Virtual Patients and Virtual Worlds

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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 for
cardiovascular 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
investigative information. He then proceeds to
administer various forms of 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 PatientseViP
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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 science
  learning

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What is a virtual patient (VP)?

• An interactive computer simulation of
  real-life clinical scenarios for the purpose of
  medical training, education, or assessment

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www.virtualpatients.eu
September 2006
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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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Universitätsklinik für Kinder- und Jugendmedizin
Heidelberg
Development of VPs for assessment
(Key-Feature-approach)
- Blueprinting - According to Key-Feature-approac
h (Page und Bordage 1995) - Review -
Realisation using CAMPUS-software -gt Question
type Long Menu -gt Long menu lists are based on
the CAMPUS vocabularies
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Universitätsklinik für 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? -gt Hypertrophic Pylorusstenosis 2.
Which initial laboratory tests besides
electrolytes, glucose and full blood count would
you order? -gt Blood gas analysis 3. By means of
which technical examination do you verify your
initial diagnosis? -gt Sonography abdomen
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Online-exam study using Key-feature-VPs

• Key-Feature-approach (Bordage Page 1995) for
  assessment 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 results
• Long 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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Problem-Based Learning
A type of Virtual Patient
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Interactive VP-based Learning!
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VP/PBL TRIAL
Year 2 students whole module trial
Groups Type of VP Type of VP Type of VP Type of VP Type of VP
Groups Case 1 Case 2 Case 3 Case 4 Case 5
1-5 Linear Branched Linear Branched Branched
6-10 Branched Linear Branched Linear Branched
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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)
I just killed the patient!

• 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

(..the poorer the choice the student takes, the
richer the learning experience..)
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Outcome-
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
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Why G(eneration) 4?
G1 Subject- or discipline-based G2 -
System-based G3 - Case based, but linear G4
Interactive with options, consequences
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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

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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_at_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!