways.
Still not convinced? Here are a few more reasons to consider using online discussions:
If you're looking for an online discussion tool, you've got a variety of options. Here are a few top picks and teacher favorites:
Backchannel Chat
Price : $15/year/class; $299/year/school Platforms : Android, iOS, and web Grades : 6-12
Backchannel Chat's moderated online discussions are intended to engage students and encourage them to share. Think of it as a teacher-moderated, private version of Twitter, where students can discuss topics that might just transcend the virtual space. Setup is quick and easy: Teachers sign up, name their chat, and give students the URL. Students can join with only a name; no other personal information is required. Teachers can moderate discussions, remove messages, and "lock" the chat at any time.
Price : Free Platforms : Android, iOS Grades : K-12
Though "online discussion" may mean text responses to most, Flip's video-based responses also invite discussion. It's also a great way to involve students who are less comfortable with written language, and younger kids may especially love participating in Flip's playful video features. Depending on the purpose of the discussion, the combination of videos and comments might not be the format you're looking for, but between the cost (free!) and the accessibility features, it's definitely a tool to consider.
Kialo Edu
Price : Free Platforms : Web Grades : 7–12
Kialo Edu is a free platform designed to foster thoughtful debate and discussion. Students can browse for and participate in existing discussions or create their own. Once they've chosen a discussion, students then choose their side—pro or con—and add their own opinions via "claims." Kialo Edu is a good platform for teaching the importance of reasoned, respectful arguments when trying to persuade others. Most teachers likely will want to create private discussions limited to their students to focus on a curriculum- or class-related topic.
Price : Free Platforms : Web Grades : 4-12
NowComment is a document-annotation and -discussion platform that allows students to mark up and discuss texts. Upload a document (in any number of formats) to create an online discussion area. Paragraphs for text are numbered, with the document shown on the left and the comment panel on the right. You can control when students can comment on a document and when they can see each others' comments. For group projects or peer-reviewed activities, you can have students upload their own documents.
Price : Contact for pricing Platforms : iOS and web Grades : 3-12
Known mostly as an online plagiarism detector, Turnitin has some lesser-known tools, too, including a built-in discussion platform. While the discussion tool may not be as robust as some other choices, Turnitin's tool does offer anonymous posting and teacher-moderation options. Plus, if your students are already signed up and have accounts, getting started will be a cinch.
Price : Free Platforms : Web Grades : 6–12
YO Teach! is a backchannel web app teachers can use to create and moderate chat rooms for real-time student interaction. The admin features allow teachers to delete posts, mute students, control room access, and use the interactive features. Students can interact with teacher and peer posts by sharing text messages, replying to others' posts, voting, responding to polls, sharing and annotating pictures, and submitting drawings. YO Teach! can be an engaging way to encourage collaboration and social interaction among students.
Image courtesy of Allison Shelley/The Verbatim Agency for American Education: Images of Teachers and Students in Action.
I'm the Director of Marketing for Common Sense's Education platform. Prior to my work at Common Sense, I was an editor and classroom teacher. I'm an advocate for the creative, thoughtful, and responsible use of technology, and I thrive on sharing his knowledge, experience, and perspectives with others.
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Here are all of our Student Opinion questions from the 2020-21 school year. Each question is based on a different New York Times article, interactive feature or video.
By The Learning Network
Each school day we publish a new Student Opinion question, and students use these writing prompts to reflect on their experiences and identities and respond to current events unfolding around them. To introduce each question, we provide an excerpt from a related New York Times article or Opinion piece as well as a free link to the original article.
During the 2020-21 school year, we asked 176 questions, and you can find them all below or here as a PDF . The questions are divided into two categories — those that provide opportunities for debate and persuasive writing, and those that lend themselves to creative, personal or reflective writing.
Teachers can use these prompts to help students practice narrative and persuasive writing, start classroom debates and even spark conversation between students around the world via our comments section. For more ideas on how to use our Student Opinion questions, we offer a short tutorial along with a nine-minute video on how one high school English teacher and her students use this feature .
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With new advancements in AI happening faster than ever before, you might be wondering how you can use these tools in your classroom to save you time and energy. Educators worldwide are making strides to understand and integrate AI into their work and often find it to be a valuable tool. You can use AI to save time creating rubrics, personalized content for students, and educational materials such as quizzes and lesson plans.
Generative AI is a newer piece of technology and a unique category of AI that focuses on creating new content. With generative AI you can generate new content like text, images, code, or audio. It achieves this by learning patterns from existing data and understanding the context and intent of language. This provides you with new opportunities for content creation, personalization, and innovation. Because this technology is creating new content, checking for accuracy in generative AI is essential—especially in the field of education.
Microsoft Copilot is a tool that uses generative AI to serve as a helpful assistant to you in the classroom. Copilot can help you save time, differentiate instruction, and enhance student learning. With Copilot, you can easily create lesson plans, quizzes, rubrics, and other class resources for any level of learner.
Here are just a few examples of the many ways you can use Microsoft Copilot to save time and energy:
Microsoft Copilot showing suggested prompts for educators. Copilot uses generative AI to serve as a helpful assistant to you in the classroom.
To get started with Microsoft Copilot, you can follow these steps:
You can also give feedback to Copilot based on the quality of its responses to help the AI learn and match your preferences.
To effectively guide generative AI, you want to give it clear and concise instructions, known as prompts. A well-crafted prompt enhances the generative AI’s output in the quality, relevance, and diversity. A good prompt should be clear, specific, and aligned with the goal of the generation task. A bad prompt can lead to ambiguous, irrelevant, or biased output. To get the best response from Copilot, consider the following tips:
A infographic about how to write AI prompts to get better answers from Copilot. A good prompt should be clear, specific, and aligned with the goal of the task.
