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REACHING PARTS MEDICAL EDUCATION DOESN’T REACH
INNOVATIVE APPROACHES IN CLINICAL EDUCATION USING VIRTUAL PATIENTS
Jonathan Round, Alex Higton, Terry Poulton
What do Virtual Patients do well?
Take you to places you can’t or shouldn’t go
Risk free practice
Deliver standardised experience in a (virtually) real way
3 models extending VPs
The virtual ward round
The virtual clinic
The multi-professional virtual patient
Error patient
Virtual Ward Round
What’s missing
Rationale
Design
Resources
Feedback
Virtual Ward Round
What’s missing…ward savvy, ward nouse, the clinical process
Rationale…online delivery of a week’s ward action
Design…html, frames driven, multiple linear, control over information
Resources…internet connection, projector, facilitator
Feedback
Virtual Ward Round ContextMonday Registration
Ethics in PaediatricsNeonatology 1Neonatology 2Intro and Virtual Ward Round Day 1Paediatric Endocrinology 1
Tuesday Genetics
Nutrition and Growth
Chronic Paediatric Neurology/ DevelopmentPaediatric Endocrinology 2
Virtual Ward Round Day 2Wednesday Child Psychiatry 1
Child Psychiatry 2Paediatric SurgeryVirtual Ward Round Day 3
Thursday Paediatric Gastroenterology
Acute Paediatric NeurologyChild SafeguardingOncology
Images in Paediatrics Virtual Ward Round Day 4
Friday Respiratory Paediatrics Paediatric Cardiology
Virtual Ward Round Day 5Common Paediatrics Infections
Introduction
ward
ward
ward
ward
ward
Course structure
VWR Aims…
EXPOSURE
UNMASKING
THE CLINICAL PROCESS
REAL PROBLEMS
WARD WISDOM
ENGAGING
FEASIBLE
www.jround.co.uk/virtual_ward_round/d1_bedview.html
Challenges…CONCEPT
LAYOUT
PROGRAMMING
CASE WRITING
DELIVERY
www.jround.co.uk/virtual_ward_round/d1_bedview.html
Tools used…
www.jround.co.uk/virtual_ward_round/d1_bedview.html
www.jround.co.uk/virtual_ward_round/d1_bedview.html
Site Architecture…Monday FridayThursdayTuesday Wednesday
Bed 3
Bed 1
Bed 2
Bed 4
www.jround.co.uk/virtual_ward_round/d1_bedview.html
Bed 3
Bed 1
Bed 2
Bed 4
Bed 3
Bed 1
Bed 2
Bed 4
Bed 3
Bed 1
Bed 2
Bed 4
Bed 3
Bed 1
Bed 2
Bed 4
Site Architecture…Monday FridayThursdayTuesday Wednesday
Bed 3
Bed 1
Bed 2
Bed 4 DevelopmentsHistory
ExaminationInvestigations
FluidsTreatment
DevelopmentsHistory
ExaminationInvestigations
FluidsTreatment
DevelopmentsHistory
ExaminationInvestigations
FluidsTreatment
DevelopmentsHistory
ExaminationInvestigations
FluidsTreatment
www.jround.co.uk/virtual_ward_round/d1_bedview.html
VWR ratings
Content
Presentation
3.9 4 4.1 4.2 4.3 4.4 4.5 4.6
course
VWR VWR
Other
Likert scale Most valuable session
221 students, 6 rotations
Feedback
www.jround.co.uk/virtual_ward_round/d1_bedview.html
Comments…Strengths
The virtual ward round may be less cases, but to go through them in more detail.
Virtual Ward Round is a great idea, but feels a bit much and 30 mins is not enough time.
I loved the Virtual WR.
Virtual ward round gave us an insight into the management of different conditions.
The Virtual WR were good at bringing all topics together and making you think.
Virtual ER - management of common problems and what happens in real life.
Comments…Weaknesses
Virtual Ward Rounds at the start of the day.I was exhausted and brain dead by the time the
Virtual Ward Round came around. Maybe do it in the morning!
Less (maybe 3) Virtual WR patients or longer time. Virtual WR is helpful but too many patients.
Virtual Clinic
What’s missing…multiple sequential clinical related challenges
Rationale…prepare students, expose students to a “morning’s” work. consolidation of learning
Design…decision simulation, linear/branched
Resources…individual or small group learning, internet connection
Feedback…
Comments - StrengthsReally goodPlease provide more to medical schoolsvery useful excersizeExcellent resource - promote
Allowed numerous cases to be explored at once in quick succession
Good to be given numerous clinical scenariosComplements PBL
You get to think like a doctorChoices within vignettes allow clinical reasoning
Brought it to life – nice to do PBL process on my own.
Comments - weaknesses
Guidance needed on … CXR intrepretation…UEC values
Where’s the back button? I’d like to review CXRs later in the case
I’d like to explore different outcomesDoesn’t tell you the idea path,
can’t be bothered to do it againToo long to complete.
Multiprofessional Virtual Patient
What’s missing...seeing patients from another angle, integrated care, teamwork
Rationale…expose students to same VP, but from different angles, allow to switch
Design…multitrack VP, with crossover points and joint meetings. Decisionsimulation/labyrinth
Resources…individual/small group, internet enabled computer
Feedback
Error Virtual Patient
What’s missing…learning from past mistakes
Rationale…professionals make the same mistakes over and over and over again
Design…branched VP
Resources…decision sim, for asynchronous or group work
Feedback
Timeline
Nov 2009
Error feedback
3.00 8.00 13.00 18.00 23.00 28.000
2
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clinic
al re
alism
chall
enge
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frien
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arnin
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a lot
quite a bit
a little
none
anticipation of difficulties different interesting realistic thought provoking
can we have another engaging interesting realistic thought provoking
challenging enjoyable interesting realistic thought provoking
challenging familiar interesting realistic useful
challenging frightening irresolute realistic useful
challenging fun prioritising realistic useful
challenging helpful prioritising realistic utilisation of personel
challenging helpful realistic relevant
challenging informative realistic scary
complicated informative realistic scary
Standing up to someone who is more “specialised” than youis difficult and scary but sometimes it needs doing and is an
important thing to learn how to do
Adjectives
What will I take away
Conclusions
Many situations where ‘typical’ VP may not be mimic clinical reality
Adaptions to VP model stretch reach of the virtual patient
Students challenged and appreciative of new designs
www.jround.co.uk/virtual_ward_round/d1_bedview.html
app.decisionsimulation.com
Chest Clinic
Lauren Brook
Errol Rouch
