Rachel Ellaway Virtual Patients

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Virtual Patients Dr Rachel Helen Ellaway e-Learning Manager Learning Technology Section, College of Medicine and Veterinary Medicine, The University of Edinburgh

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What are VPs? Artificial patients: computer simulations of the effect of drugs in humans Real patients reflected in data - e.g. electronic patient records (EPRs) Physical simulators, mannekins Simulated patients (actors, role-play) Electronic case-studies and scenarios

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What issues do VPs help to address? Clinical care is becoming faster and less invasive Patients are spending less time in care New contracts are also reducing bedside teaching capacity … but More and more doctors, nurses and AHPs required Not just more but better and safer too Moving away from opportunistic training to normalised patterns Study patterns and general expectations of learner centredness, autonomy and choice

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Why are VPs important? Valid and authentic settings - next best thing to reality Contextualises science, skills, sociology and knowledge and supports synthesis On demand Replayable - explore different options Immersive Narrative User agency

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How are VPs used? The role of the learner may take many forms: the physician, patient, observer, tutor, nurse, dietician, surgeon, manager etc The learner acts independently, under the guidance of a tutor or instructor, or in a collaborative setting The virtual patient/case learning process may be naturalistic or formalized. Different pedagogical modalities may include explorative or didactic approaches and they may or may not include aspects of problem-based learning

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VP Application Modes VP applications can take many different and distinctive forms: Predetermined scenario [directed mode] The learner may build up the patient or case data from observations and interactions [blank mode] The learner may view and appraise or review an existing patient or scenario [critique mode or rehearsal mode] The VP may be used as a mechanism to address particular topics [context mode] The learner may use a scenario or patient to explore personal/professional dimensions [reflective mode] Banks of patients or scenarios may collectively address broad issues of healthcare [pattern mode]

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Some examples: George [Early years: directed mode approach - train tracks] George Prentiss - Edinburgh bus driver with respiratory problems Year 1: lung function testing, biochemistry, physiology, patient interviews, basic diagnosis Year 3: COPD, imaging, pharmacology Year 5: in-patient emergency, intensive care, resuscitation and possible death Chronic condition management Patient ages and disease develops in real student time

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Some examples: Alcohol Family [context mode - issues of alcohol use and abuse] Based on soap operas : the Alcohol Family at a family wedding reception Death, mayhem, fire, traffic accidents Social problems as well as clinical - psychiatry taking the lead Interactions and different ages, problems etc explored One of the characters is a medical student - dimensions of self-reflection Links in as an MBChB ‘key clinical topic’

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Some examples: Sarah-Jane [rehearsal mode - decision pathways] You are enjoying a cup of tea at home. You are a GP on-call for your rural practice. The phone rings. It is the mother of Sarah-Jane Pritchard. You remember this is the baby, born at 28 weeks who was ventilated for 3 weeks but who has otherwise done well. She must now be about 6 months old. Her mother tells you that her baby has taken only 2 oz. of milk all day. She also has a tickly cough. She would like you to come and see Sarah-Jane. What do you do now? Wide range of choices - some lead to sticky ends, some to reminders and only a few to success Developed at St George’s London and uploaded to Labyrinth

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And the problems with VPs? They are still a tangent and a prosthesis to reality - view as distinct and augmenting existing modes and methods The use of VPs can lead to over-standardised encounters if variation and user agency is low within them Creating VPs is time consuming and difficult. For instance, authors need to develop skills in creating narratives as well as in clinical education Change management - perceived insubstantiality of the virtual in comparison with the real The sharing and exchange of VPs can be problematic - technical, educational socio-cultural issues etc

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Medbiquitous Virtual Patients Perceived need for interoperability of VPs Medbiquitous is a Baltimore-based but international medical education standards organisation Working group of 30+ practitioners working on a VP data standard

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Virtual Patient ‘Games’ Test results for Mr Jack Smith are just back: Haemoglobin 10.3 g/dl WBC 3.2 x 109/l Potassium 4.3 mmol/l Bicarbonate 27 mmol/l Urea 3.0 mmol/l Albumin 28 g/l ESR 40 mm/1st hr MCV 88 fl Urine analysis: urobilinogen + + + ; bilirubin trace What should you do now? Treat - examine - more tests - diagnose

Labyrinth: 

Labyrinth Decision pathways, browse paths, algorithms, games Web-based authoring and run-time, and integrated web services allow third-party systems to run Labyrinths inline at run-time Manage score as time, points, money or other items and collect and use artifacts Import/export XML (interop) Use and reuse learning objects - run traditional CALs as well as more experimental activities Lo-fi from a multimedia perspective but very immersive

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Some examples: Sarah-Jane [rehearsal mode - decision pathways] You are enjoying a cup of tea at home. You are a GP on-call for your rural practice. The phone rings. It is the mother of Sarah-Jane Pritchard. You remember this is the baby, born at 28 weeks who was ventilated for 3 weeks but who has otherwise done well. She must now be about 6 months old. Her mother tells you that her baby has taken only 2 oz. of milk all day. She also has a tickly cough. She would like you to come and see Sarah-Jane. What do you do now? Wide range of choices - some lead to sticky ends, some to reminders and only a few to success Developed at St George’s London and uploaded to Labyrinth

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Virtual Patients Dr Rachel Helen Ellaway e-Learning Manager Learning Technology Section, College of Medicine and Veterinary Medicine, The University of Edinburgh