1. 17th September 2006 Models for Virtual Patients Presented by Jonathan Round

2. 17th September 2006 Models for Virtual Patients What is a virtual patient? - entry level  Elements – Scenario – Choices and consequences – First person participant  User interface

3. 17th September 2006 Models for Virtual Patients Example  Robert is a 6 week old boy who presents to A+E with poor feeding and no other symptoms.  Examination is entirely normal apart from a temperature of 38.1° C  What should you do? Take blood cultures and start on antibiotics Reassure and send home with paracetamol

4. 17th September 2006 Models for Virtual Patients  You chose to reassure and send home with paracetamol.  Robert represents 6 hours later unresponsive with intractable convulsions.  A post mortem demonstrates bacterial meningitis.  Fevers in the very young should always be taken seriously as there are rarely any localising signs

5. 17th September 2006 Models for Virtual Patients Example  Robert is a 6 week old boy who presents to A+E with poor feeding and no other symptoms.  Examination is entirely normal apart from a temperature of 38.1° C  What should you do? Take blood cultures and start on antibiotics Reassure and send home with paracetamol

6. 17th September 2006 Models for Virtual Patients  You chose to take blood cultures, clean catch urine, lumbar puncture and start on antibiotics  This is good, because the child had bacterial meningitis. Your interventions saved Robert’s life.  Clinical signs are often absent or subtle in the young.

7. 17th September 2006 Models for Virtual Patients What is a virtual patient? - advanced levels  Elements – Scenario – Choices and consequences – First person participant  User interface  Allows realistic choices  Has realistic consequences  Appropriate for level of user  Links to/contains education

8. 17th September 2006 Models for Virtual Patients Generic problems  Inflexible  Expensive to set up  Realistic choice models require clinician time  Visually appealing models require programmer time

9. 17th September 2006 Models for Virtual Patients Clinical realism and the problem of choice - 3 option model  Patient presents3 options  First step9 options  Second step27 options  Third step81 options 120 potential clinical situations

10. 17th September 2006 Models for Virtual Patients Different models to cope with choice Hi-Fi Algorithm basedLinearLo-Fi

11. 17th September 2006 Models for Virtual Patients Different models to cope with choice Hi-Fi Algorithm basedLinearLo-Fi High degree of visual/aural realism Complex programming Expensive ++ $100,000 Solve problem with cash

12. 17th September 2006 Models for Virtual Patients Different models to cope with choice Hi-Fi Algorithm basedLinearLo-Fi Participant choices input information into a calculator that outputs clinical change Complex formulae at the heart No narrative Good for physiology or biochemical scenarios Solve problem with ‘infinite’ choice

13. 17th September 2006 Models for Virtual Patients Different models to cope with choice Hi-Fi Algorithm basedLinearLo-Fi Allows only one route through the scenario Incorrect responses lead to immediate correction Minimal real choice Good to test knowledge of protocols Poor for realism - problem not solved Easy to create

14. 17th September 2006 Models for Virtual Patients Different models to cope with choice Hi-Fi Algorithm basedLinearLo-Fi Multiple choices at each step Emphasises decisions Minimal attention to appearance Cheap Problem solved!

15. 17th September 2006 Models for Virtual Patients Major nodes - describe major points in clinical course Creating a Lo-Fi nodal virtual patient Presents to GP Referred to clinic Investigations Definitive treatment complete

16. 17th September 2006 Models for Virtual Patients Major nodes connected by appropriate management choices Creating a Lo-Fi nodal virtual patient

17. 17th September 2006 Models for Virtual Patients Other boxes added and then choices inserted Creating a Lo-Fi nodal virtual patient

18. 17th September 2006 Models for Virtual Patients Whole case completed Creating a Lo-Fi nodal virtual patient

19. 17th September 2006 Models for Virtual Patients

20. 17th September 2006 Models for Virtual Patients Mahein Hussain Welcome. You have now been a paeditrician since 4 pm, when your shift started. Its day 1 of the job, and you are trying to remember all that stuff from the paed course. Anyway, it wasn't too busy and now you have discovered the mess and the takeaway menus. A Lamb Rogon Josh has arrived and you are half way through, when the crash bleep goes off "Paediatric arrest in A+E". What would you like to do? Finish curryRun to A+E

21. 17th September 2006 Models for Virtual Patients Advantages of Lo-Fi nodal approach  Quick  Adaptable  Linkable  Uses clinicians and programmers effectively  Anyone can do it!

22. 17th September 2006 Models for Virtual Patients Thanks to… More at… Chara Balasubramaniam Arnold Somasunderam Ferhal Utku Terry Poulton www.etu.sgul.ac.uk/virtualpatients/ examples.htm