1. Virtual Patients for Teaching in Medical Education
Sören Huwendiek, Marcel Ecker, Matthias Bauch
University Children’s Hospital Heidelberg, Germany
Centre for Virtual Patients Medical Faculty Heidelberg
AthenaMed Team Heidelberg
Kernaussagen:
beide Settings ok
Studis Bearbeitungsmodus selbst wählen lassen
To do:
Geschlechtsunterschied: zusammenarbeit Kleinstgruppe
Beurteilung insgesamt

2. Zentrum für Kinder- und Jugendmedizin Heidelberg

3. Hier sehen sie als Beispiel ein Ausschnitt eines Inhaltverzeichnis eines Pädiatrie-Lehrbuchs systematisch geordnet nach Erkrankungen. Nach diesem Prinzip wurden auch häufig Vorlesungen abgehalten.
1. Eye-catcher:
z.B. Inhaltsangabe eine Pädiatrie-Buches
2. Abb. eines kranken Kindes
verdeutlichen daran:
Problem: kürzere Liegezeiten (Verdichtung des Leistungsumfang, nur noch schwerkranke Kinder stationär, können nicht alle sehen, jahreszeitlich abhängige Erkrankungen, nur vier Wochen da...

4. Why do we need Virtual Patients ?
Lack of real patients for training of students
Huwendiek et al. 2006, Irby 1995, Huang et al. 2007

5. Why do we need Virtual Patients ?
Lack of real patients for training of students
Shorter stays of patients in hospital
Critical ill patients in university hospitals
Seasonal diseases
Huwendiek et al. 2006, Irby 1995, Huang et al. 2007

6. Why do we need Virtual Patients ?
Lack of real patients for training of students
Shorter stays of patients in hospital
Critical ill patients in university hospitals
Seasonal diseases
Lack in practical training of patient management
Huwendiek et al. 2006, Irby 1995, Huang et al. 2007

7. Why do we need Virtual Patients ?
Lack of real patients for training of students
Shorter stays of patients in hospital
Critical ill patients in university hospitals
Seasonal diseases
Lack in practical training of patient management
Lack of practical training in clinical reasoning
Huwendiek et al. 2006, Irby 1995, Huang et al. 2007

8. Why do we need Virtual Patients ?
Lack of real patients for training of students
Shorter stays of patients in hospital
Critical ill patients in university hospitals
Seasonal diseases
Lack in practical training of patient management
Lack of practical training in clinical reasoning
Lack of valuable feedback
Huwendiek et al. 2006, Irby 1995, Huang et al. 2007

9. Definition of Virtual Patients:
Zentrum für Kinder- und Jugendmedizin Heidelberg
Definition of Virtual Patients:
“An interactive computer simulation
of real-life clinical scenarios
for the purpose of
medical training, education, or assessment”
Ellaway et al. 2006

10. Learning objectives of Virtual Patients:
Zentrum für Kinder- und Jugendmedizin Heidelberg
Learning objectives of Virtual Patients:

11. Learning objectives of Virtual Patients:
Zentrum für Kinder- und Jugendmedizin Heidelberg
Learning objectives of Virtual Patients:
Learning of clinical reasoning with specific VPs:

12. Learning objectives of Virtual Patients:
Zentrum für Kinder- und Jugendmedizin Heidelberg
Learning objectives of Virtual Patients:
Learning of clinical reasoning with specific VPs:
Clinical decision making in a patient with such a
cardinal symptom

13. Learning objectives of Virtual Patients:
Zentrum für Kinder- und Jugendmedizin Heidelberg
Learning objectives of Virtual Patients:
Learning of clinical reasoning with specific VPs:
Clinical decision making in a patient with such a
cardinal symptom
Discriminative features of differential diagnosis

14. Learning objectives of Virtual Patients:
Zentrum für Kinder- und Jugendmedizin Heidelberg
Learning objectives of Virtual Patients:
Learning of clinical reasoning with specific VPs:
Clinical decision making in a patient with such a
cardinal symptom
Discriminative features of differential diagnosis
How to exclude the differential diagnosis

