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Using Electronic Virtual Patients to Develop
Skills for Evidence- Based Medicine and Clinical
Reasoning
Ralph Aarons, MD, PhD and Susan S. Albright
MedBiquitous Annual Conference 2011
MedicalEvidence
Clinical Reasoning
Foundations of Evidence-Based Medicine and Clinical Reasoning
perception
cognition
perception
cognition
Presentation of problem
Solution of problem
‘Traditional’ approach to problem solving
Prior knowledge+
apply reasoning
Knowledge required BEFORE problem encountered
Presentation of problem
Solutions of problem
Learning related to problem
‘PBL’ approach to problem solving
Knowledge ARISES FROM work on the problem!
Knowledge:Basic science IntegrationClinical science
Skills:DiscussionTeamworkResearchPresentationFeedback
Knowledge & skills arise from the problem!
‘PBL’ approach to problem solving
Asking Clinical Questions
Background Questions (PBL1, Learning Questions)• general knowledge• many sources in HSL
[database, e-Books, e-Journals, OvidMEDLINE,PubMed, TUSK, etc.]
Foreground Questions (PBL2, advanced LQ’s)
• specific knowledge to make a clinical decision• 3 or 4 essential components
o Patient and/or Problemo Interventiono Comparative intervention (…optional, if relevant)o Clinical Outcome
4 - 5 students 1 facilitator
per tutorial group
45 – 50 PBL tutorial groups
PBL core materials on TUSK…..
…linked inside all group folders
Group - works through VP case (using ‘global’ navigation)
….individual work (LQs) outside group
..….....each group folder is unique
……….PICO submitted to librarian
Background + Foreground LQs
*P4
• A simulated patient (cards TUSK)• An exercise in clinical reasoning
– EVIDENCE: select History– EVIDENCE: select Exam– EVIDENCE: select Tests and Procedures– EVIDENCE: select Consultants– Manage the patient’s problem
Portable Patient Problem Pack*H. S. Barrows
20 students 1 master clinician
per tutorial group
10ICR tutorial groups
ICR core materials on TUSK…..
Individual – works VP case (using ‘linear’ navigation)
…….explore VP cases outside group
..….....answer questions during case
………. sub-groups submit group work
NEW cases with Master Clinician