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Çetinkaya L, Keser İ, Yildirim S, Keser H. The effect of case-based mobile virtual patient application on students' academic achievement in clinical reasoning skills. Med Educ Online 2024; 29:2322223. [PMID: 38445566 PMCID: PMC10919315 DOI: 10.1080/10872981.2024.2322223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
This mixed-method study aims to determine the effect of the use of mobile virtual patient application with narrated case-based virtual patients as an assistive technology on students' clinical reasoning skills. It makes a notable contribution by exploring the impact of mobile virtual patient applications on healthcare students' clinical skills and their preparation for real-world patient care. In addition, the accuracy of the analysis results regarding the effect on student achievement was analyzed with a second dataset tool, and thus, aiming to increase reliability by verifying the same research question with a different quantitative analysis technique. In the qualitative part of the study, students' views on the implementation were collected through an open-ended questionnaire and the data were subjected to content analysis. An achievement test was also developed to determine the development of students' clinical reasoning skills, which revealed that each of the learning environments had different outcomes regarding students' achievement and that supporting the traditional environment with the mobile virtual patient application yielded better results for increasing students' achievement. Students' opinions about the mobile virtual patient application and the process also support the increase in academic achievement aimed at measuring clinical reasoning skills. The content analysis showed that the students, who generally reported multiple positive factors related to the application, thought that the stories and cases presented created a perception of reality, and they especially highlighted the contribution of the application to learning the story organization. Based on all these results, it can be said that the application supports clinical reasoning, provides practical experience, improves academic achievement, and contributes positively to motivation.
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Affiliation(s)
- Levent Çetinkaya
- Department of Computer Education and Instructional Technology, Canakkale Onsekiz Universty, Canakkale, Türkiye
| | - İ̇lke Keser
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Türkiye
| | - Serkan Yildirim
- Department of Computer Education and Instructional Technology, Ankara University, Ankara, Türkiye
| | - Hafize Keser
- Faculty of Educational Sciences, Department of Computer Education and Instructional Technology, Ankara University, Ankara, Türkiye
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Shen J. The chance and challenge of creating virtual patients in prosthodontics. Hua Xi Kou Qiang Yi Xue Za Zhi 2024; 42:1-11. [PMID: 38475945 DOI: 10.7518/hxkq.2024.2023317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
In the field of prosthodontics, the use of virtual patients for biomimetic restoration holds great promise for various applications. Virtual patients consist of digitized data that encompasses details on the morphology, structure, and spatial relationships within the maxillofacial and intraoral regions. Nonetheless, there are several challenges associated with acquiring digital data, achieving accurate alignment, and recording and transferring dynamic jaw movements. This paper aims to concentrate on the process of constructing virtual patients, highlight the key and challenging aspects of virtual patient construction, and advocate for the extensive adoption and utilization of virtual patient technology.
