Dungeons & Dragons Taught Me How to Make Better VPs

Mike Paget, Janet Tworek,Kevin McLaughlin, Bruce Wright

University of CalgaryCalgary, Alberta, Canada

Randomizing Physiological Data to Rapidly Produce 97 Clinically Realistic VPs

Overview

Requirements

1. Create 97 VPs for full year course– Clerkship (Year 3) students– Little SME time– Past experience with templates• Time consuming• Overlooked data

– No preexisting cases for UofC context

Requirements

2. Clinically accurate values and variety in VP- Names- History - Laboratory - Physical Exam

Solution - Gaming

Dungeons and Dragons

Solution - GamingDungeon Master’s Guide• Randomized realism• Qualities related to

numbers

Solution - GamingDungeon Master’s Guide• Randomized realism• Qualities related to

numbers

Virtual Patients• Assign text strings to

numbers• Treat numeric data as

numbers that fall within a pre-specified range.

Solution: Process of Creating VPs

1a. Create Template for VPsNode Patient Response

Any diseases run in the family?

Lab: Anti Hepatitis A Virus - Total

Lab: Chemistry Na – Sodium

Knee exam:

Do you have any pets?

• HxExIxDxRx model of VPs• Set questions

1b. Create dB tables of VP data

ID Pet 1 No, I don’t like animals2 I have 3 dogs3 I have a cat I took in4 Just a goldfish5 I have a dog, but I think I might be allergic

ID Positive or Negative

1 Positive

2 Negative

ID Diseases that run in the family

1 Cancer

2 Stupidity

3 Heart attacks

4 Lung cancer

5 Arthritis

6 Accident prone

7 Asthma

8 Strokes

9 Dementia

10 Pneumonia

2a. Create Specific Data Range by Node

Node Low High Additional Text

Any diseases run in the family?

1 10 Not applicable

Lab: Anti Hepatitis A Virus - Total

1 2

Lab: Chemistry Na – Sodium 133 145 Normal range between 133 to 145 mmol/L

Knee exam: 1 1

Do you have any pets? 1 5

2b. Randomly Assign ID Values in Data Range to specific VPs

Node Patient 1 Patient 2 Patient 3 Additional Text

Any diseases run in the family? 3 8 1

Lab: Anti Hepatitis A Virus - Total 1 1 2

Lab: Chemistry Na – Sodium 137 139 141 Normal range between 133 to 145 mmol/L

Knee exam: Active movement:Flexion 140 degrees, Ext….

Active movement:Flexion 140 degrees, Ext….

Active movement:Flexion 140 degrees, Ext….

Do you have any pets? 3 5 2

3a. Create report by linking randomized ID values to text fields in appropriate tables

3b. Convert IDs to actual values & textNode Patient 1 Patient 2 Patient 3 Additional Text

Any diseases run in the family? Heart attacks

Strokes Cancer

Lab: Anti Hepatitis A Virus - Total Positive Positive Negative

Lab: Chemistry Na – Sodium 137 139 141 Normal range between 133 to 145 mmol/L

Knee exam: Active movement:Flexion 140 degrees, Ext….

Active movement:Flexion 140 degrees, Ext….

Active movement:Flexion 140 degrees, Ext….

Do you have any pets? I have a cat I took in

I have a dog, but I think I might be allergic

I have 3 dogs

Proofing VPs

4a. Normal Template to SME

4b. SME records editsNode John Smith Additional Text

Any diseases run in the family? Kidney disease in a few relatives

Lab: Anti Hepatitis A Virus - Total Positive

Lab: Chemistry Na – Sodium 160 Normal range between 133 to 145 mmol/L

Knee exam: Active movement:Flexion 140 degrees, Ext….

Do you have any pets? I have a dog, but I think I might be allergic

5. Upload content to OLab

• SME time

Multiple cases at once

• Insert picture of multiple cases

Results

• Time: – 20 mins per VP– 45 mins per side-by-side VPs (2)

• Salient negatives, positives/normals• Side-by-side– Contextual cues & patterns by presentation or

diagnosis– Complexity of medicine

Result – Clinically accurate content

Conclusions

• Education as driver• Realistic VPs = data issue– Leverage gaming, dB experience– Existing software + open source VP software

• Multiple clinically accurate VPs– Appropriate personnel use– Complexity of Medicine

• Sharing

Conclusions

• Gaming “nerd” = VP programming superhero

Thank You

Janet Tworekjktworek@ucalgary.ca