Want a fun way to practice creating effective prompts? Minecraft Education just announced Prompt Lab for Minecraft Educators , a free playbook on how to use Microsoft Copilot to write compelling prompts, develop interactive learning content and assessments, and generate creative ideas for Minecraft lesson plans.
You can use Image Creator from Designer in Copilot to create personalized, engaging visuals for all sorts of lessons or topics. You can type in a description of an image, provide additional context like location or activity, and choose an art style. Image Creator generates an image straight from your imagination. Prompts can begin with “draw an image” or “create an image.” You can use this tool to create images for a class newsletter, lesson, or Teams post.
An example would be “Create an image of an adorable black puppy wearing a hat in photorealistic style.”
An example of Copilot creating an image of a black dog wearing a hat in a photorealistic style, based on text descriptions.
Try creating an image in Copilot for your lesson, or just for fun!
At Microsoft, our efforts are guided by our AI principles and Responsible AI Standard and build on decades of research on grounding and privacy-preserving machine learning. Copilot provides commercial data protection and delivers a secure AI-powered chat service for educational institutions. This means user and organizational data are protected, chat prompts and responses in Copilot are not saved, Microsoft has no eyes-on access to them, and they aren’t used to train the underlying large language models. Additionally, our Customer Copyright Commitment means education customers can be confident using our services and the output they generate without worrying about copyright claims.
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BMC Medical Education volume 24 , Article number: 647 ( 2024 ) Cite this article
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Virtual Patients (VPs) have been shown to improve various aspects of medical learning, however, research has scarcely delved into the specific factors that facilitate the knowledge gain and transfer of knowledge from the classroom to real-world applications. This exploratory study aims to understand the impact of integrating VPs into classroom learning on students’ perceptions of knowledge acquisition and transfer.
The study was integrated into an elective course on “Personalized Medicine in Cancer Treatment and Care,” employing a qualitative and quantitative approach. Twenty-two second-year medical undergraduates engaged in a VP session, which included role modeling, practice with various authentic cases, group discussion on feedback, and a plenary session. Student perceptions of their learning were measured through surveys and focus group interviews and analyzed using descriptive statistics and thematic analysis.
Quantitative data shows that students highly valued the role modeling introduction, scoring it 4.42 out of 5, and acknowledged the practice with VPs in enhancing their subject matter understanding, with an average score of 4.0 out of 5. However, students’ reflections on peer dialogue on feedback received mixed reviews, averaging a score of 3.24 out of 5. Qualitative analysis (of focus-group interviews) unearthed the following four themes: ‘Which steps to take in clinical reasoning’, ‘Challenging their reasoning to enhance deeper understanding’, ‘Transfer of knowledge ‘, and ' Enhance Reasoning through Reflections’. Quantitative and qualitative data are cohered.
The study demonstrates evidence for the improvement of learning by incorporating VPs with learning activities. This integration enhances students’ perceptions of knowledge acquisition and transfer, thereby potentially elevating students’ preparedness for real-world clinical settings. Key facets like expert role modeling and various authentic case exposures were valued for fostering a deeper understanding and active engagement, though with some mixed responses towards peer feedback discussions. While the preliminary findings are encouraging, the necessity for further research to refine feedback mechanisms and explore a broader spectrum of medical disciplines with larger sample sizes is underscored. This exploration lays a groundwork for future endeavors aimed at optimizing VP-based learning experiences in medical education.
Peer Review reports
In Medical Education, a persistent challenge lies in the bridge between acquiring theoretical knowledge and applying it in real-world clinical scenarios. Many medical students struggle with translating their classroom learning into practical settings. The primary challenge lies in effectively translating the concepts students have learned into authentic patient interactions. This gap is particularly concerning because it affects the quality of patient care, as medical students are not just learning to acquire knowledge but must be able to apply this knowledge in complex healthcare settings.
One approach to address this challenge is the use of Virtual Patients (VPs), a computer-based simulation of real-life clinical scenarios for students to train clinical skills [ 1 ]. Research has shown that using VPs in the classroom can effectively improve various aspects of learning, from core knowledge and clinical reasoning to decision-making skills and knowledge transfer [ 2 , 3 , 4 , 5 ]. The VPs provide students with the opportunity to practice skills in a safe and controlled simulation environment.
Recent studies have focused on optimizing the design and arrangement of VPs as part of learning activities to facilitate both knowledge acquisition and retention [ 6 , 7 , 8 ]. For instance, Verkuyl, Hughes [ 8 ] demonstrated that using VPs as gamification tools can improve students’ confidence, engagement, and satisfaction.
However, studies focusing on the specific factors that contribute to these improvements when integrating VPs into the classroom are limited, particularly in understanding how to use VPs in the classroom to facilitate the transfer of knowledge students’ gain from the class to the subsequent studying stage of their education and eventual practice.
Acquisition and transfer of knowledge are critical factors in medical education, as medical students must be able to apply their knowledge and skills to real-world clinical scenarios [ 9 ]. Research suggests that for the effective transfer of knowledge, students should be immersed in authentic environments, enabling the transition of learned competencies to advanced stages [ 10 , 11 , 12 , 13 ].
Despite the consensus on the efficacy of VPs as a tool, there is a gap in understanding how to integrate VPs in the classroom to optimize students’ learning, especially in facilitating learning transfer. The effectiveness of VPs is not just in their use but also in how they are used by students to enhance their understanding on how to reason and make decisions about medical treatments when dealing with clinical cases. Without a clear and deep understanding, we risk underutilizing their potential and losing opportunities for medical students to become well prepared for real-world clinical scenarios.
