The challenge: knowledge vs. decisions
In medical schools throughout the world, medical faculty work hard to transfer their knowledge to learners. While a daunting task, it’s really only the first step toward successfully educating the doctors of tomorrow. The more difficult challenge: teaching the critical decision-making skills that turn a student of medicine into a good practicing physician.

“Think about a doctor working in an emergency department,” says Dr. James Bateman, research fellow at the University of Warwick/University Hospitals Coventry and Warwickshire NHS Trust in Coventry, England. “The quality of the doctor’s decisions is going to be the most important factor in each patient’s outcome, not the doctor’s overall knowledge.”

“It’s hard to teach applied decision-making in a lecture,” adds Dr. Bateman. It’s much easier when educators can simulate patient cases in a virtual environment. Virtual patients, interactive computer simulations of clinical scenarios, can be used to help teach clinical decision-making safely and effectively.

“Virtual patient cases sharpen the use of knowledge, not just knowledge itself,” he explains.

Evaluating virtual patient learning
As a practicing internal medicine physician and educator, Dr. Bateman recently began to wonder: How does the design of a virtual patient case aff ect learning outcomes for undergraduate medical students?

He currently is seeking to answer that question through his research. In conjunction with three universities—the University of Warwick, the University of Birmingham, and the University of Keele—Dr. Bateman is engaged in a project examining the best way to design virtual patients for learners of various ages, genders and curriculums. The research project is supervised by Dr. David Davies of the University of Warwick and Dr. Maggie Allen of University Hospitals Coventry and Warwickshire as well as supported by the charity Arthritis Research UK.

Using the DecisionSim™ branched narrative virtual case platform as the foundation of his investigation, Dr. Bateman has created four peer-reviewed clinical scenarios from the field of musculoskeletal medicine and is asking learners from the three universities to complete them. While Dr. Bateman evaluated a variety of virtual patient software as he planned his study, he discovered the ideal tool in DecisionSim’s simple-to-use, flexible branched narrative platform.

“I didn’t need any training on the software. The very fi rst case I created with it worked well; in fact, the software runs checks for you to ensure it will work. That’s important for doctors pressed for time. You can spend 20 minutes writing a case, then use it!”

Branching is a critical part of virtual case design, Bateman adds. Since it allows learners to explore diff erent paths of investigation and treatment, it brings a sense of realism to each case. When learners are presented with a decision, they see the consequences as they would in the real world.

“Branching reinforces consequences. That’s a powerful learning tool,” Bateman says.

However, in the past, medical educators often had difficulty in developing and maintaining complicated branched narrative cases. Simple and intuitive authoring tools are essential, and Dr. Bateman found those with DecisionSim.

“It’s always been a challenge, especially for physicians with limited IT skills. We’re forever presented with ‘new’ and ‘simple’ IT, but with DecisionSim you can create a lot of different question types and incorporate multi-media… yet it’s still easy to storyboard a case and see that it works right away.”

Why virtual patients?
Learning from experience—especially from mistakes—is extremely valuable. However, mistakes in medicine can cost lives. While interactions with actual patients will always be a critical part of medical education, it is not always an ideal way for learners to gain all of the knowledge they need. Nor can it expose learners to clinical situations that in real life are rare or extremely dangerous. Simulation is a proven educational technique that overcomes these limitations.

“Virtual patients put medical students in the position of doctors. Learners take a patient story in a step-by-step fashion like they would in an actual clinical scenario, without knowing immediately what’s relevant and what’s not. They build a mental picture of the case,” describes Dr. Bateman. “After 30 minutes with a virtual patient, learners have a connection with that case. They experience all the emotions of working through important clinical problems.”

Valuable understanding
Testing factual knowledge is only one small part of a complete medical education. It is much more difficult—and arguably more important—to be able to gauge learners’ effective use of that knowledge.

Through research, Dr. Bateman expects to prove how different branched narrative designs affect student learning. He anticipates that he will soon be able to provide all medical educators with a better, more practical understanding about the role of virtual patient design in promoting quality clinical reasoning.

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