Writing virtual patients; table d’hôte

or à la carte?

David Davies & Rachel EllawayWarwick Medical School, UK

Northern Ontario School of Medicine, Canada

Reasons for this presentation

Case based learning smörgåsbord

Mezze of diverse designs and applications

Simulated patients, PBL triggers, paper cases, simulation scripts/scenarios, virtual patients etc

Where to start?Same difference?

Chalk and cheese?

Warwick Medical School

UK’s only graduate-only school, rural & urban, affluence & deprivation

group-learning, professionalism and IPE themes

case-based template: HEIDR - history, examination, investigation, diagnosis & therapy (management)

… biological, clinical & social science dimension

Northern Ontario School of Medicine

Northern, rural, remote and aboriginal focus

strong family practice, cultural and IPE themes

Narrative template: characters, person and POV, plot, pace and density, frame of action, regional issues

… socio-cultural and inter-professional dimension

Ingredients of our cases

Case Case templatetemplate

Case Case templatetemplate

TherapyTherapyTherapyTherapy

DiagnosisDiagnosisDiagnosisDiagnosis

InvestigatiInvestigationon

InvestigatiInvestigationon

ExaminatioExaminationn

ExaminatioExaminationn

HistoryHistoryHistoryHistory

Case Case templatetemplate

Case Case templatetemplate

POVPOVPOVPOV

PacePacePacePace

FrameFrameFrameFrame

CharactersCharacters& culture& culture

CharactersCharacters& culture& culture

PlotPlotPlotPlot

Maybe we have the wrong perspective?

Maybe we are too focused on VPs as artifact rather than on the

context in which they are used

Case Case templatetemplate

Case Case templatetemplate

SchematicSchematicSchematicSchematic NarrativeNarrativeNarrativeNarrative GameGameGameGame SimulationSimulationSimulationSimulation

‘Object oriented’ parent case

child VPs activity/context focused

SchematicSchematicSchematicSchematic NarrativeNarrativeNarrativeNarrative GameGameGameGame SimulationSimulationSimulationSimulationtype

PresentatiPresentation-basedon-basedPresentatiPresentation-basedon-based

Character-Character-basedbased

Character-Character-basedbased Rule-basedRule-basedRule-basedRule-based PerformanPerforman

ce-basedce-basedPerformanPerformance-basedce-basedbasis

Assessing Assessing patternspatterns

Assessing Assessing patternspatterns

DevelopinDeveloping g

strategiesstrategies

DevelopinDeveloping g

strategiesstrategiesRehearsalRehearsalRehearsalRehearsal

Dealing Dealing with with

complexitycomplexity

Dealing Dealing with with

complexitycomplexityskills

HEIDRHEIDRHEIDRHEIDR Socio-Socio-culturalculturalSocio-Socio-

culturalcultural

Win/loseWin/losecompetitiocompetitio

nn

Win/loseWin/losecompetitiocompetitio

nn

MannequinMannequinss

MannequinMannequinssactivity

Ingredients & flavours

Compositional constructs

SchematicSchematicSchematicSchematic NarrativeNarrativeNarrativeNarrative GameGameGameGame SimulationSimulationSimulationSimulationSchematicSchematicSchematicSchematic NarrativeNarrativeNarrativeNarrative GameGameGameGame SimulationSimulationSimulationSimulation

Biological Biological sciencessciencesBiological Biological sciencessciences

BehaviourBehavioural sciencesal sciencesBehaviourBehavioural sciencesal sciences

Ethics and Ethics and valuesvalues

Ethics and Ethics and valuesvalues

Medical Medical practicepracticeMedical Medical practicepractice

Form and Form and functionfunction

Form and Form and functionfunction

Social Social interactioninteraction

ss

Social Social interactioninteraction

ss

Dealing Dealing with with

dilemmasdilemmas

Dealing Dealing with with

dilemmasdilemmas

Managing Managing patientspatients

Managing Managing patientspatients

Contextual constructs

Case Case templatetemplate

Case Case templatetemplate

Form and Form and functionfunction

Form and Form and functionfunction

Social Social interactioninteraction

ss

Social Social interactioninteraction

ss

Dealing Dealing with with

dilemmasdilemmas

Dealing Dealing with with

dilemmasdilemmas

Managing Managing patientspatients

Managing Managing patientspatients

In practice

Case Case templatetemplate

Case Case templatetemplate

SchematicSchematicSchematicSchematic NarrativeNarrativeNarrativeNarrative GameGameGameGame SimulationSimulationSimulationSimulation

Contextual use

Compositional construct

For us all to think about

(not quite recommendations)

Don’t try and swallow too much in a ‘super’ VP

Better to have more small VPs than few big ones

Activities should be no more complex than

the assigned learning outcomes

VPs as simple as possible, but no simpler

…it’s the context, stupid!

The same case/VP acquires different meaning (and utility) depending upon

where and how it’s used

No wonder it’s difficult comparing VPs…

There is a difference between…

activity encoded within a VPvs

activity constructed around a VP

Therefore…

seek alignment between encoded andconstructed activity

framed by the context of the integrated curriculum

Bon Appétit!