developing a knowledge base of interactive cases teaching prescribing in hospitals

Shock of the Old 2005 | Prescriptions | [email protected]

Developing a knowledge

base of interactive

cases teaching

prescribing in hospitals

• Presentation Aims• Project Aims• Who’s Involved• Use Cases• Initial Position• Technical Challenges• Approach• Achievements• Demo• Questions


Presentation Aims

Raise Awareness• Educators

– Ease with which online content can be created

– Potential use of knowledge bases in learning contexts

• Technologists– Small, structured, interactive

components can EASILY be incorporated into online content management systems

– Large applications with suitable APIs have potential educational use and value


Education by

Questioning

Shockingly Old

Can it be, Ischomachus, that asking questions is teaching? I am just beginning to see what is behind all your questions. You lead me on by means of things I know, point to things that resemble them, and persuade me that I know things that I thought I had no knowledge of. — Socrates (Quoted in Xenophon's "Economics”)


TASK

Minor Childhood

MedicalCondition

• Think back to your childhood

• Pick a minor medical condition that you had then e.g.

– Bad belly– Bumped elbow– Scraped knee– Bit of a cold

• On your card write

– Your name (optional)– The name of the condition– Something that made it feel better– Something that would have made it feel

worse

• We’ll be using the information on your card in a later exercise


Project Aims

• Interactive case studies• Medical students• Spot errors in

prescriptions• Correct the errors• Get feedback• Realistic as possible


Project Aims

Challenges

• Lots of forms• Lots of boxes on the

forms• Different form designs in

different hospitals• The completed forms

need to be meaningful and correct

• Need to give feedback on all forms in a case


Who’s Involved

• NHS– Bee Wee– Rhagib Ali– Diane Evans

• MSD Teaching and Learning– Vivien Sieber– Andrew Stenhouse– Phil Rees


Use Cases

StudentDomainExpert

Create/Edit Case

Read Scenario

View Forms

Correct Errors

Suggest Additional Therapies

Obtain Feedback

Create Knowledge BaseDeveloper

Create/Edit Scenario

Create/Edit Forms

Release Case

Create/Edit Supplimentary Questions

Create Editing Framework

Answer Supplimentary Questions


Initial Position

• QuestionMark Perception/TOIA– Questions with Feedback– Different question types– Questions don’t interact

• Flash– Control of visual design

• WebLearn– Central Navigation


Technical Challenges

• Forms– Look real– Capture data effectively– Change appearance

without changing function

• Feedback– Complex set of choices

and interactions

• Content Authoring– Easy and intuitive– No bottlenecks


Approach

• Forms– Visual Design– Data Handling

• Marking and Feedback• Content Creation


Approach

Forms

Design in Flash

• Screen versions look like paper versions

• Basic validation of data can be handled in Flash


A Flash Version of a

Standard Form


Approach

Forms

Data in XML

• XML = Extensible Markup Language

• Separates how something looks from what it means

• Same XML can be used for two different designs of the same form

• <readable> <by>humans</by> <by>machines</by></readable>


A Sample of XML

Generated by Flash

<?xml version="1.0" encoding="utf-8"?><WQN255><Identification><Name>Name</Name><Address><Line1>1</Line1><Line2>2</Line2><Line3>3</Line3></Address><Consultant>4</Consultant><HospitalNumber>klj</HospitalNumber><AreaCode>kljlkj</AreaCode><Sex>lklkj</Sex><DateOfBirth>lkjkjlk</DateOfBirth><Weight>lkjlk</Weight></Identification><Medication><Item><Drug>lklklk</Drug><Dose>jlkj</Dose><Route>lkjlkj</Route><Continue>lkjlk</Continue><Pharmacy>lkjl</Pharmacy></Item>


The Cool Web

Robert Graves

Children are dumb to say how hot the day is,How hot the scent is of the summer rose,How dreadful the black wastes of evening sky,How dreadful the tall soldiers drumming by. But we have speech, to chill the angry day,And speech, to dull the rose’s cruel scent.We spell away the overhanging night,We spell away the soldiers and the fright. …


Approach

Creating a Knowledge

Base for Marking,

Feedback and

Questioning

• Protégé• Ontology Editor• Knowledge Base

Framework• National Library of

Medicine• Stanford Medical

Informatics


Approach

Knowledge Base

What do we mean by

Ontology?

• An ontology is a specification of a conceptualization.Tom Gruber, Stanford

• Contains– Classes (types of thing)– Instances (individual

things)– Relationships– Constraints


Approach

Knowledge Base

Ontology

• People– Patient– Doctor– Pharmacist

• Condition• Drug• Signs• Symptoms• Indication• Contra-Indication• Side Effect


Approach

Knowledge Base

Ontology

• Patient have underlying Conditions• Conditions may be treatable by Drug

therapies • Patients may exhibit signs• Patients may exhibit symptoms• Signs and symptoms may inform

diagnoses • Diagnoses, signs and symptoms may

indicate the appropriateness of particular drug therapies

• Prescribing particular drugs may be contra-indicated by the prescription of other drugs or by the existence of signs, symptoms or additional diagnoses

• Particular drugs may cause side effects

etc. etc. etc. . . . . . .


Approach

User Interface

for Content Creation

• Magnolia– Content Management System– Page Templates– Paragraph Templates*– Custom Controls*– Standards Based (JSR-170)

• Flash– WYSIWYG Form Editing

• Magnolia + Flash– Easy Interface– Case Creation– Prescription Form Generation


Achieved So Far

• Ontology – initial version• Flash XML libraries• Content Creation

framework• Developed Case Content


Demo

N.B. This is the backend.

We’re seeing the model,

not the final application.

• Quick tour of a small knowledge base

• Group construction of a knowledge base (have your cards ready)http://www.cmaj.ca/cgi/content/full/169/12/1294

• Constraint Checking• Two visualisation tools

http://www.cmaj.ca/cgi/content/full/169/12/1294


Potential

Generating Follow-up Questions

A return to the

Socratic?

• You’ve prescribed Drug X which signs and symptoms led to you this choice?

• What other drug could you prescribe for Condition Y?

• What other conditions could Drug X be prescribed for?

• Some of the drugs you’ve prescribed have interactions. Identify them.

• Your patient is now showing Sign Y. Which of your drugs could be causing this? What alternatives are there?


Links

• ProtégéOntology editorhttp://www.protege.stanford.edu

• MagnoliaContent Management Systemhttp://www.magnolia.info

• FlashGraphical Web Interactionshttp://www.macromedia.com

• Flash XPath LibrariesManipulating XML in Flashhttp://www.xfactorstudio.com

http://www.protege.stanford.edu/

http://www.magnolia.info/

http://www.macromedia.com/

http://www.xfactorstudio.com/


Questions and

Discussion

• Who has the first question?

developing a knowledge base of interactive cases teaching prescribing in hospitals

Documents

interactive components

potential educational

suitable apis

errorsget feedbackrealistic

formsdifferent form

flashscreen versions

intuitiveno bottlenecksshock

feedbackcontent creationshock