Serious Games Modeling Virtual Patients and Virtual Cases

Via: MELD - MedBiquitous E-Learning Discourse

Virtual Patients, Virtual Cases

Rachel Ellawaye-Learning Manager, Learning Technology Section,College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland, UK

Virtual patients (VPs) have been used for many years.

Paper-based cases and patients have been used for many years and certainly since the explosive growth of the web in the ‘90s the use of virtual patients has spread into many areas of healthcare delivery and education.

A virtual patient is a set of data that describes an individual as a patient. This may be data about a real patient, a hypothecated patient or some combination of the two. The concept of virtuality is based on the patient being modeled in data rather than as an embodied entity.

The concept of ‘virtual case’ is often interchangeable with that of virtual patient in healthcare although a case is in fact a slightly broader concept. One particular aspect therefore about cases is that they include the context of a scenario as well as its subject.

There are many different ways that a virtual patient may be used in an educational setting. For instance:

• The role of the learner may take many forms with respect to the patient: the student may take the role of the physician, the patient (or their family or friends), a third-party observer, a tutor, another participant in the healthcare process (nurse, dietitian, surgeon, manager etc) or any other active or passive role in the scenario.

The learner may be acting independently, or under the guidance of a tutor or instructor, or in a collaborative setting with their peers.

University of Florida Project: Medical students to interview DIANA, a virtual patient

The virtual patient/case learning process may be set up to take many different and distinctive forms:

• The learner may progress through a predetermined scenario where
  each step is predetermined and interaction prescribed (directed mode).
• The learner may start from scratch with a first patient presentation clerking their patient and building up the patient or case data from observations and interactions with the scenario or patient (blank mode).

DIANA, the virtual patient, complains of acute abdominal pain

• The learner may view and appraise or review an existing patient or scenario. For instance this may be as an example of good (or bad) patient management in a case conference (critique mode) or as a means to rehearse skills such as diagnosis or prescription (rehearsal mode).

Head tracking data shows where the medical student is looking during the interview

• The learner may use a case or patient as a mechanism to address particular topics. For instance the patient may be a means to present scientific topics, particular clinical skills or management issues. In this situation the case or patient is the secondary medium rather than the primary substance of the activity (context mode).
• The learner may use a scenario or patient to explore personal/professional aspects of the patient-doctor relationship. In this situation the case is intended to promote and guide reflective thinking regarding issues such as conduct, communication and ethics (reflective mode).
• Banks of patients or scenarios may collectively address broad issues of healthcare such as patient management, clinical governance or public health (pattern mode).

Webcast: Transforming Professional Healthcare Narratives into Structured Game-Informed-Learning Activities

Innovate-Live Webcasts offer an opportunity to synchronously interact with authors of selected articles.

The schedule for September includes the Webcast Transforming Professional Healthcare Narratives into Structured Game-Informed-Learning Activities, by Michael Begg, Rachel Ellaway, David Dewhurst, and Hamish Macleod, to be held on September 19, 2007, at 11:00 AM EDT. In the related article , the authors argue that virtual patient simulations that make use of the motivational power of professional narrative can best reproduce practice settings online. In so doing, the authors showcase an online virtual simulation called Labyrinth.

Narrative is an essential part of rendering a virtual patient activity meaningful and educationally effective. The goal is to find a way of developing rich narratives for a range of virtual patients and instantiating them in the Labyrinth virtual patient authoring system.

The Labyrinth System

The Labyrinth system was developed by the University of Edinburgh's Learning Technology Section. It is an online activity modeling system that allows users to build interactive ‘game-informed’ educational activities such as virtual patients, simulations, games, mazes and algorithms. It has been designed to be adaptable and simple to use while retaining a wealth of game-like features.

Labyrinth-authored virtual patient cases incorporate elements of narrative and computer game play into complex, branching scenarios that offer highly individualized experiences focused primarily on decision making skills and evaluation and synthesis of knowledge, rather than the linear knowledge base enquiries typical of most virtual patient applications.

Labyrinth authoring, both by individuals, collaborating clinicians, and clinicians working closely with learning technologists is an effective way of “surfacing” tacit knowledge held by clinical practitioners that has been acquired, then internalized – and consequently hidden - through experience. The formalizing of this tacit knowledge allows it to become more immediately accessible as a learning opportunity and, significantly, suggests possible assessment avenues based on decision making skills and the synthesis and evaluation of knowledge; keystones of professional practice.