G. Kossekova, T. Monova
Department of Medical Chemistry and Biochemistry, Medical Univercity – Sofia, Bulgaria

Objective: To facilitate implementation of problem-solving oriented e-learning, the aim is to develop a Web-based interactive clinical case with a virtual patient with Parkinson's disease to be solved by the Bulgarian and English speaking preclinical medical students at the Medical University of Sofia.

Materials and Methods: The Web-based programs for simulation of virtual patients are written in PHP and JavaScript languages. Data arrays include current situations, questions, suggested decisions, comments, decision weights and data for navigation through the steps of the problem-solving process.

Results: The Web-based program for simulation of the virtual patient displays the case history, data from physical examination, laboratory tests, other investigations, diagnosis making, discussion of disease mechanism, therapy, case-specific help with reference values, links to internal or external sources and additional information. To solve the case, the students choose decisions among suggested ones or enter their independent decision via the keyboard. The feedback is after each chosen decision in the form of detailed comments.

Discussion: Initial questions accentuate on the dopamine deficiency as the major pathobiochemical symptom and on the causes for neurons degeneration in substantia nigra and other brain areas. Knowledge of the synthesis and degradation of dopamine is necessary to understand the mechanisms of neuroprotection and delaying the disease progression via treatment with anticholinergic agents or dopamine precursors in combination of inhibitors of the peripheral DOPA decarboxylase. The program allows the students to understand and learn about the action of MAO and COMT inhibitors, dopamine agonists, and drugs increasing dopamine concentration in the synapses or inhibiting back uptake of dopamine. The harmful action of reserpine and neuroleptics is also considered. Solving the case is useful for future clinical activities. The case shows the possibility for better future collaboration between preclinical and clinical disciplines.

The financial support of the Council of Medical Science at Medical University – Sofia is gratefully acknowledged (Grant 10-2012/17.07.2012).

Key words: interactive virtual patient, parkinson disease.

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