Simulating patient encounters with multimedia case studies.

John Priestley, MA, Carolyn Peel, MD, Jeanne Schlesinger, MEd, and Chris Stephens

Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA

ABSTRACT:

Problem and intervention: Family Practice faculty in the VCU School of Medicine identified a need to enhance student training in skills pertaining to patient encounters, such as examination and interviewing skills, cultural competency, and problem management. To address this need, medical teaching faculty and the VCU School of Medicine Office of Faculty and Instructional Development have developed a framework for a set of eight interactive multimedia case studies designed for third-year medical students. The cases are to be delivered on CD-ROM, linked to current materials maintained on the Internet.

Case design: Each case addresses a clinical problem and a psychosocial issue. The first completed case deals with accurate diagnosis of an acute GI problem in an infant. It also deals with cultural competency issues that arise when the doctor is faced with a patient's mother who does not speak English and is already convinced the child has a folk illness called empacho. This case is currently undergoing formative evaluation by medical students. Remaining cases, slated for completion over the next 18 months, address problems such as smoking cessation in a noncompliant asthmatic patient; end-of-life care in a patient with dementia; and diabetes mellitus and family dynamics.

Instructional design: The case studies use digital video to model effective communication strategies and to demonstrate the psychosocial context that informs the patient encounter. Students are then presented with a screen that serves as a menu, procedural checklist, and simulated patient record that automatically tracks progress through the case. From this base, students can conduct simulated interviews and examinations, order labs, make diagnoses, and recommend treatments.

Patient interaction is simulated with a databank of available queries and responses, which students access by means of a simple search tool. For example, if a student wants to ask the patient a question about diet, he/she would search on a keyword pertaining to diet. Then a set of relevant questions is presented, from which the student can choose to ask a question and receive the patient's response. In this way the student is challenged to identify appropriate issues, but we have avoided the enormous development task of creating a natural-language system for interpreting open-ended user input.

Feedback from this databank can present images, sounds, and movies as well as text, providing opportunities for rich-media interaction. For example, in response to a physical examination query, the case can present an x-ray, heart sound, or endoscopy video, leaving it to the student to analyze the data and draw conclusions.

Technical design: The program framework was developed in Authorware. Each case is a separate learning module, consisting of a set of text files (structured as XML) and media files, which are loaded into the program when the user calls up the case from the main menu. Didactic materials for each case are presented as HTML using a dynamic hierarchical outline structure so that students can elect to scan the materials as an overview or drill down for in-depth information. The basic structure of the program is scalable and very flexible, to accommodate different kinds of cases while maintaining a consistent user interface.

Case builder: Content for eight faculty members who developed their own topics during a faculty development workshop for the program provide the cases. We developed a case-builder tool to provide a simple means for faculty to develop their cases with correct design and technical form. It provides a menu including all the same items as are used in the main program; each menu item calls up a form page with text entry fields wherein the case developer is prompted to type in case content, user feedback, prompts and labels, and paths to externally linked media files. Online help is available to explain the function of each entry field and the correct form for entries. The case builder tool is fully scalable, allowing the case developer to include, for example, an unlimited number of relevant but incorrect diagnoses for a case. The tool stores case data in the form of text files that can subsequently be edited using any standard text editor.

BENEFIT TO PARTICIPANTS ATTENDING SESSION:

Participants will see an effective model for the design and development of a case-based teaching tool and an accompanying case-builder tool. The presented model strikes a useful balance between rich-media content and user-driven interaction. The presentation will address instructional and technical design perspectives.

John Priestley, MA

1217 E. Marshall Street

Richmond VA 23298-0496

Phone: 804.828.3919

Fax: 804.828.1603

Email: mailto:jwpriest@vcu.edu

Website: http://www.medschool.vcu.edu/intranet/ofid/id.html

CO-AUTHORS:

Carolyn Peel, MD

Jeanne Schlesinger, MEd

Chris Stephens

c/o John Priestley