International Conference of Virtual Patients 5 -6 06

International Conference of Virtual Patients 5 -6. 06. 2009 Kraków Authoring and implementation of virtual patients in nursing and obstetrics – the new challenge at the Jagiellonian University Medical College A. Stachoń, E. Walewska, L. Ścisło, D. Matuszyk, M. Dziedzic, A. Kononowicz Jagiellonian University Medical College

AUTHORING OF VIRTUAL PATIENTS e. Vi. P Project = electronic Virtual Patients 3 -years project co-funded by the European Union Authoring tool of CASUS® system – Ludwig Maximilian University in Munich ■ Repurposing (language, culture and discipline) ■ Creating original cases 2

AUTHORING OF VIRTUAL PATIENTS Presentation of patient’s problem Classic linear model of virtual patient Anamnesis Physical examination Presentation of Diagnosis Other medical tests Therapy Nursing model of virtual patient’s problem Purpose of nursing intervention Anamnesis and physical examination Patient’s condition estimation Nursing diagnosis Nursing interventions Purpose of nursing intervention Solution of diagnoses 3

VIRTUAL PATIENTS IN NURSING CASE TYPE SOURCE STATUS Mr Myszkowski 77 yr old patient with bloody vomiting: Part 1 Nursing diagnostics and interventions in gastric ulcer Repurposed case - ready, in CASUS® system, - media and nursing documentation added, - implemented into Surgical Nursing course Mr Myszkowski 77 yr old patient with bloody vomiting: Part 2 Nursing procedures in gastric lymphoma (surgery) Repurposed case Mr Meissner 77 yr old patient with bloody vomiting Diagnostic and treatment in gastric ulcer/lymphoma (CASUS® case for physicians) Mr Andrzejewski Repurposed A 48 yr old male with severe case chest pain Nursing care in myocardial infarction Mr Sobczyński A 38 yr old male with haemophilia A Home care in haemophilia - translated, - in discipline repurposing Mr Angermeier A 48 yr old male with severe chest pain Diagnostic and treatment in myocardial infarction (CASUS® case for physicians) Original case --- - translated, - in discipline repurposing, - media and nursing documentation added - created, - media and medical/nursing documentation added, 4 - in amending

VIRTUAL PATIENTS IN OBSTETRICS CASE TYPE Mrs Miłowicz 19 yr old pregnant patient Obstetric care of patient in danger of premature delivery Original case Mrs Iwanowska 41 yr old pregnant patient Obstetric care and procedures in premature delivery STATUS - ready, in CASUS® system - media and obstetric documentation added - implemented into Obstetrics course in creation Original case 5

AUTHORING OF VIRTUAL PATIENTS Repurposing workflow – VP Meissner/Myszkowski content culture adaptation translation 10 h media 5 h evaluation draft of patient’s history discipline adaptation media implementation Creating workflow – VP Miłowicz patient’s documentation ready 49 h 34 h ready 57 h 45 h broadening of particular aspects media 10 h implementation ready 6 2 h evaluation

IMPLEMENTATION OF VIRTUAL PATIENTS Faculty of Health Sciences JUMC scenario: self-study, invitation students by e-mail Surgery and Surgical Nursing Obstetrics Care VP Myszkowski VP Miłowicz purpose: teach students define nursing diagnoses, purposes of interventions and plan nursing procedures. ~ 100 students (3 rd year) purpose: familiarize young students with reality of obstetrics care in case of endangered pregnancy. ~ 50 students (1 st year) ~ 50 students (2 nd year) 7

COMPARISON OF IMPLEMENTED VPs ELEMENTS VP MYSZKOWSKI VP MIŁOWICZ PAGES WORDS 33 ~ 4830 41 ~ 7031 CARDS 25 29 13 + 5 21 HIPERLINKS 10 17 EXPERT COMMENTS 4 16 QUESTIONS 21 24 PICTURES (series gastroscopy pictures) (15 MCQ + 5 free + 3 others) (18 MCQ + 6 free) LINK TO ONLINE SOURCES --- 1 VP’s MARK 4, 3 4, 5 (by students) 8

STUDENTS EVALUATION OF VPs Online student questionnaire concerning their learning and clinical reasoning experiences with virtual patients Sören Huwendiek, Bas de Leng et al. 2008 N = 13 N = 14 9

QUESTIONS VIRTUAL PATIENT N SCENARIO OF IMPLEMENTATION (AVERAGE MARKS IN LIKERT SCALE) Q 1 Q 4 Q 9 Q 10 AUTHENTICITY MOTIVATING COACHING EFFECT MYSZKOWSKI 14 sefl-study 3, 6 4, 3 4, 2 4, 1 MIŁOWICZ 13 sefl-study 3, 8 4, 1 4, 6 4, 2 Q 1 - While working on this case, I felt as if I had to make the same decisions a nurse/obstetrics would make in real life. Q 4 - While working through this case, I was actively engaged in revising my initial image of the patient’s problem as new information became available. Q 9 - The feedback I received while working through this case was helpful in enhancing my diagnostic reasoning in this case. Q 10 - After completing this case, I feel better prepared to confirm a diagnosis and exclude differential diagnoses in a real life patient with this complaint. § well present reality of work in hospital ward § mobilize to thinking of patient’s problem and finding solution § expert comments were very helpful, especially when I didn’t undrestand more complicated issues § some questions were too difficult and too detailled § I would like to solve more virtual medical cases 10 § It was hard to motivate myself to go through all at home

SUMMARY & CONCLUSIONS § Repurposing and creating VP is time-consuming § Difficulties with creation of new media § Additional elements activating and coaching students are helpful § Troublesome implementation (lack of computer lab, low motivation of students) § Student like this new educational tool §… 11

Thank you for your attention 12