17th September 2006 Models for Virtual Patients Presented by Jonathan Round.

17th September 2006

Models for Virtual Patients

Presented by

Jonathan Round

17th September 2006Models for Virtual Patients

What is a virtual patient? - entry level

Elements– Scenario– Choices and consequences– First person participant

User interface


Example

Robert is a 6 week old boy who presents to A+E with poor feeding and no other symptoms.

Examination is entirely normal apart from a temperature of 38.1° C

What should you do?

Take blood cultures and start on antibiotics

Reassure and send home with paracetamol


You chose to reassure and send home with paracetamol.

Robert represents 6 hours later unresponsive with intractable convulsions.

A post mortem demonstrates bacterial meningitis.

Fevers in the very young should always be taken seriously as there are rarely any localising signs


Example

Robert is a 6 week old boy who presents to A+E with poor feeding and no other symptoms.

Examination is entirely normal apart from a temperature of 38.1° C

What should you do?

Take blood cultures and start on antibiotics

Reassure and send home with paracetamol


You chose to take blood cultures, clean catch urine, lumbar puncture and start on antibiotics

This is good, because the child had bacterial meningitis. Your interventions saved Robert’s life.

Clinical signs are often absent or subtle in the young.


What is a virtual patient?- advanced levels

Elements– Scenario– Choices and consequences– First person participant

User interface Allows realistic choices Has realistic consequences Appropriate for level of user Links to/contains education


Generic problems

Inflexible Expensive to set up Realistic choice models require clinician time Visually appealing models require programmer time


Clinical realism and the problem of choice - 3 option model

Patient presents 3 options First step 9 options Second step 27 options Third step 81 options

120 potential clinical situations


Different models to cope with choice

Hi-Fi Algorithm based Linear Lo-Fi




High degree of visual/aural realism

Complex programming

Expensive ++

$100,000

Solve problem with cash




Participant choices input information into a calculator that outputs clinical change

Complex formulae at the heart

No narrative

Good for physiology or biochemical scenarios

Solve problem with ‘infinite’ choice




Allows only one route through the scenario

Incorrect responses lead to immediate correction

Minimal real choice

Good to test knowledge of protocols

Poor for realism - problem not solved

Easy to create




Multiple choices at each step

Emphasises decisions

Minimal attention to appearance

Cheap

Problem solved!


Major nodes -

describe major points in

clinical course

Creating a Lo-Fi nodal virtual patient

Presents to GP

Referred to clinic

Investigations

Definitive treatment complete


Major nodes connected by appropriate management choices



Other boxes added and then choices inserted



Whole case completed



QuickTime™ and aSorenson Video decompressorare needed to see this picture.


Mahein Hussain

Welcome. You have now been a paeditrician since 4 pm, when your shift started.

Its day 1 of the job, and you are trying to remember all that stuff from the paed course. Anyway, it wasn't too busy and now you have discovered the mess and the takeaway menus. A Lamb Rogon Josh has arrived and you are half way through, when the crash bleep goes off

"Paediatric arrest in A+E".

What would you like to do?

Finish curry Run to A+E


Advantages of Lo-Fi nodal approach

Quick Adaptable Linkable Uses clinicians and programmers effectively Anyone can do it!


Thanks to… More at…

Chara BalasubramaniamArnold SomasunderamFerhal UtkuTerry Poulton

www.etu.sgul.ac.uk/virtualpatients/examples.htm

17th September 2006 Models for Virtual Patients Presented by Jonathan Round.

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