Using Electronic Virtual Patients to Develop

Skills for Evidence- Based Medicine and Clinical

Reasoning

Ralph Aarons, MD, PhD and Susan S. Albright

MedBiquitous Annual Conference 2011

MedicalEvidence

Clinical Reasoning

Foundations of Evidence-Based Medicine and Clinical Reasoning

perception

cognition

perception

cognition

Presentation of problem

Solution of problem

‘Traditional’ approach to problem solving

Prior knowledge+

apply reasoning

Knowledge required BEFORE problem encountered

Presentation of problem

Solutions of problem

Learning related to problem

‘PBL’ approach to problem solving

Knowledge ARISES FROM work on the problem!

Knowledge:Basic science IntegrationClinical science

Skills:DiscussionTeamworkResearchPresentationFeedback

Knowledge & skills arise from the problem!

‘PBL’ approach to problem solving

Paper cases

Virtual caseson tusk

PBL Whiteboard Headings

What We KnowWant to Know Hypotheses LQsProblem

List

PBL Whiteboard Headings

What We KnowWant to Know Hypotheses LQsProblem

List

Asking Clinical Questions

Background Questions (PBL1, Learning Questions)• general knowledge• many sources in HSL

[database, e-Books, e-Journals, OvidMEDLINE,PubMed, TUSK, etc.]

Foreground Questions (PBL2, advanced LQ’s)

• specific knowledge to make a clinical decision• 3 or 4 essential components

o Patient and/or Problemo Interventiono Comparative intervention (…optional, if relevant)o Clinical Outcome

P4 Cases*H. S. Barrows

4 - 5 students 1 facilitator

per tutorial group

45 – 50 PBL tutorial groups

PBL core materials on TUSK…..

…linked inside all group folders

Group - works through VP case (using ‘global’ navigation)

….individual work (LQs) outside group

..….....each group folder is unique

……….PICO submitted to librarian

Background + Foreground LQs

*P4

• A simulated patient (cards TUSK)• An exercise in clinical reasoning

– EVIDENCE: select History– EVIDENCE: select Exam– EVIDENCE: select Tests and Procedures– EVIDENCE: select Consultants– Manage the patient’s problem

Portable Patient Problem Pack*H. S. Barrows

the assignment

the form to send to librarian

the form received back from librarian

review, grade, feedback

20 students 1 master clinician

per tutorial group

10ICR tutorial groups

ICR core materials on TUSK…..

Individual – works VP case (using ‘linear’ navigation)

…….explore VP cases outside group

..….....answer questions during case

………. sub-groups submit group work

NEW cases with Master Clinician

illness script

descriptor table

Critical Thinking

CLINICAL REASONING

TUSKCase

SimulatorPBL

*Zaid Alsagoff, 2008

TUSK is now open source !

Contact: tusk@tufts.edu if you want to join