This document summarizes a presentation on integrating electronic clinical procedure libraries (eCPLs) into health education. It discusses 1) the context and use of eCPLs like VAR Healthcare in clinical settings, 2) a collaboration between universities in Norway and Japan to study eCPL integration, and 3) approaches to incorporating eCPLs into active learning methods like problem-based learning, experiential learning, simulation, and role-playing. The goal is to seamlessly integrate evidence-based clinical procedures from eCPLs into health education and bridge the gap between education and practice.

1. Mind the Steps: Electronical Clinical
Procedure Library in Health
Education and Practice
Renée Schulz1, Takahiro Hara1, Santiago Martinez2
1 Department of Multimedia Engineering, Osaka University (JAPAN)
2Faculty of Health and Sport Science, University of Agder (NORWAY)

2. This is the INTED 2019 virtual presentation of the paper:
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3. 1. Introduction
• eHealth technology  support for clinical decision-making, diagnosis
and intervention
• Health work environment technology  into health education.
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Methodology
Context of
eCPLs and VAR
Including eCPLs into
the Learning Context
Conclusion
End.

4. 2. Methodology
• International cooperation project between universities from Norway (University
of Agder) and Japan (Osaka University)
• Financed by the Japanese Society for the Promotion of Science (JSPS) [2] in a
bilateral agreement with the Norwegian Research Council (NFR).[3]
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5. 2. Methodology
• Context analysis and
evaluation of existing digital
systems
• Use and learning of eCPLs in
health education
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• Human-centered design (HCD) approach, DIN EN ISO 9241-210
DIN EN ISO 9241 – 210 [6]

6. 3. The Context of eCPLS and VAR
• Used in healthcare settings: ensure quality in clinical procedures
(routinely performed or unpracticed), support medical staff in their
daily work and as a tool for lifelong learning
• Provide resources from basic information to advanced and specialized
routines
• Inform their decision-making process by means of using an eCPL
• Example: VAR Healthcare (https://www.varnett.no/) [1]
• Includes an advanced search engine with decision support, knowledge
summaries for clinical procedures, tests and exercises, and a variety of
calculators
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7. 3. The Context of eCPLS and VAR
Overview of three different VAR Healthcare (https://www.varnett.no/) screenshots: search,
procedure and a picture of the same procedure [1].
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8. 3. Brief Overview of Functions in VAR
Search functionality for clinical procedures and other resources stored in the
database of VAR
Visualization of procedure steps in pictures and/or animations.
On and off-toggling of adequate tools and materials.
Display of changes from previous procedure versions (part of the evidence-
based practice).
Hyperlinks to related procedures.
Knowledge/Study material to research further topics.
Calculators (dose, amount, intensity, speed, body mass index and
conversions).
Knowledge self-tests to keep updated on the knowledge stored in VAR.
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9. 3.1 Japanese Context
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Figure 2. Nurse trolley in use at
Osaka University Hospital [7].
• Large Health IT market size,
• an expanded health IT infrastructure,
• and generally tech-friendly society.
• Japan is emphasizing the use of healthcare IT
• One reason: aging population
• “Vision and actions plan for 2035”
• https://www.export.gov/article?id=Japan-healthcare-IT
• http://www.mhlw.go.jp/healthcare2035
• PBL since 1990
• 2004  at 63 of the 79 Japanese medical schools