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Affiliation(s)
- Jiefei Shen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Gray M, Baird A, Sawyer T, James J, DeBroux T, Bartlett M, Krick J, Umoren R. Increasing Realism and Variety of Virtual Patient Dialogues for Prenatal Counseling Education Through a Novel Application of ChatGPT: Exploratory Observational Study. JMIR Med Educ 2024; 10:e50705. [PMID: 38300696 PMCID: PMC10870212 DOI: 10.2196/50705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/18/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Using virtual patients, facilitated by natural language processing, provides a valuable educational experience for learners. Generating a large, varied sample of realistic and appropriate responses for virtual patients is challenging. Artificial intelligence (AI) programs can be a viable source for these responses, but their utility for this purpose has not been explored. OBJECTIVE In this study, we explored the effectiveness of generative AI (ChatGPT) in developing realistic virtual standardized patient dialogues to teach prenatal counseling skills. METHODS ChatGPT was prompted to generate a list of common areas of concern and questions that families expecting preterm delivery at 24 weeks gestation might ask during prenatal counseling. ChatGPT was then prompted to generate 2 role-plays with dialogues between a parent expecting a potential preterm delivery at 24 weeks and their counseling physician using each of the example questions. The prompt was repeated for 2 unique role-plays: one parent was characterized as anxious and the other as having low trust in the medical system. Role-play scripts were exported verbatim and independently reviewed by 2 neonatologists with experience in prenatal counseling, using a scale of 1-5 on realism, appropriateness, and utility for virtual standardized patient responses. RESULTS ChatGPT generated 7 areas of concern, with 35 example questions used to generate role-plays. The 35 role-play transcripts generated 176 unique parent responses (median 5, IQR 4-6, per role-play) with 268 unique sentences. Expert review identified 117 (65%) of the 176 responses as indicating an emotion, either directly or indirectly. Approximately half (98/176, 56%) of the responses had 2 or more sentences, and half (88/176, 50%) included at least 1 question. More than half (104/176, 58%) of the responses from role-played parent characters described a feeling, such as being scared, worried, or concerned. The role-plays of parents with low trust in the medical system generated many unique sentences (n=50). Most of the sentences in the responses were found to be reasonably realistic (214/268, 80%), appropriate for variable prenatal counseling conversation paths (233/268, 87%), and usable without more than a minimal modification in a virtual patient program (169/268, 63%). CONCLUSIONS Generative AI programs, such as ChatGPT, may provide a viable source of training materials to expand virtual patient programs, with careful attention to the concerns and questions of patients and families. Given the potential for unrealistic or inappropriate statements and questions, an expert should review AI chat outputs before deploying them in an educational program.
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Affiliation(s)
- Megan Gray
- Division of Neonatology, University of Washington, Seattle, WA, United States
| | - Austin Baird
- Division of Healthcare Simulation Sciences, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Taylor Sawyer
- Division of Neonatology, University of Washington, Seattle, WA, United States
| | - Jasmine James
- Department of Family Medicine, Providence St Peter, Olympia, WA, United States
| | - Thea DeBroux
- Division of Neonatology, University of Washington, Seattle, WA, United States
| | - Michelle Bartlett
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jeanne Krick
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, United States
| | - Rachel Umoren
- Division of Neonatology, University of Washington, Seattle, WA, United States
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Antoniou P, Dafli E, Giannakoulas G, Igimbayeva G, Visternichan O, Kyselov S, Lykhasenko I, Lashkul D, Nadareishvili I, Tabagari S, Bamidis PD. Education of Patients With Atrial Fibrillation and Evaluation of the Efficacy of a Mobile Virtual Patient Environment: Protocol for a Multicenter Pseudorandomized Controlled Trial. JMIR Res Protoc 2024; 13:e45946. [PMID: 38261376 PMCID: PMC10848131 DOI: 10.2196/45946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is a leading cause of mortality and morbidity. Patient knowledge about AF and its management is paramount but often limited. Patients need to be appropriately informed about treatment options, medicinal adherence, and potential consequences of nonadherence, while also understanding treatment goals and expectations from it. Mobile health apps have experienced an explosion both in their availability and acceptance as "soft interventions" for patient engagement and education; however, the prolific nature of such solutions revealed a gap in the evidence base regarding their efficacy and impact. Virtual patients (VPs), interactive computer simulations, have been used as learning activities in modern health care education. VPs demonstrably improved cognitive and behavioral skills; hence, they have been effectively implemented across undergraduate and postgraduate curricula. However, their application in patient education has been rather limited so far. OBJECTIVE This work aims to implement and evaluate the efficacy of a mobile-deployed VP regimen for the education and engagement of patients with AF on crucial topics regarding their condition. A mobile VP app is being developed with the goal of each VP being a simple scenario with a set goal and very specific messages and will be subsequently attempted and evaluated. METHODS A mobile VP player app is being developed so as to be used for the design of 3 educational scenarios for AF management. A pseudorandomized controlled trial for the efficacy of VPs is planned to be executed at 3 sites in Greece, Ukraine, and Kazakhstan for patients with AF. The Welch t test will be used to demonstrate the performance of patients' evaluation of the VP experience. RESULTS Our study is at the development stage. A preliminary study regarding the system's development and feasibility was initiated in December 2022. The results of our study are expected to be available in 2024 or when the needed sample size is achieved. CONCLUSIONS This study aims to evaluate and demonstrate the first significant evidence for the value of VP resources in outreach and training endeavors for empowering and patients with AF and fostering healthy habits among them. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45946.