15. Learning objectives of Virtual Patients:
Zentrum für Kinder- und Jugendmedizin Heidelberg
Learning objectives of Virtual Patients:
Learning of clinical reasoning with specific VPs:
Clinical decision making in a patient with such a
cardinal symptom
Discriminative features of differential diagnosis
How to exclude the differential diagnosis
How to confirm the final diagnosis

16. Learning objectives of Virtual Patients:
Zentrum für Kinder- und Jugendmedizin Heidelberg
Learning objectives of Virtual Patients:
Learning of clinical reasoning with specific VPs:
Clinical decision making in a patient with such a
cardinal symptom
Discriminative features of differential diagnosis
How to exclude the differential diagnosis
How to confirm the final diagnosis
-> Not to substitute but prepare best for real patient

17. CAMPUSVirtualPatients
Medical history
Physical examination
Differential diagnosis
Diagnosis therapy loop
Diagnostics (lab./ tech.)
Diagnosis
Therapy plan
Control investigations
Clinical course
x n
Each case starts with a short introduction..
For example like here a 4 day old boy , who had convolsions and come with the ambulance
End of case

18. Concept CAMPUSVirtualPatients for teaching:
- Authentic course and work-up of cases
(simulative system)
Highly interactive
Multimedia-assisted
Flexible
Easy to use authoring system
What s the concept of campus?
CAMPus stands for:
Case-Based Training in Medicine as part of a
Problem-oriented Educational Strategy
CAMPUS-Pediatrics is the pediatric extension of the main campus shell which includes
an authentic course and work-up of pediatric case
presentations
anamnesis-vocabulary for 5 the different age-groups consisting of newborn, infants, todllers, scholage children and adolescents
pediatric specific laboratory tests and technical
investigations
interactive , multimedia-assisted learning by photographs, video and audiofiles,
allows flexible learning: (time, location, platform-independent)
context-sensitive knowledge on demand: like expert comments and links to internal and external knowledge-resources (medline etc.) .
neutral feedback, knowledge questions
“blended learning”
Context-sensitive knowledge on demand by links to internal and
external knowledge-resources (medline etc.)
Extensible
case-oriented educational computer program
authentic course and work-up of pediatric case presentations
interactive learning
simulative learning: great variety of investigative, diagnostic and therapeutic
options
flexible learning: CAMPUS is executable online and locally, can be used flexibly
of time and location and platform-independently
multimedia assisted learning (photographs, audio, video)
links to internal and external knowledge-resources (text book on CD-ROM,
medline, etc.)
neutral feedback, expert comments and knowledge questions
authentic course and work-up of case presentations
simulative learning
flexible learning: (time, location, platform-independent)
Interactive, Flexible, Extensible
Context-sensitive knowledge on demand
Local or Web-based
links to internal and external knowledge-resources (medline etc.)
CAMPUS-Shell
interactive
simulative
flexible
multimedia assisted
context-sensitive knowledge on demand
neutral feedback and expert comments
knowledge questions

19. Expert (e.g. consultant) Case-engineer (e.g. intern)
Supervision
Content development
Case-engineer (e.g. intern)
Case development
Learning
platform
Cases
How are Campus-Ped cases develloped ?
Campus training cases are developed in cooperation of young medical doctors under supervision of medical experts (consultants) on basis of real patient cases.
( the so called case engineers)

20. Expert (e.g. consultant) Case-engineer (e.g. intern)
Supervision
Content development
Case-engineer (e.g. intern)
Case development
Learning
platform
Cases
Authoring tool:
History questions-vocabulary for 5 different age-
groups
Laboratory tests and technical investigations
The Authoring component includes anamnesis questions for 5 different age-groups: newborn, infants, toddlers, scholage-children and adolescents.
All pediatric relevant physical examinations, laboratory and technical investigations are included: you just chose the investigations you would like to include.. and give in the values....
standard normal values are already ageadjusted integrated..
just, give in the age