Certain elements, such as role modeling instruction [ 14 , 15 , 16 ], using various authentic cases [ 17 , 18 , 19 ], and engaging in peer discussions on feedback [ 20 , 21 , 22 ], emerge as potential key components that could be integrated to maximize the knowledge acquisition via VPs. For instance, Stalmeijer, Dolmans [ 23 ] show how an expert, serving as a role model, provides guidance that facilitates student learning by demonstrating clinical skills and reasoning out loud. While there is ample evidence supporting the advantages of inclusion of VPs in education, there is not enough research focusing on the detailed aspects of effective instructional design techniques. This paper delves into these components, seeking to understand how the VP integration influences students’ learning and knowledge transfer. Figure 1 shows the theoretical framework of how integrating VPs in class affects students’ learning and might impact the transfer of learning in a simulated VP environment to practice.
Relationship of implementing, impact factor, and transfer of training
This exploratory study aims to investigate how instructional design elements such as role modeling, various authentic cases, and peer dialogues on feedback within VP sessions affect students’ learning from the learner’s perceptions. The core research question in this study focuses on how the implementation of role modeling, various authentic cases, and peer dialogue on feedback in VPs, influences learners’ perception of knowledge gain and transfer in personalized medicine.
The study was conducted at Maastricht University in the elective course, “Personalized Medicine in Cancer Treatment and Care”. This course is open to second-year undergraduate medical students of Maastricht University.
Initially, 24 students enrolled in this course for the academic year of 2022–2023, and 22 students participated in the Virtual Patient session. In total, 19 students voluntarily completed the survey designed to evaluate their experiences and perceptions of the Virtual Patients session. Thereafter, 9 of the 19 survey respondents voluntarily agreed to participate in three focus group interviews, with 2–4 students in each focus group. Students were informed that participation in this research study had no impact on student’s academic performance or their continuation in their studies.
The instructional approach for the VP cases was structured in a specific format for the students. Figure 2 shows the instructional design for VP integration. The first stage was a role-modeling phase, where an expert demonstrated the clinical reasoning process using VP Case A. This was followed by a practice session where students worked in pairs on two different VP cases (Case B and C). After that, students formed two larger groups each including 5 or 6 students, and discussed the system feedback that was provided by VP platform. Finally, the expert summarized the session and addressed students’ questions. The whole intervention lasted 120 min. Figure 1 gives an overview of the intervention steps.
The flow of integrated virtual patient session
1. Role modeling (30 min): The intervention started with an expert, a clinician with teaching experience, demonstrating a clinical case (Case A) and showing the clinical reasoning process by thinking aloud. The expert served as a role model in showcasing the approach toward clinical problem-solving, provided supportive information, and demonstrated how to proceed through the case. The aim of the role modeling session was to empower students to apply the insights and methodology gained from experts in case A to solve subsequent cases (case B and case C), Although these cases shared similarities in underlying principles, they diverged on patient characteristics such as age, complications, and smoking history that can influence patient treatment outcomes.
2 and 3. Two VP pair tasks (20 min each): In this segment, the 22 participating students were paired, resulting in 11 pairs. These pairs were then divided into two groups. Group 1 (6 pairs) and group 2 (5 pairs) alternated in going through Case B and Case C to account for the practice effect. These cases were variations of the clinical cases introduced during the role-modeling demonstration, differing in patient characteristics such as age, complications, and smoking history to challenge the students’ reasoning. Students were encouraged to work collaboratively.
4. Feedback discussion (30 min): Upon completion of the VP cases, an automated feedback is immediately provided about the reasoning analysis. Participants were instructed to save this feedback for later discussion. After that, Students were organized into groups of six, based on the sequence in which they engaged with the cases. For instance, those who first practiced with Case B and then proceeded to Case C formed Group (1) Conversely, students who started with case C and then moved on to case B were assembled into Group (2) To foster meaningful dialogue, students engaged in discussions focused on the feedback generated by the Virtual Patient system, guided by a printed discussion guide distributed to each group (see Appendix 2 ). The discussion aimed to deepen students’ understanding and enrich their conversations about the cases they had just completed.
5. Plenary (15 min): This part lasted 15 min. Hosted by the expert to summarize the session and address questions or doubts raised by students.
During the practice and discussion sessions, the expert circulated among the groups to offer additional guidance and support.
Three Virtual Patient (VP) cases (Case A, B, and C) were created to enhance students’ comprehension of specific concepts, knowledge, and skills in clinical reasoning. The VP practice was developed on the P-Scribe ( www.pscribe.nl ) learning platform, a web-based e-learning system based in the Netherlands. The platform facilitates the design and implementation of text-based VP sessions (Appendix 4 ).
While these cases shared a foundation on authentic head and neck cancer treatment, they were characterized by varying patient characteristics in terms of age, gender, and medical history (anamnesis).
VP case flow chart
Within each VP case, students were presented with a scenario related to neck cancer. Figure 3 shows the chart of a VP case. Each case starts with an overview of the patient and their medical history which students had to use to make an initial assessment. After this, students encountered a mix of multiple-choice and open-ended practice questions. These questions guided students in planning diagnostics, formulating a diagnosis, and devising a treatment plan tailored to the patient’s specific needs. Immediate feedback was provided after students submitted each response, and comprehensive summative feedback was given at the conclusion of each case to foster understanding and learning from any potential misjudgments or oversights (See Appendix 4 ).
