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Can a virtual patient be used as an individual, team and system needs assessment tool?

Can a virtual patient be used as an individual, team and system needs assessment tool?. Timothy Willett , RCPSC; Pierre Cardinal, uOttawa & RCPSC; Angele Landriault, RCPSC; Thomas Low, uOttawa MedBiq Conference, 11 May 2011. Disclosure. Employee of Royal College Royal College owns SimuCase.

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Can a virtual patient be used as an individual, team and system needs assessment tool?

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  1. Can a virtual patient be used as an individual, team and system needs assessment tool? Timothy Willett, RCPSC; Pierre Cardinal, uOttawa & RCPSC; Angele Landriault, RCPSC; Thomas Low, uOttawa MedBiq Conference, 11 May 2011

  2. Disclosure • Employee of Royal College • Royal College owns SimuCase

  3. Needs Assessment • 1st step in curriculum development • Perceived vs. unperceived • Not all needs are educational Moore DE, Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. The Journal of continuing education in the health professions. 2009;29(1):1-15. Kern DE, Thomas PA, Howard DM, Bass EB. Curriculum Development for Medical Education: A Six Step Approach. Baltimore, MD: Johns Hopkins Press; 1998:192.

  4. Needs assessment • Broad • ICU had self-identified desire to improve recognition & care for massive PE • Focussed • What is the ideal care? • What is reality? • What are priority needs?

  5. Virtual Patients “Specific type of computer program that simulates real-life clinical scenarios; learners emulate the roles of health care providers to obtain a history, conduct a physical exam, and make diagnostic and therapeutic decisions.” Cook DA, Triola MM. Virtual patients: a critical literature review and proposed next steps. Medical education. 2009;43(4):303-11. • Variety of VPs • Linear vs. branched • Individual vs. group • Synchronous vs. asynchronous Huwendiek S, De Leng BA, Zary N, et al. Towards a typology of virtual patients. Medical Teacher. 2009;31(8):743-748.

  6. SimuCase Virtual Patient • Live, face-to-face • Individual or small group • Facilitator + operator • Open-ended • Text, photos, videos, dynamic vital sign monitor • Feedback from facilitator

  7. SimuCase Virtual Patient Operator Facilitator Care team

  8. Research questions • Can a VP aid with needs assessment? • What kinds of needs? • Individual? • Team? • System/resource? • Perceived or unperceived? • PILOT INVESTIGATION ONLY

  9. Method • Two care team groups • 1 MD (ICU fellow) • 2 RNs • 1 RT or pharmacist • Case: 65F with massive PE (based on real case) • 40 min with case, uninterrupted • Notes made by 2 MD and 1 RN facilitators • Feedback & discussion afterwards

  10. The Case • Background • 65 F • 3-day hx progressive dyspnea & chest pain • PMHx hypertension • Seen in ER overnight and admitted to ICU • On exam: • Severely dyspneic • O2 sats >90% on room air • BP low by her standards • Course • Responds to O2 but dyspnea continues • Chest pain is pleuritic • BP trends down, little response to IV fluids, some response to pressors • Requires workup • Goes into PEA arrest if sent for CT or sedated or inadequate pressors • Requiresthrombolysis

  11. Results • Team did work as team • MD led, input from others • 1 group: RN very experienced and assertive • Discussed resources • RN: “I’ll need to leave for 2 minutes to do that – want me to?” • “Don’t have that available – need to order from pharmacy” • Knowledge, cognitive, and communication errors • Fixation on wrong diagnosis • Failure to share mental model

  12. Types of Needs • Unperceived  • Individual  • Team  • System/resource  • From debrief: WHY

  13. Types of Needs

  14. Conclusions • Preliminary! • VP identifies unperceived needs • Individual, team and system • Variety of professional roles • Can further explore WHY • Educational for participants

  15. Matrix (examples)

  16. Next steps • More rigorous evaluation • Test as part of multifaceted needs assessment • Refine strengths, weaknesses • Does VP add anything new/different?

  17. Thank you • Questions? • twillett@royalcollege.ca

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