Students Language Proficiency and

Cross-Cultural Use of Virtual Patients

Valentin Muntean*, Uno Fors**, Nabil Zary**, Tudor Calinici*

* “Iuliu Hatieganu” University of Medicine, Cluj-Napoca, Romania

**Karolinska Institutet, Stockholm, Sweden

Email:valentin.muntean@gmail.com
 Language Proficiency and Cross-Cultural Use of VP’s

 Sharing educational resources, specifically virtual

patients (VP’s), among medical schools, is a way to
improve education. However, several cultural aspects
may have an impact on the development and the use of
VP’s.

 This study focus on the influence of learners language

proficiency on cross-cultural use of VP’s.
 Language Proficiency and Cross-Cultural Use of VP’s

 As a part of the eViP-project, 42 fifth year Romanian

medical students from the Faculty of Medicine in Cluj,
Romania, enrolled in the optional lecture “Methods of
teaching and evaluation for medical students” were
asked to participate in a pilot study with virtual patients.
 The students’ previous training was exclusively in
Romanian and none of them had worked with VPs
before, however, a requisite for participation in the study
was a good understanding of English.
 Language Proficiency and Cross-Cultural Use of VP’s

 Three cases developed by faculty in internal medicine,

surgery and endocrinology were used. Every case had
an English and a Romanian version. The content of the
versions was identical and translation into English was
performed by the case authors and reviewed by a native
English speaker.
 Language Proficiency and Cross-Cultural Use of VP’s

 30 out of the 42 students considered themselves as

having a good or very good understanding of English
and agreed to participate in the study.

 The identity of the students remained unknown for

researchers throughout the study. Every student was
given a code name (anonymous) and was randomly
assigned two different cases, one in English and one in
Romanian. The access to the cases was given for a two-
week period. The students logged to the cases through
the Internet from home.
 Language Proficiency and Cross-Cultural Use of VP’s
raspun
suri nr de
nr.de student cuvinte
date de nr.de date in in
caz nr.intre exame examin tratament ROM(R) justific
NUME ROMm(R) bari n ari de diagnostic corect sau area
student / sau timp/ca anamn obiecti lab/radi corect (YES/NO/INC ENGLl( diagno
caz ENGgl(E) z (min) eza v ologice (YES/NO) OMPLETE) E) sticului

student049 BT-ROM 40 48 11 19 YES INCOMPLETE ROM 51

student058 BT-ROM 25 21 10 12 YES YES ROM 11

student 23 BT-ROM 80 103 81 50 INCOMPLETE YES ROM 53

student 3 BT-ENG 50 29 5 12 YES INCOMPLETE ENG 50

student 57 BT-ENG 90 98 31 43 YES YES ROM 37

student 9 BT-ENG 32 90 7 33 INCOMPLETE INCOMPLETE ROM 29

student048 BT-ENG 70 32 28 38 YES INCOMPLETE ROM 48

student054 BT-ENG 52 55 7 33 YES INCOMPLETE ROM 51

student055 BT-ENG 34 25 8 21 YES YES ROM 8

student 20 BT-ENG 75 97 99 19 INCOMPLETE INCOMPLETE ROM 57

student 26 D.R. ROM 52 141 118 25 INCOMPLETE NO ROM 36

student 27 D.R. ROM 120 131 158 28 NO NO ROM 84

student 29 D.R. ROM 42 117 27 38 INCOMPLETE INCOMPLETE ROM 31

student 41 D.R. ROM 46 119 39 37 YES INCOMPLETE ROM 31

student 5 D.R. ROM 35 135 15 19 YES YES ROM 75

student 9 D.R. ROM 52 117 20 46 INCOMPLETE YES ROM 40

student047 D.R. ROM 46 92 5 35 INCOMPLETE INCOMPLETE ROM 25

student056 D.R. ROM 60 123 64 50 NO NO ROM 51

student059 D.R. ROM 44 65 7 6 YES YES ROM 37

student046 D.R. ENG 30 93 36 32 NO NO ROM 31

 Language Proficiency and Cross-Cultural Use of VP’s

 Of the 30 students enrolled in the study, 8 did not

finalize both cases and were excluded from the final
analysis of the results. The following criteria were
analyzed:
 Time per case (average +/-SD)
 No. of history questions asked (average +/-SD)
 No. of tests ordered for physical examination (average +/-
SD)
 No. of lab or imaging tests ordered (average +/-SD)
 Correct diagnosis and treatment (Yes, Incomplete or No)
 Student answer (in English or Romanian)
 No. of words in diagnosis justification (average +/-SD)
 Language Proficiency and Cross-Cultural Use of VP’s

