Can a virtual patient be used as
an individual, team and system
needs assessment tool?
Timothy Willett, RCPSC; Pierre Cardinal,
uOttawa & RCPSC; Angele Landriault, RCPSC;
Thomas Low, uOttawa
MedBiq Conference, 11 May 2011
Disclosure
• Employee of Royal College
• Royal College owns SimuCase
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Needs Assessment
• 1st step in curriculum development
• Perceived vs. unperceived
• Not all needs are educational
Moore DE, Green JS, Gallis HA. Achieving desired results and improved
outcomes: integrating planning and assessment throughout learning activities.
The Journal of continuing education in the health professions. 2009;29(1):1-15.
Kern DE, Thomas PA, Howard DM, Bass EB. Curriculum Development for
Medical Education: A Six Step Approach. Baltimore, MD: Johns Hopkins Press;
1998:192.
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Needs assessment
• Broad
• ICU had self-identified desire to improve
recognition & care for massive PE
• Focussed
• What is the ideal care?
• What is reality?
• What are priority needs?
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Virtual Patients
“Specific type of computer program that simulates
real-life clinical scenarios; learners emulate the roles
of health care providers to obtain a history, conduct a
physical exam, and make diagnostic and therapeutic
decisions.”
Cook DA, Triola MM. Virtual patients: a critical literature review and proposed next
steps. Medical education. 2009;43(4):303-11.
• Variety of VPs
• Linear vs. branched
• Individual vs. group
• Synchronous vs. asynchronous
Huwendiek S, De Leng BA, Zary N, et al. Towards a typology of virtual patients.
Medical Teacher. 2009;31(8):743-748.
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SimuCase Virtual Patient
• Live, face-to-face
• Individual or small group
• Facilitator + operator
• Open-ended
• Text, photos, videos, dynamic vital sign
monitor
• Feedback from facilitator
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SimuCase Virtual Patient
Operator
Care team
Facilitator
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Research questions
• Can a VP aid with needs assessment?
• What kinds of needs?
• Individual?
• Team?
• System/resource?
• Perceived or unperceived?
• PILOT INVESTIGATION ONLY
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Method
• Two care team groups
• 1 MD (ICU fellow)
• 2 RNs
• 1 RT or pharmacist
• Case: 65F with massive PE (based on real
case)
• 40 min with case, uninterrupted
• Notes made by 2 MD and 1 RN facilitators
• Feedback & discussion afterwards
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The Case
• Background
• 65 F
• 3-day hx progressive
dyspnea & chest pain
• PMHx hypertension
• Seen in ER overnight
and admitted to ICU
• On exam:
• Severely dyspneic
• O2 sats >90% on
room air
• BP low by her
standards
• Course
• Responds to O2 but
dyspnea continues
• Chest pain is pleuritic
• BP trends down, little
response to IV fluids,
some response to
pressors
• Requires workup
• Goes into PEA arrest if
sent for CT or sedated
or inadequate pressors
• Requires thrombolysis
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Results
• Team did work as team
• MD led, input from others
• 1 group: RN very experienced and assertive
• Discussed resources
• RN: “I’ll need to leave for 2 minutes to do that –
want me to?”
• “Don’t have that available – need to order from
pharmacy”
• Knowledge, cognitive, and communication
errors
• Fixation on wrong diagnosis
• Failure to share mental model
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Types of Needs
• Unperceived 
• Individual 
• Team 
• System/resource 
• From debrief: WHY
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Types of Needs
CanMEDS role
Individual
Team
System/
resources
Medical Expert



Communicator



Collaborator



Health Advocate

Manager


Scholar


Professional



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Conclusions
• Preliminary!
• VP identifies unperceived needs
• Individual, team and system
• Variety of professional roles
• Can further explore WHY
• Educational for participants
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Matrix (examples)
CanMEDS
role
Individual
Team
System/
resources
Medical Expert
Knowledge, pt
assessment, mgmt,
problem-solving…
Problem-solving, task
prioritization…
Resources for
assessment & mgmt &
support…
Communicator
Share mental model,
listen, assertiveness,
elicit info…
Synthesis into shared
care plan…
Systems for comm,
arranging transfer…
Collaborator
Own role, delegation,
leadership, conflict
resolution…
Role adaptivity,
synthesis, situational
awareness, confl res…
Policies on roles/
responsibilities, support
for collaboration…
Health
Advocate
Recognition & system
activation…
Manager
Own role, leadership,
priority-setting,
resource allocation…
Synthesize care plan,
resource optimization…
Scholar
Insight into limitations,
peer feedback…
Insight into
limitations…
Professional
Ethical practice,
interprofessional
attitudes…
System response
mechanisms, barriers
to access care…
Support & barriers to
team-based care…
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Next steps
• More rigorous evaluation
• Test as part of multifaceted needs
assessment
• Refine strengths, weaknesses
• Does VP add anything new/different?
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Thank you
• Questions?
• twillett@royalcollege.ca
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