Learning-perception survey : The survey (Appendix 1 ) consisted of 20 items, structured into five primary sections: general experience, intended learning outcome, role modeling, practicing with various authentic cases, and reflection on peer dialogue around feedback. The first item asked about students’ general experience through the whole session. The second item focused on their perception of intended learning outcomes. Six items then focused on the students’ perceptions of learning through role modeling followed by 5 items addressing perceptions related to their learning on practicing with authentic cases. The final seven items explored students’ perception of learning from dialogue around feedback. Participants indicated their level of agreement for each statement using a 5-point Likert scale: 1 denoting “Strongly Disagree”, 2 for “Disagree”, 3 for “Neutral”, 4 for “Agree”, and 5 for “Strongly Agree”. For interpretation, average scores below 3 were considered as “in need for improvement”, those of 4 or higher as ‘good’, and those between 3 and 4 as ‘neutral’.
Focus group interviews : Three focus group interviews (Appendix 3 ) were conducted to dive deeper into students’ perceptions of their learning experience, knowledge gain, and knowledge transfer in real-world settings. The focus group took place after the survey and the survey data did not affect the development of the focus group questions. In focus group 1, two students, in focus group 2, two students and in focus group 3, five students participated. The interviews were structured around a series of questions that explored students’ perceptions of their learning across specifically designed sections. These sections included Role Modeling, Practice with Various Authentic Cases, and Dialogue around Feedback. The structure aimed to understand students’ perspectives on each key component of the learning sections.
The analysis of the survey data was conducted by calculating the mean, standard deviation, and the Alpha Coefficient for the responses pertaining to each of the five key dimensions of the survey. The mean score provided an indicator of the average student perception, while the standard deviation offered insights into the variability of the responses. The Alpha Coefficient, a measure of internal consistency, was computed to assess the reliability of the survey dimensions. Through these statistical measures, an overall understanding of the students’ perceptions regarding the various aspects of the Virtual Patients was attained, facilitating a robust analysis aligned with the research objectives.
The focus-group interview data were analyzed following the thematic analysis procedure set out by Braun and Clarke [ 24 ]: (1) familiarize yourself with your data, (2) generate initial codes, (3) search for themes, (4) review themes, (5) define and name themes, and (6) produce the report. The interview was guided by pre-existing frameworks or theories in medical education. This ensured the capture of major aspects of the VP learning experience as underscored in the existing literature: role modeling, using various authentic cases, and peer dialogue around feedback [ 16 , 17 , 18 , 20 , 21 ]. The focus group interview was recorded, transcribed, and coded by three team members and ordered in initial themes (Z.L, M.A, and X.L). These themes were discussed with the larger team. We used a process of inductive and deductive analysis and used the three design principles of role modeling, practice with various authentic cases, and group discussion on feedback as sensitizing concepts to study the data [ 24 ]. Thereafter, quantitative and qualitative analyses were collectively appraised, compared, and checked for inconsistencies. In this triangulation, the themes identified in focus-group interviews were explanatory to the descriptive statistics of the survey.
Several measures were taken to enhance the study’s trustworthiness. First, triangulation was achieved by employing multiple data collection methods, including surveys and focus group interviews. The interview data collection continued until saturation was reached, ensuring a comprehensive understanding of the student’s experiences and perceptions. Secondly, the coding process followed an iterative approach. Team members initially coded transcripts independently, and then met to reach a consensus before moving on to code subsequent transcripts. Three researchers conducted the coding independently to minimize bias and enhance the validity of the findings. Finally, a member check among a sample of the focus group interviewees was conducted. In response to the question asking whether they agreed with summaries of preliminary results and would provide comments, confirmatory responses were received as well as some minor additional comments and clarifications. The latter were taken into account in the analysis and interpretation of the data.
The Maastricht University Ethical Committee reviewed and approved this study. The approval number is FHML-REC/2023/021.
The findings from both the survey data and focus group interviews were presented to explore students’ perceptions of the effectiveness of the Virtual Patient (VP) Session in enhancing their clinical reasoning skills.
The survey explored students’ perceptions across five key dimensions: General Experience, Intended Learning Outcome, Role Modeling, Practicing with Various Authentic Cases, and students’ reflection on Peer Dialogue around Feedback. The students scored the VP sessions on 20 items (Table 1 ). The scores varied between M = 2.95 to M = 4.58, on a scale of 1–5.
For the General Experience of Virtual Patient Session (Items Q1-Q2) the average score was M = 4.13 (SD = 0.70). Specifically, the overall experience was positively rated at M = 4.11. The component that assessed the improvement of clinical reasoning skills received an average score of M = 4.16.
Regarding the Students’ Perception of Learning from Role Modeling (Items Q3-Q8), the average score was M = 4.38 (SD = 0.61). Students agreed that the expert demonstration at the start of the session helped them understand the intended learning outcomes and was useful in guiding them through the Virtual Patient cases, with scores ranging from M = 4.26 to M = 4.58.
Students’ perception of learning from practicing with various authentic cases (Items Q9-Q13), received an average score of M = 4.00 (SD = 0.86). The scores measured the students’ perception of how well the provided Virtual Patient cases matched their current level of understanding, enhanced their comprehension of the subject matter, and helped them grasp the complexities inherent in real-world clinical scenarios.
For their perception of learning from Peer Dialogue around Feedback (Questions 14–20), the average score was M = 3.24 (SD = 1.05). These scores measure the students’ perception of the effectiveness of peer dialogue in enhancing understanding, generating strategies to address feedback, and prioritizing areas of improvement.
The interviews revealed five themes: ' Which steps to take in clinical reasoning’, ' Asking challenging questions to enhance deeper understanding of knowledge’, ‘The variety in cases helps to enhance transfer to the real world’, and ‘Deeper understanding of reasoning through reflections’.