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Affiliation(s)
- Panagiotis Antoniou
- Lab of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Dafli
- Lab of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- 1st Cardiology Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Olga Visternichan
- Internal Medicine Department, Karaganda Medical University, Karaganda, Kazakhstan
| | - Serhii Kyselov
- Department of Internal Diseases No.1 and Simulation Medicine, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine
| | - Ivetta Lykhasenko
- Department of Propedeutics of Internal Diseases, Radiation Diagnostics and Radiation, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine
| | - Dmytro Lashkul
- Department of Internal Diseases No.1 and Simulation Medicine, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine
| | - Ilia Nadareishvili
- AIETI Medical School, David Tvildiani Medical University, Tbilisi, Georgia
| | - Sergo Tabagari
- AIETI Medical School, David Tvildiani Medical University, Tbilisi, Georgia
| | - Panagiotis D Bamidis
- Lab of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Hsieh HY, Lin CH, Huang R, Lin GC, Lin JY, Aldana C. Challenges for Medical Students in Applying Ethical Principles to Allocate Life-Saving Medical Devices During the COVID-19 Pandemic: Content Analysis. JMIR Med Educ 2024; 10:e52711. [PMID: 38050366 PMCID: PMC10799279 DOI: 10.2196/52711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/18/2023] [Accepted: 12/03/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND The emergence of the COVID-19 pandemic has posed a significant ethical dilemma in the allocation of scarce, life-saving medical equipment to critically ill patients. It remains uncertain whether medical students are equipped to navigate this complex ethical process. OBJECTIVE This study aimed to assess the ability and confidence of medical students to apply principles of medical ethics in allocating critical medical devices through the scenario of virtual patients. METHODS The study recruited third- and fourth-year medical students during clinical rotation. We facilitated interactions between medical students and virtual patients experiencing respiratory failure due to COVID-19 infection. We assessed the students' ability to ethically allocate life-saving resources. Subsequently, we analyzed their written reports using thematic analysis to identify the ethical principles guiding their decision-making. RESULTS We enrolled a cohort of 67 out of 71 medical students with a mean age of 34 (SD 4.7) years, 60% (n=40) of whom were female students. The principle of justice was cited by 73% (n=49) of students while analyzing this scenario. A majority of them expressed hesitancy in determining which patient should receive life-saving resources, with 46% (n=31) citing the principle of nonmaleficence, 31% (n=21) advocating for a first-come-first-served approach, and 25% (n=17) emphasizing respect for patient autonomy as key influencers in their decisions. Notably, medical students exhibited a lack of confidence in making ethical decisions concerning the distribution of medical resources. A minority, comprising 12% (n=8), proposed the exploration of legal alternatives, while 4% (n=3) suggested medical guidelines and collective decision-making as potential substitutes for individual ethical choices to alleviate the stress associated with personal decision-making. CONCLUSIONS This study highlights the importance of improving ethical reasoning under time constraints using virtual platforms. More than 70% of medical students identified justice as the predominant principle in allocating limited medical resources to critically ill patients. However, they exhibited a lack of confidence in making ethical determinations and leaned toward principles such as nonmaleficence, patient autonomy, adherence to legal and medical standards, and collective decision-making to mitigate the pressure associated with such decisions.