21. Expert (e.g. consultant) Case-engineer (e.g. intern)
Supervision
Content development
Case-engineer (e.g. intern)
Case development
Learning
platform
Cases
Authoring tool:
Easy integration of:
Flexible multi-level knowledge
Knowledge questions (MCQ, Long Menu etc.)
Multimedia
The Authoring component includes anamnesis questions for 5 different age-groups: newborn, infants, toddlers, scholage-children and adolescents.
All pediatric relevant physical examinations, laboratory and technical investigations are included: you just chose the investigations you would like to include.. and give in the values....
standard normal values are already ageadjusted integrated..
just, give in the age

22. Authoring tool Details Window Here you see the authoring system:
An extendable base case structure is given and you fill it with case-information, including text, media-files and links.
On the left side you see the case structure...
The authoring component allows the easy input of case presentations without any knowledge of computer sciences.
Evtl. demo authoring system, engl. screen-shot? Auswahlfenster etc...
Case Structure Window
Media Window

23. Expert (e.g. consultant)
Supervision
Case-engineer (e.g. intern)
Content development
Case development
Learning
platform
Textbook knowledge
Communication
chat,
Cases
Assessment
CAMPUS-Ped can flexibly be used in different application scenarios.
Is a case once in the authoringsystem, it can be presented in different player-modes…
The most interactive form is ideal for students to learn basic clinical skills like taking an pediatric anamnesis, performing an pediatric physical examination etc.
For PBL and CME less complex player modes are superior to our opinion..
and problem solving competence
This is used for self- and small group study: here two students work through a case together, for about an hour, then the whole group consiting of 8 Students discuss about the case, while all the time a tutor is present.
Less interactive forms can be used…
Selfstudy is possible via the learning platform, the internet and published CDs and cases on the cds which we give the students..
Last year CAMPUS-Ped has been used in an OSCE for the first time, where all acts of the user were recorded..
CAMPUS-Ped is used for PBL in Berlin, where Kai Sostman demonstrates a poster.
Further Campus offers the possibility to switch from this decision mode, where the user has to take a full history , physical exam etc at any stage to a presentationmode, where case-information is presented..., which alows the flexibel use...
Another presentation form “ the lightplayer” has been developed, which uses the... Format...
The most interactive form is ideal for students to learn basic clinical skills and problem solving competence. Here the user cares for his patient in a virtual Children’s Hospital by taking a full medical history, ordering all required physical, laboratory or technical examinations, and making diagnostic and therapeutic decisions
(At the moment campus pediatrics is mainly used in its most interative form.)
Self-study
Small
group
study
Application
CME
PBL
Tutors / Students / Physicians

24. Player component Technical Examination Case Selection
Laboratory Examination
Physical Examination
Medical History
Now I would like to give you a short presentation of CAMPUS in its most interaktive way:
Here you can see the doctors office: when clicking on this field you can take the anamnesis...
Patient Record
Tutor
Time-Line

25. CAMPUS-“Thin-Player“
Now I will demonstrate you some slides in the lightplayer-version..
This is side (/ html java script) based..... With a very easy navigation-> CME!!!
Here as MCQ, but currently the possibility to show the items as LMQ are developped.
This the presentation of the same case by the lightplayer...

26. PBL-Case Extractor Tutor handout Student handout Deskription of media
From the authorsystem…Possibility to easily devellop PBL- cases with an easy media presentation mode!!

27. Centre for Virtual Patients Heidelberg
Virtual Patient (VP) working group since 1997
VPs are curricular integrated since 1999
CAMPUS VPs are used at several national and
international medical faculties..
VPs as assessment tool since 2006
Two VP player types available since 2005
6 awards for the CAMPUS VP-system

28. Centre for Virtual Patients Heidelberg
Part of the EU-project: electronic Virtual Patients
since 2007 (
Students world health symposium 2007:
-> CAMPUS VPs for multiprofesional education
Planned in Heidelberg: Longitudinal VPs project:
-> VPs in every speciality incl. preclinical
as learning and assessment tool

29. Virtual Patient Studies
1. Design of Virtual Patients
2. Curricular integration of Virtual Patients
- Students want to have them in any speciality
- Feel best prepared for real patients with VPs
- At least one VP per week
Huwendiek et al. 2006a, Huwendiek et al 2006b

30. Zentrum für Kinder- und Jugendmedizin Heidelberg