Students acknowledged the expert’s initial demonstration helped them to develop structured knowledge and gain understanding of the clinical reasoning process.
I think it (Role modeling) helps to find a pattern in clinical reasoning as well. At first, it (the expert) explained to us. For example, are there possible lymph nodes? Yes or no. Then you need to do this and this…Then you can make kind of…pattern that differs for the diagnosis and the prognosis. So you can make kind of a diagram in your head. Which you can use later on. And your knowledge becomes more structured. (Focus Group 2, Student B)
Students also perceived that the integrated practice with Virtual Patients helped them to anticipate the subsequent steps in clinical reasoning. They indicated the patterns learned through practicing with virtual Patients helped them understand the procedures they needed to follow to evaluate the patient.
I think now I know the steps which they (the procedural) followed to evaluate the patient, so first we can do this and then that. First, you determine the TNM (Tumour, Node, Metastasis) staging and do the endoscopy, then the TNM staging, and then you make the treatment plan. Now it’s more clear how they do those steps. (Focus Group 1, Student A)
Moreover, students thought the pair work and dialogue helped them think and clarify with each other what steps they needed to do in clinical reasoning when they had different opinions.
Yeah, that (pair working) was really nice because you can discuss, like I think do this and the other one says, you know, I think do that step, and then you’re already discussing the answers which is really nice to have. (The discussion) really make you think about the steps. (Focus Group 1, Student b)
Students reported how the course design differed from other blocks. According to the students, the VP practice was particularly beneficial in helping them integrate knowledge, and make the knowledge their own.
It (the VP practice) helps you to integrate knowledge because other blocks are really only lectures, they are all listening and listening. So the virtual patient was really nice to make this stuff our own. (Focus Group 2, Student A)
Students indicated the examples given by the expert helped them get a better understanding of the more detailed TNM (Tumor, Node, Metastasis) table, that are used in clinical reasoning.
Yeah, she (the expert) gave examples and guided the reading of the tables for TNM (Tumor, Node, Metastasis) staging, and those were also in the Virtual Patient cases, but because she already used them once and explained how we have to use them, it became more clear to us, what these tables are for and how they are used (Focus Group 1, Student B) .
The students noted that in VP practice sessions, compared with passive learning in traditional lectures, they were challenged to engage directly with the material by making clinical decisions, such as selecting appropriate tests to reach a diagnosis.
In lectures, we passively learn the trajectory from symptoms to diagnosis. During Virtual Patient practice, we actively process it. So you have to make decisions and select the test etc. (Focus Group 2, Student B)
Students indicated that practicing with the VP cases challenged them to look up information and reasoned by themselves. They gave an example of the imaging practice in which they were tasked with examining specific body parts in medical images on their own, they thought they were challenged to reason about what they saw instead of getting the information directly.
Yeah, also the (medical) imaging in the assignments where you need to look at a specific part of the body, normally you just see a picture and someone says, yeah, this is the stomach or this is the heart, whatever, and now you need to look it up yourself and think about it yourself, what you see, so that really helps. (Focus Group 1, Student B)
Furthermore, they emphasized the questions asked by experts challenged them to think, put the knowledge in their own words and apply the knowledge with their own reasoning.
The questions she (the expert) asked really make you think about the things she’s learning(teaching). So if she asks questions, you’re really thinking, and yeah, you’re challenged to put it in your own words. (Focus Group 1, Student B) For instance, she (the expert) asked questions that not from official guidelines, instead, it came from where widely doctor worked and her personal experiences. I applied what she said with my own reasoning behind it. (Focus Group 2, Student B)
Students perceived that practicing with VP cases in different situations offered them hands-on experience, where they actively engaged with various situations, which prepared them for future patient interactions.
Having cases that are closer to the real world, like the comorbidity we discussed, would make it more realistic. (For instance, ) What if he also has obesity or diabetes? Those are the patients that we are going to see in the future. So it helps out a lot to have those different conditions as well. (Focus Group 2, Student B)
Students also indicated their preference for the structured approach of the VP session, where an initial demonstration by an expert, sharing their clinical experience, followed by hands-on practice with VP cases was perceived to enhance transfer to practice. This method, as described by the student, bridged the gap between theoretical knowledge and practical application. They think this structure made the knowledge clear and further helped them to transfer their knowledge from theory to practice.
You (the Virtual Patient session that integrated with role modeling, authentic VP practice, and peer discussion around feedback) made it (the clinical reasoning) clear for me because of the first case we discussed with the teacher. Well, he discussed it and showed us how to think, and how to get things from certain perspectives with risk factors, age, et cetera. And then we do it ourselves. We had to find out what was wrong and go on. So I quite liked it. It gave me a deeper understanding. (Focus Group 3, Student A)
Students indicated the sense of practical immersion is amplified by the “side information that you don’t really need” (Focus Group 3, Student E) from the cases. They highlighted the side information represented the interaction with real patients and made them think of clinical situations in real-world settings.
(Side) information would be more realistic, also side information that you don’t really need because a patient also tells you a lot of things, and some of those things aren’t as important, but you still need to decide if they are important or not. What do you see, why do you see it, what’s different than normal. (Focus Group 3, Student E)
Moreover, several students indicated that the hypothetical “what-if” discussions during the role modeling session helped them with reasoning, prompting them to consider complications that might arise in real-life medical situations.
