jonathan round, alex higton , terry poulton

REACHING PARTS MEDICAL EDUCATION DOESN’T 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 goRisk free practiceDeliver standardised experience in a (virtually) real way

3 models extending VPs

The virtual ward roundThe virtual clinicThe multi-professional virtual patientError patient

Virtual Ward Round What’s missing

Rationale

Design

Resources

Feedback

Virtual Ward Round What’s missing…ward savvy, ward nouse, the

clinical processRationale…online delivery of a week’s ward action

Design…html, frames driven, multiple linear, control over informationResources…internet connection, projector, facilitatorFeedback

Virtual Ward Round ContextMonday Registration

Ethics in PaediatricsNeonatology 1Neonatology 2Intro and Virtual Ward Round Day 1Paediatric Endocrinology 1

Tuesday GeneticsNutrition and GrowthChronic Paediatric Neurology/ DevelopmentPaediatric Endocrinology 2Virtual Ward Round Day 2

Wednesday Child Psychiatry 1 Child Psychiatry 2Paediatric SurgeryVirtual Ward Round Day 3

Thursday Paediatric GastroenterologyAcute Paediatric NeurologyChild SafeguardingOncologyImages in Paediatrics Virtual Ward Round Day 4

Friday Respiratory Paediatrics Paediatric CardiologyVirtual Ward Round Day 5Common Paediatrics Infections

Introductionwardwardwardwardward

Course structure

VWR Aims…

EXPOSURE

UNMASKING

THE CLINICAL PROCESS

REAL PROBLEMS

WARD WISDOM

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 FridayThursdayTuesday Wednesday

Bed 3

Bed 1

Bed 2

Bed 4

www.jround.co.uk/virtual_ward_round/d1_bedview.html

Bed 3

Bed 1

Bed 2

Bed 4

Bed 3

Bed 1

Bed 2

Bed 4

Bed 3

Bed 1

Bed 2

Bed 4

Bed 3

Bed 1

Bed 2

Bed 4

Site Architecture…Monday FridayThursdayTuesday Wednesday

Bed 3

Bed 1

Bed 2

Bed 4 DevelopmentsHistory

ExaminationInvestigations

FluidsTreatment

DevelopmentsHistory

ExaminationInvestigations

FluidsTreatment

DevelopmentsHistory

ExaminationInvestigations

FluidsTreatment

DevelopmentsHistory

ExaminationInvestigations

FluidsTreatment

www.jround.co.uk/virtual_ward_round/d1_bedview.html

VWR ratings

Content

Presentation

3.9 4 4.1 4.2 4.3 4.4 4.5 4.6

courseVWR VWR

Other

Likert scale Most valuable session

221 students, 6 rotations

Feedback

www.jround.co.uk/virtual_ward_round/d1_bedview.html

Comments…Strengths

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.

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.

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 ClinicWhat’s missing…multiple sequential clinical related challengesRationale…prepare students, expose students to a

“morning’s” work. consolidation of learningDesign…decision simulation, linear/branched

Resources…individual or small group learning, internet connection

Feedback…

Comments - StrengthsReally goodPlease provide more to medical schoolsvery useful excersizeExcellent resource - promote

Allowed numerous cases to be explored at once in quick succession

Good to be given numerous clinical scenariosComplements PBL

You get to think like a doctorChoices 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 outcomesDoesn’t tell you the idea path,

can’t be bothered to do it againToo long to complete.

Multiprofessional Virtual PatientWhat’s missing...seeing patients from another angle, integrated care, teamworkRationale…expose students to same VP, but from

different angles, allow to switchDesign…multitrack VP, with crossover points and

joint meetings. Decisionsimulation/labyrinthResources…individual/small group, internet enabled computerFeedback

Error Virtual PatientWhat’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

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a lotquite a bita littlenone

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

Standing up to someone who is more “specialised” than youis difficult and scary but sometimes it needs doing and is an

important thing to learn how to do

Adjectives

What will I take away

ConclusionsMany situations where ‘typical’ VP may not be mimic clinical realityAdaptions to VP model stretch reach of the virtual patientStudents challenged and appreciative of new designs

www.jround.co.uk/virtual_ward_round/d1_bedview.htmlapp.decisionsimulation.com 

Chest ClinicLauren BrookErrol Rouch