What is needed for successful development broad adoption maintenance of virtual patients?

1. Collaborative Development and Maintenance of Virtual Patients Norm Berman, MDLeslie Fall, MDDartmouth Medical SchoolInstitute for Innovative Technology in Medical Education

2. What is needed for successful • development • broad adoption • maintenance of virtual patients?

3. If you build it, they won’t come Virtual patients are only effective if used!

4. If you build it, they won’t come • Designed to cover specific/isolated content • Single institution view • Poorly designed • Expensive to produce • Does not meet the need of course directors

5. If you build it right, they will come • Comprehensive curriculum • Multi-institutional collaborative authoring • Peer-reviewed • Physician authors • Developed by course directors!

6. CLIPP • Computer-assisted Learning In Pediatrics Program • 2000 - 2006 US Grant funding for virtual patients in Pediatrics • Virtual patients broadly used in pediatric clerkships • 2006 Grant funding ended

7. Independent non-profit organization • Academic Switzerland • Paid subscription model

8. Building on CLIPP Success • 2007 - SIMPLE • Virtual patients for Internal Medicine • 2008 - fmCASES • Virtual patients for Family Medicine • 2009 - WISE-MD • Teaching modules for surgery

9. Virtual Patient Use • CLIPP - 31 VPs • 110 medical schools, 12,000 students • 250,000 case sessions per year • SIMPLE - 36 VPs • 50 medical schools, 75,000 cases per year • fmCASES - 29 VPs • in pilot testing, available 2010

11. Maintenance Development Key Factors • Curriculum • Authoring • Pedagogy • Academics • Integration • Maintenance • Infrastructure

12. Curriculum • Nationally developed and accepted curriculum • Comprehensive coverage of that curriculum • Support of the educators organization • CDIM, STFM, COMSEP • Critical to credibility

13. Authoring • Collaborative • Iterative • Multi-institutional • Peer-reviewed • CASUS • The challenge is in the teaching, not in the technology!

14. Pedagogy • Consistent approach • Teaching over assessment • Useful interactivity • Rich feedback • Little evidence to support any particular approach • Linear vs Branched?

15. Academics • Incentive to collaborate • Fundamentally important to success

16. Integration • Make the virtual patients integral to learning • Average student completes 20 cases, spends 15-20 hours • Balance use with elimination of redundancy • Integration resources for the clerkship director

17. Maintenance • Editorial boards comprised of members of the national organization • Keep content up-to-date • Maintains connection to national curriculum

18. Infrastructure • Support staff • Hardware • Software • This cannot be done without money

19. = Individual virtual patients Repository + Useful Curriculum

20. = Virtual patient components Technical standards + Useful Curriculum

21. Diffusion of Innovation • Rogers’ elements • diffusion process • adopter categories • innovation attributes • rate of adoption

22. trialability • compatibility • low complexity • relative advantage • observable benefit • knowledge • persuasion • adoption • implementation • confirmation Diffusion of Innovation • Rogers’ elements • diffusion process • adopter categories • innovation attributes • rate of adoption

23. Key Factors • knowledge • persuasion • adoption • implementation • confirmation • Curriculum • Authoring • Pedagogy • Academics • Integration • Maintenance • Infrastructure Collaborative development • trialability • compatibility • low complexity • relative advantage • observable benefit

24. Key Factors • Curriculum • Authoring • Pedagogy • Academics • Integration • Maintenance • Infrastructure $

25. Acknowledgement • Colleague - Leslie Fall, M.D.