Virtual patient

The term virtual patient is used to describe interactive computer simulations used in health care education.^[1] The special focus is targeted on the simulation of clinical processes with virtual patients. Virtual patients combine scientific excellence, modern technologies and the innovative concept of game-based learning. Virtual patients allow the learner to take the role of a health care professional and develop clinical skills such as making diagnoses and therapeutic decisions.^[2] Virtual patients have also been considered computer-based simulations designed to complement clinical training.^[3] The use of virtual patient programmes is increasing in healthcare, partly in response to increasing demands on health care professionals and education of students but also because they allow opportunity for students to practice in a safe environment^[2] There are many different formats a virtual patient may take. However the overarching principle is that of interactivity - a virtual patient will have mechanisms for the learner to interact with the case and material or information is made available to the learner as they complete a range of learning activities. The interactivity is non-sequential.

Forms

Virtual patients may take a number of different forms:

Artificial patients: computer simulations of biochemical processes such as the effect of drugs in organisms, the physiologic processes of a given organ or entire systems (systems biology) in a given organism. These can be used in different phases of a compound or drug in development in a given pharmacological research as a preliminary to testing on animals and humans for the drug development processes.
Real patients: reflected in data e.g. electronic health records (EHRs). In this case the virtual patient is the reflection of the real patient in terms of data held about them. These are sometimes called e-patients.
Physical simulators: mannequins (sometimes spelled 'manikins'), models or related artefacts.
Simulated patients: where the patient is recreated by humans or computer-generated characters and Virtual Humans acting as such or engaging in other kinds of role-play.
Electronic case-studies and scenarios where users work through problems, situations or similar narrative-based activities.

Types of interaction with simulated or electronic patients

A number of different modes of virtual patient delivery have been defined:

Predetermined scenario [directed mode]
The learner may build up the patient or case data from observations and interactions [blank mode]
The learner may view and appraise or review an existing patient or scenario [critique mode or rehearsal mode]
The VP may be used as a mechanism to address particular topics [context mode]
The learner may use a scenario or patient to explore personal/professional dimensions [reflective mode]
Banks of patients or scenarios may collectively address broad issues of healthcare [pattern mode]

Types of interaction with artificial patients

To create and run a mathematical quantitative simulation of a healthy person (physiology) and diseased person to test multiple hypothesis against known and unknown processes in a given set or sets of processes to help fill gaps in knowledge of the physiology or system under investigation.

Possible benefits of physical simulators and simulated patients

Simulated patients increase the availability of training opportunities for medical students, making them less dependent on actual cases to learn how to handle different situations. Unlike real patients, simulated patients can be accessed on demand and they can be endlessly replayable to allow the user to explore different options and strategies. They can be structured with narratives that represent real situations while challenging the user with a wide range of tasks. They also allow simulation of rare or unusual events, and reduce risk to actual patients in the process.

Despite their efficacy simulated patients are still a tangent and a prosthesis to reality. They should be viewed as augmenting existing modes and methods of clinical teaching.

Possible benefits of artificial patients

Artificial patients increase the possibility of exploring millions of hypothesis driven experiments on known areas of biological systems to extrapolate the unknown, which enables efficient exploration, informed research and development predictive simulation, which must also be proven by real patient studies clinical trials. If more tests can be done on Artificial patients to filter out possibly unnecessary tests or experiments, fewer subjects pharmacovigilance maybe needed. The Artificial patients insilico modeling are still in the early to middle developmental stages. It will require continual updates and development with the endless availability of new data.

Virtual patient data standards

The MedBiquitous consortium established a working group in 2005 to create a free and open data standard for expressing and exchanging virtual patients between different authoring and delivery systems. This was in part to address the problem of exchanging and reusing virtual patients and in part to encourage and support easier and wider use of virtual patients in general.

This standard has been very successful and is now widely adopted, e.g. in major projects like eViP.

In 2010, this standard attained status as an ANSI standard.

Examples

Case presentations and interactive patient scenarios

Case presentations and interactive patient scenarios are mainly designed to support the training of clinical reasoning skills with virtual patients. The systems are usually web-based and a variety of multimedia elements can be incorporated. Interactivity is often included with questions, specific decision-making tasks, text-composition etc. Most systems provide quantitative and qualitative feedback.^[4]

Virtual Patients from Harvard Medical School
Medical Exam Tutor
HCV Virtual Patient program
(SIMPLE, CLIPP, fmCASES, WISE-MD)
WebSP from Karolinska Institutet
Virtual Patient Project from New York University
Virtual Patients from Centre for Virtual Patients (University of Heidelberg)
OpenLabyrinth from Canada
Labyrinth from the University of Edinburgh
TUSK Case Simulator from Tufts University
CASUS - Case-based, multimedia learning and authoring system
(A whole virtual clinic with 25 different faculties and offer 250 virtual patients)
Shadow Health Digital Standardized Patients™

Virtual worlds

Simulators and manikins

Other

Notes and references

↑ JiSC (2009) Repurposing existing virtual patients. Available http://www.jisc.ac.uk/whatwedo/programmes/elearningcapital/reproduce/revip.aspx accessed 08.06.09
1 2 Imison M, Hughes C(2008) http://www.ascilite.org.au/conferences/melbourne/procs/imison.pdf "The virtual patient project: using low fidelity, student generated online case studies in medical education. in Hello? Where are you in the landscape of educational technology? Proceedings ascilite Melbourne 2008.
↑ Huang, Grace (May 2007). "Virtual Patient Simulation at U.S. and Canadian Medical Schools". Educational Strategies 82 (5): 446. doi:10.1097/ACM.0b013e31803e8a0a. Retrieved 11 February 2016.
↑ Talbot, TB; Sagae, K; John, B; Rizzo, AA (2012). "Sorting out the Virtual Patient". International Journal of Gaming and Computer-Mediated SimulationsInternational Journal of Gaming and Computer-Mediated Simulations 4 (3): 1–19. doi:10.1373/clinchem.2011.176958.

External links

Telemedicine

Background concepts	Health informatics Telecommunication

Medical record	Admission note Blue Button De-identification Electronic health record Health Insurance Portability and Accountability Act Personal health record

Patient participation	Decision aids Doctor–patient relationship E-patient Health 2.0 Health education Knowledge translation mHealth Participative decision-making Participatory medicine Patient Activation Measure Patient-centered care Shared decision-making

Health information on the Internet	Health information on Wikipedia Online patient education PubMed

Telemedicine subspecialties	eHealth Remote surgery Remote therapy Tele-audiology Tele-epidemiology Teledentistry Teledermatology Telehealth Telemental health Telenursing Teleophthalmology Telepathology Telepharmacy Telepsychiatry Teleradiology Telerehabilitation

Roles to play	Open-source healthcare software Patient opinion leader Research participant Virtual patient

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