Beyond the Software – What Educators Need to Implement Virtual Patients James B. McGee, Dmitriy Babichenko May 2011

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

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

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

“We shape our tools and then our tools shape us.” Marshall McLuhan ( )

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

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

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

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

Writing - Planning Define your learning objectives & outcomes Define your audience Assess the environment Perform due diligence

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

The vpSim.pitt.edu

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:

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:

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?

Decision Node/Patient State: Learning Objective: CHOICEOUTCOMESCORE Decision Node/Patient State: Learning Objective: CHOICEOUTCOMESCORE

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 or line for questions Collect feedback Always provide at the end: Some summary 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 address

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

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

Implementation - Models EASY – supplement didactics, self-assessment, independent learning (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)

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

thankYou vpSim vpSim.pitt.edu Lab for Educational Technology let.pitt.edu JB McGee |