Implementation of the

MedBiquitous Standard into the

learning system CASUS
Inga Hege – LMU Munich
Andrzej Kononowicz - Jagellonian
University
Michael Pfähler – LMU Munich
Martin Adler - Instruct AG
 Overview

• CASUS
• MVP standard
• Implementation in CASUS
• Challenges
• Scenarios
• Conclusions
 CASUS

• Developed at LMU since 1993, distributed by instruct

• Linear case-based learning system
• 9 different question types with quantitative and qualitative
feedback
• Optional Expert comments and Hyperlinks for additional
content
• Player in 6 languages
• Reporting and analysis of students results
• Currently about 1000 VPs (in 8 languages) in database
• About 1000 cases session daily, 130 faculties
• SingleSignOn to other systems (e.g. LMS) via AICC,
Shibboleth
CASUS Player
 MVP standard

Media Resources: all of the DAM: expresses the aggregation

images, animations, videos, audio of VPD and MR elements for
files and any other digital objects exposure through the AM.

VPD: provides the personal and AM: encodes what the learner can [MVP 09]

clinical data relevant to the clinical do and how they engage with the
scenario being simulated. virtual patient.
MVP standard
 ActivityModel
DataAvailabilityModel
linear Case progress
DAMNode

ActivityNode

ActivityNode

ActivityNode

ActivityNode
 VirtualPatientData
No specialized fields are used, only VPDText

VPDText VPDText

VPDText

Xtensibleinfo/VPDText

VPDText
 Metadata

Metadata – provides information

about, other data managed within
an application or environment
(e.g. name, author, size, data type)

LOM
Learning
Objects
Metadata

CASUS VP metadata
(authoring view)
 Challenges

• Implementation of questions
– important component of a Casus VP
• Example: case of Mr. Angermeier
– 47,69% on text content (this case
contains with questions 22.730
characters {without spaces} after
removing questions 11.889)
– 8 out of 29 cards ceased to exist

-> Assessment items are not

supported in the MVP standard
-> but two solutions ... Almost 50% of the case is lost after
removing questions and their feedback
 Questions in CASUS
Correct answers
>500
• 9 different question types Distractors
• Multiple/Single Choice (MC)
• Freetext (rated and non-rated), Cloze Schuwirth LW, van der Vleuten CP,
Stoffers HE, Peperkamp AG.
• Sorting, Mapping Computerized long-menu questions as
• Lab values an alternative to openended questions in
computerized assessment.
• Underline Med Educ.1996;30(1):50-5.

• Long Menu Long-Menu Questions

• Differential diagnostic network tool

•-> Implementation of QTI in MVP by

the XtensibleInfo element in VPD

Differential diagnostic network

 IMS QTI

• = Question and Test Interoperability specification

• Defines an information model and associated binding that
can be
used to represent and exchange assessment items.
• Limitations:
• QTI > 1.2 unstable (QTI 2.1 withdrawal/reposted)
• Lack of standard support for specific question types (e.g. Long Menu)
Extension proposals: M.Pfähler, M. Holzer, An extension to the QTI standard to support long menu items and specific metadata in
QTI 2.1, GMS Medizinische Informatik, Biometrie und Epidemiologie 2009, Vol. 5(1), ISSN 1860-9171

-> VPs for assessment can be shared using QTI

Import/Export of QTI questions in CASUS is optional

CASUS’ QTI questions in Heidelberg’s CAMPUS system

 Challenges

• Implementation of Answers
• Import of branched VPs
• Import of highly structured VPs
 Challenges -
Import of branched VPs

Branched VP Linear VP Our solution:

•Import of all nodes in a
Node Node linear order
• Display of available next
nodes and marking of start
Node Node
node and end nodes.
Node -> Author can decide how to
re-structure VP
Node
Node Node Node

Node

Node Node

Node
 Challenges – Import of
highly structured VPs

WEB-SP VP
 Challenges

• Implementation of Answers
• Import of branched VPs
• Import of highly structured VP
• Tracking of changes in VPs
• Textstyles need filtering to exchange correctly and match
the
standard
• Image maps with Hyperlinks -> XtensibleInfo
• Hyperlinks to text elements/images/movies
 Challenges

VPDText
 Why Standards?

• Exchange and communication between systems

• Access to teaching resources in different systems
• Use of learning resources independently from the
original system
• Content is still accessible if a system is not
supported
any longer or in case of system change
 Scenarios
Other
systems
implementin
g MVP

Casus Exam
Wiki system
tool

VP duplication
QTI

Assessment Item - Printing

Database - Backup
- Standalone/local VP
 Conclusions

• MVP and other standards can be more than an exchange

format for
VPs
• QTI is a good starting point to exchange assessment items
• Import from branched and highly structured systems needs
further
improvement (e.g. a graphical interface)
• CASUS does not fit 100% into the MVP Standard ->
didactical value
preserved?
 Thank you!

More information:

www.casus.eu

www.virtualpatients.eu