TestDriveGrad_v2

Graduate test drive

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All material copyright © 2013 Shadow Health Inc.Graduate Test Drive | www.ShadowHealth.com

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Goals

Before You Begin

Assignment

Time to complete:

o Open Google Chrome. Close all other programs, tabs, and windows.o Login to the Digital Clinical Experience™ (DCE) at ShadowHealth.com

All material copyright © 2012 Shadow Health Inc.Graduate Student Workbook | www.ShadowHealth.com

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Overview: In this module, you will become familiar with the DCE, as well as with the most effective ways to communicate with Tina Jones™.

Instructions: To interact with Tina Jones, you will type questions, statements, and instructions as you use tools and tests to conduct your examinations. As a virtual patient, Tina Jones has had thousands of conversations with nursing students across the country, and she understands over 35,000 unique questions. However, as you talk with Tina Jones, you will probably ask her a question that she’s never been asked before. The following steps will help you to successfully overcome potential communication challenges in order to have the best possible experience. You will begin by logging in and entering the Orientation Module. Preceptor Diana will guide you through the module step-by-step.

o Go to https://app.ShadowHealth.com

o Login to the system using your username and password.

o Click on “Orientation Module” to review the module’s content. o If necessary, install the Unity Web Player.

o Click on “Start New Patient Exam” to begin the module. Preceptor Diana™ will give you instructions as the module loads.

STEP 1: DROPDOWN MENUThere are multiple resources available in the DCE simulation environment.

o Scroll over your name in the upper-right corner. A dropdown menu will appear. This dropdown menu will allow you to edit your profile, sign out, or view a PDF copy of the Student Workbook.

o Next to the dropdown menu is “Help Desk,” which you can click to contact Shadow Health’s Learner Support team.

STEP 2: COMMUNICATING WITH TINA JONESYou enter Tina Jones’ room when you click the Begin Exam button. Ms. Jones is in the clinic for a follow-up after a recent ER visit. Also, while she’s here, you’ll give her a thorough annual physical exam. Any time you’re with Tina Jones, you can have an in-depth dialog with her about her health history, home life, and more. She contains thousands of responses to questions that nurses ask.

Learn to effectively communicate with your Digital Standardized Patient™Become familiar with the action menusOperate an exam instrumentIllustration of Advanced Clinical Concepts, Self-Reflection, and reviewing results

Interacting with Tina Jones™Orientation Module

20 minutes

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Interacting with Tina Jones™

However, when you interview Tina Jones, you need to follow some rules. Preceptor Diana will take you through a series of steps so that you can learn to communicate effectively, including how to use the Communication Menu to make statements.

Some basic guidelines for communicating with Tina Jones:

o To practice interpersonal communication, open the Communication Menu to Greet, Educate, or Empathize with Tina Jones. The Communication Menu is in the lower right-hand corner of the room.

o To elicit information from Tina Jones, or to direct her to perform an action during an exam, type your question or instruction directly into the conversation bar in the lower left-hand corner of Tina Jones’ room. You do not have to select a Communication Menu action.

o When you formulate your questions, they should be medically relevant, clear, and longer than two words.

o Sometimes, Tina Jones will ask you for clarification.

o Tina Jones may not recognize a question. When this happens, assess your question to make sure it’s medically relevant. If it is, try rephrasing it more simply. If Tina Jones still doesn’t recognize your question, move on to the next topic of conversation. Your instructor will be able to review your transcript to see the questions that you asked, and if they were medically relevant.

o Avoid compound questions that use the word “or,” such as, “Do you have any nausea or dizziness?” Instead, ask about each topic separately: “Do you have any nausea?” and “Are you feeling dizzy?”

o Avoid pronouns, such as it, he, she, her, him, they, and them.

STEP 3: NAVIGATING Preceptor Diana will teach you how to navigate the tabs on the right side of the screen. You’ll use these tabs throughout every module, both as a resource and to document your nursing process. The five tabs are Assignment, Instructions, Patient Chart, Transcript, and Focus Notes. These tabs contain a wealth of information and guidance for you as you proceed through a module.

o Assignment - Contains the Learning Objectives for a module. You can refer to the Assignment tab to help guide your interactions with Tina Jones.

o Instructions - Contains steps to complete the module successfully. You can refer to the Instructions tab to help guide your interactions with Tina Jones.

o Patient Chart - Contains Tina Jones’ vitals, chief complaint, and other information. You can review this chart at any time.

o Transcript - Contains a running record of everything you say to Tina Jones, and every action you perform.

o Focus Notes - Record all of your findings here. Within the Focus Notes are sub-tabs where you can type in your findings by category. The sub-tabs will vary a little bit, depending on the focus of the module. You should record in your Focus Notes throughout your interaction with Tina Jones.

