Timothy Willett RCPSC Pierre Cardinal uOttawa amp RCPSC Angele Landriault RCPSC Thomas Low uOttawa MedBiq Conference 11 May 2011 Disclosure Employee of Royal College Royal College owns SimuCase ID: 433607
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Can a virtual patient be used as an individual, team and system needs assessment tool?
Timothy Willett
, RCPSC; Pierre Cardinal, uOttawa & RCPSC; Angele Landriault, RCPSC; Thomas Low, uOttawa
MedBiq
Conference, 11 May 2011Slide2
Disclosure
Employee of Royal College
Royal College owns SimuCase
2Slide3
Needs Assessment
1
st
step in curriculum development
Perceived vs. unperceived
Not all needs are educational
Moore DE, Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. The Journal of continuing education in the health professions. 2009;29(1):1-15.Kern DE, Thomas PA, Howard DM, Bass EB. Curriculum Development for Medical Education: A Six Step Approach. Baltimore, MD: Johns Hopkins Press; 1998:192.
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Needs assessment
Broad
ICU had self-identified desire to improve recognition & care for massive PE
Focussed
What is the ideal care?
What is reality?
What are priority needs?4Slide5
Virtual Patients
“Specific type of computer program that simulates real-life clinical scenarios; learners emulate the roles of health care providers to obtain a history, conduct a physical exam, and make diagnostic and therapeutic
decisions.”
Cook DA, Triola MM. Virtual patients: a critical literature review and proposed next steps.
Medical education
. 2009;43(4):303-11.
Variety of VPsLinear vs. branchedIndividual vs. groupSynchronous vs. asynchronousHuwendiek S, De Leng
BA,
Zary
N, et al. Towards a typology of virtual patients.
Medical Teacher
. 2009;31(8):743-748.
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SimuCase Virtual Patient
Live, face-to-face
Individual or small group
Facilitator + operator
Open-ended
Text, photos, videos, dynamic vital sign monitor
Feedback from facilitator6Slide7
SimuCase Virtual Patient
7
Care team
Operator
FacilitatorSlide8
Research questions
Can a VP aid with needs assessment?
What kinds of needs?
Individual?
Team?
System/resource?
Perceived or unperceived?PILOT INVESTIGATION ONLY8Slide9
Method
Two care team groups
1 MD (ICU fellow)
2 RNs
1
RT
or pharmacistCase: 65F with massive PE (based on real case)40 min with case, uninterruptedNotes made by 2 MD and 1 RN facilitatorsFeedback & discussion afterwards9Slide10
The Case
Background
65 F
3-day
hx
progressive dyspnea & chest pain
PMHx hypertensionSeen in ER overnight and admitted to ICUOn exam:Severely dyspneicO2 sats >90% on room airBP low by her standards10
Course
Responds to O2 but dyspnea continues
Chest pain is
pleuritic
BP
trends down, little response to IV fluids, some response to
pressors
Requires workup
Goes
into PEA arrest if sent for CT or sedated or inadequate
pressors
Requires
thrombolysisSlide11
Results
Team did work as team
MD led, input from others
1 group: RN very experienced and assertive
Discussed resources
RN: “I’ll need to leave for 2 minutes to do that – want me to?”
“Don’t have that available – need to order from pharmacy”Knowledge, cognitive, and communication errorsFixation on wrong diagnosisFailure to share mental model11Slide12
Types of Needs
Unperceived
Individual
Team
System/resource From debrief: WHY12Slide13
Types of Needs
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CanMEDS
role
Individual
Team
System/ resources
Medical Expert
Communicator
Collaborator
Health Advocate
Manager
Scholar
ProfessionalSlide14
Conclusions
Preliminary!
VP identifies unperceived needs
Individual, team and system
Variety of professional roles
Can further explore WHY
Educational for participants14Slide15
Matrix (examples)
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CanMEDS
role
Individual
Team
System/ resources
Medical Expert
Knowledge, pt assessment, mgmt, problem-solving…
Problem-solving, task prioritization…
Resources for assessment & mgmt
& support…
Communicator
Share mental model, listen, assertiveness, elicit info…
Synthesis into shared care plan…
Systems for
comm
, arranging transfer…
Collaborator
Own role, delegation, leadership, conflict resolution…
Role
adaptivity
, synthesis, situational awareness,
confl res…Policies on roles/ responsibilities, support for collaboration…
Health AdvocateRecognition & system activation…System response mechanisms, barriers to access care…Manager Own role, leadership, priority-setting, resource allocation…
Synthesize care plan, resource optimization…Support & barriers to team-based care…ScholarInsight into limitations, peer feedback…Insight into limitations…
ProfessionalEthical practice, interprofessional attitudes…Slide16
Next steps
More rigorous evaluation
Test as part of multifaceted needs assessment
Refine strengths, weaknesses
Does VP add anything new/different?
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Thank you
Questions?
twillett@royalcollege.ca
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