Casebook: a virtual patient iPad application for teaching decision-making through the use of electronic health records

BACKGROUND: Virtual Patients are a well-known and widely used form of interactive software used to simulate aspects of patient care that students are increasingly less likely to encounter during their studies. However, to take full advantage of the benefits of using Virtual Patients, students should have access to multitudes of cases. In order to promote the creation of collections of cases, a tablet application was developed which makes use of electronic health records as material for Virtual Patient cases. Because electronic health records are abundantly available on hospital information systems, this results in much material for the basis of case creation. RESULTS: An iPad-based Virtual Patient interactive software system was developed entitled Casebook. The application has been designed to read specially formatted patient cases that have been created using electronic health records, in the form of X-ray images, electrocardiograms, lab reports, and physician notes, and present these to the medical student. These health records are organised into a timeline, and the student navigates the case while answering questions regarding the patient along the way. Each health record can also be annotated with meta-information by the case designer, such as insight into the thought processes and the decision-making rationale of the physician who originally worked with the patient. Students learn decision-making skills by observing and interacting with real patient cases in this simulated environment. This paper discusses our approach in detail. CONCLUSIONS: Our group is of the opinion that Virtual Patient cases, targeted at undergraduate students, should concern patients who exhibit prototypical symptoms of the kind students may encounter when beginning their first medical jobs. Learning theory research has shown that students learn decision-making skills best when they have access to multitudes of patient cases and it is this plurality that allows students to develop their illness scripts effectively. Casebook emphasises the use of pre-existing electronic health record data as the basis for case creation, thus, it is hoped, making it easier to produce cases in larger numbers. By creating a Virtual Patient system where cases are built from abundantly available electronic health records, collections of cases can be accumulated by institutions

On the usage of health records for the design of virtual patients: a systematic review

BACKGROUND: The process of creating and designing Virtual Patients for teaching students of medicine is an expensive and time-consuming task. In order to explore potential methods of mitigating these costs, our group began exploring the possibility of creating Virtual Patients based on electronic health records. This review assesses the usage of electronic health records in the creation of interactive Virtual Patients for teaching clinical decision-making. METHODS: The PubMed database was accessed programmatically to find papers relating to Virtual Patients. The returned citations were classified and the relevant full text articles were reviewed to find Virtual Patient systems that used electronic health records to create learning modalities. RESULTS: A total of n = 362 citations were found on PubMed and subsequently classified, of which n = 28 full-text articles were reviewed. Few articles used unformatted electronic health records other than patient CT or MRI scans. The use of patient data, extracted from electronic health records or otherwise, is widespread. The use of unformatted electronic health records in their raw form is less frequent. Patient data use is broad and spans several areas, such as teaching, training, 3D visualisation, and assessment. CONCLUSIONS: Virtual Patients that are based on real patient data are widespread, yet the use of unformatted electronic health records, abundant in hospital information systems, is reported less often. The majority of teaching systems use reformatted patient data gathered from electronic health records, and do not use these electronic health records directly. Furthermore, many systems were found that used patient data in the form of CT or MRI scans. Much potential research exists regarding the use of unformatted electronic health records for the creation of Virtual Patients

Projekt „Digital Skills, Knowledge and Communication für Studierende der Medizin“

Die Digitalisierung verändert alle Lebensbereiche und damit auch die Anforderungen an zukünftige Ärztinnen und Ärzte. In einem gemeinsamen Ansatz haben interuniversitäre und interdisziplinäre Arbeitsgruppen der österreichischen öffentlichen medizinischen Universitäten und Fakultäten Ausbildungselemente zur Digitalisierung in der Medizin entwickelt. In einem ersten Schritt wurden diese Elemente als Wahlfächer implementiert, die nach einer Evaluierungsphase in die Curricula integriert werden. Zukünftige Ärzt:innen erhalten damit eine Basiskompetenz für den für Patient:innen nutzbringenden Einsatz digitaler Werkzeuge