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Virtual Patients

and

Virtual Worlds

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COMPUTER-BASED PROBLEM SOLVING EXERCISES

A series of physiological models are available forcardiovascular physiology ("McMan"), respirology("McPuff"), renal physiology ("McPee), and pharmacology("McDope").

The student is presented with basic clinical data about his"patient" and may ask for further clinical or investigativeinformation. He then proceeds to administer various formsof treatment and receives feedback about the

physiological and clinical effects of his manipulations.

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So, if that isnt the way

that VPs developed (in 2005)

Why didnt they develop that way?

Why did we need them?

and-

What did we get from them?

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why did we need them...

Short stays in hospital

Increasing specialisation

Increasing pressure on clinical time

Reduced teaching time

Trend towards standardisation in

competency training

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To create a shared online bank of 320 VPs,adapted for multicultural, multilingual use:

for the improved quality and efficiency of

healthcare education across the EU

EC-funded grant (1.8 million euros)

electronic Virtual Patients

eViP

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What DID we get from them?

Provided greater exposure to different scenarios

Practise of correct clinical decisions

Provided safe practice and feedback

Allowed rehearsal

Provided a good self-directed learning tool

Provided a trigger for basic and clinical sciencelearning

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What is a virtual patient (VP)?

An interactive computer simulation of real-lifeclinical scenarios for the purpose of medical

training, education, or assessment

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September 2006www.virtualpatient

http://www.virtualpatients.eu/http://www.virtualpatients.eu/http://www.virtualpatients.eu/

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What are (electronic) VPs best for?

Students will always like VPs-

Excellent for remote/mobile access,

learning when, where you like

Attractive, image rich

And above all, core subjects for their profession

But given the choice,

- they prefer a book!

So what can we do,

- that cant be done - with a book?

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So..how do we find uses for VPs that are NOT

just page-turners?

They should do things that paper cannot do?!

- Assessment Virtual Patients

- Decision-making Virtual Patients (?)

- True Virtual Patients?

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Assessment example 1

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- Blueprinting

- According to Key-Feature-approach

(Page und Bordage 1995)

- Review

- Realisation using CAMPUS-software

-> Question type: Long Menu

-> Long menu lists are based on the CAMPUSvocabularies

Universittsklinik fr Kinder- und Jugendmedizin

Heidelberg

Development of VPs for assessment

(Key-Feature-approach)

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Universittsklinik fr Kinder- und Jugendmedizin

Heidelberg

Example of a VP for assessment

Introduction: Six week old male infant with projectile vomiting

1. What is your initial diagnosis?

-> Hypertrophic Pylorusstenosis

2. Which initial laboratory tests besides electrolytes, glucose and full blood

count would you order?

-> Blood gas analysis

3. By means of which technical examination do you verify your initial

diagnosis?

-> Sonography abdomen

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M. Fischer 18

Online-exam study using

Key-feature-VPs

Key-Feature-approach (Bordage & Page 1995) forassessment of clinical decision making of

undergraduate students:

Solution of the problem of content-related

knowledge

VPs focused on main clinical decision nodes

and common errors

Automatic analysis of resultsLong menu answer format (Schuwirth 1996)

Fischer & Kopp 2004

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What are VPs best for?From David A Cooke, AMEE Genoa 2006, and Medical Education 2009, 43

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What can VPs provide for decision-making?

What effective learning requires, ideally, is: Doing Failing!

Reasoninggenerating explanations for failure, then Trying again! Well-told stories Just-in-time instruction And then:

the VP would be doing for medical students

what flight simulators do for trainee pilots

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The simple decision-making virtual patient

Scenario..

Choices and consequences

Feedback to the student,

(based upon the consequences)

Suitable players: OpenLabyrinth, vpSim

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A type of Virtual Patient

Problem-Based Learning

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Interactive VP-based Learning!

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VP/PBL TRIAL

Groups

Type of VP

Case 1 Case 2 Case 3 Case 4 Case 5

1-5 LinearBranche

dLinear

Branched

Branched

6-10Branche

dLinear

Branched

LinearBranche

d

Year 2 students whole module trial

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Student FEEDBACK

Decision-Making

The biggest benefit I believe is the decision making.

;We tried hard and we still killed the patient! I will never, ever, forget

that!

Its not the decisions, its the consequences!

More than once we deliberately went down the 'wrong' track to see

what happened. Very useful to do this on a virtual patient

Paper

Not having a paper copy of the tutorial makes everyone in the group

look at the screen rather than at each other.. I think probably, as a year, we are just used to having paper!

I was dreading this as I am used to scribbling all over the notes as we

talkActually I found this OK.

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Why do we need VPs? (1 of 2)

Provide students with an opportunity to

develop and practice their clinical reasoning

and decision making skills

Provide students with an opportunity to

learn by making mistakes

I just killed

the patient!

(..the poorer the choice the

student takes, the richer the

learning experience..)

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A new programme

To change the existing PBL curriculum, to create

a more interactive, personalised model of course

delivery with virtual patients at its core

To be delivered in the Transitional year between

campus-based learning and clinical attachments,

as Clinical PBL

Outcome-

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G1 Subject- or discipline-based

G2 - System-based

G3 - Case based, but linear

G4 Interactive with options, consequences

Why G(eneration) 4?

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So, where next?

options are all very well- but I would like to see infinite options,

not a few preset choices!M.Fischer, eViP project meeting , Munich 2008

I would like to do a PhD in simulation, but I would also like to do a

PhD in VPs! Is there any way that VPs can run simulations.?Eleni Dalfi mEducator kick off meeting , Thessaloniki, May 2009

Why are virtual patients not Virtual Patients you know, people you

can see, who move around.. in your computer. (!)

Daffyd Walters, Head of Paediatrics, St Georges

Its good greater realism would be even better!St Georges student

Virtual Patients in Virtual

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Virtual Patients in Virtual

Worlds

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Virtual Patients in Virtual Worlds

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Conclusion?

Will virtual patients come full circle and return to the

ambitious aims of the algorithmic VPs physiological

simulations - of the 60s?

(i.e. can Eleni Dalfi REALLY do a PHD combining VPs

and simulations??)

Will VPs really become as useful as flight simulators?

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Thank you

tpoulton@sgul.ac.uk

On behalf of the whole e-Learning Unit,

St Georges University of London

and

Rachel Ellaway

(our visiting Prof!)

and the eVIP team!

mailto:tpoulton@sgul.ac.ukmailto:tpoulton@sgul.ac.uk