Authoring and implementation of virtual patients in nursing and obstetrics

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Authoring and implementation of virtual patients
in nursing and obstetrics the new challenge at
the Jagiellonian University Medical College

• International Conference of Virtual Patients
  5-6.06.2009 Kraków

A. Stachon, E. Walewska, L. Scislo, D. Matuszyk,
M. Dziedzic, A. Kononowicz Jagiellonian
University Medical College
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AUTHORING OF VIRTUAL PATIENTS

• eViP Project electronic Virtual Patients
• 3-years project co-funded by the European Union

Authoring tool of CASUS system Ludwig
Maximilian University

in Munich
Repurposing (language, culture and
discipline) Creating original cases
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AUTHORING OF VIRTUAL PATIENTS
Presentation of patients problem
Classic linear model of virtual patient
Anamnesis
Physical examination
Diagnosis
Other medical tests
Therapy
Nursing model of virtual patient
Presentation of patients problem
Nursing interventions
Nursing interventions
Purpose of nursing intervention
Nursing interventions
Anamnesis and physical examination
Purpose of nursing intervention
Nursing interventions
Purpose of nursing intervention
Nursing diagnosis
Purpose of nursing intervention
Nursing diagnosis
Nursing diagnosis
Solution of diagnoses
Patients condition estimation
Nursing diagnosis
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VIRTUAL PATIENTS IN NURSING
CASE TYPE SOURCE STATUS
Mr Myszkowski 77 yr old patient with bloody vomiting Part 1 Nursing diagnostics and interventions in gastric ulcer Repurposed case Mr Meissner 77 yr old patient with bloody vomiting Diagnostic and treatment in gastric ulcer/lymphoma (CASUS case for physicians) - ready, in CASUS system, - media and nursing documentation added, - implemented into Surgical Nursing course
Mr Myszkowski 77 yr old patient with bloody vomiting Part 2 Nursing procedures in gastric lymphoma (surgery) Repurposed case Mr Meissner 77 yr old patient with bloody vomiting Diagnostic and treatment in gastric ulcer/lymphoma (CASUS case for physicians) - translated, - in discipline repurposing
Mr Andrzejewski A 48 yr old male with severe chest pain Nursing care in myocardial infarction Repurposed case Mr Angermeier A 48 yr old male with severe chest pain Diagnostic and treatment in myocardial infarction (CASUS case for physicians) - translated, - in discipline repurposing, media and nursing documentation added
Mr Sobczynski A 38 yr old male with haemophilia A Home care in haemophilia Original case --- - created, media and medical/nursing documentation added, - in amending
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VIRTUAL PATIENTS IN OBSTETRICS
CASE TYPE STATUS
Mrs Milowicz 19 yr old pregnant patient Obstetric care of patient in danger of premature delivery Original case - ready, in CASUS system - media and obstetric documentation added - implemented into Obstetrics course
Mrs Iwanowska 41 yr old pregnant patient Obstetric care and procedures in premature delivery Original case in creation
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AUTHORING OF VIRTUAL PATIENTS
Repurposing workflow VP Meissner/Myszkowski
49 h
culture adaptation
ready
discipline adaptation
translation
content
media
10 h
34 h
5 h
media
ready
evaluation
implementation
57 h
Creating workflow VP Milowicz
45 h
draft of patients history
broadening of particular aspects
10 h
patients documentation
media
2 h
ready
implementation
evaluation
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IMPLEMENTATION OF VIRTUAL PATIENTS
Faculty of Health Sciences JUMC
scenario self-study, invitation students by
e-mail
Surgery and Surgical Nursing VP Myszkowski
Obstetrics Care VP Milowicz
purpose teach students define nursing
diagnoses, purposes of interventions and
plan nursing procedures.
purpose familiarize young students with
reality of obstetrics care in case of endangered
pregnancy.
50 students (1st year) 50 students (2nd year)
100 students (3rd year)
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COMPARISON OF IMPLEMENTED VPs
ELEMENTS VP MYSZKOWSKI VP MILOWICZ
PAGES WORDS 33 4830 41 7031
CARDS 25 29
PICTURES 13 5 (series gastroscopy pictures) 21
HIPERLINKS 10 17
EXPERT COMMENTS 4 16
QUESTIONS 21 (15 MCQ 5 free 3 others) 24 (18 MCQ 6 free)
LINK TO ONLINE SOURCES --- 1
VPs MARK (by students) 4,3 4,5
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STUDENTS EVALUATION OF VPs
Online student questionnaire concerning their
learning and clinical reasoning experiences
with virtual patients Sören Huwendiek, Bas de
Leng et al. 2008
N 13 N 14
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VIRTUAL PATIENT N SCENARIO OF IMPLEMENTATION QUESTIONS (AVERAGE MARKS IN LIKERT SCALE) QUESTIONS (AVERAGE MARKS IN LIKERT SCALE) QUESTIONS (AVERAGE MARKS IN LIKERT SCALE) QUESTIONS (AVERAGE MARKS IN LIKERT SCALE)
VIRTUAL PATIENT N SCENARIO OF IMPLEMENTATION Q1 AUTHENTICITY Q4 MOTIVATING Q9 COACHING Q10 EFFECT
MYSZKOWSKI 14 sefl-study 3,6 4,3 4,2 4,1
MILOWICZ 13 sefl-study 3,8 4,1 4,6 4,2
Q1 - While working on this case, I felt as if I
had to make the same decisions a nurse/obstetrics
would make in real life. Q4 - While
working through this case, I was actively engaged
in revising my initial image of the
patients problem as new information became
available. Q9 - The feedback I received while
working through this case was helpful in
enhancing my diagnostic reasoning in
this case. Q10 - After completing this case, I
feel better prepared to confirm a diagnosis and
exclude differential diagnoses in a
real life patient with this complaint.

• well present reality of work in hospital ward
• mobilize to thinking of patients problem and
  finding solution
• expert comments were very helpful, especially
  when I didnt undrestand more complicated issues
• some questions were too difficult and too
  detailled
• I would like to solve more virtual medical cases
  
• It was hard to motivate myself to go through all
  at home

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SUMMARY CONCLUSIONS

• Repurposing and creating VP is
• time-consuming
• Difficulties with creation of new media
• Additional elements activating and coaching
  students are helpful
• Troublesome implementation (lack of computer lab,
  low motivation of students)
• Student like this new educational tool

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Thank you for your attention