Repurposing Virtual Patients For Clinical Reasoning

Centre for Virtual Patients

Repurposing virtual patients for clinical reasoning Development of a guideline and assessment of time and effort Benjamin Hanebeck, Burkhard Tönshoff, Sören Huwendiek Department of General Paediatrics, University Hospital for Paediatric and Adolescent Medicine and Centre for Virtual Patients, Medical Faculty of Heidelberg University, Heidelberg, Germany

ICVP Krakau, 06.06.2009

Centre for Virtual Patients

Clinical reasoning • Taught through experience by seeing patients (Eva, 2005) • Strategies to facilitate learning (Bowen, 2006) But:

• Patient encounters are limited, virtual patients increasingly used as a supplement

Centre for Virtual Patients

Virtual patients and clinical reasoning • VPs should be designed and used to promote clinical reasoning skills (Cook, 2009)

Centre for Virtual Patients

VP design principles to foster clinical reasoning (Huwendiek, 2009) • Interactivity • Specific elaborated feedback • Questions to enhance clinical reasoning – Summary of presenting problem – Differential diagnoses – Defining and discriminative features

• Recapitulation of key learning points (questions, comments)

Centre for Virtual Patients

Virtual patients and clinical reasoning But: • Virtual patients are costly to make from scratch (Huang, 2005)  Repurposing to save resources (Ellaway, 2008)

Centre for Virtual Patients

CAMPUS Virtual Patient system • Vocabulary based VP system • Possibility to enhance with questions at any given point of the case • 15 cases in German language: – specific selection of older cases – duration 45-60min each

Centre for Virtual Patients

Guideline • 1. Case selection, definition of learning objectives • 2. Literature review • 3. Development of a repurposing concept

Centre for Virtual Patients

3. Repurposing concept • Refinement of learning objectives • Visualization of clinical reasoning process with mind map

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3. Repurposing concept Dx 1 Dx 2 Dx 3 Dx 4

Defining and  descriminating  features Feature A

Features A, B + C

Dx 5

Feature C

Dx 6

Feature A

Defining and  descriminating  features

Dx 1 Dx 3 Dx 4

Features E + F

Dx 4 Feature D

Centre for Virtual Patients

Guideline • 1. Case selection, definition of learning objectives • 2. Literature review • 3. Development of a repurposing concept • 4. Enrichment for fostering clinical reasoning

Centre for Virtual Patients

4. Enrichment for fostering clinical reasoning • Implementation of questions according to the mind map • Summary of problem representation in abstract terms • Prompt for differential diagnosis • Elaborate feedback / comments on important aspects of the case • Inclusion of clinical reasoning map at end of case

Centre for Virtual Patients

Guideline • • • • • •

1. Case selection, definition of learning objectives 2. Literature review 3. Development of a repurposing concept 4. Enrichment for fostering clinical reasoning 5. Reduction of cognitive load 6. Final checks including review by expert and completion

Centre for Virtual Patients

Efforts Activity

hours

1. Case selection, definition of learning objectives

2

2. Literature review

4

3. Development of a repurposing concept

4

4. Enrichment for fostering clinical reasoning

11

5. Reduction of cognitive load

5

6. Final checks including review by expert and completion

7

Total

33

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Conclusions • Guideline for implementation of strategies to foster clinical reasoning • More time consuming and costly than expected • But: students value these strategies as ideal preparation for encounters with real patients  worth the effort, increase in value

Centre for Virtual Patients

Perspective • Comparison of repurposed vs. original VPs – Evaluation with questionaire specifically designed for clinical reasoning – Controlled study with electronic key-feature cases to assess clinical reasoning

Centre for Virtual Patients

Thank you!

Contact: www.campusvirtualpatients.com