Collaborative Development and Maintenance of Virtual Patients Norm Berman, MD Leslie Fall, MD Dartmouth Medical School Institute for Innovative Technology in Medical Education

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

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

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

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

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

Independent non-profit organization Independent non-profit organization Academic Switzerland Academic Switzerland Paid subscription model Paid subscription model

Building on CLIPP Success SIMPLE SIMPLE Virtual patients for Internal Medicine Virtual patients for Internal Medicine fmCASES fmCASES Virtual patients for Family Medicine Virtual patients for Family Medicine WISE-MD WISE-MD Teaching modules for surgery Teaching modules for surgery

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

Key Factors Curriculum Curriculum Authoring Authoring Pedagogy Pedagogy Academics Academics Integration Integration Maintenance Maintenance Infrastructure Infrastructure Development Maintenance

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

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

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

Academics Incentive to collaborate Incentive to collaborate Fundamentally important to success Fundamentally important to success

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

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

Infrastructure Support staff Support staff Hardware Hardware Software Software This cannot be done without money This cannot be done without money

+ = Individual virtual patients Repository Useful Curriculum

+ = Virtual patient components Technical standards Useful Curriculum

Diffusion of Innovation Rogers’ elements Rogers’ elements  diffusion process  adopter categories  innovation attributes  rate of adoption

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

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

Key Factors Curriculum Curriculum Authoring Authoring Pedagogy Pedagogy Academics Academics Integration Integration Maintenance Maintenance Infrastructure Infrastructure $

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