STEP 4: PROCEEDING THROUGH A MODULEYou can keep track of which phase you’re in by looking at the top of the screen above Tina Jones’ room. The phase that you’re currently in will be highlighted in green.

Preceptor Diana will ask you to click on the Complete Exam button in the lower right corner of the screen. This will take you out of Tina Jones’ room and into the next phase. Once you’ve clicked Complete Exam, you will not be able to go back in to Tina Jones’ room for that module attempt.


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Summary of the phases of a module:

o Clinical Exam - Your interactions with Tina Jones in the exam room.

o Advanced Clinical Concepts - An opportunity to think critically about and respond to additional patient-care concerns such as lifespan issues.

o Self-Reflection - An opportunity to assess and reflect upon your examination and documentation skills as you compare your focus notes to a model focus note written by an expert.

o Review Results - Upon completion of a module, you may review your clinical findings, transcript, advanced clinical concept responses, and self-reflections.

STEP 5: ANSWERING ADVANCED CLINICAL CONCEPT QUESTIONSAfter the Clinical Exam, you’ll enter the Advanced Clinical Concept phase of the module, where you’ll answer questions exploring issues related to the module, such as how a patient’s phase in life affects the way you pro-vide care for them.

Click the Next button to move on to the next phase.

STEP 6: COMPLETING YOUR SELF-REFLECTIONIn the Self-Reflection phase, you have the opportunity to review your own performance by comparing your focus notes to a set of model notes, and then reflecting on your experience.

Once you have completed your Self-Reflections, you will click the Turn It In button. This will submit all of your work to the instructor, including your clinical findings, your transcript, your Advanced Clinical Concept responses, and your self-reflections.

Preceptor Diana will instruct you to click the Turn It In button to complete the Orientation Module.

Congratulations! You’ve completed your orientation. In the following nine modules, once you complete a module you will be able to review your clinical findings. Once your instructor has reviewed your performance, you will receive an email from Shadow Health to notify you that you can log in and view any comments from your instruc-tor by opening up the reviewed module from that module’s launch page.

Interacting with Tina Jones™


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Take a Test Drive

Before You Begino Open Google Chrome. Close all other programs, tabs, and windows.o Login to the Digital Clinical Experience™ (DCE) at ShadowHealth.com.

Key Diagnosis

Key FindingsÑ

ÑYou would expect your students to find:

• Diabetes• Asthma

• Diabetes diagnosed at age 17• Diabetes poorly controlled

Module 1History

Ask Tina subjective questions like the following

Use Tests and Tools• Focus Notes

Investigate the LMS

• Asthma diagnosed at age 5• Asthma is mild, intermittent

• What brings you in today?

• Do you have any chronic conditions?

• Tell me aout any medical conditions you have.

• When were you diagnosed with asthma?

• What medication do you take for your asthma?

• When were you diagnosed with dabetes?

• What medication do you take for your diabetes?

• None This module is a conversation only module.


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Key Diagnosis

Key FindingsÑ


• Vision Loss• PCOS

• Cotton wool patches• Acne on face

Module 2HEENT

• How is your vision?

• Do you wear glasses?

• Do you wear contact lenses?

• Are your eyes dry?

• When did you notice that your vision was changing?

• Have you seen an eye doctor?

• Any skin changes?

• Any hair changes?

• Inspect Face and neck

• PalpationUpper and lower eyelids

• Eye chartRight eye 20/40

• OpthamalscopeCotton wool changes


Use Tests and Tools

• Patient chart (i.e. vitals)

Investigate the LMS

• Acanthosis ngrigans • Facial Hair


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Take a Test Drive


Key Diagnosis

Key FindingsÑ


• Asthma

• Expiratory wheezes in the lung bases

• Decreasedpeakflow

Module 3Respiratory

• When was your last asthma attack?

• Haveyouhadanydifficultybreathing?

• Are you having trouble breathing?

• Are you experiencing wheezing?