So for example, about age, it’s more difficult to do a treatment above 70. (What if that patient) has things like smoking history and that kind of stuff. I think it’s really valuable because you have already had an example about it (Demonstrating Case A). (Focus Group 1, Student A)
Students indicated that the diagnosis practice in VP led them to realize the difference in real-world scenarios. They said while in the simulated environment might seem easy to choose multiple diagnostic options, in the real world, medical professionals must make more selective decisions due to limitations. They think this experience taught them to think of prioritizing and decision-making in a realistic medical setting.
Yeah, maybe also there (in VP cases) were also a question about which imaging techniques you would use and then it was Echo or CT, MRI, there was also an option where you could listen to the lungs and some of the people also checked that one, but it isn’t really necessary, so you think it only takes one minute, so why not, but in the real world there isn’t always time to do everything, so it’s also good to think what is really necessary and what’s not. (Focus Group 1, Student A)
During the VP session, students received feedback and conducted conversations around the feedback provided by the Virtual Patient system. Students thought the peer dialogues around feedback provided opportunities for collective reflection and insights, allowing them to pinpoint areas of improvement.
I thought that (the peer dialogue) was really useful, because sometimes one person, for example, when the teacher explains everything, you don’t pick up everything he says. She (your peer) might pick up a different thing, and I pick up a different thing, and we can ask each other, do you know how this works? So I thought that was really useful. (Focus Group 3, Student B)
The students emphasized the importance of expressing and discussing different opinions. They noted that such interactions could provide new insights and perspectives that they would not have considered independently, thereby enriching their understanding.
When you do have different opinions, I think they (your peers) can give you insight that you maybe didn’t have for yourself. So you can add to each other’s knowledge. If somebody has another view, then we can discuss it. It (the discussion) brightens my tunnel view. Also having to say it (the knowledge) out loud and explaining your thoughts to someone else can also help, I think. (Focus Group 2, Student A)
When talking about the peer dialogues around feedback during the VP session, Some students highlighted the benefits of immediate feedback, which provided them with clarity and instant validation. However, others saw value in delayed feedback, as it fostered discussion and multiple interpretations.
I liked that the Virtual Patient program, that it gave you immediate feedback. That was really handy. And I also liked the discussion afterward so we could speak about it a bit more (Focus Group 3, Student B) . There was immediate feedback on most questions, so you knew if you had been correct or wrong. But for the learning process it might be handy to have that after the group discussion, because now we all have the same answer. (Focus Group 2, Student B)
The study demonstrated the perception of students’ learning and knowledge transfer by integrating VP cases with role modeling introductions, and peer dialogue around feedback, specifically in the context of personalized medicine in cancer treatment and care. The survey reflected a positive learning experience and students reported they gained a better understanding of the clinical reasoning process as well as which steps to take when dealing with a clinical case through this specific course design with integration of VP cases. Qualitative data showed that the integration of VPs into the educational setting clearly shifted the students from being passive observers in a traditional lecture-based format to active participants in a simulated clinical environment. This shift is in line with previous research findings, which suggest that the use of VPs in clinical training actively engages learners and encourages the application of their knowledge [ 4 ].
The quantitative data revealed that students highly valued the role modeling session, as indicated by the high average scores. Qualitative data explained that the role modeling session enabled students to not only observe the clinical process being demonstrated but also to engage in active thinking by interacting with the expert. As discussed by Cruess, Cruess [ 15 ], role modeling not only consciously imparts knowledge but also unconsciously influences students’ attitudes and behaviors, making the learning experience more relatable to the clinical environment. In this study, by sharing clinical reasoning and personal anecdotes during the class, experts made the learning experience more relatable to the clinical environment that students would face in the future. This mirrored the role modeling research by Morgenroth, Ryan [ 25 ] which emphasizes the importance of role models in shaping the self-concept and motivation of individuals. Moreover, the qualitative data showed that the demonstration by the expert serves as a fundamental pre-knowledge for students to cover the knowledge gap and prepare them with the following practice. This finding aligns with van Merrienboer’s scaffolding concept emphasizing the importance of initial expert guidance in learning processes [ 16 ].
Followed by the role modeling demonstration, students practiced on two VP cases in pairs and perceived that the VP practice enhanced their clinical reasoning skills, and also helped them understand the real-world clinical setting. The result showed that the variety and real-life complexity of cases in the VP sessions were perceived to be essential for students’ knowledge gain and transfer. The positive perception of various authentic cases aligns with previous research highlighting the importance of exposure to diverse and authentic scenarios in medical training [ 17 , 18 ]. Moreover, the hypothetical “what-if” scenarios further enhanced students’ analytical abilities, preparing them for the multifaceted challenges they would encounter in real-world medical situations. Survey responses (Q10, mean = 4.37; Q13, mean = 4.05 in Table 1 ) indicated a consensus among students on the improvement with this practice in understanding and applying knowledge. Our findings corroborate with Jonassen and Hernandez-Serrano [ 26 ]’s study emphasis on the importance of authentic learning environments for effective knowledge transfer.
After the practice, students discussed the feedback provided by the VP system. Despite its mixed quantitative reception, the peer dialogue on feedback was qualitatively found to be a vital component for promoting critical thinking, discussion, and reflection. The Feedback from the VPs, both immediate and delayed, along with peer dialogue, emerged as crucial elements in students’ learning process. In this study, students showed different preferences for receiving feedback. Some students preferred immediate feedback, however, others preferred delayed feedback. How feedback was provided notably influenced peer interactions. Given that immediate feedback was dispensed upon submission of answers, the peer dialogues automatically started when students noticed disparities or encountered obstacles. Such dialogues not only served to resolve ambiguities but also fostered collective reflection, enhancing comprehension of the subject. By vocalizing their thoughts and engaging in active discussions, students were able to solidify their understanding and uncover nuances they might have missed otherwise. This aligns with the importance of engaging in peer discussions on feedback as outlined in the theoretical background [ 20 , 21 , 22 ].
