1. Learning Real Medicine in a Virtual World: Using Simulation to Integrate Essential Critical Thinking and Communication Skills Lynn Crespo, Ph.D. Assistant Dean, Medical Education College of Medicine

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3. 9/7/20153 bioche m The Building Blocks of Medicine anatomy genetics pharm micro clinical med pathology doctoring physiology biochem immuno

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6. Poor Quality of Care & Medical Errors: Contributing Factors Integrated application of knowledge through critical thinking Poor communication skills Lack of compassion Hidden biases

7. Knowledge, Skills, Attitudes and Behaviors 9/7/20157

8. Learning Modalities Standardized Patients Advantages Safe, controlled environment Limitations Limited opportunities for practice Limited pool of patients Delayed feedback Expensive Lecture Advantages Efficient transfer of knowledge Limitations Low fidelity Lack of ability to demonstrate communication No skills training Virtual Patient Advantages Repetitive practice Standardized Exposure to many populations Immediate feedback Safe practice environment Limitations Case Development Programming Mannequin Advantages Procedural skills Immediate feedback for decisions Limitations Poor communication skills training Expensive Greatest learning follows debriefing Clerkship & Internship Advantages Real patients Limitations Limited opportunities for practice Negative role modeling possible Delayed or missing feedback

9. “Real Medicine in a Virtual World” Goal 1: Improve communication skills with patients Goal 2: Recognize and overcome biases Goal 3: Integrate basic science and clinical reasoning across curriculum Goal 4: Monitor and develop critical thinking skills

10. The Challenge Multiple presentation modalities with different technology and informational requirements. Document Based (Level 1) Text Pictures Video Virtual Case (Level 2) Patient appearance Patient interview Mixed/Immersive (Level 4) Multiple stages, technologies High coordination Standardized Patient/Human Patient Simulator (Level 3) Scripts Interactive Setting Technology Case Objectives Difficulty Capstone Integration

11. Strategic Plan Innovative use of simulation in undergraduate medical education. Avatar patient will be managed across his/her lifespan across 4 year curriculum Clinical skills – basic science integration –Continuity of care through contingencies –Proactive/Preventative medicine (patient empowerment) –Student motivation and interactivity –Supports long term memory storage and retrieval –Leverages narrative/digital storytelling

12. Sickle Cell Capstone Case Patient AGE Patient Health Episodes 3 EPISODE 1 sore knee fatigue EPISODE 2 Upper respiratory infections EPISODE 3 EPISODE 4 Myocardial Infarction EPISODE 5 Dementia, cancer, et… 78050 5

13. Benefits of Capstone Cases Simulate longitudinal factors across the lifespan Compare alternative treatments and self correct Assessment of decision making skills transfer Emphasize physician-patient relationship Fosters integration Motivation – we tend to think in narrative

14. Simulatior Applications for Clinical Cases Virtual People FactoryWeb-SP Human Patient Simulator Standardized Patient

15. Virtual Patients for Medical School Curricula

16. VPF development supported by University of Florida Alumni Fellowships and National Science Foundation Grant IIS- 0643557 COLLABORATORS AND SUPPORTERS 16

17. What is VirtualPeopleFactory? 17 Interactive web-based tool –Create virtual patients –Interview virtual patients –Assess VP encounters Developed at UF –Brent Rossen, Dr. Ben Lok

18. What is VPF used for? Interpersonal skills –Knowing what to ask –Addressing patient concerns –Empathy and rapport Critical thinking skills –Diagnosis Basic science knowledge 18

19. Advantages of VPF 19 24 hours/day availability on the web –Additional practice and feedback Scenario diversity –Abnormal findings –Diversity training Standardization Semi-automated student assessment

20. Interviewing a VP 20  Simulation of SP encounter  Go to web page  Freeform conversation –Student types questions –Patient answers naturally Realistic patient behavior –Patient challenges Patient: “Doctor, my mother had breast cancer. Do you think my pain could be because I have cancer?” Student: “What seems to be the problem?” Patient: “I found a mass in my breast, and I’m really worried about it.”

24. Feedback and Assessment 24 Transcripts 2009-03-23 12:40:31 Anonymous said: how long has your breast hurt Amanda Jones replied: i guess the pain started a couple months ago. i've just been trying to ignore it 2009-03-23 12:40:44 Anonymous said: can you describe the pain for me Amanda Jones replied: it's kind of a dull pain, it's really sensitive to the touch though 2009-03-23 12:40:54 Anonymous said: on a scale of 1 to 10, how would you rate the pain Amanda Jones replied: i don't know, maybe a four 2009-03-23 12:40:57 Anonymous said: is it always a four Amanda Jones replied: i know what they are, but i've never had one 2009-03-23 12:41:05 Anonymous said: does the pain change Amanda Jones replied: the pain started before my period and it still hurts, so i didn't think it could be related 2009-03-23 12:41:16 Anonymous said: does the pain spread to anywhere else Amanda Jones replied: no

25. Feedback and Assessment 25 Critical Information Gathered

26. Feedback and Assessment 26 Interview Organization

27. Face Validity 27 Faculty feedback –“Easy to use with relatively little training” –“Worthwhile because it can be used over and over” –“Provides an alternative for students to learn history-taking skills” Students –Multiple uses –Some students – over an hour Over 1600 VPF interactions to date

28. Summary 28 Web-based virtual patients Based on SP encounters Additional practice on –Interpersonal skills –Diverse patients –Critical thinking –Basic Science

29. Summary, cont’d Delivers –Frequent practice –Diverse scenarios –Standardization –Automated assessment 29

30. Acknowledgements UCF College of Medicine Medical Education Faculty Dr. Moshe Feldman Dr. Laura Cuty- Ruiz Collaborators Brent Rossen – Creator of VPF Dr. Benjamin Lok – Supervisor Dr. Carole Kimberlin, Dr. Diane Beck, Hevil Shah, Aaron Kotranza, Joon Chuah, Dr. Kyle Johnsen, Dr. D. Scott Lind, Dr. Juan Cendan. 30