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The Deteriorating Patient Smartphone App How Can Achievement Emotions Guide the Design of

a Medical TRE?

Jeffrey Wiseman Emmanuel G. Blanchard

Susanne Lajoie

LEADS 2nd Annual Team MeetingMay 2, 2013 San Francisco

Outline

• Rationale• Research Questions• Methods• Data to be analyzed• Deliverables• Implications +

Conclusion

Rationale

• Emergencies = emotionally challenging situations

• ABCDEFG algorithm guides emergency care & helps with some emotional challenges

• Medical Simulations: Role of debrief; “Hi Fi” versus “Low Fi”

• Deliberate practice with feedback (Ericsson, 2004)

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Rationale

The Deteriorating Patient Simulation (DPS) (Wiseman, Lajoie, Lu, Blanchard 2006, 2010, 2012)

• Human tutors– Small groups of learners + few tutors

• Digital tutors– Large numbers of learners + digital tutor

• TRE (Smartphone App: Authoring + Case tools)– Community of live & digital learners and tutors– Deliberate practice with feedback anywhere, anytime– Serious games

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Emotions?

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From the Live Tutor Deteriorating Patient Simulation…

(Wiseman, Snell, 2008; Lu, Lajoie, Wiseman, 2010)

Patient Scenario

Listen to Learner

Your approach Learner’s approach

Important differences or weaknesses

Patient deteriorates by a small increment

specific to the weakness

Learner

corrects

Learnerdoesn’t correct

Hints & Humor

Prompt to consult

Listen to next

learner

E E

EE

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…To the Digital Deteriorating Patient Application(Blanchard, Wiseman, Naismith, Hong, Lajoie, 2010; Blanchard, Wiseman,

Naismith, Lajoie, 2012)

Action categories

Information panelVital signs

Choice of actions in the selected category

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Research Questions

• What types of achievement emotions (Pekrun, 2006) occur in the setting of medical learners attempting to solve an emergency case simulation presented by a human tutor?

• Are similar achievement emotions induced by a smartphone-based TRE presenting the same case?

• If not, what additional adjustments in the TRE are needed to bring the TRE-induced achievement emotions closer to those induced by a human tutor?

Methods

• User-centred design iterative approach (Lai et al 2010)

– DP app developers interact with 5 target users to test and adjust TRE design choices

– Modules for collecting user data embedded into the TRE

• Compare + adjust TRE to human Tutor with using an isometric case for 10 medical learners

Data to be Analyzed

• Technical – Self-report measures, log files

• Cognitive– Process: use of ABCDEFG algorithm to guide diagnostic and

management choices; response to changes in vital signs & hints; persistence

– Outcome: Diagnosis, Management, Timing of help-seeking• Emotional– AEQ (Pre? During? As part of Debrief to guide recall?), Task

value + control

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Deliverables

• A new version of the DDPA running on smartphones• A first version of the DDPA authoring tool running on

smartphones• A paper submission to ECTEL2014 • An advanced draft of a paper to be submitted to a

peer-reviewed international journal in late 2014• A grant proposal submission to the Royal College of

Physicians and Surgeons of Canada for additional evaluations on the emotional and cognitive impacts of DDPA for medical learners

Implications + Conclusions

• Role of learner emotions– in medical simulations are relatively unexplored– in TRE design is new for medical contexts

• DPA Smartphone App promises to– Support further adaptation + application of the AEQ to

a medical education context– Provide a TRE designed for learners’ emotions– Permit tracking of learner development over time– Provide links with Empathy/Giving Bad News/Cultural

Differences/Bioworld

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Thank YouThank You!