Learning Real Medicine in a Virtual World: Using Simulation to Integrate Essential Critical Thinking and Communication

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

2. Our New Home Opening Spring 2010

3. The Building Blocks of Medicine Traditional biochem pathology immuno clinical med pharm micro anatomy physiology genetics biochem doctoring

4. A Better Way to Build! Integrated and Interlocking

5. Putting it All Together

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

8. Learning Modalities • 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 • Standardized • Patients • Advantages • Safe, controlled environment • Limitations • Limited opportunities for practice • Limited pool of patients • Delayed feedback • Expensive • Clerkship & Internship • Advantages • Real patients • Limitations • Limited opportunities for practice • Negative role modeling possible • Delayed or missing feedback Lecture Advantages Efficient transfer of knowledge Limitations Low fidelity Lack of ability to demonstrate communication No skills training

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

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 3 7 50 80 5 Patient AGE Patient Health Episodes • EPISODE 2 • Upper respiratory infections EPISODE 4 Myocardial Infarction • EPISODE 1 • sore knee • fatigue EPISODE 5 Dementia, cancer, et… • EPISODE 3

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 Factory Web-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

17. What is VirtualPeopleFactory? • 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

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

24. Feedback and Assessment Transcripts

25. Feedback and Assessment Critical Information Gathered

26. Feedback and Assessment Interview Organization

27. Face Validity • 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 • 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

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.