raspun
suri nr de
nr.de student cuvinte
date de nr.de date in in
caz nr.intre exame examin tratament ROM(R) justific
NUME ROMm(R) bari n ari de diagnostic corect sau area
student / sau timp/ca anamn obiecti lab/radi corect (YES/NO/INC ENGLl( diagno
caz ENGgl(E) z (min) eza v ologice (YES/NO) OMPLETE) E) sticului

student049 BT-ROM 40 48 11 19 YES INCOMPLETE ROM 51

student058 BT-ROM 25 21 10 12 YES YES ROM 11

student 23 BT-ROM 80 103 81 50 INCOMPLETE YES ROM 53

student 3 BT-ENG 50 29 5 12 YES INCOMPLETE ENG 50

student 57 BT-ENG 90 98 31 43 YES YES ROM 37

student 9 BT-ENG 32 90 7 33 INCOMPLETE INCOMPLETE ROM 29

student048 BT-ENG 70 32 28 38 YES INCOMPLETE ROM 48

student054 BT-ENG 52 55 7 33 YES INCOMPLETE ROM 51

student055 BT-ENG 34 25 8 21 YES YES ROM 8

student 20 BT-ENG 75 97 99 19 INCOMPLETE INCOMPLETE ROM 57

student 26 D.R. ROM 52 141 118 25 INCOMPLETE NO ROM 36

student 27 D.R. ROM 120 131 158 28 NO NO ROM 84

student 29 D.R. ROM 42 117 27 38 INCOMPLETE INCOMPLETE ROM 31

student 41 D.R. ROM 46 119 39 37 YES INCOMPLETE ROM 31

student 5 D.R. ROM 35 135 15 19 YES YES ROM 75

student 9 D.R. ROM 52 117 20 46 INCOMPLETE YES ROM 40

student047 D.R. ROM 46 92 5 35 INCOMPLETE INCOMPLETE ROM 25

 Language Proficiency and Cross-Cultural Use of VP’s

Case
(ROM or Time/case  Interestingly, the
ENG) (min) SD average time per case
      was longer for the
Romanian versions of
BT-ROM 48,3 28,4 VPs (55.7 +/- 21.3 min)
DR-ROM 55,2 25,21 versus English versions
(48.2 +/- 18.8).
SV-ROM 59,3 19,3

ROM 55,7 21,3

 When comparing
individual cases,
      students working with
BT-ENG 57,56 21,6
the Romanian version
used more time per
DR-ENG 38.0 11,3 case than for the
English version in two of
SV-ENG 46,9 19,6 the cases and less in
ENG 48,2 18,8 one.
     
 Language Proficiency and Cross-Cultural Use of VP’s
Case No.
(ROM or question/histo  There were more
ENG) ry SD history questions
      asked for Romanian
VPs (84.4 +/- 36.8)
BT-ROM 57,3 41,7 when compared with
DR-ROM 115,6 23,5 English versions
SV-ROM 64,2 26,7
(68.1 +/- 35.1).
ROM 84,4 36,7  In two cases, the
      students asked more
questions for the
BT-ENG 60,8 33,4
English VPs and in
DR-ENG 74.0 52,1 one many more
SV-ENG 70,4 33,5
questions for the
Romanian cases.
ENG 68,1 35,1
     
 Language Proficiency and Cross-Cultural Use of VP’s

Case No. physical No.

