Elaine D. KauschingerPhD, MSN, APRN, FNP-BC

Duke University School of Nursing

Durham, North Carolina

Objectives ▪ Describe the i-Human Patients virtual learning simulation

and its core components.

▪ Analyze i-Human analytics from two nurse practitioner courses.

▪ Discuss the design and implementation of virtual patient case simulation in an online graduate course.

Purpose of Pilot Project

The purpose of this pilot project is to evaluate the impact of a new pedagogical approach combined with a cloud-based learning platform supporting patient encounter simulation on student performance in two graduate-level online courses.

▪ Advanced Pathophysiology Across the Lifespan ▪ Specialty Seminars in Advanced Pathophysiology for Neonatal

through Gerontological Health

Overview: i-Human Patients ➢ Cloud-based patient encounter simulator ➢ Symptoms-based approach to patient assessment and diagnostic

reasoning

➢ Learning vs testing mode: • Students can receive objective feedback at each step of the

encounter or at the end ➢ Focus on cognitive competencies rather than psychomotor skills

Take PatientHistory

Develop Treatment

Plan

Select DefinitiveDiagnosis

EvaluateTests

OrderTests

Select/Rank Differential Diagnoses

Perform Physical Exams

Advanced Pathophysiology Across the Lifespan

Cases Author/Institution/

Yr.Chief

Complaint

Natalie Grant

49 y/o female

New onset DM type 2

D. Gowda, MD, MPH

Columbia University College of Physicians and Surgeons, 2016

Polyuria, polydipsia,

fatigue

Dianne Steinberg

69 y/o female

Community acquired

pneumonia

S. Shah, MD

Rush Medical College,

2015

Progressive acute

dyspnea

Florence Blackman

50 y/o female

Acute coronary

syndrome

M. Prystowsky, MD, PhD

Albert Einstein School of

Medicine, 2016

Severe chest pain with

SOB

▪ Spring 2016: 2 sections of this course N=54

▪ Voluntary participation

▪ No grading

▪ For each case: • 1st week: H&P only

• 2nd week: H&P & remainder of case (determined by student)

• 3rd week: online session that reviewed the case with pathophysiology implications from i-Human problem list

Meet your Patient

Physical Exam Section

Student results compared to expert’s result

Student Clinical Notes

Power of Analytics

Insights to students progress and performances

What?i-Human provides:

• Step by step view of how student choices & behavior impact clinical decision making

How?Efficiency & effectiveness in course design

Why?

i-Human Analytics History accuracy: appropriate questions needed for an accurate diagnosis

Physical exam: were appropriate parts of the exam completed

Problem List : validates the identification of normal and abnormal findings

Problem Statement : demonstrates accurate communication skills

Differential Diagnosis List: objective measure of diagnostic reasoning

Order and Interpret tests: objective measure of diagnostic reasoning

Select Final Diagnosis

What are my students competencies?

Week over week student participation

70.4%

42.6%

51.9%

37.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Week over Week Student Participation Rate

Week 1 Week 2

# of Students 39 23

Same Number of Students from Week to

Week n/a 19

Case 1 Case 2

Percent of correct questions asked by students

Week 2

History & Physical exam analysis Student ID 1st Hx 2nd Hx 1st PE 2nd PE

1 51% 51% 100% 74%

2 31% 42% 70% 89%

3 20% 71% 93% 78%

4 67% 44% 89% 63%

5 7% 56% 81% 74%

6 7% 18% 52% 63%

7 58% 29% 100% 96%

8 44% 78% 89% 100%

9 44% 67% 71% 93%

10 31% 96% 27% 81%

11 49% 52% 56% 59%

12 51% 70% 51% 96%

13 31% 59% 53% 81%

14 18% 70% 18% 70%

15 33% 81% 31% 96%

16 67% 89% 49% 93%

17 9% 44% 33% 85%

18 36% 78% 20% 96%

Average 36% 61% 60% 83%

Red Flag

Student Survey

43%

30%

13%

13%

What Students Liked

Interactive Clinical Experience Simulation

Stress-Free Environment Complete Patient Experience

50%

32%

11%

7%

What Students Disliked

Issue with Receiving Credit with Questions Asked

Organization of Options

Time Consuming

Audio Difficulty

Student Survey

0%

10%

20%

30%

40%

50%

60%

70%

Highly Disagree Disagree Neutral Agree Highly Agree

i-Human N591 Student Surveyn=21

The i-human cases were helpful in understanding the pathophysiology content presented in this course

Overall, I was satisfied with my learning experience with i-Human

Having the i-Human cases helped in my development as a nurse practitioner or nurse educator

I would recommend using i-Human cases in other courses

ONLINE SESSION: NATALIE GRANT

Seminar in Advanced Pathophysiology➢ 2 sections comprised of FNP and Women’s Health

For each case:

Completed H &P on individual basis

Developed PPT based on 4 problems identified in case

Included for each problem: HPI

Brief overview of normal physiology

Pathophysiology

Linked to the 4 Is: inflammation, immunity, infection & injury

Influences of genetics, behavior & environmental factors

Age-related difference

Cases 594 Author/Institution/Year Chief complaint

Bebe Babbit

26 y/o female

Migraines

S. Durning, MD, PhD,

FACP

USUHS, 2015

More frequent headaches

Tod Gouseau

57 y/o male

Gout

J. Kherani, MD

Weill Cornell Medical

College, 2016

Left knee pain

Christine Smith

33 y/o female

Pyelonephritis

S. Shah, M.D

Rush Medical College,

2015

Fever and flank pain

Col Casey Kilroy

50 y/o female

Iron deficiency anemia

J. LaRochelle & S. Durning

USUHS, 2016

Progressive fatigue with SOB

Jerome Cauthen

22 y/o male

Appendicitis

J. Rencic, MD, FACP

Tufts University School of

Medicine, 2016

Periumbilical pain

Fred O MacIntrye

62 y/o male

Stable angina

A. Ellis, MD, PhD

University of Buffalo

School of Medicine, 2016

Stress-induced chest pain

STUDENT SURVEY

36%

27%

14%23%

What Students Liked

Interactive Clinical Experience simuation

Complete Patient Experience Other

47%

20%

13%20%

What Students Disliked

Issue with Receiving Credit with Questions Asked

Organization of Options

Time consuming

Other