Reaching parts medical education doesn't reach Innovative

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					REACHING PARTS MEDICAL EDUCATION DO
             REACH

   INNOVATIVE APPROACHES IN CLINICAL
    EDUCATION USING VIRTUAL PATIENTS


   Jonathan Round, Alex Higton, Terry Poulton 
 
What do Virtual Patients do well?
Take you to places you can’t or shouldn’t go
Risk free practice
Deliver standardised experience in a (virtually) real way
3 models extending VPs
The virtual ward round
The virtual clinic
The multi-professional virtual patient
Error patient
Virtual Ward Round 
What’s missing

Rationale

Design

Resources

Feedback
Virtual Ward Round 
What’s missing…ward savvy, ward nouse, the 
     clinical process
Rationale…online delivery of a week’s ward action

Design…html, frames driven, multiple linear, 
     control over information
Resources…internet connection, projector, 
     facilitator
Feedback
 Virtual Ward Round Context
Monday      Registration
            Ethics in Paediatrics
            Neonatology 1
            Neonatology 2
            Intro and Virtual Ward Round Day 1
            Paediatric Endocrinology 1
Tuesday     Genetics
            Nutrition and Growth
            Chronic Paediatric Neurology/
            Development
            Paediatric Endocrinology 2                       Introduction
            Virtual Ward Round Day 2                         ward
Wednesday   Child Psychiatry 1                    Course     ward
            Child Psychiatry 2                   structure   ward
                                                             ward
            Paediatric Surgery                               ward
            Virtual Ward Round Day 3
Thursday    Paediatric Gastroenterology
            Acute Paediatric Neurology
            Child Safeguarding
            Oncology
            Images in Paediatrics
            Virtual Ward Round Day 4
Friday      Respiratory Paediatrics
            Paediatric Cardiology
            Virtual Ward Round Day 5
            Common Paediatrics Infections
VWR Aims…
  EXPOSURE                     REAL PROBLEMS




      UNMASKING                WARD WISDOM




 THE CLINICAL PROCESS             ENGAGING




                    FEASIBLE




                                 www.jround.co.uk/virtual_ward_round/d1_bedview.html
Challenges…
CONCEPT


          LAYOUT



                   PROGRAMMING



                             CASE WRITING



                                                     DELIVERY



                                     www.jround.co.uk/virtual_ward_round/d1_bedview.html
Tools used…




              www.jround.co.uk/virtual_ward_round/d1_bedview.html
www.jround.co.uk/virtual_ward_round/d1_bedview.html
 Site Architecture…
Monday   Tuesday   Wednesday   Thursday                      Friday


 Bed 1    Bed 1     Bed 1        Bed 1                          Bed 1



 Bed 2    Bed 2     Bed 2        Bed 2                          Bed 2



 Bed 3    Bed 3     Bed 3        Bed 3                          Bed 3



 Bed 4    Bed 4     Bed 4        Bed 4                          Bed 4



                               www.jround.co.uk/virtual_ward_round/d1_bedview.html
 Site Architecture…
Monday    Tuesday         Wednesday   Thursday                      Friday
         Developments
                History
           Examination
 Bed 1   Investigations
                 Fluids
             Treatment
         Developments
                History
 Bed 2     Examination
         Investigations
                 Fluids
             Treatment
         Developments
                History
 Bed 3     Examination
         Investigations
                 Fluids
             Treatment

 Bed 4   Developments
                History
           Examination
         Investigations
                 Fluids
             Treatment                www.jround.co.uk/virtual_ward_round/d1_bedview.html
VWR ratings
221 students, 6 rotations




 Presentation




                                                           course
                                                           VWR                              VWR
                                                                                            Other



     Content




                3.95    4.05   4.15   4.25   4.35   4.45    4.55




                       Likert scale                                 Most valuable session
Feedback




           www.jround.co.uk/virtual_ward_round/d1_bedview.html
Comments…Strengths
Virtual ward round gave us an insight into the 
        management of different conditions. 
The Virtual WR were good at bringing 
        all topics together and making you think.
Virtual ER - management of common problems 
        and what happens in real life. 

          The virtual ward round may be less cases,
               but to go through them in more detail.
        Virtual Ward Round is a great idea, but feels
         a bit much and 30 mins is not enough time.
                               I loved the Virtual WR.
 Comments…Weaknesses

Virtual Ward Rounds at the start of the day.
I was exhausted and brain dead by the time the
       Virtual Ward Round came around.
       Maybe do it in the morning!
Less (maybe 3) Virtual WR patients or longer time.
Virtual WR is helpful but too many patients.
Virtual Clinic
What’s missing…multiple sequential clinical related 
     challenges
Rationale…prepare students, expose students to a 
     “morning’s” work. consolidation of learning
Design…decision simulation, linear/branched

Resources…individual or small group learning, 
     internet connection
Feedback…
Comments - Strengths
Really good
Please provide more to medical schools
very useful excersize
Excellent resource - promote


                  Allowed numerous cases to be explored
                                 at once in quick succession
           Good to be given numerous clinical scenarios
                                           Complements PBL
                                You get to think like a doctor
         Choices within vignettes allow clinical reasoning
     Brought it to life – nice to do PBL process on my own .
  Comments - weaknesses

Guidance needed on …
        CXR intrepretation…UEC values
Where’s the back button?
        I’d like to review CXRs later in the case
I’d like to explore different outcomes
Doesn’t tell you the idea path,
        can’t be bothered to do it again
Too long to complete.
Multiprofessional Virtual Patient
What’s missing...seeing patients from another 
     angle, integrated care, teamwork
Rationale…expose students to same VP, but from 
     different angles, allow to switch
Design…multitrack VP, with crossover points and 
     joint meetings. Decisionsimulation/labyrinth
Resources…individual/small group, internet 
     enabled computer
Feedback
Error Virtual Patient
What’s missing…learning from past mistakes

Rationale…professionals make the same mistakes 
     over and over and over again
Design…branched VP

Resources…decision sim, for asynchronous or 
     group work
Feedback
Timeline
           Nov 2009
Error feedback
                 18


                 16


                 14


                 12


                 10
                                                                                a lot
                                                                                quite a bit
                 8
                                                                                a little
                                                                                none
                 6


                 4

             1
                 2
             2

                 0
                      clinical    challenge     user     revision      new 
                      realism                 friendly     use       learning
Adjectives
anticipation of difficulties    different    interesting    realistic    thought provoking
  can we have another           engaging     interesting    realistic    thought provoking
challenging                    enjoyable     interesting    realistic    thought provoking
challenging                     familiar     interesting    realistic    useful
challenging                    frightening   irresolute     realistic    useful
challenging                       fun        prioritising   realistic    useful
challenging                      helpful     prioritising   realistic   utilisation of personel
challenging                      helpful      realistic     relevant
challenging                    informative    realistic      scary
complicated                    informative    realistic      scary




                                                                                          What will I take away

                                      Standing up to someone who is more “specialised” than you
                                      is difficult and scary but sometimes it needs doing and is an
                                                                   important thing to learn how to do
Conclusions
Many situations where ‘typical’ VP may not be 
mimic clinical reality
Adaptions to VP model stretch reach of the virtual 
patient
Students challenged and appreciative of new 
designs

www.jround.co.uk/virtual_ward_round/d1_bedview.html
app.decisionsimulation.com 
        Chest Clinic
        Lauren Brook
        Errol Rouch

				
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