Development of a virtual patient environment to facilitate teaching of medical students Lester AH Critchley Shekhar M Kumta Anaesthesia & Intensive Care CUHK

Sept 2008Curriculum Retreat – Virtual Patient Development of a virtual patient environment to facilitate teaching of medical students Teaching Development Grant: PI: Lester AH Critchley Co.Is: Shekhar Kumta, Anthony Ho Application: Sept 2006 Duration: 01 Jan 2007 to 31 Dec 2008 Award: HK$ 386,000 Location:Teaching & Learning Resources Centre

Sept 2008Curriculum Retreat – Virtual Patient What is a virtual patient? Internet based simulated patient Presented as series of story pages Integrated with question pages & feedback

Sept 2008Curriculum Retreat – Virtual Patient Thinking behind virtual patients: Illness & treatment take places over weeks / months / years. Undergraduate teaching is fragment –“Snap shots” of the process –Don’t witness the whole disease process Virtual environments allow students to follow a single patient scenario from start to end. Patient’s history and condition is teacher controlled.

Sept 2008Curriculum Retreat – Virtual Patient Our objectives: Create a virtual patient (VP) to teach: – Peri-operative (Anaesthetic) care Determine the best method of delivery: –Existing CUHK internet systems

Sept 2008Curriculum Retreat – Virtual Patient Why chose peri-operative care? 1 st year surgical interns: –Preparing patients for surgery –Treating patients after surgery Pain / nausea & vomiting / iv fluids regimens / etc Problem of how to teach peri-operative care: –Ideally - full-time 1-week attachment to anaesthetist –In practice – teaching & exposure very fragmented –Virtual Patient - help us demonstrate the whole process

Sept 2008Curriculum Retreat – Virtual Patient Outline of case: Sections 1Pre-assessment outpatient clinic 2Pre-operative assessment on ward 3Preparing for the anaesthetic 4The anaesthetic 5Recovery room 6Post operative care

Sept 2008Curriculum Retreat – Virtual Patient Contents: Sections6 Web pages162 Pictures & illustrations344 Tables & pop ups57 Summary pages8 Self-scoring questions29

Sept 2008Curriculum Retreat – Virtual Patient Topics: Anaesthetic assessment clinics Anaesthetic assessment: –Airway assessment –Consent, etc Patient safety issues: –Checks Giving antibiotics Blood administration Preventing hypoxia Performing anaesthesia –Airway management –Intubation –Anaesthetic drugs –Monitoring –Computerized records –Reversal Recovery room care Acute pain management –PCA –Continuous epidurals

Sept 2008Curriculum Retreat – Virtual Patient

Sept 2008Curriculum Retreat – Virtual Patient

Sept 2008Curriculum Retreat – Virtual Patient

Sept 2008Curriculum Retreat – Virtual Patient

Sept 2008Curriculum Retreat – Virtual Patient Progress report: Jan 07Started with appointed of research assistant July 071 st draft in web format (text / photos / etc) Nov 07Complete preliminary testing / 2 nd draft Apr 08Tested on 60 Med5 students / focused interviews July 08Sorted out major software issues / TLRC server PresentLaunched version 1 / current Med5-Anaesthesia

Sept 2008Curriculum Retreat – Virtual Patient Evaluation Focus Group Interviews: –A set of questions were developed. –These addressed the main issues / problem with setting up the Virtual Patient. Student-Teacher questionnaires: –Added new items this academic year to include the Virtual Patient

Sept 2008Curriculum Retreat – Virtual Patient Focus Group Interviews (GOODS) Examples of positive feedback QUESTIONSEXAMPLES OF REPLIES Comprehensive to follow the case through the scenario More impressive than reading books / Able to visualise what is going on Easy to read with tables and graphs Whether questions triggered thinking Questions are asking something really important Format of questions (Typed)Helpful for students as have to write medical notes / If not viewed by professor, not highly motivated / Specially good for showing tricky point Summary pages Good to get a checklist of key points Helpful and authentic pictures Helpful for recalling memories

Sept 2008Curriculum Retreat – Virtual Patient Focus Group Interviews (BADS) Examples of negative feedback QUESTIONSEXAMPLES OF REPLIES Lengthy / Lots of unnecessary information Lots of descriptions on clinically irrelevant actions Overlapping contentThe data provided by charts or graphs are described in words as well Unclear focusDifficult to pick up useful bits from long paragraphs Reading comprehension likeJust copy and paste relevant information to answer the questions Typing & grammatical errors Speedwell / Sleepwell No challenging enough VP case does not have any critical health issues Not cost effective Time spent doing VP is much longer than actual process