E-LEARNING COURSE: DONATION AND HARVEST OF CELLS AND TISSUES

E-LEARNING COURSE: DONATION AND HARVEST OF CELLS AND TISSUES

Pavel Měřička (1), Pavel Navrátil(2), Daniel Brandejs (1), Lubomír Štěrba (1), Hana Straková (1), Barbora Honegrová(1)

(1) Tissue Bank, University Hospital Hradec Králové,

(2) Dept.of Urology Charles University in Prague, Medical Faculty and University Hospital Hradec Králové, Czech Republic
Corresponding author: mericka@fnhk.cz

ABSTRACT
Background
The design of the e-learning course: Donation and Harvest of cells and tissues“ is presented. This course represents more advanced updated and enlarged English version of the original e-learning course focused exclusively on the issues of cell and tissue donation and harvest. Its aim is to enable the students to learn individually the theoretical and practical principles of the subject and to present the gained knowledge at the final seminar.
Methods
All functions of the course aree operated in Moodle, local application of the Charles University in Prague, Medical Faculty Hradec Králové. The course covers the topic Donation and harvest of cells and tissues and is divided into 2 parts. A test consisting of 5 questions selected randomly from the bank of questions follows each part. If the student answers correctly at least 3 questions he/she is allowed to pass to the next part and/or final test consisting of 15 questions (8 ones from the part one, 7 ones from the part two). It is necessary to answer correctly at least 10 questions to receive a certificate of completing the course.
The third topic is represented by a database for uploading theses presented by students at the final seminar.

Results
The experience from the pre-verification stage of the Czech version of the course has been already published recently. The first English version was verified in the group of 14 English speaking students (9 men, 5 women) from different countries (Greece 1, FRG 6, Ireland 1, Malaysia 1, Norway 2, UK 3). All students completed the course and accepted well this form of teaching/learning including the system of knowledge testing. The experience from the verification stage lead the authors to making some improvements of the study materials such as enlarging the practical aspects of tissue donation and harvest as well as enlarging the number of questions in the bank.

Conclusions
The previous experience showed that the e-learning course could serve as a useful support of the elective subject „Basis of Harvest and Preservation of Tissues“. This enlarged and updated English version aimed exclusively at the topic Donation and harvest of cells and tissues is planed to be used by a broader spectrum of users including the surgeons in post-graduate training and post-graduate students of different doctoral study programmes.

1. Introduction
The elective subject “Basis of Harvest and Preservation of Tissues“ was established at the Charles University in Prague Medical Faculty Hradec Králové by authors of this paper in the academic year 2001/2002 both in Czech and English versions as an extension of teaching activities of the Tissue Bank University Hospital Hradec Králové existing before [3,7,8]. Traditionally the subject dealt with 3 topics: Donation and harvest of cells and tissues, low temperature preservation of cells, tissues and organs and safety and quality assurance in the practice of tissue and procurement establishments. The first e-learning course serving as a support of this subject was put into operation in the academic year 2013/2014. It served exclusively Czech speaking students and was funded by the project “Innovation and development of the study programme of general medicine at the Charles University in Prague, Medical Faculty Hradec Králové by means of information technologies (IT Medik*). The first, more brief, English version of the original course was put into operation in the academic year 2014/2015. The presented paper describes more advanced updated and enlarged English version focused exclusively on the issues of cell and tissue donation and harvest. This issue was already well reviewed in the textbook Transplantology for medical students edited by Třeška (17) in 2002 and more recently in the monograph Tissue and Cell Donation – An Essential Guide edited by Warwick, Fehily, Brubaker and Eastlund (19). Nevertheless the fast development of the European Union (EU) legislation and its impact on practices of cell and tissue establishments and/or organ transplantation centres in the EU member states requires that innovative teaching/learning tools be implemented to assure regular updating and/or supplementing study materials. This new course enables the students to learn individually theoretical and practical principles of this topic and facilitates preparation, presentation and archivation of seminar theses. In its construction the authors used their previous experience with programmed instructions [6] and e-learning (9), including the results of the verification stage of the first English version of the course (12).

2. Methods

2.1 Course prerequisites:
The course can be attended by students with basic knowledge of medical biology, anatomy and physiology. The students´ interest in tissue transplantation is required as well.

2.2 Course aim
The aim of the course is to enable the students to learn individually theoretical and practical principles of the subject and to give them the skill in preparation, presentation and discussing seminar theses.

