The students in the EG had to solve five virtual patient cases chosen by the lecturer in order to be in line with the learning objectives of the subject. Each student had to solve the same five virtual patient cases. The students in the CG had to solve five paper-based clinical cases, which were the same as the virtual ones but presented in written form. The cases were a 65-year-old woman with insomnia, a 24-year-old woman with headache, a 42-year-old man with pain in the right upper abdomen, a 55-year-old man with fatigue, and a 30-year-old woman with palpitations.
The virtual patient case comprised 15-30 pages in which students assume the role of a virtual student working with a preceptor. The students move through the stages of a patient's presentation, engaged in continuous practice of their clinical reasoning skills, from eliciting the main complaint to taking a history, performing a physical exam, composing an assessment, formulating a differential diagnosis, and on to diagnostic testing and management. The methods applied consist of reading additional material (articles, textbook chapters), photographic images of patients during a physical exam, video clips of topics associated with the case, and so on.
The paper-based clinical case consisted of patient history, results from a clinical examination, and investigations. No additional material was provided.
Data was collected by paper forms consisting of demographic data (gender and age of the students), a learning strategies scale, a learning habits scale, and a knowledge of family medicine scale. We collected data in two phases: (1) before the beginning of the experiment (in October 2014) we obtained data on the students' initial knowledge of family medicine, learning strategies, and learning habits and (2) at the end of the experiment, after four months of teaching (in February 2015), we checked the students' final knowledge of family medicine.
Both tests included 50 multiple choice questions (MCQs) on factual knowledge of family medicine, and the same MCQs were used for the initial and the final knowledge tests. The maximum number of points in each test was 50. The MCQ questions were based on the learning outcomes of the family medicine subject in the 4th study year and were taken from the textbook of family medicine used in the curriculum as the obligatory learning source.
This scale is composed of 20 statements covering four sets of learning strategies: strategies of conditions management (e.g., real-time learning, time distribution); strategies of processing learning material (e.g., repetition of old material, independent renewal, and linking courses); metacognitive strategies (e.g., self-questioning); and strategies of controlling emotional motivation states (e.g., concentration in learning). The statements can be rated on a 3-point scale: 1:disagree, 2:partly agree, and 3:agree. The scale's total score is 60 points; a higher total result indicates a better mastery of the internal and external factors of learning and a better processing of learning material and hence a higher quality (durability, usability) of knowledge.
This scale is composed of 20 statements which assess internal learning motivation positively and negatively (e.g., self-initiative learning; learning beyond others' demands; striving for knowledge rather than marks). The statements can be rated on a 3-point scale: 1:disagree, 2:partly agree, and 3:agree. The scale's total score is 60 points; a higher total outcome in the scale denotes a higher level of internal learning motivation.
Both scales are established tools for the measurement of learning motivation and strategies and have been proven to be valid and reliable. Both scales have been adapted for the Slovenian language and have proved to be reliable.
Data was processed at the level of descriptive and inferential statistics. The following methods were applied: descriptive statistics for sample description; independent samples t-test and paired samples t-test for analyses of differences between groups; analysis of covariance (ANCOVA) for homogeneity; and effect size measures (eta2, R2) for determining the size of the study effect. The reliability of the scales was assessed by Cronbach's alpha. A P value of <0.05 was considered as statistically significant.