When looking at the integration of VP cases with the particular course design, students perceived that the expert demonstration, followed by VP practice, and peer dialogue around feedback fostered a comprehensive understanding, allowing them to integrate diverse clinical knowledge, which in turn promoted understanding. The “Watch-think-do-reflect” structure not only ensured better knowledge retention but also enhanced students’ enthusiasm towards the subject. Observing model demonstrations enabled students to assimilate clinical nuances and contemplate real-world applications. Subsequent hands-on practice with VP cases fortified their cognitive structures, honing their clinical reasoning. Ultimately, students perceived that reflective peer discussions on feedback solidified their learnings, enhancing knowledge retention.
This study employed a survey and focus group interviews that provided a comprehensive understanding of students’ perceptions of learning. However, there are several limitations. The study had a small sample size and was conducted in the context of an elective course, which may limit the generalizability of the findings. Furthermore, the study was exploratory in nature and did not measure actual learning outcomes or long-term retention, which are critical aspects of educational impact.
Future research should investigate whether integrating Virtual Patients (VPs) into classroom activities enhance student learning outcomes by incorporating learning assessments and involving larger and more diverse participant groups to validate our findings. Additionally, a deeper analysis of students’ reasoning processes and interactions could provide insights into how and why knowledge gain and transfer are fostered or hindered. Furthermore, it is also important to understand the most beneficial moment for integrating VPs into educational settings to enhance transfer from a simulated to a real practice setting. This understanding could inform the development of more effective educational strategies and interventions.
The integration of Virtual Patients into classroom learning appears to offer a promising approach to enrich medical education. Key elements such as role modeling and various authentic cases contribute positively to students’ perception of learning, as well as peer dialogue on feedback. However, the approach to peer dialogue on feedback may need to be refined for more consistent benefits. Furthermore, studies with larger sample sizes and broader participant groups are essential to provide robust support for the efficacy of this educational approach and its components.
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
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Thanks to all the participants and education workers who contributed to the study. ZL was supported by a scholarship granted by the China Scholarship Council. Thanks for the support of my family, and thanks Ang Li for joining our family.
ZL was supported by a scholarship granted by the China Scholarship Council (CSC, 202208440100).
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Department of Educational Development & Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
Zhien Li, Maryam Asoodar, Xian Liu & Diana Dolmans
School of Health Professions Education, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
Nynke de Jong
Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
Tom Keulers
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ZL, MA, DD, and NJ conceived of the presented idea. MA and DD verified the analytical methods. TK and ZL contribute to the creation of learning materials. ZL analyzed the data and drafted the manuscript under the supervision of MA and DD. All authors contributed to the article and approved the submitted version.
Correspondence to Zhien Li .
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The Maastricht University Ethical Committee reviewed and approved this study. The approval number is FHML-REC/2023/021. All participants were informed about the aims, methods, their right to withdraw, and anticipated benefits of the study. Written informed consent was obtained from all participants prior to their inclusion in the study.
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Li, Z., Asoodar, M., de Jong, N. et al. Perception of enhanced learning in medicine through integrating of virtual patients: an exploratory study on knowledge acquisition and transfer. BMC Med Educ 24 , 647 (2024). https://doi.org/10.1186/s12909-024-05624-7
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DOI : https://doi.org/10.1186/s12909-024-05624-7
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by KENNEDY BUCK, NBC 10 NEWS
FALL RIVER, Mass. (WJAR) — The school year has ended for students, but the work is just starting for the Fall River Educators’ Association and the city.
“There are many districts that are paid better then Fall River,” said Keith Michon, who is the president of the Fall River Educators’ Association. “We’re looking for a fair contract, our priorities are competitive compensation, reasonable workloads, paid parental leave and health and safety in our schools.”
The teachers’ union’s contract with the district expires in August and Michon said deficiencies in the current contract have caused some teachers to leave.
Recruitment and retention is a challenge in education across the country but right now we’re seeing more of an issue because we don’t offer the highest pay and the job, its not the easiest job in the world,” continued Michon.
On Monday, a little over 200 teachers rallied outside of BMC Durfee High School holding up sings during a school committee meeting.
The teachers said that Fall River students deserve the best education and that means making sure teachers are being taken care of.
“Our belief is that teachers should be paid between $65,000 and $130,000 and right now we’re at about $47,000 thousand to $87,000,” said Michon.
Michon said that school committee members and the administration have been willing to hear some of their concerns and the next step now is getting it down on paper.
“We hope to make progress and have it ratified before the first day of school,” continued Michon.
NBC 10 News reached out to the Fall River School District about the unions’ complaints and are still waiting to hear back.
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Hello colleagues, One of the most popular lessons in my classes has been an Electoral College Project . I can hear some of you asking, "Really?!" And my response is "Yes! Really!" We all know that the US President is determined by the results of the Electoral College rather than by the popular vote totals. Since other countries' elections are determined by the popular vote, our system is surprising and even quite confusing for many newcomers.
We typically talk about the results of the presidential election in terms of "red states" and "blue states." While viewing the results of the election on election night, we see a US map and states turning either red or blue depending on which candidate won the state. I wanted the students in my classes to understand what these red and blue state designations results mean for the outcome of the presidential election.
In the Electoral College Project in my classes, students work in teams of 2-3 and are assigned a set of 8-10 states (depending on how many students are in the class) to search online for data. I provide them with a handout as well as list of websites to complete a scavenger hunt to locate information, including:
The students then present their information to the rest of the class while their classmates fill in the information on their own handout. I've done this lesson with learners at the beginning level who have quite limited English skills with success.