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Affiliation(s)
- Hsing-Yen Hsieh
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chyi-Her Lin
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan
| | - Ruyi Huang
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Holistic Medicine, Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
- Data Science Degree Program, National Taiwan University and Academia Sinica, Taipei, Taiwan
- Division of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Guan-Chun Lin
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Jhen-Yu Lin
- Holistic Medicine, Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Clydie Aldana
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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Li J, Joda T, Revilla-León M, Saleh MHA, Chen Z, Wang HL. Recommendations for successful virtual patient-assisted esthetic implant rehabilitation: A guide for optimal function and clinical efficiency. J ESTHET RESTOR DENT 2024; 36:186-196. [PMID: 37792734 DOI: 10.1111/jerd.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Complete arch implant rehabilitation necessitates meticulous treatment planning and high-level collaboration between surgical and prosthetic dental teams. Emerging virtual technologies hold considerable promise in streamlining this process. The aim of this article is to extend recommendations to clinicians venturing into the virtual patient-assisted esthetic implant rehabilitation workflow. OVERVIEW This article summarizes recommendations for virtual patient-assisted esthetic implant rehabilitation in the following five aspects: three-dimensional data handling and superimposition, occlusion and virtual articulator integration in creating virtual patients, streamlined face- and prosthetic-driven surgical planning, reuse of presurgical data ("Copy & Paste"), and final impression for passive fitting of final restoration. To illustrate these principles, a case with complete-mouth implant rehabilitation completed within six visits using this virtual patient workflow is presented. CONCLUSION The virtual patient workflow serves as an invaluable tool to perform treatment planning, enhance efficiency, and ensure predictable outcomes in esthetic complete arch implant rehabilitation. CLINICAL SIGNIFICANCE Virtual workflows are increasingly prevalent in esthetic implant rehabilitation. Nevertheless, these workflows necessitate a distinct set of knowledge and tools divergent from conventional dentistry practices. This article offers guidelines and recommendations for dental clinicians who are new to this field.
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Affiliation(s)
- Junying Li
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Tim Joda
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Marta Revilla-León
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA
- Kois Center, Seattle, Washington, USA
- Graduate Prosthodontics, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Zhaozhao Chen
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Tang W, Zhang H, Wang H, Li L. A digital technique of bone reduction for a maxillary full-arch implant-supported fixed dental prosthesis. J Prosthodont 2023. [PMID: 37811545 DOI: 10.1111/jopr.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/14/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023] Open
Abstract
When fabricating a maxillary full-arch implant-supported fixed dental prosthesis, it is often challenging to systematically reduce alveolar bone to create prosthetic space and hide the prosthesis-tissue junction. This article presents a digital technique that allows for precise bone reduction while simultaneously placing implants and interim prostheses. By using this technique, clinicians can perform surgical procedures in a systematic manner without compromising the functional or esthetic outcomes.
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Affiliation(s)
- Weimao Tang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hai Zhang
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Haozhe Wang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lei Li
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Lau ST, Siah RCJ, Dzakirin Bin Rusli K, Loh WL, Yap JYG, Ang E, Lim FP, Liaw SY. Design and Evaluation of Using Head-Mounted Virtual Reality for Learning Clinical Procedures: Mixed Methods Study. JMIR Serious Games 2023; 11:e46398. [PMID: 37647108 PMCID: PMC10500353 DOI: 10.2196/46398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/19/2023] [Accepted: 07/19/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The capacity of health care professionals to perform clinical procedures safely and competently is crucial as it will directly impact patients' outcomes. Given the ability of head-mounted virtual reality to simulate the authentic clinical environment, this platform should be suitable for nurses to refine their clinical skills for knowledge and skills acquisition. However, research on head-mounted virtual reality in learning clinical procedures is limited. OBJECTIVE The objectives of this study were (1) to describe the design of a head-mounted virtual reality system and evaluate it for education on clinical procedures for nursing students and (2) to explore the experience of nursing students using head-mounted virtual reality for learning clinical procedures and the usability of the system. METHODS This usability study used a mixed method approach. The stages included developing 3D models of the necessary instruments and materials used in intravenous therapy and subcutaneous injection procedures performed by nurses, followed by developing the procedures using the Unreal Engine (Epic Games). Questionnaires on the perception of continuance intention and the System Usability Scale were used along with open-ended questions. RESULTS Twenty-nine nursing students took part in this questionnaire study after experiencing the immersive virtual reality (IVR) intervention. Participants reported largely favorable game perception and learning experience. Mean perception scores ranged from 3.21 to 4.38 of a maximum score of 5, while the mean system usability score was 53.53 of 100. The majority found that the IVR experience was engaging, and they were immersed in the game. The challenges encountered included unfamiliarity with the new learning format; technological constraints, such as using hand controllers; and physical discomfort. CONCLUSIONS The conception of IVR for learning clinical procedures through deliberate practice to enhance nurses' knowledge and skills is promising. However, refinement of the prototypes is required to improve user experience and learning. Future research can explore other ways to use IVR for better education and health care purposes.
