Exploring the use of a web-based virtual patient to support learning through reflection

This thesis explores the support of learning through reflection, in the context of medical students and practitioners, working through a series of simulated consultations involving the diagnosis and management of chronic illness. A model of the medical consultative process was defined, on which a web-based patient simulation was developed. This simulation can be accessed over the Internet using commonly available web-browsers. It enables users to interact with a virtual patient by taking a history, examining the patient, requesting and reviewing investigations, and choosing appropriate management strategies. The virtual patient can be reviewed over a number of consultations, and the patient outcome is dependant on the management strategy selected by the user. A second model was also developed, that adds a layer of reflection over the consultative process. While interacting with the virtual patient users are asked to formulate and test their hypotheses. Simple tools are included to encourage users to record their observations and thoughts for further learning, as well as providing links to web-based library resources. At the end of each consultation, users are asked to review their actions and indicate whether they think their actions were critical, relevant, or not relevant to the diagnosis and management of the patient in light of their current knowledge. Users also have the opportunity to compare their activity to their peers or an expert in the case under study. Three formal cycles of evaluation were undertaken during the design and development of the software. A number of clinicians were involved in the initial design to ensure there was an appropriate structure that matched clinical practice. Formative evaluation was conducted to review the usability of the application, and based on user feedback a number of changes were made to the user interface and structure of the application. A third, end user, evaluation was undertaken using a single case concerning the diagnosis and management of hypertriglyceridaemia in the context of Type 1B Glycogen Storage Disease. This evaluation involved ten medical students, five general practitioners and two specialists. The evaluation involved observation using a simplified think-aloud, as well as administration of a questionnaire. Users were engaged by the simulation, and were able to use the application with only a short period of training. Usability issues still exist with respect to the processing of natural language input, especially when asking questions of the virtual patient. Until such time that natural language recognition is able to provide satisfactory performance, alternative, list-based, methods of interaction will be required. Evaluation involving medical students, general practitioners, and specialist medical practitioners demonstrated that reflection can be supported and encouraged by providing appropriate tools, as well as by judiciously interrupting the consultative process and providing time for reflection to take place. Reflection could have been further enhanced if users had been educated on reflection as a learning modality prior to using SIMPRAC. Further work is also required to improve the simulation environment, improve the interfaces for supporting reflection, and further define the benefits of using this approach for medical education and professional development with respect to learning outcomes and behavioural change

ASKAP and MeerKAT surveys of the magellanic clouds

The Magellanic Clouds are a stepping stone from the overwhelming detail of the Milky Way in which we are immersed, to the global characteristics of galaxies both in the nearby and distant universe. They are interacting, gas-rich dwarf galaxies of sub-solar metallicity, not unlike the building blocks that assembled the large galaxies that dominate groups and clusters, and representative of the conditions at the height of cosmic star formation. The Square Kilometre Array (SKA) can make huge strides in understanding galactic metabolism and the ecological processes that govern star formation, by observations of the Magellanic Clouds and other, nearby Magellanic-type irregular galaxies. Two programmes with SKA Pathfinders attempt to pave the way: the approved Galactic ASKAP Spectral Line Survey (GASKAP) includes a deep survey in H I and OH of the Magellanic Clouds, whilst MagiKAT is proposed to perform more detailed studies of selected regions within the Magellanic Clouds - also including Faraday rotation measurements and observations at higher frequencies. These surveys also close the gap with the revolutionizing surveys at far-IR wavelengths with the Spitzer Space Telescope and Herschel Space Observatory

A specialized POMDP form and algorithm for clinical patient management

Partially observable Markov decision pro-cesses (POMDPs) have recently been sug-gested as a suitable model to formalising the planning of clinical patient management over a prolonged period of time. However, prac-tical application of POMDP models is ham-pered by the computational complexity of as-sociated solution methods. It is argued that the full generality of POMDPs is not needed to support many decision problems in clini-cal patient management, and that specialised forms are often sufficient. A specialised form of POMDP, tailored to a particular type of management problem, is introduced. It is de-scribed how a new solution method, based on Monte Carlo simulations of the decision pro-cess, can take advantage of this specialised form.