2.3 Design of the course and knowledge testing
The course is designed on basis of more than 10 year experience with teaching an elective subject: Basis of harvest and preservation of tissues for transplantation. It covers the first topic of this subject, ie.the issue of the cell and tissue donation and harvest. The topic is divided into two parts. In the first one organization of donation, its ethical and legal aspects, the influence of traditions and religion on its practice, donation of cells and tissues for manufacturing advanced medicinal products and presentation of donation issues to the public are dealt with. The second part deals with the following issues: Categories of cell and tissue donors and donor eligibility assessment, technique of cell and tissue harvest, evaluation of donation and harvest activities in the European Union member states including examples from the University Hospital Hradec Králové. Each part is accompanied by the list of recommended study sources that are available at the author s workplaces. A short intermediate knowledge test consisting of five questions follows each part. If the student passes successfully through the first part, i.e. answers correctly at least three questions, he/she is allowed to continue with the second part and/or to go to the final test. If not, he/she is returned to the beginning of the first and /or second part and has to study again all obligatory materials. The third part of the course is represented by a database for uploading seminar theses. In the academic year 2014/2015 the themes of theses were focused on comparison of data on donation and harvest activities in different EU member states using the database Eurocet. To complete the course the students have to pass successfully through both short intermediate knowledge tests and through the final knowledge test consisting of fifteen questions. In the case of failure in the final test (less than ten correct answers) he/she is allowed to repeat this test maximally twice. The minimal interval between two consecutive attempts is adjusted to 48 hours. A certificate of attendance of the course is issued automatically and immediately after completion of the course. The course schedule is presented in the Fig.1.

2.4 Study materials and bank of questions
The study materials are divided into obligatory and recommended ones. Without studying obligatory materials the student is not allowed to pass to the short intermediate tests. The study materials consist of electronic study supports (Table 1), audio presentations and important website addresses (Table 2).
All obligatory study materials and the majority of the recommended ones can be studied on-line or after downloading or printing.
The bank of questions consists of 22 questions belonging to the topic 1 and 20 questions belonging to the topic 2. The questions used in the short tests are selected randomly from the bank belonging to the particular part. The final test consists of 8 questions belonging to the topic one and 7 questions belonging to the topic two.

2.5 The means of communication
The technical support of the project “IT Medik” – Moodle, made it possible that the course participants communicate individually with their teacher by e-mail. The communication among the participants using the function: “Chat”, was possible as well. The students, who completed the course can use standard questionnaire consisting of seven questions as a feedback. As the replies are automatically analyzed by Moodle, the teacher has immediate information on the level of the students´ satisfaction with the course.

2.6 Technical background and course address
All functions of the course were operated by Moodle, local application of the Medical Faculty Hradec Králové supervised by the IT management team of the Department of Medical Physics. The course was reviewed by two reviewers, internationally recognized experts in the transplantation surgery, and put on the website: http://moodle.lfhk.cuni.cz/moodle2/course/view.php?id=798
The address is easily accessible also using tablets or smart-phones.

3. Results
The experience from the pre-verification stage of the Czech version of the course has been published recently (3). The first English version (12) was verified in the group of 14 English speaking students (9 men, 5 women) from different countries (Greece 1, FRG 6, Ireland 1, Malaysia 1, Norway 2, UK 3). All students completed the course, some of them repeated the short test however. In the Table 3 the number and/or percentage of students who repeated the short test is presented.

4. Disscussion
E-learning courses have become standard part of the medical and nursing education [1,2,14]. The authors were acquainted with the principles of programmed instructions already 40 years ago [6, 15, 16],and combined this knowledge with the new technical background compatible with current trends [4,5,13,18] that was available at their workplaces after joining the project IT Medik. The experience from the academic years 2013/2014 and 2014/2015 showed that the course including the system of testing was well accepted by medical students. In this version some improvements were made on basis of evaluation of the verification stage: More practical aspects were included in the part 2, so that this part can also serve as an electronic support of practical lessons. The number of questions was also enlarged. The first Czech versions of the course (9) as well as its first English version (12) were oriented primarily on pre-graduate medical students. This new course covering the issue of donation and harvest is planed to be used by a broader spectrum of participants. We expect the interest of surgeons in post.-graduate training, specialists involved in cell, tissue and organ banking as well as of post-graduate students from different schools. The effectiveness of the learning process is being assessed on results of the final knowledge tests only. Further improvements are also planed, the optional study materials will be enlarged by translation of two chapters written by authors (10,11) that are included in the Czech-Slovak monograph Organ Harvests for transplantation.

