1. Authoring and implementation of virtual patients in nursing and obstetrics – the new challenge at the Jagiellonian University Medical College A. Stachoń, E. Walewska, L. Ścisło, D. Matuszyk, M. Dziedzic, A. Kononowicz Jagiellonian University Medical College International Conference of Virtual Patients 5-6.06.2009 Kraków

2. 2 ■ Repurposing (language, culture and discipline) ■ Creating original cases AUTHORING OF VIRTUAL PATIENTS Authoring tool of CASUS® system – Ludwig Maximilian University in Munich eViP Project = electronic Virtual Patients 3-years project co-funded by the European Union

3. 3 Presentation of patient’s problem Anamnesis Physical examination Other medical tests Therapy Classic linear model of virtual patient Presentation of patient’s problem Anamnesis and physical examination Purpose of nursing intervention Nursing diagnosis Nursing interventions Patient’s condition estimation Nursing model of virtual patient Diagnosis AUTHORING OF VIRTUAL PATIENTS Solution of diagnoses Nursing diagnosis

4. 4 VIRTUAL PATIENTS IN NURSING CASETYPESOURCESTATUS Mr Myszkowski 77 yr old patient with bloody vomiting: Part 1 Nursing diagnostics and interventions in gastric ulcer Repurposed case Mr Meissner 77 yr old patient with bloody vomiting Diagnostic and treatment in gastric ulcer/lymphoma (CASUS® case for physicians) - ready, in CASUS® system, - media and nursing documentation added, - implemented into Surgical Nursing course Mr Myszkowski 77 yr old patient with bloody vomiting: Part 2 Nursing procedures in gastric lymphoma (surgery) Repurposed case- translated, - in discipline repurposing Mr Andrzejewski A 48 yr old male with severe chest pain Nursing care in myocardial infarction Repurposed case Mr Angermeier A 48 yr old male with severe chest pain Diagnostic and treatment in myocardial infarction (CASUS® case for physicians) - translated, - in discipline repurposing, - media and nursing documentation added Mr Sobczyński A 38 yr old male with haemophilia A Home care in haemophilia Original case --- - created, - media and medical/nursing documentation added, - in amending

5. 5 VIRTUAL PATIENTS IN OBSTETRICS CASETYPESTATUS Mrs Miłowicz 19 yr old pregnant patient Obstetric care of patient in danger of premature delivery Original case - ready, in CASUS® system - media and obstetric documentation added - implemented into Obstetrics course Mrs Iwanowska 41 yr old pregnant patient Obstetric care and procedures in premature delivery Original case in creation

6. 6 AUTHORING OF VIRTUAL PATIENTS Repurposing workflow – VP Meissner/Myszkowski Creating workflow – VP Miłowicz content culture adaptation translation media ready implementation discipline adaptation draft of patient’s history broadening of particular aspects media ready patient’s documentation 10 h media ready 34 h5 h 45 h implementation 49 h 57 h evaluation 2 h 10 h

7. 7 IMPLEMENTATION OF VIRTUAL PATIENTS ~ 100 students (3rd year) ~ 50 students (1st year) ~ 50 students (2nd year) Faculty of Health Sciences JUMC scenario: self-study, invitation students by e-mail Surgery and Surgical Nursing VP Myszkowski Obstetrics Care VP Miłowicz purpose: teach students define nursing diagnoses, purposes of interventions and plan nursing procedures. purpose: familiarize young students with reality of obstetrics care in case of endangered pregnancy.

8. 8 ELEMENTSVP MYSZKOWSKIVP MIŁOWICZ PAGES WORDS 33 ~ 4830 41 ~ 7031 CARDS2529 PICTURES13 + 5 (series gastroscopy pictures) 21 HIPERLINKS1017 EXPERT COMMENTS416 QUESTIONS21 (15 MCQ + 5 free + 3 others) 24 (18 MCQ + 6 free) LINK TO ONLINE SOURCES ---1 VP’s MARK (by students) 4,34,5 COMPARISON OF IMPLEMENTED VPs

9. 9 Online student questionnaire concerning their learning and clinical reasoning experiences with virtual patients Sören Huwendiek, Bas de Leng et al. 2008 STUDENTS EVALUATION OF VPs N = 13 N = 14

10. 10 VIRTUAL PATIENT N SCENARIO OF IMPLEMENTATION QUESTIONS (AVERAGE MARKS IN LIKERT SCALE) Q1 AUTHENTICITY Q4 MOTIVATING Q9 COACHING Q10 EFFECT MYSZKOWSKI 14 sefl-study 3,64,34,24,1 MIŁOWICZ 13 sefl-study 3,84,14,64,2 Q1 - While working on this case, I felt as if I had to make the same decisions a nurse/obstetrics would make in real life. Q4 - While working through this case, I was actively engaged in revising my initial image of the patient’s problem as new information became available. Q9 - The feedback I received while working through this case was helpful in enhancing my diagnostic reasoning in this case. Q10 - After completing this case, I feel better prepared to confirm a diagnosis and exclude differential diagnoses in a real life patient with this complaint.  well present reality of work in hospital ward  mobilize to thinking of patient’s problem and finding solution  expert comments were very helpful, especially when I didn’t undrestand more complicated issues  some questions were too difficult and too detailled  I would like to solve more virtual medical cases  It was hard to motivate myself to go through all at home

11. 11  Repurposing and creating VP is time-consuming  Difficulties with creation of new media  Additional elements activating and coaching students are helpful  Troublesome implementation (lack of computer lab, low motivation of students)  Student like this new educational tool  … SUMMARY & CONCLUSIONS

12. 12 Thank you for your attention