1. Using E lectronic V irtual P atients to Develop Skills for E vidence- B ased M edicine and C linical R easoning Ralph Aarons, MD, PhDandSusan S. Albright MedBiquitous Annual Conference 2011

2. Medical Evidence Clinical Reasoning Foundations of Evidence-Based Medicine and Clinical Reasoning perception cognition perception cognition

3. Presentation of problem Solution of problem ‘Traditional’ approach to problem solving Prior knowledge + apply reasoning Knowledge required BEFORE problem encountered

4. Presentation of problem Solutions of problem Learning related to problem ‘PBL’ approach to problem solving Knowledge ARISES FROM work on the problem!

5. Knowledge: Basic science Integration Clinical science Skills: Discussion Teamwork Research Presentation Feedback Knowledge: Basic science Integration Clinical science Skills: Discussion Teamwork Research Presentation Feedback Knowledge & skills arise from the problem! ‘PBL’ approach to problem solving

6. Paper cases Virtual cases on tusk

7. PBL Whiteboard Headings What We KnowWant to KnowHypotheses LQs Problem List

8. PBL Whiteboard Headings What We KnowWant to KnowHypotheses LQs Problem List

9. Asking Clinical Questions Background Questions (PBL1, Learning Questions) general knowledge many sources in HSL [database, e-Books, e-Journals, OvidMEDLINE,PubMed, TUSK, etc.] Foreground Questions (PBL2, advanced LQ’s) specific knowledge to make a clinical decision 3 or 4 essential components o Patient and/or Problem o Intervention o Comparative intervention (…optional, if relevant) o Clinical Outcome

11. P4 Cases *H. S. Barrows

12. 4 - 5 students 1 facilitator per tutorial group 45 – 50 PBL tutorial groups PBL core materials on TUSK….. …linked inside all group folders Group - works through VP case (using ‘global’ navigation) ….individual work (LQs) outside group..….....each group folder is unique ……….PICO submitted to librarian Background + Foreground LQs

13. *P4 A simulated patient (cards  TUSK) An exercise in clinical reasoning – EVIDENCE : select History – EVIDENCE: select Exam – EVIDENCE: select Tests and Procedures – EVIDENCE: select Consultants –    Manage the patient’s problem P ortable P atient P roblem P ack *H. S. Barrows

19. the assignment

20. the form to send to librarian

21. the form received back from librarian

22. review, grade, feedback

23. 20 students 1 master clinician per tutorial group 10 ICR tutorial groups ICR core materials on TUSK….. Individual – works VP case (using ‘linear’ navigation) …….explore VP cases outside group..….....answer questions during case ………. sub-groups submitgroup work NEW cases with Master Clinician

28. illness script

30. descriptor table

43. Critical Thinking CLINICAL REASONING TUSK Case Simulator PBL *Zaid Alsagoff, 2008

44. TUSK is now open source ! Contact: tusk@tufts.edutusk@tufts.edu if you want to join