Andrzej A. Kononowicz

Virtual patients - what are we talking about? A framework to classify the meanings of the term in healthcare education

BackgroundThe term “virtual patients” (VPs) has been used for many years in academic publications, but its meaning varies, leading to confusion. Our aim was to investigate and categorize the use of the term “virtual patient” and then classify its use in healthcare education.MethodsA literature review was conducted to determine all articles using the term “virtual patient” in the title or abstract. These articles were categorized into: Education, Clinical Procedures, Clinical Research and E-Health. All educational articles were further classified based on a framework published by Talbot et al. which was further developed using a deductive content analysis approach.Results536 articles published between 1991 and December 2013 were included in the study. From these, 330 were categorized as educational. Classifying these showed that 37% articles used VPs in the form of Interactive Patient Scenarios. VPs in form of High Fidelity Software Simulations (19%) and Virtual Standardized Patients (16%) were also frequent. Less frequent were other forms, such as VP Games.Analyzing the literature across time shows an overall trend towards the use of Interactive Patient Scenarios as the predominant form of VPs in healthcare education.ConclusionsThe main form of educational VPs in the literature are Interactive Patient Scenarios despite rapid technical advances that would support more complex applications. The adapted classification provides a valuable model for VP developers and researchers in healthcare education to more clearly communicate the type of VP they are addressing avoiding misunderstandings.

Beyond xMOOCs in healthcare education: study of the feasibility in integrating virtual patient systems and MOOC platforms

Background. Massive Open Online Courses (MOOCs) are an emerging trend in online learning. However, their technology is not yet completely adjusted to the needs of healthcare education. Integration of Virtual Patients within MOOCs to increase interactivity and foster clinical reasoning skills training, has been discussed in the past, but not verified by a practical implementation. Objective. To investigate the technical feasibility of integrating MOOCs with Virtual Patients for the purpose of enabling further research into the potential pedagogical benefits of this approach. Methods. We selected OpenEdx and Open Labyrinth as representative constituents of a MOOC platform and Virtual Patient system integration. Based upon our prior experience we selected the most fundamental technical requirement to address. Grounded in the available literature we identified an e-learning standard to guide the integration. We attempted to demonstrate the feasibility of the integration by designing a “proof-of-concept” prototype. The resulting pilot implementation was subject of verification by two test cases. Results. A Single Sign-On mechanism connecting Open Labyrinth with OpenEdx and based on the IMS LTI standard was successfully implemented and verified. Conclusion. We investigated the technical perspective of integrating Virtual Patients with MOOCs. By addressing this crucial technical requirement we set a base for future research on the educational benefits of using virtual patients in MOOCs. This provides new opportunities for integrating specialized software in healthcare education at massive scale.

A framework for different levels of integration of computational models into web-based virtual patients.

Background Virtual patients are increasingly common tools used in health care education to foster learning of clinical reasoning skills. One potential way to expand their functionality is to augment virtual patients’ interactivity by enriching them with computational models of physiological and pathological processes. Objective The primary goal of this paper was to propose a conceptual framework for the integration of computational models within virtual patients, with particular focus on (1) characteristics to be addressed while preparing the integration, (2) the extent of the integration, (3) strategies to achieve integration, and (4) methods for evaluating the feasibility of integration. An additional goal was to pilot the first investigation of changing framework variables on altering perceptions of integration. Methods The framework was constructed using an iterative process informed by Soft System Methodology. The Virtual Physiological Human (VPH) initiative has been used as a source of new computational models. The technical challenges associated with development of virtual patients enhanced by computational models are discussed from the perspectives of a number of different stakeholders. Concrete design and evaluation steps are discussed in the context of an exemplar virtual patient employing the results of the VPH ARCH project, as well as improvements for future iterations. Results The proposed framework consists of four main elements. The first element is a list of feasibility features characterizing the integration process from three perspectives: the computational modelling researcher, the health care educationalist, and the virtual patient system developer. The second element included three integration levels: basic, where a single set of simulation outcomes is generated for specific nodes in the activity graph; intermediate, involving pre-generation of simulation datasets over a range of input parameters; advanced, including dynamic solution of the model. The third element is the description of four integration strategies, and the last element consisted of evaluation profiles specifying the relevant feasibility features and acceptance thresholds for specific purposes. The group of experts who evaluated the virtual patient exemplar found higher integration more interesting, but at the same time they were more concerned with the validity of the result. The observed differences were not statistically significant. Conclusions This paper outlines a framework for the integration of computational models into virtual patients. The opportunities and challenges of model exploitation are discussed from a number of user perspectives, considering different levels of model integration. The long-term aim for future research is to isolate the most crucial factors in the framework and to determine their influence on the integration outcome.

