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Virtual Patients and
Virtual Worlds
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.
So, if that isn’t the way that VPs developed (in 2005)…
Why didn’t they develop that way?
•Why did we need them?
and-
•What did we get from them?
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
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
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
What is a virtual patient (VP)?
“An interactive computer simulation of real-life clinical scenarios for the purpose of medical
training, education, or assessment”
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 can’t be done - with a book?
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?
Assessment – example 1
- 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 CAMPUS vocabularies
Universitätsklinik für Kinder- und Jugendmedizin Heidelberg
Development of VPs for assessment (Key-Feature-approach)
Universitätsklinik für Kinder- und Jugendmedizin Heidelberg
Example of a VP for assessmentIntroduction: 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
M. Fischer 18
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
knowledgeVPs focused on main clinical decision nodes
and common errorsAutomatic analysis of results Long menu answer format (Schuwirth 1996)
Fischer & Kopp 2004
What are VPs best for?From David A Cooke, AMEE Genoa 2006, and Medical Education 2009, 43
What can VPs provide for decision-making?
● What effective learning requires, ideally, is:● Doing● Failing!● Reasoning…generating 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
The simple decision-making virtual patient…
● Scenario..
● Choices and consequences
● Feedback to the student,
(based upon the consequences)
Suitable players: OpenLabyrinth, vpSim
…A type of Virtual Patient
Problem-Based Learning
Interactive VP-based Learning!
VP/PBL TRIAL
GroupsType of VP
Case 1 Case 2 Case 3 Case 4 Case 5
1-5 Linear Branche
dLinear
Branched
Branched
6-10Branche
dLinear
Branched
Linear Branche
d
Year 2 students whole module trial
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, it’s 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
talk…Actually I found this OK.’•
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”..)
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-
G1 – Subject- or discipline-based G2 - System-basedG3 - Case based, but linearG4 – Interactive with options, consequences
Why G(eneration) 4?
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 George’s
● ‘Its good – greater realism would be even better!’St George’s student
Virtual Patients in Virtual Worlds
Virtual Patients in Virtual Worlds
Conclusion?
Will virtual patients come full circle and return to the ambitious aims of the algorithmic VPs – physiological simulations - of the 60’s?
(i.e. can Eleni Dalfi REALLY do a PHD combining VPs and simulations??)
Will VPs really become as useful as flight simulators?
Thank you
On behalf of the whole e-Learning Unit,St George’s University of London
andRachel Ellaway
(our visiting Prof!)
and the eVIP team!