(ROM or exam. lab./imaging
ENG) ordered SD ordered SD
           The number of
BT-ROM 34.0 40,7 27.0 20,2 tests ordered for
DR-ROM 50,3 53,7 31,5 13,6 physical
SV-ROM 40,5 26,3 38,4 18,1
examination and
lab or imaging
ROM 43,5 38,2 33,6 15,7 tests ordered was
          almost the same
BT-ENG 26,44 33,7 28,4 11,2 for Romanian and
DR-ENG 61,2 65,7 27.0 16,9 English cases.
SV-ENG 43,3 45,1 34,1 22,3
ENG 42,1 45 30,4 17
         
 Language Proficiency and Cross-Cultural Use of VP’s

Case (ROM or
ENG) Correct diagnosis
(YES/INCOMPLETE/
  NO)  We found high
BT-ROM 2/Y. 1/I differences for correct
diagnosis between
DR-ROM 3/Y. 4/I. 2/N Romanian and English
SV-ROM 8/Y. 2/I VPs.
ROM 13/Y. 7/I. 2/N  The diagnosis was
    correct in 13 of the
Romanian VPs and 9
BT-ENG 5/Y. 2/I of English VPs,
incomplete in 7
DR-ENG 1/Y. 3/I. 1/N Romanian and 9
English cases and
SV-ENG 3/Y. 4/I. 3/N wrong in 2 Romanian
ENG 9/Y. 9/I. 4/N and 4 English cases.
   
 Language Proficiency and Cross-Cultural Use of VP’s
Case (ROM or
ENG) Correct treatment
(YES/INCOMPLETE/
  NO)  The differences between
BT-ROM 2/Y. 1/I the two versions were
DR-ROM 3/Y. 3/Y. 3/N
even greater for
treatment plan.
SV-ROM 6/Y. 4/I
ROM 11/Y. 8/I. 3/N
 The correct treatment
plan was given in 11
    Romanian and 4
English VPs, the
BT-ENG 2/Y. 5/I answer was incomplete
in 8 Romanian and 10
DR-ENG 1/I. 4/N English and wrong in 3
SV-ENG 2/Y. 45I. 3/N Romanian and 7
English cases.
ENG 4/Y. 10/I. 7/N
   
 Language Proficiency and Cross-Cultural Use of VP’s

Case (ROM or
ENG) Studnt answer
  (ROM/ENGL)
BT-ROM 2/ROM
DR-ROM 9/ROM
 The student
answers were in
SV-ROM 10/ROM
Romanian in all
ROM 22/ROM Romanian cases
    and in Romanian for
BT-ENG 6/ROM. 1/ENG most English VPs
DR-ENG 4/ROM. 1/ENG (19 out of 22).
SV-ENG 9/ROM. 1/ENG
ENG 19/ROM. 3/ENG
   
 Language Proficiency and Cross-Cultural Use of VP’s
Case (ROM or
ENG) No.words in
diagnosis  The number of words
  justification in diagnosis
BT-ROM 38,3
justification was
larger for Romanian
DR-ROM 45,5 versions of VPs (46.7
+/- 4.6) when
SV-ROM 51,3 compared with
ROM 46,7 English versions
(39.4 +/- 2.0).
   
BT-ENG 40.0  The difference is
due to only one of
DR-ENG 45,8 individual cases, in
the other two the
SV-ENG 35,2 figures being almost
the same.
ENG 39,4
   
 Language Proficiency and Cross-Cultural Use of VP’s

 We found unexpected high

differences of student
performance on Romanian and
English versions of VP’s.

 Further studies are necessary to

refine those differences and to
understand their significance.
 Language Proficiency and Cross-Cultural Use of VP’s

 Number of students
 Number of cases/student
 Student English proficiency
 Student training/experience with VP’s
and diferent players
 Student experience for a specific
domain of medicine
 Case difficulty/complexity
 Case cultural specificity
 Language Proficiency and Cross-Cultural Use of VP’s

 Planned future studies:

 Cultural/content
 Cases from Karolinska, London, Munchn,
Heidelberg versus “Home made cases” - Cluj
 Language
 English/Swedish versus Romanian
 Students
 Romanian versus International students
 Players
 Web-SP, Labyrinth, Casus, Campus
 Language Proficiency and Cross-Cultural Use of VP’s

 VP’s could play a role in

addressing the cultural diversity
that exists in the society and
increased mobility of healthcare
professionals, students and
patients.
 Curriculum reform: what next?

OUR VP’s PROGRAM IS NOW UNDER

 Curriculum reform: what next?

It’s already a *** PROGRAM / although it

 Curriculum reform: what next?

We are getting ready for the next season