This study examines the role of regulatory processes in medical students as they learn to deliver bad news to patients in the context of an international web-based problem based learning environment (PBL). In the PBL a medical facilitator and students work together to examine video cases on giving bad news and share their perspectives on what was done effectively and what could be done differently. We examine how regulation occurs within this collaboration. A synchronous computer-supported collaborative learning environment (CSCL) facilitated peer discussion at a distance using a combination of tools that included video-conferencing, chat boxes, and a shared whiteboard to support collaborative engagement. We examine regulation along a continuum, spanning from self- to co-regulation, in situations where medical students learn how to manage their own emotions and adapt their responses to patient reactions. We examine the nature of the discourse between medical students and facilitators to illustrate the conditions in which metacognitive, co-regulation and social emotional activities occur to enhance learning about how to communicate bad news to patients

The goal of this study is to examine how to facilitate cross-cultural groups in problem-based learning (PBL) using online digital tools and videos. The PBL consisted of two video-based cases used to trigger student-learning issues about giving bad news to HIV-positive patients. Mixed groups of medical students from Canada and Hong Kong worked with facilitators from each country along with an expert facilitator. The study used AdobeConnect to support the international model through synchronous video interaction and shared applications. This study examines strategies and challenges in facilitating PBL across distance and cultures. Discourse was analyzed using both an inductive and deductive approach where the later used the Community of Inquiry coding scheme. The international context provides a way to facilitate multiple perspectives about how to communicate bad news to patients from different cultural backgrounds. In addition, we present the results of an exploratory analysis of pre and post tests using a standardized patient that demonstrate that the students' pattern of communication showed qualitative change. Several conjectures were developed for future research.

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This article provides a road map, along with recommendations, for the adoption and implementation of telesimulation at a large scale. We provide tools for translating an in-presence simulation curriculum into a telesimulation curriculum using a combination off-the-shelf telecommunication platform. We also describe the roles and tasks that emerged within the simulation team when planning and delivering a telesimulation curriculum.

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