Exploring the validity and reliability of a questionnaire for evaluating virtual patient design with a special emphasis on fostering clinical reasoning

Abstract Background: Virtual patients (VPs) are increasingly used to train clinical reasoning. So far, no validated evaluation instruments for VP design are available. Aims: We examined the validity of an instrument for assessing the perception of VP design by learners. Methods: Three sources of validity evidence were examined: (i) Content was examined based on theory of clinical reasoning and an international VP expert team. (ii) The response process was explored in think-aloud pilot studies with medical students and in content analyses of free text questions accompanying each item of the instrument. (iii) Internal structure was assessed by exploratory factor analysis (EFA) and inter-rater reliability by generalizability analysis. Results: Content analysis was reasonably supported by the theoretical foundation and the VP expert team. The think-aloud studies and analysis of free text comments supported the validity of the instrument. In the EFA, using 2547 student evaluations of a total of 78 VPs, a three-factor model showed a reasonable fit with the data. At least 200 student responses are needed to obtain a reliable evaluation of a VP on all three factors. Conclusion: The instrument has the potential to provide valid information about VP design, provided that many responses per VP are available.

Virtual Patients as a Practical Realisation of the E-learning Idea in Medicine

Medicine has long been regarded as a discipline impossible to teach online. The complexity of the human organism and the intricacies of the patient-doctor interaction seemed beyond the reach of ‘soulless’ computers. However, a brief glimpse at recent advances in medical education reveals a different picture. The technically savvy Generation Y has entered medical school and their expectations of learning methods are different from previous generations’. Electronic devices like laptops, palmtops and smartphones are no longer expensive gimmicks, but have become indispensable elements of everyday life. This evolution coincides with significant changes in the healthcare sector. The ageing population demands increasing attention from medical personnel, resulting in a reduction in the time that can be devoted to teaching activities. In addition, the trend towards decreasing lengths of patients’ stays in hospitals reduces the possibilities for medical students to observe the treatment process. It is in this context that harnessing computers to support the learning process by simulation of clinical scenarios may be very helpful, especially in the case of rare conditions. Virtual patients (VPs) are “interactive computer simulations of real-life clinical scenarios for the purpose of medical training, education, or assessment” (Ellaway et al., 2006b). They offer a wide variety of (anonymous) patient-related data including medical history, physical and technical examinations, as well as laboratory tests. In most cases, the goal of the student is to find the right diagnosis and propose a correct medical treatment based on the data presented. Virtual patients provide a training opportunity in a risk-free environment before students are allowed to take part in bedside teaching. They may also be used to document the fact that all students have been exposed to all diseases defined by curricular objectives. The first virtual patient systems emerged in the early 70’s (Harless et al., 1971) and since then have evolved significantly, taking advantage of new possibilities offered by the Internet and multimedia technologies. Research has shown that such systems enable students to learn clinical problem-solving more efficiently (Lyon et al., 1992). Increasingly, Virtual patients as a practical realisation of the e-learning idea in medicine 345

Conservative secondary structure motifs already present in early-stage folding (in silico) as found in serpines family.