5. Conclusion
The previous experience showed that the e-learning course could serve as a useful support of the elective subject „Basis of Harvest and Preservation of Tissues“. This enlarged and updated English version aimed exclusively at the topic Donation and harvest of cells and tissues is planed to be used by a broader spectrum of users including the surgeons in post-graduate training and post-graduate students of different doctoral programmes.

6. References
1. Brumini,G., Spalj,S., Mavrinac,M., Biocina-Lukenda,D., Strujc,M., Brumini,M.: Attitudes towards e-learning amongst dental students at universities in Croatia. European Journal of Dental Education, 18, 2014, p.15-23.
2. Felder,E., Fauler,M., Geier,S,: Introducing e-learning/teaching in physiology course for medical students: Acceptance by students and subjective effect of learning. Advances in Physiology Education, 37, 2013, p. 337-342
3. Klen,R.: Tissue Banking in Czechoslovakia, Transplantation Proceedings, 1976, p.49-51
4. Kulič, V.: Psychology of guided learning. Academia, Prague 1992, 187 p. (In Czech)
5. Lau,RWH., Yen,NY, Li,F., Wah,B.: Recent development in multimedia e-learning technologies.World Wide Web-Internet and Web Information Systems,17, 2014,p.189-198
6. Měřička,P.,Vít,P. : Initial Experience with the Use of Audiovisual Programmes in Practical Teaching of Anatomy. Sbor.věd prací LFKU v Hradci Králové, Suppl.17, 1974, p.207-216 (In Czech)
7. Měřička,P.: Brief history of the Tissue Bank University Hospital Hradec Králové, Czech Republic. Cell and Tissue Banking, 1, 2000, p.17-25
8. Měřička,P.: Medical Priorities of Hradec Králové (2): History of The Tissue Bank. Scan 2, 2008, p.16-17 (in Czech)
9. Měřička,P., Štěrba L., Straková H., Navrátil P.: E-learning Course: Basis of Harvest and Preservation of Tissues – Design and Initial Experience, Mefanet Journal, 2014, 2, p. 15-19
10. Měřička, P., Navrátil,P., Špatenka,J.: Legislation of Tissue Donation and Harvest in the Czech Republic . In: Baláž, P., Janek,J,., Adamec,M. et al: Organ Harvests for Transplantation. Karolinum, Prague, 2011,p. 223-239 (In Czech )
11. Měřička,P., Špatenka J., Navrátil,P, : Organization and Surgical Technique of the Tissue Harvest in Multi-organ Harvests.In: Baláž, P., Janek,J,., Adamec,M. et al: Organ Harvest for Transplantation . Karolinum, Prague, 2011, p. 240-251 (In Czech)
12.Měřička,P,Štěrba,L.,Straková,H.,Navrátil,P.,Honegrová,B.,Brandejs,D.: Cryobiology in the e-learning course for medical students:Three-year experience. Cryobiology 71, 2015, p.565
13. Paechter,M., Kreisier,M., Luttenberger,S., Macher,D., Wimmer,S.: Communication in e-learning courses.Students´ experiences and their preferences for online or face – to - face communication. Gruppendynamik und Organisationsberatung, 44, 2013, p. 429-443
14. Segal,G., Balik,C., Hovav,B., Mayer,A., Rozani,V., Damari,I., Golan-Hadari,D., Kalishek,S., Khaikin,R.: Online nephrology course replacing a face to face course in nursing schools bachelor´s program: A prospective ,controlled trial, in four Israeli nursing schools. Nurse Education Today 33, 2013, p.1587-1591
15. Talyzinová,N.F.: Theoretical Issues of Programmed Learning . SPN Prague 1971, 148 p. (In Czech)
16. Tollingerová,D. ,Knězů,D. ,Kulič,V.: Programmed Learning. SPN Prague, 1966, 189 p. (In Czech)
17. Třeška,V. et al. : Transplantology for Medical Students. Karolinum, Prague 2002,125 p.(In Czech)
18. Wang,T.H. : Developing an assessment - centered e-Learning system for improving student learning effectiveness. Computers & Education, 73, 2014, p. 189-203
19. Warwick,R.M.,Fehily,D.,,Brubaker,S.A.,,Eastlund,T. : Tissue and Cell Donation-An Essential Guide. Wiley-Blackwell,Ltd.,,Oxford, 2009,278p.

7. Key words
E-learning, programmed instructions,cell and tissue donation,cell and tissue harvest, cell and tissue transplantation, tissue bank, tissue establishment, procurement establishment

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