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

 James B. McGee, MD Chair, Scientific Advisory Board for Decision Simulation Equity holder in Decision Simulation  Michael Eakins Contract work for Decision Simulation through UCF Decision Simulation is a commercial provider of virtual patient simulation software and services. Disclaimer

 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, strategy 1  VPs that engage the student in clinical decision-making can train and assess 2 ; accelerate expertise Virtual Patient (VP) Simulation 1. Epstein RM, Hundert EM. JAMA 2002;287(2): Chapman DM, et al. J Clin Reason 2013;1(1):1-1

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

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

 Academic pharmacologist  Educational needs  Formative evaluation clinical pharmacology  Increased exposure to uncommon conditions  Deliberate practice: decision-making with feedback  (5:58) 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. 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 Neal Benedict

 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 Virtual patients 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 Aug 1;12:62. Virtual patients can be used to teach clinical reasoning. Bateman J, Hariman C, Nassrally M. Clin Teach Apr;9(2):133-4 James Bateman

 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 3 rd year clinical rotations Ankur Doshi

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 Ankur Doshi

 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 AAAAI

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

 Creating cases for national distribution  Requires more robust development  Content for expert level medical education  Engaging

 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

 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.

 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.

 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.

 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.

 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.

 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

 Parallel development: medical research, narrative, media, case logic  Converge  Quality Assurance  Weekly Alignment meetings  Focused development

 The 1 st case required approximately hours per instructional team member (PM, SME, ID, and GD) and about 15 hours for the DM specialists  With the 2 nd and 3 rd 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)

 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

 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 (407)

Novice individual learner Novice small group Continuing Education StoryHighModerateHigh InteractivityHighModerate FeedbackHighModerateHigh MultimediaHighModerate Summary

Novice individual learner Novice small group Continuing Education WriterHighModerateHigh Instructional Designer HighModerate Subject matter expert HighModerateHigh Media specialistHighModerate Summary

 J.B. McGee, MD Associate Professor of Medicine University of Pittsburgh School of Medicine  Michael Eakins Thank you