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Affiliation(s)
- Siew Tiang Lau
- Alice Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rosalind Chiew Jiat Siah
- Alice Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Khairul Dzakirin Bin Rusli
- Alice Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Liang Loh
- Alice Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - John Yin Gwee Yap
- Alice Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Emily Ang
- Alice Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fui Ping Lim
- Alice Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Barakat CS, Sharafutdinov K, Busch J, Saffaran S, Bates DG, Hardman JG, Schuppert A, Brynjólfsson S, Fritsch S, Riedel M. Developing an Artificial Intelligence-Based Representation of a Virtual Patient Model for Real-Time Diagnosis of Acute Respiratory Distress Syndrome. Diagnostics (Basel) 2023; 13:2098. [PMID: 37370993 DOI: 10.3390/diagnostics13122098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/10/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Acute Respiratory Distress Syndrome (ARDS) is a condition that endangers the lives of many Intensive Care Unit patients through gradual reduction of lung function. Due to its heterogeneity, this condition has been difficult to diagnose and treat, although it has been the subject of continuous research, leading to the development of several tools for modeling disease progression on the one hand, and guidelines for diagnosis on the other, mainly the "Berlin Definition". This paper describes the development of a deep learning-based surrogate model of one such tool for modeling ARDS onset in a virtual patient: the Nottingham Physiology Simulator. The model-development process takes advantage of current machine learning and data-analysis techniques, as well as efficient hyperparameter-tuning methods, within a high-performance computing-enabled data science platform. The lightweight models developed through this process present comparable accuracy to the original simulator (per-parameter R2 > 0.90). The experimental process described herein serves as a proof of concept for the rapid development and dissemination of specialised diagnosis support systems based on pre-existing generalised mechanistic models, making use of supercomputing infrastructure for the development and testing processes and supported by open-source software for streamlined implementation in clinical routines.
