Beyond the Software – What Educators Need to Implement Virtual Patients

1. Beyond the Software – What Educators Need to Implement Virtual Patients May 2011 James B. McGee, DmitriyBabichenko Laboratory for Educational TechnologyUniversity of Pittsburgh School of Medicine

2. Disclosure • Chair, Scientific Advisory Board & equity holder • Decision Simulation, LLC - licensee of virtual patient simulation technology from the University of Pittsburgh

3. Technology Adoption Curve Chasm Early Adopters Early Majority Innovators Late Majority Laggards Adapted from Geoffrey Moore, Crossing the Chasm, 1991

4. Where are we now? • Virtual Patients – diverse collection of case-based eLearning • Much focus on the software • Some research showing educational value • Better short and long-term performance • Clinical decision-making skills • It is still early… Botezatu M, Hult H, Tessma MF, Fors U. Med Teach 2010; 32 Cook DA, Triola MM. Med Educ 2009; 43 Cook DA, Erwin PJ, Triola MM. Acad Med 2010; 85

5. “We shape our tools and then our tools shape us.” Marshall McLuhan (1911-1980)

6. vpSim & DecisionSim early adopters • University of Pittsburgh • Northwestern • Cleveland Clinic • Mayo Clinic • St George’s University of London (UK) • Warwick (UK) • University of the West (UK) • Veterans Administration Health System • 540 virtual patient cases

7. All are different… • Same software, VERY different implementations • Different perspectives on objectives, development, implementation, and outcomes

8. who, where, when feedback performance assessment integration testing case structure media content case narrative Writing a Case learning goals

9. administration students curriculum committee the curriculum the course the case the case the setting Implementing VP Cases

10. Writing - Planning • Define your learning objectives & outcomes • Define your audience • Assess the environment • Perform due diligence • http://www.aamc.org/MedEdPortal • http://www.virtualpatients.eu

11. Writing - Guides • 12 Tips: Guidelines for authoring virtual patient cases • Medical Teacher Aug 2009 31(8):701-8Posel N, Fleiszer D, Shore BM • Workshops – MedBiq, AMEE, AAMC • VP Template • free download @ vpSim.pitt.edu

12. The Template@vpSim.pitt.edu

13. PLANNING • Case Title: • Authoring Team: • Case Owner: • Editors: • Reviewers: • Learning Objectives (3-6): • Educational Design: • Self-Directed Learning • Problem-based Learning (in a group) • Formative Assessment • Summative Assessment • Other • Target Audience:

14. Playable by: • Logged in users • Publicly shared • Specific users, groups or institution • Navigation Panel (on-screen links to nodes visited): • None – no panel, forward only navigation • Review Only – able to look at previously visited nodes but not able to change decisions • Open Navigation – able to revisit nodes and make different choices (all choices and scoring are retained) • Setting: • Limitations: • Primary challenges: • Counters needed? • Score • Time • Steps to complete • Other • Multimedia anticipated:

15. Case stem: setting, characters, role of learner, starting point, chief complaint, HPI, history, initial clinical data Case body: Questions, labs, imaging, diagnosis Decision nodes (branching nodes): diagnostic studies, differential diagnosis, additional diagnostics, therapy, complications, long-term consequences….RELATE TO LEARNING OBJECTIVES Ideal (critical) path: sequence of optimal steps Case conclusion(s): What is the ideal ending or outcome? What are the alternate outcomes?

17. Summary • Summarize case • Summarize learning • Show learning objectives • Review possible outcomes • Allow to restart case • Reveal score • Compare score to others, to expected score, to passing score • Refer to links to external resources, additional reading • Refer to email or line for questions • Collect feedback • Always provide at the end: • Somesummary of what should have been accomplished • Feedback regarding – score, success/failure, compare to expectations and other learners • Instructions on what to do next – where to get more help, next step in course • Link to external survey, feedback, or email address

18. Case - Validation • Is the logic intact? • Blind loops, dead ends, orphans • Trapped in a rule • Some software automates validation • Does your case make sense? To you and to others? • Authenticity is essential – expert review, target-audience review

19. Implementation - Process Create motivation Distribute Evaluate Maintain the content Track performance

20. Implementation - Models • EASY – supplement didactics, self-assessment, independentlearning (Pitt) • REPLACE – PBL, case workshop, mannequin, SP (SGUL, UWE, Pitt) • OVERHAUL – full integration with case-based curriculum (Warwick, VA) • INNOVATE – learners write their own, prep for SP, mannequin and task trainers(NW, Wright State)

21. Recommendations make VPs required, essential component of curriculum track & report performance, competence create repositories of validated cases (MVP standard) blend with other eLearning demonstrate & communicate success create communities of VP writers & implementers

22. thankYou vpSim vpSim.pitt.edu Lab for Educational Technology let.pitt.edu JB McGee mcgee@medschool.pitt.edu| +1-412-648-9679