Planning and Developing Virtual PatientsA team approachJames McGee1, Anya Andrews2, Michael Eakins2, Ester Beltran2, David Metcalf2

1University of Pittsburgh School of Medicine, 2University of Central Florida

James B. McGee, MDChair, Scientific Advisory Board for Decision SimulationEquity holder in Decision Simulation

Michael EakinsContract work for Decision Simulation through UCF

Decision Simulation is a commercial provider of virtual patient simulation software and services.

Disclaimer

Computer-based clinical simulation – from interactive case reports…to full physiologic simulation

Clinical reasoning – an essential competency What tests, diagnosis, therapy, and prevention Proficiency, efficiency, thoroughness, strategy1

VPs that engage the student in clinical decision-making can train and assess2; accelerate expertise

Virtual Patient (VP) Simulation

1. Epstein RM, Hundert EM. JAMA 2002;287(2):226-352. Chapman DM, et al. J Clin Reason 2013;1(1):1-1

VPs at the University of Pittsburgh (66) Decision Simulation VPs (341) Workshops and tutorials

Technical challenges have been eliminated MedBiquitous VP standard to share and repurpose

How best to authoring and deliver effective cases remains an open question

The authoring process

People Planning Tools – templates, storyboarding Story writing Leadership and communication

Four success stories…

Ingredients for success

Academic pharmacologist Educational needs

Formative evaluation clinical pharmacology Increased exposure to uncommon conditions Deliberate practice: decision-making with feedback http://vimeo.com/43108504 (5:58)

Neal Benedict

12 cases for advanced students Lecture supplement & replacement Small group practica focused on decision-making

and clinical reasoning Large group with audience response system High-stakes assessment and formative assessment Mentoring – residents build their own cases; teaches

education theory, pedagogy, gaming theory, curriculum integration, etc.

Neal Benedict

Virtual Patient Team Instructional design = Neal Subject matter expertise = Neal (review by

colleagues) Story writing, media = Neal VP instructional technology = Neal, Maria Hahn Curriculum integration, promotion, motivation =

Neal

Neal Benedict

Warwick University School of Medicine (UK) Arthritis Education Research Fellow, PhD Educational need

Independent learning supplement to medical curriculum

Research different VP designs; learning outcomes

Virtual patients design and its effect on clinical reasoning and student experience: a protocol for a randomised factorial multi-centre study.Bateman J, Allen ME, Kidd J, Parsons N, Davies D.BMC Med Educ. 2012 Aug 1;12:62.

Virtual patients can be used to teach clinical reasoning.Bateman J, Hariman C, Nassrally M.Clin Teach. 2012 Apr;9(2):133-4

James Bateman

Course director for Integrated Case Studies Convert and condense existing linear cases

into branching cases with multiple outcomes Facilitated small group learning (2 hours x 12) Educational goals

Integrate basic and clinical sciences Build clinical reasoning skills Practice for board examination and 3rd year clinical

rotations

Ankur Doshi

Virtual Patient Team Course design committee = Ankur + 8 faculty Instructional design = Ankur Subject matter expertise = Existing content,

committee Story writing, media = Committee, Ankur Instructional technology = Workshops, committee,

Maria Hahn Curriculum integration, “visible point of contact” =

Ankur, committee, facilitators

Ankur Doshi

Specialty society of practicing and academic MDs Grant funding for educational program Educational need

Continuing education of members Three highly specialized and uncommon diseases Independent learning at home for credit

AAAAI

Integrating Mobile, Simulation and Cloud into Medical Curriculum Partnered with UCF College of Medicine in

2009 for strategic consulting and R&D: Partnership development Enterprise systems Games Simulations Mobile 3D Health IT

Goals for CME Case Creation Creating cases for national distribution

Requires more robust development Content for expert level medical education Engaging

Team – Medical Doctor Medical Doctor –

The subject matter expert (SME) for information related to case content and the accuracy of the information presented to the user.

Tasks include:▪ Medical research▪ Collaboration with game designer/writer and digital

media specialist to guide the content creation for medical accuracy of the case

Team – Instructional Designer Instructional Designer –

Crafts the user experience and keeps the case based on pedagogical learning foundations.

Tasks include:▪ Directing user interactions▪ Working with game designer/writer to establish and

promote learning objectives.

Team – Digital Media Specialists

Multimedia Specialists– Creates and/or finds media for the case to enhance

the visual quality of a case. Tasks include: ▪ Providing engaging

visual experience▪ Working with the SME and game

designer/writer to facilitate medically accurate media that fits within the story.

Team – Game Designer/Writer Game Designer/Writer –

Constructs the narrative for the case that engages the learner throughout the experience.

Tasks include: ▪ Creating an interesting story that keeps users engaged

with the case▪ Working with the SME, ID, and digital media specialists

to meet learning objective needs, direct media usage, and maintain medical accuracy.

Team – Project Manager Project Manager –

A little bit of all roles and responsible for organization

Tasks include: ▪ Keeping the case on schedule▪ Filling in gaps▪ Working with all other members to support case

development and organization.

Outcome – Reduced time for case development▪ When team members are experienced in communicating with medical SMEs ▪ Team members work collaboratively and does so beyond their skill set.▪ Capable of working within the disciplines of other members.

▪ All team members are familiar with case authoring technology Improved quality▪ Multiple developers reviewing case throughout development▪ Mixed disciplines contribute valuable techniques to promote learning and

engagement.

The Benefits of Trans-disciplinary

Strategy-Development Process

Clearly defined learning objectives Entire team involved early and often in planning stages Plan multiple cases in parallel 1st pass: map key decision points, plot points, key interactions,

alternative paths 2nd pass: develop medical narrative, create underlying story, identify

media needs Repurpose/create consistent characters (mentor, supporting cast, etc.) Review

Strategy-Development Process

Parallel development: medical research, narrative, media, case logic Converge Quality Assurance Weekly Alignment meetings Focused development

Outcome The 1st case required approximately 40 - 50 hours per instructional team member (PM, SME,

ID, and GD) and about 15 hours for the DM specialists With the 2nd and 3rd cases, time spent for all team members reduced by at least 5 hours each

time (we expect to see efficiency increase with more cases).

Result of Clear learning objectives Trans-disciplinary team Systematic approaches to case construction Team building Evolving review process Strategic media planning (reusable pervasive characters that fit within the narrative)

Lessons Learned Frequent communication and alignment Develop modular narrative Clear definition of roles Spend the time up-front to plan out key

decision points Team familiarity with platform for development

is critical for parallel development

Simulation Case Library Consortium Access to cases that follow MedBiquitous Standards Goal:

To increase access to existing cases and promote collaboration by leveraging existing resources for the development of new cases.

Contact Information:Dr. David Metcalf

dmetcalf@ist.ucf.edu(407) 882 - 1496

  Novice individual learner

Novice small group

Continuing Education

Story High Moderate High

Interactivity High Moderate Moderate

Feedback High Moderate High

Multimedia High Moderate Moderate

Summary

  Novice individual learner

Novice small group

Continuing Education

Writer High Moderate High

Instructional Designer

High Moderate Moderate

Subject matter expert

High Moderate High

Media specialist

High Moderate Moderate

Summary

J.B. McGee, MDAssociate Professor of MedicineUniversity of Pittsburgh School of Medicinejbm1@pitt.edu

Michael Eakins

Thank you