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Planning and Developing Virtual Patients A team approach

Planning and Developing Virtual Patients A team approach. James McGee 1 , Anya Andrews 2 , Michael Eakins 2 , Ester Beltran 2 , David Metcalf 2 1 University of Pittsburgh School of Medicine, 2 University of Central Florida. Disclaimer.

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Planning and Developing Virtual Patients A team approach

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  1. Planning and Developing Virtual PatientsA team approach James McGee1, Anya Andrews2, Michael Eakins2, Ester Beltran2, David Metcalf2 1University of Pittsburgh School of Medicine, 2University of Central Florida

  2. Disclaimer • 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.

  3. Virtual Patient (VP) Simulation • 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 1. Epstein RM, Hundert EM. JAMA 2002;287(2):226-35 2. Chapman DM, et al. J Clin Reason 2013;1(1):1-1

  4. The authoring process • VPs at the University of Pittsburgh (66) • Decision Simulation VPs (341) • Workshops and tutorials • Technical challenges have been eliminated • MedBiquitousVP standard to share and repurpose • How best to authoring and deliver effective cases remains an open question

  5. Ingredients for success • People • Planning • Tools – templates, storyboarding • Story writing • Leadership and communication • Four success stories…

  6. Neal Benedict • Academic pharmacologist • Educational needs • Formative evaluation clinical pharmacology • Increased exposure to uncommon conditions • Deliberate practice: decision-makingwith feedback • http://vimeo.com/43108504 (5:58)

  7. 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.

  8. 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

  9. James Bateman • 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 Virtualpatients 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

  10. AnkurDoshi • 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

  11. AnkurDoshi 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

  12. AAAAI • 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

  13. 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

  14. Goals for CME Case Creation • Creating cases for national distribution • Requires more robust development • Content for expert level medical education • Engaging

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. The Benefits of Trans-disciplinary • 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.

  21. 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

  22. Strategy-Development Process • Parallel development: medical research, narrative, media, case logic • Converge • Quality Assurance • Weekly Alignment meetings • Focused development

  23. 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)

  24. 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

  25. 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

  26. Summary

  27. Summary

  28. Thank you • J.B. McGee, MDAssociate Professor of MedicineUniversity of Pittsburgh School of Medicinejbm1@pitt.edu • Michael Eakins

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