Planning and Developing
Virtual Patients
A team approach
James McGee1, Anya Andrews2, Michael Eakins2, Ester Beltran2, David Metcalf2
1University
of Pittsburgh School of Medicine, 2University of Central Florida
Disclaimer

James B. McGee, MD
Chair, Scientific Advisory Board for Decision Simulation
Equity holder in Decision Simulation
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Michael Eakins
Contract work for Decision Simulation through UCF
Decision Simulation is a commercial provider of virtual patient simulation software
and services.
Virtual Patient (VP) Simulation
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Computer-based clinical simulation – from interactive case
reports…to full physiologic simulation
Clinical reasoning – an essential competency
 What tests, diagnosis, therapy, and prevention
1
 Proficiency, efficiency, thoroughness, strategy
VPs that engage the student in clinical decision-making can train
and assess2; accelerate expertise
1. Epstein RM, Hundert EM. JAMA 2002;287(2):226-35
2. Chapman DM, et al. J Clin Reason 2013;1(1):1-1
The authoring process
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VPs at the University of Pittsburgh (66)
Decision Simulation VPs (341)
Workshops and tutorials
Technical challenges have been eliminated
MedBiquitous VP standard to share and repurpose
How best to authoring and deliver effective cases
remains an open question
Ingredients for success
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People
Planning
Tools – templates, storyboarding
Story writing
Leadership and communication
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Four success stories…
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Neal Benedict
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Academic pharmacologist
Educational needs
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Formative evaluation clinical pharmacology
Increased exposure to uncommon conditions
Deliberate practice: decision-making with feedback
http://vimeo.com/43108504 (5:58)
Neal Benedict
12 cases for advanced students
 Lecture supplement & replacement
 Small group practica focused on decision-making and
clinical reasoning
 Large group with audience response system
 High-stakes assessment and formative assessment
 Mentoring – residents build their own cases; teaches
education theory, pedagogy, gaming theory, curriculum
integration, etc.
Neal Benedict
Virtual Patient Team
 Instructional design = Neal
 Subject matter expertise = Neal (review by colleagues)
 Story writing, media = Neal
 VP instructional technology = Neal, Maria Hahn
 Curriculum integration, promotion, motivation = Neal
James Bateman
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Warwick University School of Medicine (UK)
Arthritis Education Research Fellow, PhD
Educational need
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Independent learning supplement to
medical curriculum
Research different VP designs; learning outcomes
Virtual patients design and its effect on clinical reasoning and student experience: a
protocol for a randomised factorial multi-centre study.
Bateman J, Allen ME, Kidd J, Parsons N, Davies D.
BMC Med Educ. 2012 Aug 1;12:62.
Virtual patients can be used to teach clinical reasoning.
Bateman J, Hariman C, Nassrally M.
Clin Teach. 2012 Apr;9(2):133-4
Ankur Doshi
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Course director for Integrated Case Studies
Convert and condense existing linear cases
into branching cases with multiple outcomes
Facilitated small group learning (2 hours x 12)
Educational goals
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Integrate basic and clinical sciences
Build clinical reasoning skills
Practice for board examination and 3rd year clinical rotations
Ankur Doshi
Virtual Patient Team
 Course design committee = Ankur + 8 faculty
 Instructional design = Ankur
 Subject matter expertise = Existing content, committee
 Story writing, media = Committee, Ankur
 Instructional technology = Workshops, committee, Maria
Hahn
 Curriculum integration, “visible point of contact” = Ankur,
committee, facilitators
AAAAI
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Specialty society of practicing and academic MDs
Grant funding for educational program
Educational need
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Continuing education of members
Three highly specialized and uncommon diseases
Independent learning at home for credit
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Partnered with UCF College of Medicine in
2009 for strategic consulting and R&D:
 Partnership development
 Enterprise systems
 Games
 Simulations
 Mobile
 3D
 Health IT
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Creating cases for national distribution
 Requires more robust development
 Content for expert level medical education
 Engaging
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Medical Doctor –
 The subject matter expert (SME) for information
related to case content and the accuracy of the
information presented to the user.
 Tasks include:
▪ Medical research
▪ Collaboration with game designer/writer and digital
media specialist to guide the content creation for
medical accuracy of the case
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Instructional Designer –
 Crafts the user experience and keeps the case
based on pedagogical learning foundations.
 Tasks include:
▪ Directing user interactions
▪ Working with game designer/writer to establish and
promote learning objectives.
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Multimedia Specialists–
 Creates and/or finds media for the case to enhance
the visual quality of a case.
 Tasks include:
▪ Providing engaging
visual experience
▪ Working with the SME and game
designer/writer to facilitate
medically accurate media that
fits within the story.
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Game Designer/Writer –
 Constructs the narrative for the case that engages
the learner throughout the experience.
 Tasks include:
▪ Creating an interesting story that keeps users engaged
with the case
▪ Working with the SME, ID, and digital media specialists to
meet learning objective needs, direct media usage, and
maintain medical accuracy.
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Project Manager –
 A little bit of all roles and responsible for
organization
 Tasks include:
▪ Keeping the case on schedule
▪ Filling in gaps
▪ Working with all other members to support case
development and organization.
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Outcome –
 Reduced time for case development
▪ When team members are experienced in communicating with medical
SMEs
▪ Team members work collaboratively and does so beyond their skill set.
▪ Capable of working within the disciplines of other members.
▪ All team members are familiar with case authoring technology
 Improved quality
▪ Multiple developers reviewing case throughout development
▪ Mixed disciplines contribute valuable techniques to promote learning and
engagement.
Clearly defined learning objectives
Entire team involved early and often in planning stages
Plan multiple cases in parallel
1st pass: map key decision points, plot points, key interactions,
alternative paths
 2nd pass: develop medical narrative, create underlying story, identify
media needs
 Repurpose/create consistent characters (mentor, supporting cast, etc.)
 Review
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Parallel development: medical research, narrative, media, case logic
Converge
Quality Assurance
Weekly Alignment meetings
Focused development
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The 1st case required approximately 40 - 50 hours per instructional team
member (PM, SME, ID, and GD) and about 15 hours for the DM specialists
With the 2nd and 3rd cases, time spent for all team members reduced by at
least 5 hours each time (we expect to see efficiency increase with more cases).
Result of
 Clear learning objectives
 Trans-disciplinary team
 Systematic approaches to case construction
 Team building
 Evolving review process
 Strategic media planning (reusable pervasive characters that fit within the narrative)
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Frequent communication and alignment
Develop modular narrative
Clear definition of roles
Spend the time up-front to plan out key
decision points
Team familiarity with platform for development
is critical for parallel development
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Access to cases that follow MedBiquitous Standards
Goal:
 To increase access to existing cases and promote
collaboration by leveraging existing resources for
the development of new cases.
Contact Information:
Dr. David Metcalf
dmetcalf@ist.ucf.edu
(407) 882 - 1496
Summary
Novice individual
learner
Novice small
group
Continuing
Education
Story
High
Moderate
High
Interactivity
High
Moderate
Moderate
Feedback
High
Moderate
High
Multimedia
High
Moderate
Moderate
Summary
Novice individual
learner
Novice small
group
Continuing
Education
Writer
High
Moderate
High
Instructional
Designer
High
Moderate
Moderate
Subject matter
expert
High
Moderate
High
Media specialist
High
Moderate
Moderate
Thank you

J.B. McGee, MD
Associate Professor of Medicine
University of Pittsburgh School of Medicine
jbm1@pitt.edu

Michael Eakins