The well-known procedure implemented in ClustalW oriented on the sequence comparison was applied to structure comparison. The consensus sequence as well as consensus structure has been defined for proteins belonging to serpine family. The structure of early stage intermediate was the object for similarity search. The high values of W(sequence) appeared to be accordant with high values of W(structure) making possible structure comparison using common criteria for sequence and structure comparison. Since the early stage structural form has been created according to limited conformational sub-space which does not include the beta-structure (this structure is mediated by C7eq structural form), is particularly important to see, that the C7eq structural form may be treated as the seed for beta-structure present in the final native structure of protein. The applicability of ClustalW procedure to structure comparison makes these two comparisons unified.

A qualitative analysis of virtual patient descriptions in healthcare education based on a systematic literature review

BackgroundVirtual Patients (VPs) have been in the focus of research in healthcare education for many years. The aim of our study was to analyze how virtual patients are described in the healthcare education literature, and how the identified concepts relate to each other.MethodsWe performed a literature review and extracted 185 descriptions of virtual patients from the articles. In a qualitative content analysis approach we inductively-deductively developed categories and deducted subcategories. We constructed a concept map to illustrate these concepts and their interrelations.ResultsWe developed the following five main categories: Patient, Teacher, Virtual Patient, Curriculum, and Learner. The concept map includes these categories and highlights aspects such as the under-valued role of patients in shaping their virtual representation and opposing concepts, such as standardization of learner activity versus learner-centeredness.ConclusionsThe presented concept map synthesizes VP descriptions and serves as a basis for both, VP use and discussions of research topics related to virtual patients.

MPEG-7 as a Metadata Standard for Indexing of Surgery Videos in Medical E-Learning

The analysis of video recorded surgical procedures is considered to be a useful extension of the medical curriculum. We can foster the development of video-based e-learning courses by working out a unified description method which would facilitate the exchange of these materials between different platforms. Sophisticated metadata enables a broader integration of artificial intelligence techniques into e-learning. The aim of this paper is to present the possibility of combining the MPEG-7 metadata standard with the MeSH classification for indexing of video recordings in medical e-learning. A tool for metadata descriptions of surgical videos in accordance with the MPEG-7 standard is also presented. This tool is part of a larger architecture for the exchange of medical multimedia objects.

Virtual patient simulations for health professional education

his is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this review is to evaluate the effectiveness of virtual patient simulation as an educational intervention versus traditional learning, other types of e-Learning interventions and other forms of virtual patient simulation interventions for delivering pre-registration and post-registration healthcare professional education. We will primarily assess the impact of these interventions on learners’ knowledge, skills and attitudes. Our secondary objective is to assess the cost-effectiveness of these interventions.

Implementation of targeted temperature management after cardiac arrest in Polish intensive care units. What has changed in the last five years

BACKGROUND Studies conducted up to 2010 indicate the underuse of targeted temperature management (TTM) in Poland. AIM This study evaluated the current degree of TTM implementation in Polish intensive care units (ICUs) and analysed the implementation process since 2010. METHODS A telephone survey, conducted from December 2014 to July 2015, was carried out to determine the number of ICUs using TTM in patients after cardiac arrest. We collected data on the details and prevalence of TTM, and the impact of organisational and financial issues and recently published papers on its use. RESULTS We obtained data from 271 of 396 ICUs (68.4%). In total, 79 (29.2%) ICUs indicated TTM use and 27 (34.2%) used dedicated TTM equipment. Overall, 62% of the ICUs used TTM regardless of the cardiac arrest rhythm. Target temperatures of 32-34°C and 34.1-36°C were reached by 44.3% and 43.0% of ICUs, respectively. The duration of TTM was 12-24 h in 58.2% of the ICUs. The most common barriers to TTM implementation were a lack of dedicated devices (36.3%) and organ-isational and logistical issues (31.2%). Any influence of recently published data on TTM practice modifications was reported by only 23.4% of the ICUs. CONCLUSIONS Targeted temperature management is underused in Polish ICUs. There is a need for additional educational and implementation efforts supporting the translation of knowledge into clinical practice at the regional and national levels.