1. Can a virtual patient be used as an individual, team and system needs assessment tool? Timothy Willett, RCPSC; Pierre Cardinal, uOttawa & RCPSC; Angele Landriault, RCPSC; Thomas Low, uOttawa MedBiq Conference, 11 May 2011

2. Disclosure Employee of Royal College Royal College owns SimuCase 2

3. Needs Assessment 1 st step in curriculum development Perceived vs. unperceived Not all needs are educational Moore DE, Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. The Journal of continuing education in the health professions. 2009;29(1):1-15. Kern DE, Thomas PA, Howard DM, Bass EB. Curriculum Development for Medical Education: A Six Step Approach. Baltimore, MD: Johns Hopkins Press; 1998:192. 3

4. Needs assessment Broad ICU had self-identified desire to improve recognition & care for massive PE Focussed What is the ideal care? What is reality? What are priority needs? 4

5. Virtual Patients “Specific type of computer program that simulates real-life clinical scenarios; learners emulate the roles of health care providers to obtain a history, conduct a physical exam, and make diagnostic and therapeutic decisions.” Cook DA, Triola MM. Virtual patients: a critical literature review and proposed next steps. Medical education. 2009;43(4):303-11. Variety of VPs Linear vs. branched Individual vs. group Synchronous vs. asynchronous Huwendiek S, De Leng BA, Zary N, et al. Towards a typology of virtual patients. Medical Teacher. 2009;31(8):743-748. 5

6. SimuCase Virtual Patient Live, face-to-face Individual or small group Facilitator + operator Open-ended Text, photos, videos, dynamic vital sign monitor Feedback from facilitator 6

7. SimuCase Virtual Patient 7 Care team Operator Facilitator

8. Research questions Can a VP aid with needs assessment? What kinds of needs? Individual? Team? System/resource? Perceived or unperceived? PILOT INVESTIGATION ONLY 8

9. Method Two care team groups 1 MD (ICU fellow) 2 RNs 1 RT or pharmacist Case: 65F with massive PE (based on real case) 40 min with case, uninterrupted Notes made by 2 MD and 1 RN facilitators Feedback & discussion afterwards 9

10. The Case Background 65 F 3-day hx progressive dyspnea & chest pain PMHx hypertension Seen in ER overnight and admitted to ICU On exam: Severely dyspneic O2 sats >90% on room air BP low by her standards 10 Course Responds to O2 but dyspnea continues Chest pain is pleuritic BP trends down, little response to IV fluids, some response to pressors Requires workup Goes into PEA arrest if sent for CT or sedated or inadequate pressors Requires thrombolysis

11. Results Team did work as team MD led, input from others 1 group: RN very experienced and assertive Discussed resources RN: “I’ll need to leave for 2 minutes to do that – want me to?” “Don’t have that available – need to order from pharmacy” Knowledge, cognitive, and communication errors Fixation on wrong diagnosis Failure to share mental model 11

12. Types of Needs Unperceived Individual Team System/resource From debrief: WHY 12

13. Types of Needs 13 CanMEDS roleIndividualTeamSystem/ resources Medical Expert Communicator Collaborator Health Advocate Manager Scholar Professional

14. Conclusions Preliminary! VP identifies unperceived needs Individual, team and system Variety of professional roles Can further explore WHY Educational for participants 14

15. Matrix (examples) 15 CanMEDS role IndividualTeamSystem/ resources Medical Expert Knowledge, pt assessment, mgmt, problem-solving… Problem-solving, task prioritization… Resources for assessment & mgmt & support… Communicator Share mental model, listen, assertiveness, elicit info… Synthesis into shared care plan… Systems for comm, arranging transfer… Collaborator Own role, delegation, leadership, conflict resolution… Role adaptivity, synthesis, situational awareness, confl res… Policies on roles/ responsibilities, support for collaboration… Health Advocate Recognition & system activation… System response mechanisms, barriers to access care… Manager Own role, leadership, priority-setting, resource allocation… Synthesize care plan, resource optimization… Support & barriers to team-based care… Scholar Insight into limitations, peer feedback… Insight into limitations… Professional Ethical practice, interprofessional attitudes…

16. Next steps More rigorous evaluation Test as part of multifaceted needs assessment Refine strengths, weaknesses Does VP add anything new/different? 16

17. Thank you Questions? twillett@royalcollege.ca 17