Saturday, September 15, 2007

Serious Games And The Art of Medical Interview

Serious Games for learning medical communication skills

Via: Medical College of Georgia - Virtual Patient Teaches Bedside Manners to Medical Students

She is a simulated patient in a simulated doctor’s office, but the skills she teaches medical students are very real.

Digital Animated Avatar, or DIANA, is a virtual reality character projected life-size onto a wall in the Medical College of Georgia Virtual Education and Surgical Simulation Laboratory. A very lifelike representation of a 19-year-old woman, she checks the clock as she waits, reaches out for a handshake when the doctor arrives and answers questions in a young female voice.

“DIANA helps us create a non-stressful environment for first-and second-year medical students to learn history-taking and communication skills,” Dr. Adeline Deladisma, an MCG general surgery resident, says of the collaboration between the MCG Department of Surgery and computer scientists at the University of Florida. “She is a good stepping stone for students who’ve had little or no interaction with real patients.”

Students wear headsets to communicate with DIANA and she “listens” and responds using voice recognition. Keywords and phrases prompt her to respond appropriately. When DIANA does not answer, often the question just needs to be rephrased. This was the case when third-year medical student Thomas Wood interviewed her for the first time. After getting no response to “What's wrong?” he tried “What hurts?” and she pointed to her left side and explained the duration and intensity of her pain. Even with this setback, Mr. Wood says he nearly forgot he was speaking with a projection on the wall.

“The life-size presentation, speech and gestures of DIANA are designed to have the virtual patient more similarly represent a real patient interaction,” says Dr. Benjamin Lok, an assistant professor in University of Florida’s computer and information science and engineering department. “This increased level of immersion will result in students interacting with DIANA more similarly to the way they interact with real people. This will allow the system to track, evaluate and eventually teach communication skills to medical students.”

“We consider this technology a supplement to the learning process,” says Dr. D. Scott Lind, MCG Jarrell Distinguished Professor of Surgery and chief of surgical oncology. “Unlike our standardized patients, a virtual patient can be accessed day and night as many times as the student needs. It lets students practice again and again until they’re comfortable with their interviewing skills.”

DIANA is particularly useful in situations that can be awkward for beginning medical students. Taking a sexual history for the first time, for example, can be especially hard, says third-year resident James Bittner.

“I’ve seen students get halfway through it with a standardized patient and get so embarrassed they walk out," he explains. “Working with a virtual patient a few times will decrease their anxiety.”

Virtual patients can also perform a wide variety of interview scenarios. The team is developing several new ones for varying medical conditions, ages, races and genders.

The Use of a Virtual Scenario to Teach Communication Skills for Geriatric Patients

“We can plug in the less-common scenarios that you don’t see all the time, like combative patients and trauma patients – the ones that might be challenging for standardized patients to portray,” Dr. Deladisma says.

For example, the team is working on a scenario involving a patient with a brain tumor. “The ways they control their eyes and answer you are very different – this can be hard for an actor to present,” Dr. Lok says.
Virtual patients also fill in gaps that standardized patients can’t.

“There have been studies that the local population really influences the makeup of standardized patients,” Dr. Lok explains. “This means your pool of patients may be skewed if you don’t have certain minority groups in the area. Also, it can be hard to find actors in certain age ranges, particularly the young and elderly.”

Beyond her educational benefits, DIANA offers potential cost savings since virtual patients will require fewer standardized patients to educate students.
“The National Board of Medical Examiners spends millions of dollars training standardized patients every year,” Dr. Lind says. “Meanwhile we developed our virtual patient with off-the-shelf technology for less than $10,000.”

Although some medical schools offer Web-based virtual patients, the team does not plan to create a scaled-down version of the project.

“The thing that we think is important, particularly in learning communication skills, is that the simulation needs to be life-size,” Dr. Lind says. “When you interact with a 17-inch computer screen, you just don’t get the same anxiety or emotions that occur with a real interaction. We want to make the experience as authentic as possible.”

The next step for the team is coordinating the virtual patient with a new breast examination simulator developed by Dr. Carla Pugh, assistant professor of surgery and associate director of the Center for Advanced Surgical Education at Northwestern University. The equipment uses sensors to measure the amount of pressure the student applies during a simulated breast exam, something that can be hard for clinical educators to teach.