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
 electronic Virtual Patients
eViP

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)

 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”
www.virtualpatients
September 2006
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
 Universitätsklinik für Kinder- und Jugendmedizin
Heidelberg

Development of VPs for assessment

(Key-Feature-approach)
- 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

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
 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

M. Fischer 18
 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

Problem-Based Learning

…A type of Virtual Patient

Interactive VP-based Learning!
 VP/PBL TRIAL
Year 2 students whole module trial

Type of VP
Groups
Case 1 Case 2 Case 3 Case 4 Case 5
Branche Branche Branche
1-5 Linear Linear
d d d

Branche Branche Branche

6-10 Linear Linear
d d d
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)

I just killed
●Provide students with an opportunity to
develop and practice their clinical reasoning
the patient!
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”..)
 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
 Why G(eneration) 4?

G1 – Subject- or discipline-based
G2 - System-based
G3 - Case based, but linear
G4 – Interactive with options, consequences
 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

tpoulton@sgul.ac.uk

On behalf of the whole e-Learning Unit,

St George’s University of London
and
Rachel Ellaway
(our visiting Prof!)

and the eVIP team!