10. 3.2 Norwegian Context
• Government has prioritized ICT for healthcare since 2012 [12]
• VAR is an eCPL designed for clinical guidelines that does not handle any patient
data
• DIPS is an electronical health record system
• Evidence-based practice (EBP) is seen as relevant for providing the most
qualitative care and treatment
• VAR is used by nursing schools in Norway
• Norway is striving for a digital transformation in healthcare services
•  Computer Science and Health Sciences can come together
•  Universities in Norway developed courses in health informatics
•  Student-centered learning and teaching approach, including active elements
targeting problem-solving and practical aspects
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11. 4. Including eCPLS into the Learning Context
• Using lectures without active elements are less effective
• Active learning approaches
• E.g., team-based learning, problem-based learning, simulation, and
gamification
Goal: seamlessly integrate evidence-based clinical procedure libraries
into the health education
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12. 4. Including eCPLS into the Learning Context
Instrumental genesis with eCPL as artifact and healthcare as subject, based on Trouche, 2005 [8] and Verillon, & Rabardel, 1995 [9].
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13. 4.1 Technology Integration within the Problem-based Learning Approach
• PBL is introduced in the curricula of health sciences and nursing
• Emphasizes active participation, critical thinking and helps to develop
problem-solving skills
• Develop transferrable knowledge that is not bound to specific situations
Example: simulation of a real-life situation using real props including role-
playing elements, such as storytelling, learning quests (learning tasks) or
healthcare professional roles played by health students
Possibility of adding gamified key elements of the simulation to the scenario
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14. 4.2 ECPL Integration in the Experiential Learning Context
• Kolbs’ theory of experiential learning: learning as an active occurrence
• Concrete experience, reflective observation, abstract conceptualization and
active experimentation
• Example: practical phases in the training or hands-on medical discussions
and/or cases, students can discuss with or without technology, so that they
learn problem solving the traditional way, as well as how to use eCPLs
effectively and efficiently, active experimentation with the technology,
reflect on the healthcare topic at hand but also on the use of the eCPL and
how it could support them in the future (see next Fig.)
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15. 4.2 ECPL Integration in the Experiential Learning Context
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Including an ECPL example into
the experiential learning cycle
(adapted after Kolbs’ theory of
experiential learning [10], [11]).

16. 4.3 Simulation, Serious Game, Role-playing
• To deliver education effectively is the main purpose of this learning and
teaching approach in this project
• Simulation is already used in health education
• Different healthcare scenarios are simulated using role-playing either in a
real or virtual world
• Elements of role-playing games (RPG) or role-playing learning (RPL) can be
used in a simulation, discussion or scenario playthrough
• Role-playing elements are e.g., storytelling, a narrator, learning tasks, and
roles played by the students
• Help students to understand the healthcare context and how to integrate
technology & help to test and evaluate the technologies
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17. 5. Conclusion
• Opportunities that lay in the intersection of health and technology are just
beginning to be explored.
• Systematic inclusion of health technology in the curricula of nurses and doctors
can only benefit all stakeholders
• Bridging the gap between education and practice
Teachers have to be trained in using the technologies and educated on active
learning and teaching principles for student-centered learning and teaching. There
is a great range of active learning and teaching approaches of which some are
already used in healthcare education. This means that higher education teachers
may already be familiar with the teaching methods so that these approaches (e.g.,
problem-based learning, experiential learning, and serious game or simulation
related elements) can be used for the integration of workplace technology.
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18. References (used in this presentation)
[The complete list of references can be found in the fulltext version of the paper.]
[1] https://www.varnett.no/
[2] http://www.jsps.go.jp/english/
[3] https://www.forskningsradet.no/
[4] https://www.export.gov/article?id=Japan-healthcare-IT
[5] http://www.mhlw.go.jp/healthcare2035
[6] ISO 9241-210: 2010. Ergonomics of human system interaction - Part 210: Human-centred design for interactive systems. International Standardization
Organization (ISO). Switzerland, 2010.
[7] Y. Matsumura, “Hospital Information System of Osaka University Hospital,” Presentation at Osaka University Graduate School of Medicine Medial
Informatics, 2013. Retrieved from http://jami-ks.umin.jp/files/20130316_GJ06.pdf
[8] L. Trouche, “An instrumental approach to mathematics learning in symbolic calculator environments,” in The didactical challenge of symbolic
calculators, pp. 137-162, Boston, MA: Springer, 2005.
[9] P. Verillon, & P. Rabardel, “Cognition and artifacts: A contribution to the study of though in relation to instrumented activity,” European journal of
psychology of education, vol. 10, no. 1, p. 77, 1995.
[10] D. A. Kolb, “Experiential learning: Experience as the source of learning and development,” New Jersey: Prentice Hall, 1984.
[11] A. Y. Kolb & D. A. Kolb, “Learning styles and learning spaces: Enhancing experiential learning in higher education,” Academy of management learning
& education, vol. 4, no. 2, pp. 193–212, 2005.
[12] Det Kongelige Helse og Omsorgsdepartement, Meld. St. 9 (2012–2013) Melding til Stortinget Én innbygger – én journal Digitale tjenester i helse- og
omsorgssektoren. Retrieved from https://www.regjeringen.no/no/dokumenter/meld-st-9-20122013/, (acessed on 17.01.2019)
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19. Thank you.
Renée Schulz
@Sciencefication
renee.schulz@ist.osaka-u.ac.jp
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