elaine d. kauschinger phd, msn, aprn, fnp-bc duke
TRANSCRIPT
Elaine D. KauschingerPhD, MSN, APRN, FNP-BC
Duke University School of Nursing
Durham, North Carolina
Objectives ▪ Describe the i-Human Patients virtual learning simulation
and its core components.
▪ Analyze i-Human analytics from two nurse practitioner courses.
▪ Discuss the design and implementation of virtual patient case simulation in an online graduate course.
Purpose of Pilot Project
The purpose of this pilot project is to evaluate the impact of a new pedagogical approach combined with a cloud-based learning platform supporting patient encounter simulation on student performance in two graduate-level online courses.
▪ Advanced Pathophysiology Across the Lifespan ▪ Specialty Seminars in Advanced Pathophysiology for Neonatal
through Gerontological Health
Overview: i-Human Patients ➢ Cloud-based patient encounter simulator ➢ Symptoms-based approach to patient assessment and diagnostic
reasoning
➢ Learning vs testing mode: • Students can receive objective feedback at each step of the
encounter or at the end ➢ Focus on cognitive competencies rather than psychomotor skills
Take PatientHistory
Develop Treatment
Plan
Select DefinitiveDiagnosis
EvaluateTests
OrderTests
Select/Rank Differential Diagnoses
Perform Physical Exams
Advanced Pathophysiology Across the Lifespan
Cases Author/Institution/
Yr.Chief
Complaint
Natalie Grant
49 y/o female
New onset DM type 2
D. Gowda, MD, MPH
Columbia University College of Physicians and Surgeons, 2016
Polyuria, polydipsia,
fatigue
Dianne Steinberg
69 y/o female
Community acquired
pneumonia
S. Shah, MD
Rush Medical College,
2015
Progressive acute
dyspnea
Florence Blackman
50 y/o female
Acute coronary
syndrome
M. Prystowsky, MD, PhD
Albert Einstein School of
Medicine, 2016
Severe chest pain with
SOB
▪ Spring 2016: 2 sections of this course N=54
▪ Voluntary participation
▪ No grading
▪ For each case: • 1st week: H&P only
• 2nd week: H&P & remainder of case (determined by student)
• 3rd week: online session that reviewed the case with pathophysiology implications from i-Human problem list
Meet your Patient
Physical Exam Section
Student results compared to expert’s result
Student Clinical Notes
Power of Analytics
Insights to students progress and performances
What?i-Human provides:
• Step by step view of how student choices & behavior impact clinical decision making
How?Efficiency & effectiveness in course design
Why?
i-Human Analytics History accuracy: appropriate questions needed for an accurate diagnosis
Physical exam: were appropriate parts of the exam completed
Problem List : validates the identification of normal and abnormal findings
Problem Statement : demonstrates accurate communication skills
Differential Diagnosis List: objective measure of diagnostic reasoning
Order and Interpret tests: objective measure of diagnostic reasoning
Select Final Diagnosis
What are my students competencies?
Week over week student participation
70.4%
42.6%
51.9%
37.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Week over Week Student Participation Rate
Week 1 Week 2
# of Students 39 23
Same Number of Students from Week to
Week n/a 19
Case 1 Case 2
Percent of correct questions asked by students
Week 2
History & Physical exam analysis Student ID 1st Hx 2nd Hx 1st PE 2nd PE
1 51% 51% 100% 74%
2 31% 42% 70% 89%
3 20% 71% 93% 78%
4 67% 44% 89% 63%
5 7% 56% 81% 74%
6 7% 18% 52% 63%
7 58% 29% 100% 96%
8 44% 78% 89% 100%
9 44% 67% 71% 93%
10 31% 96% 27% 81%
11 49% 52% 56% 59%
12 51% 70% 51% 96%
13 31% 59% 53% 81%
14 18% 70% 18% 70%
15 33% 81% 31% 96%
16 67% 89% 49% 93%
17 9% 44% 33% 85%
18 36% 78% 20% 96%
Average 36% 61% 60% 83%
Red Flag
Student Survey
43%
30%
13%
13%
What Students Liked
Interactive Clinical Experience Simulation
Stress-Free Environment Complete Patient Experience
50%
32%
11%
7%
What Students Disliked
Issue with Receiving Credit with Questions Asked
Organization of Options
Time Consuming
Audio Difficulty
Student Survey
0%
10%
20%
30%
40%
50%
60%
70%
Highly Disagree Disagree Neutral Agree Highly Agree
i-Human N591 Student Surveyn=21
The i-human cases were helpful in understanding the pathophysiology content presented in this course
Overall, I was satisfied with my learning experience with i-Human
Having the i-Human cases helped in my development as a nurse practitioner or nurse educator
I would recommend using i-Human cases in other courses
ONLINE SESSION: NATALIE GRANT
Seminar in Advanced Pathophysiology➢ 2 sections comprised of FNP and Women’s Health
For each case:
Completed H &P on individual basis
Developed PPT based on 4 problems identified in case
Included for each problem: HPI
Brief overview of normal physiology
Pathophysiology
Linked to the 4 Is: inflammation, immunity, infection & injury
Influences of genetics, behavior & environmental factors
Age-related difference
Cases 594 Author/Institution/Year Chief complaint
Bebe Babbit
26 y/o female
Migraines
S. Durning, MD, PhD,
FACP
USUHS, 2015
More frequent headaches
Tod Gouseau
57 y/o male
Gout
J. Kherani, MD
Weill Cornell Medical
College, 2016
Left knee pain
Christine Smith
33 y/o female
Pyelonephritis
S. Shah, M.D
Rush Medical College,
2015
Fever and flank pain
Col Casey Kilroy
50 y/o female
Iron deficiency anemia
J. LaRochelle & S. Durning
USUHS, 2016
Progressive fatigue with SOB
Jerome Cauthen
22 y/o male
Appendicitis
J. Rencic, MD, FACP
Tufts University School of
Medicine, 2016
Periumbilical pain
Fred O MacIntrye
62 y/o male
Stable angina
A. Ellis, MD, PhD
University of Buffalo
School of Medicine, 2016
Stress-induced chest pain
STUDENT SURVEY
36%
27%
14%23%
What Students Liked
Interactive Clinical Experience simuation
Complete Patient Experience Other
47%
20%
13%20%
What Students Disliked
Issue with Receiving Credit with Questions Asked
Organization of Options
Time consuming
Other