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Affiliation(s)
- Chadi S Barakat
- Jülich Supercomputing Centre, Forschungszentrum Jülich, 52428 Jülich, Germany
- School of Engineering and Natural Science, University of Iceland, 107 Reykjavik, Iceland
- SMITH Consortium of the German Medical Informatics Initiative, 07747 Leipzig, Germany
| | - Konstantin Sharafutdinov
- SMITH Consortium of the German Medical Informatics Initiative, 07747 Leipzig, Germany
- Joint Research Centre for Computational Biomedicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Josefine Busch
- Jülich Supercomputing Centre, Forschungszentrum Jülich, 52428 Jülich, Germany
| | - Sina Saffaran
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK
| | - Declan G Bates
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK
| | | | - Andreas Schuppert
- SMITH Consortium of the German Medical Informatics Initiative, 07747 Leipzig, Germany
- Joint Research Centre for Computational Biomedicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Sigurður Brynjólfsson
- School of Engineering and Natural Science, University of Iceland, 107 Reykjavik, Iceland
| | - Sebastian Fritsch
- Jülich Supercomputing Centre, Forschungszentrum Jülich, 52428 Jülich, Germany
- SMITH Consortium of the German Medical Informatics Initiative, 07747 Leipzig, Germany
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Morris Riedel
- Jülich Supercomputing Centre, Forschungszentrum Jülich, 52428 Jülich, Germany
- School of Engineering and Natural Science, University of Iceland, 107 Reykjavik, Iceland
- SMITH Consortium of the German Medical Informatics Initiative, 07747 Leipzig, Germany
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Bonnin C, Pejoan D, Ranvial E, Marchat M, Andrieux N, Fourcade L, Perrochon A. Immersive virtual patient simulation compared with traditional education for clinical reasoning: a pilot randomised controlled study. J Vis Commun Med 2023:1-9. [PMID: 37309646 DOI: 10.1080/17453054.2023.2216243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Immersive virtual patient simulation could help medical students in clinical reasoning, but there is a lack of literature on the effectiveness of this method in healthcare learning. A pilot randomised controlled study compared performance (exam score) on a clinical case in immersive virtual simulation to a text for physiotherapy students. In the experimental group, the clinical case was presented by an immersive 360° video that students watched with a standalone headset, whereas the control group used the text only. A survey investigated students' perceptions of the clinical case, their experience of virtual reality, and sense of presence. Twenty-three students in immersive virtual reality had a significantly lower total score than 25 students with a text. This difference appeared in the assessment part of a clinical case. More precisely, it concerned patient history (including a few other elements of assessment and bio-psycho-social factors, p = 0.007). Satisfaction and motivation were strong in the experimental group. In conclusion, the performance was higher in text than in virtual reality situations. Nevertheless, immersive virtual patient simulation remains an interesting tool could train novices to follow history-taking skills of a new patient, as similar to a real-life situation.
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Affiliation(s)
| | | | - Eric Ranvial
- IRFSS Nouvelle Aquitaine Croix-Rouge Française - Site de Limoges, Limoges, France
| | - Méryl Marchat
- Centre de Simulation Virtuelle en Santé, Université de Limoges, Limoges, France
| | | | - Laurent Fourcade
- Centre de Simulation Virtuelle en Santé, Université de Limoges, Limoges, France
- Département de Chirurgie Pédiatrique, Hôpital Mère Enfant, Université de Limoges, Limoges, France
| | - Anaick Perrochon
- ILFOMER, Université de Limoges, Limoges, France
- Centre de Simulation Virtuelle en Santé, Université de Limoges, Limoges, France
- HAVAE, UR 20217, Universite de Limoges, Limoges, France
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Moingeon P, Chenel M, Rousseau C, Voisin E, Guedj M. Virtual patients, digital twins and causal disease models: paving the ground for in silico clinical trials. Drug Discov Today 2023; 28:103605. [PMID: 37146963 DOI: 10.1016/j.drudis.2023.103605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/22/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
Computational models are being explored to simulate in silico the efficacy and safety of drug candidates and medical devices. Disease models that are based on patients' profiling data are being produced to represent interactomes of genes or proteins and to infer causality in the pathophysiology {AuQ: Edit OK?}, which makes it possible to mimic the impact of drugs on relevant targets. Virtual patients designed from medical records as well as digital twins were generated to simulate specific organs and to predict treatment efficacy at the individual patient level {AuQ: Edit OK?}. As the acceptance of digital evidence by regulators grows, predictive artificial intelligence (AI)-based models will support the design of confirmatory trials in humans and will accelerate the development of efficient drugs and medical devices.