If you'd like to try out this lesson between now and November, you can find the updated handouts I created below. Please feel free to adapt these resources to make them your own ! If you have any questions, let me know here in our community.
Cheers, Susan Finn Miller
Moderator, English Language Acquisition Group
I am also looking at how to incorporate civics into summer and fall lessons right now. In 2016, there was some good-natured grumbling about why the electoral college was important and then... a real-life example of why.
Thanks for all the many helpful insights and resources you share--including this wonderful set of resources for learning and teaching about the electoral college! I will review and share these with colleagues!
Again, THANK YOU!
Happy Summer!
I got a "Page not found" message when I clicked on the links. Hmmm...
Thanks for the heads up, Dave. I'm checking on this now!
Thanks to our tech support, the links to the handouts above are are now valid.
Cheers, Susan
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In 2024, OhioLINK funded a group of member librarians to become Open Education Network Open Education Certified Librarians . In September, they will join nine OhioLINK librarians who are already certified. This expanding group of OER-specialists will serve as champions for open and adaptable teaching materials and in collaborating with their faculty. Register here to learn about the genesis of this program, the certification process, the role it can play advancing OER at OhioLINK institutions, and how the panelists will be applying what they've learned on their own campuses. Read the full description on the updated Summit 2024 Ostaff page , where you can also find the recordings for the Summit Year in Review and Jason Griffey’s AI keynote.
A reminder that OhioLINK has worked with Lyrasis to offer discounts for ArchivesSpace Hosting to interested OhioLINK members. Details about the offer and a link to the Information Session are available on Ostaff .
Yolanda Cooper of Case Western Reserve University will moderate the next Directors’ discussion on June 18 at 3-4 p.m. A Webex invitation was sent to the directors’ list and details can be found on the Ostaff Directors’ page.
The OhioLINK central office will be closed Wednesday, June 19 for Juneteenth. If you need to report an emergency outage during this time, please contact the OARnet 24/7 Service Desk at 1-800-627-6420 and identify your report as an OhioLINK issue and provide them with the name of your institution and your contact information. For all other questions and non-emergency issues, please email OhioLINK Support or complete the support form on our site.
Central catalog searches of interest, may 27 – june 2.
Ohio department of higher education, state government links, education links.
The Association of Corporate Counsel (ACC) is the world's largest organization serving the professional and business interests of attorneys who practice in the legal departments of corporations, associations, nonprofits and other private-sector organizations around the globe.
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This M&A call will be an open discussion on how department intake metrics can be developed and measured and how the metrics provide vital analysis to your department's value.
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This teacher-created scaffolding tool can elevate classroom dialogue, empowering students to express themselves while learning from the ideas of others.
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But using online discussion tools can be one great way to help your students build these skills. Plus, the ability to engage in online discussions responsibly is a great 21st-century skill in and of itself. Online discussions often lead to better in-class discussions afterward—you know, the kind where students raise their hands and speak out ...
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Education, school, and university are great ESL discussion topics! Get everyone talking with these ESL conversation questions about education, school, and university. Almost everyone in the world has had direct experience with education in some way, shape, or form. So get your students talking and sharing their experiences on the education ...
Explore your AI assistant for education: Microsoft Copilot. Learn how to get started with Microsoft Copilot and ways to use Copilot in education.
Twenty-two second-year medical undergraduates engaged in a VP session, which included role modeling, practice with various authentic cases, group discussion on feedback, and a plenary session. Student perceptions of their learning were measured through surveys and focus group interviews and analyzed using descriptive statistics and thematic ...
I'm helping setup a Non-profit teen center in the a remote area of Alaska and would like to have multiple users on each of the ten iPads purchased, is the Education manager the way to do that or is there something else t
The school year has ended for students but the work is just starting for The Fall River Educators' Association and the city.
Hello colleagues, One of the most popular lessons in my classes has been an Electoral College Project. I can hear some of you asking, "Really?!" And my response is "Yes! Really!" We all know that the US President is determined by the results of the Electoral College rather than by the popular vote totals. Since other countries' elections are determined by the popular vote, our system is ...
The Governor met with students and counselors to hear firsthand about their mental health challenges and shared how his 2024-25 budget proposal would invest $100 million to improve mental health services in K-12 schools. The Governor's 2024-25 budget proposal would continue that historic progress with a nearly $1.1 billion increase in basic education funding, building on the work of the ...
In 2024, OhioLINK funded a group of member librarians to become Open Education Network Open Education Certified Librarians. In September, they will join nine OhioLINK librarians who are already certified. ... Directors Open Discussion, June 18, 3PM. Yolanda Cooper of Case Western Reserve University will moderate the next Directors' discussion ...
Overview (Program Summary) This M&A call will be an open discussion on how department intake metrics can be developed and measured and how the metrics provide vital analysis to your department's value. Speaker: Elaine Darr, the Vice President, Regulatory & Legal Affairs, from DHL Supply Chain.
Middle and High School-level discussion and decisions affecting people, wildlife, and their shared habitat in the community. *No longer in print* - contact Texas Project WILD Coordinator about workshops or digital versions. Awareness: alerts students to the impact of human and individual activities on habitat quality and quantity
In 1938, it was granted town status. [citation needed]Administrative and municipal status. Within the framework of administrative divisions, it is incorporated as Elektrostal City Under Oblast Jurisdiction—an administrative unit with the status equal to that of the districts. As a municipal division, Elektrostal City Under Oblast Jurisdiction is incorporated as Elektrostal Urban Okrug.
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