• Do you have a cough?• Are you having any chest

pain?• Do you smoke?• When did you last use your

inhaler?• Does your inhaler help?

• Inspect • Palpation

Chest expansion, fremitus• Percuss• Auscultate

Posterior lower lobes• Pulse Oximetry

Decreased O2

• SpirometryDecreasedpeakflow


Use Tests and Tools

• Medical History

Investigate the LMS

• Slightly decreased O2

saturation


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Key Diagnosis

Key FindingsÑ


• Decreased pulses in right foot secondary to ankle edema from injury

• Poorly managed diabetes may impact peripheral blood flow

• Right tibial and dorsalis pedis pulses 1+

Module 4Cardiovascular

• Do you have any heart problems?

• Has anyone in your family had heart problems?

• Does high cholesterol run in your family?

• Does high blood pressure run in your family?

• Do you smoke?

• Do you exercise?

• Inspect Right leg for edema

• PalpationDorsalis pedis pulseTibial pulse in right and left leg (1+ pulse due to edema or lack of peripheral blood flow)

• AuscultateTorso (try multiple locations on the heart)


Use Tests and Tools

• 1+ nonpitting edema right ankle


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Key Diagnosis

Key FindingsÑ


• Foot wound• Decreased strength in right foot

• Wound• Bruising and edema of

right ankle

Module 6Musculoskeletal

• How did you hurt your foot?

• Do you fall often?

• Did you hurt your wrists when you fell?

• Anystiffnessinyourjoints?

• Anyjointpain?

• Inspect Right ankle+1 edema and bruising

• PalpationStrength test Right ankle 4/5

• TestsROM right ankle Right ankle 4/5


Use Tests and Tools

• Patient chart

Investigate the LMS

• Decreased strength and ROM right foot


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Take a Test Drive


Key Diagnosis

Key FindingsÑ


• Diabetic neuropathy• Gait abnormalities

• Gaitalteredduetorightfootinjury• Decreased sensation in toes of both feet

Module 7Neurological

• Can you walk?

• Can you feel your toes?

• Do you have any numbness in your legs?

• Do you have a history of difficultywalking?

• Motor testing• Sensory testing


Use Tests and Tools

• Patient history

Investigate the LMS


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Key Diagnosis

Key FindingsÑ


• No psychological abnormalities

• Normal recall, abstract thinking, memory, comprehension, attentionspanandjudgement

Module 8Psychosocial

• All questions are prompted by Preceptor Diana™

• All tests and tools are prompt-ed by Preceptor Diana™


Use Tests and Tools


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DifferentialDiagnosisHerethestudentwillreviewthesubjectiveandobjectivedatafromthepreviousmodules.Thestudentwillwritedifferentialdiagnoseshe/sheisbeginningtothink about after interviewing and assessing Tina. By having the students write outthedifferentialdiagnosestheywillbeabletojustifythelabsandradiologictest they choose to order.

Examples: Diabetes; Asthma; PCOS; Foot Wound Infection; HTN

Module 9Assessment

LabsWhenorderingthelabs,thestudentswilljustifytheirdecisions.Theywillprac-tice their diagnostic reasoning and explain why certain labs or reasonable and necessary versus others that are not.

Examples: CBC; CMP; HBA1c; Lipid Panel; Throid Panel

Radiologic TestThestudentscanorderandjustifiywhytheywouldchoosecertainradiologictests. This makes for a dynamic lecture on why or why not ot order certain ra-dioloigc tests, costs, billing, etc.

Examples: Foot MRI; Foot X-ray

Treatment Plan, Follow Up and ReferralsHere the student will have the opportunity to write out a treatment plan for each diagnoses. The student can enhance their critical thinking skills and diagnostic reasoning skills as he/she works through appropriate treatment, medication and education for each dignoses. For any medical problems that need furhter follow up or referrals, the students can write in the course of action.

Examples: Medication for Diabetes and MRSA; Follow up for a PAP smear and B/P check.

PrioritizingDifferentialDiagnosisIn this section, the student can begin to priortize the diagnoses and think about which areas should be addressed on today’s intial visit, versus those diagnoses that can be addressed through a follow up appt or referral. There may be some secondary problems that resolve when certain primary issues are treated initially.

Examples: MRSA; Diabetes; Sprained ankle

Documents

TestDriveGrad_v2