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Safe Prescribing and Use of OpioidsNational Rx Drug Abuse Summit 4-11-12
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Safe Prescribing and Use of Opioids
April 10-12, 2012 Walt Disney World Swan Resort
Accepted Learning Objectives: 1. Analyze current professional education programs on safe use of opioids and new programs under development. 2. Explain a potentially transformative on-line educational tool for health professionals that enable them to train by interacting with “virtual patients.” 3. Describe a Massachusetts program for training physicians on safe opioid prescribing, and the curriculum developed to teach residents and faculty.
Disclosure Statement
• Drs. Daniel P. Alford and Sarah Ball have disclosed no relevant, real or apparent personal or professional financial relationships.
• Dr. Benjamin Lok has disclosed that he has a relationship with Shadow Health, Inc.
Simulation-based training for health care providers on
prescription drug abuse
Benjamin Lok, Ph.D. Computer and Information Sciences and
Engineering University of Florida
National Prescription Drug Abuse Summit April 10-12th, 2012
Overview of talk
Existing approaches Level of integration Costs and benefits
New approaches What’s coming down the pike Defining the direction of simulation (what does
simulation look like in 5 years?) Goals:
Identifying how you can benefit from simulation today
Identifying your part in shaping the future of education
Current Simulation Efforts
• Humans – Lecture – Role-playing – Standardized patients – “gold standard”
• Pros – Empathy – Emotion – Rapport
Current Computer Simulation Efforts
Computer-based learning case studies Passive –
multimedia presentation of information
“Choose your own adventure”
Image from Harvard Medical School
Current state of simulation
Simulation wings UF-Jacksonville has dedicated
24,000 sq. ft. UF-Jacksonville 55 simulators Basic understanding of
integration into curriculums [Huang 2007] Virtual patients
Ad-hoc (26 of 108 schools building cases)
Still images and video (83% of virtual patients)
Expensive (each case $10,000-$50,000, 1-2 years to develop)
Known education potential Compliments classrooms
Human Patient Simulator – image from Samsun Lampotang
Current approaches have difficulty providing:
• Sufficient opportunities for practice • Exposure to infrequent – yet critical –
scenarios • Tailoring for each student • Standardization • Patient variability • Team-based learning • Cultural competency • Feedback
Addiction Management Challenges
• Large scale deployment (40k+ learners)
• Solution: virtual human simulation
• Effective training using simulation – Track progress – Provide feedback – Implement protocols
Serious Games
• Interactive training exercises • Using computer game engines and the
Internet
Image from Breakaway Ltd.
Example: Virtual Human
Can interacting with a virtual human make you a better person?
Dr. Gregory House Good with medical knowledge Not so good with interacting with people
Dr. Doug Ross Good with medical knowledge Good with interacting with people
Dr. Derek Shepherd Good with medical knowledge Good with interacting with people
Virtualpatientsgroup.com
• 6 universities, 35 researchers, 8 years of VP research • Technologies to:
– Create virtual patients – Deploy virtual patients
• Enable – Curricular building and integration of training
scenarios – Teaching and training with
• Variety of scenarios • Variety of patients • After-action review systems
• Looking for: Research partners
Deployment - Continuum of Experiences
Virtual Worlds
Immersive Interaction
Video Conference Chat
Web Browser Instant Message
Mobile Deployment
Imm
ersi
on
Images from www.virtualpatientsgroup.com Fidelity, Learning efficacy
Virtual People Factory
• www.virtualpeoplefactory.com • Web-based interface to virtual
humans • Deployed Early 2008 – 56 active developers – 2700 users – 105,000 utterances Opiod patient
Mobile Distribution of Simulation
Deploy simulations via mobile platforms
Android app, released December 2010, over 4600 downloads
In Android Market, search for “Virtual Patient”
Image from www.virtualpatientsgroup.com
Repositories
• MedEdPORTAL – Peer reviewed medical education
resource
• 400 institution downloads in 10 months
Scripts at VPF General http://vpf.cise.ufl.edu/wiki/index.php/VPF_Script_Tracking
• Anesthesia – Pre-op OSA (UF) – Conscious sedation (UF)
– Myocardial Ischemia (UF)
• Cancer – Abnormal mammogram (UF) – BRCA Pedigree (UCF) – Clinical breast exam (UF/MCG) – Clinical prostate exam (UF) – Melanoma (MCG)
• Pain – Abdominal Pain (UF) – Chest pain (UF) – Gallstones (UCF) – Lower back pain (UF) – Lower back pain (PCOM) – Opiod prescription (AAAP)
• Psychiatry – Failure to thrive (UF) – Depression (MCG)
– Bi-polar (MCG)
• General – Breaking bad news (MCG) – Cranial Nerve (UF) – Dysphagia (UF) – Dyspepsia – Pharmacy (UF) – Gastro-Band (UF)
– GI Hemorrhage (UF) – Handoff (UF) – Meningitis (PCOM) – Patient-Centered Counseling (USF) – Pediatric Interview (UF) – Post Operative Hemorrhage (UF) – Sexually Transmitted Diseases (UF)
– Contraceptive Counseling (UF)
NERVE: The Neurological Examination Rehearsal Virtual
Environment • Virtual multi-tool interface – Playstation Move
controls multiple virtual tools
– Gestural and tool input, in addition to speech
• Medical students – Learn how to use
neurological tests to diagnose a patient with a vision disorder
– Receive additional exposure to patients with abnormal findings (Cranial Nerve 2,3,4,5,6,7,12)
After-Action Review by Students
• IPSViz – Web-based interface – Students received
email with link (automated)
– Sample student (10158/00000)
– Self-directed review of content, video, and feedback
• Each student can review their performance and compare with experts
After-Action Review by Educators
• IPSVizn – Web-based
interface – Educators can
review completed student interactions
– Data from study – Filter based on user
background • Level of expertise • Gender • Educator-defined
metrics
• Experts can – Identify trends
(mean of class) – Identify outliers
Physical Examinations of Virtual Human Patients
• Mixed reality humans – Passive-haptic
interface to life-sized virtual human
– Applications • Clinical breast exam • Prostate Exam
• Students can – Practice physical
examination and communication skill sets
– Get real-time feedback of exam performance • Coverage • Pressure • Conversation topics
Getting Involved
Now (<6 months) Use systems to create web-deployable “cases”
Case study-based Adaptive raining – could branch depending on trainee’s selections Example: http://www.md-inc.com/Products/product_details.cfm?
mm=2&sm=4027&courseno=172
Near term (<2 years) Work with developers to create interactive virtual patients
Different levels of fidelity Requires funding More interactive
Long term (3 years+) Coordinated teaching/training/testing using simulation
Valid and reliable training materials Work with professional, licensing, continuing education groups
Demo of Creating Virtual Patient
• www.virtualpatientsgroup.com
Thank You!
Build virtual patients: www.virtualpatientsgroup.com Contact: [email protected] Support: National Science Foundation and National Institutes of Health