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12
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Schmidt C, Kesztyüs D, Haag M, Wilhelm M, Kesztyüs T. Proposal of a Method for Transferring High-Quality Scientific Literature Data to Virtual Patient Cases Using Categorical Data Generated by Bernoulli-Distributed Random Values: Development and Prototypical Implementation. JMIR Med Educ 2023; 9:e43988. [PMID: 36892938 PMCID: PMC10037169 DOI: 10.2196/43988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Teaching medicine is a complex task because medical teachers are also involved in clinical practice and research and the availability of cases with rare diseases is very restricted. Automatic creation of virtual patient cases would be a great benefit, saving time and providing a wider choice of virtual patient cases for student training. OBJECTIVE This study explored whether the medical literature provides usable quantifiable information on rare diseases. The study implemented a computerized method that simulates basic clinical patient cases utilizing probabilities of symptom occurrence for a disease. METHODS Medical literature was searched for suitable rare diseases and the required information on the respective probabilities of specific symptoms. We developed a statistical script that delivers basic virtual patient cases with random symptom complexes generated by Bernoulli experiments, according to probabilities reported in the literature. The number of runs and thus the number of patient cases generated are arbitrary. RESULTS We illustrated the function of our generator with the exemplary diagnosis "brain abscess" with the related symptoms "headache, mental status change, focal neurologic deficit, fever, seizure, nausea and vomiting, nuchal rigidity, and papilledema" and the respective probabilities from the literature. With a growing number of repetitions of the Bernoulli experiment, the relative frequencies of occurrence increasingly converged with the probabilities from the literature. For example, the relative frequency for headache after 10.000 repetitions was 0.7267 and, after rounding, equaled the mean value of the probability range of 0.73 reported in the literature. The same applied to the other symptoms. CONCLUSIONS The medical literature provides specific information on characteristics of rare diseases that can be transferred to probabilities. The results of our computerized method suggest that automated creation of virtual patient cases based on these probabilities is possible. With additional information provided in the literature, an extension of the generator can be implemented in further research.
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Affiliation(s)
- Christian Schmidt
- Medical Data Integration Center, Department of Medical Informatics, University Göttingen, Göttingen, Germany
| | - Dorothea Kesztyüs
- Medical Data Integration Center, Department of Medical Informatics, University Göttingen, Göttingen, Germany
| | - Martin Haag
- GECKO Institute, Heilbronn University of Applied Sciences, Heilbronn, Germany
| | - Manfred Wilhelm
- Department of Mathematics, Natural and Economic Sciences, Ulm University of Applied Sciences, Ulm, Germany
| | - Tibor Kesztyüs
- Medical Data Integration Center, Department of Medical Informatics, University Göttingen, Göttingen, Germany
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Revilla-León M, Alonso Pérez-Barquero J, Zubizarreta-Macho Á, Barmak AB, Att W, Kois JC. Influence of the Number of Teeth and Location of the Virtual Occlusal Record on the Accuracy of the Maxillo-Mandibular Relationship Obtained by Using An Intraoral Scanner. J Prosthodont 2023; 32:253-258. [PMID: 35448911 DOI: 10.1111/jopr.13526] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/07/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the influence of the number of teeth (2, 3, or 4) and location (molars, molar and premolar, or premolars and canines) of the bilateral virtual occlusal record on the accuracy of the virtual maxillo-mandibular relationship acquired by an intraoral scanner (IOS). MATERIAL AND METHODS Diagnostic casts mounted on a semi-adjustable articulator were obtained. Four markers were adhered on the facial surfaces of the first molars and canines. The mounted casts were digitized using an extraoral scanner. Maxillary and mandibular intraoral digital scans were obtained using an intraoral scanner (TRIOS 4). The maxillary and mandibular digital scans were duplicated 105 times and divided into 7 groups based on the number of teeth (2, 3, or 4) and location (molar, molar and premolar, or premolars and canines) of the bilateral virtual occlusal records (n = 15). The alignment of the scans was automatically performed after the acquisition of the corresponding occlusal records by the IOS program. Eight linear distances between the gauge balls were computed on the reference scan and on the 105 digital scans. The distances obtained on the reference scan were used to calculate the discrepancies with the distances obtained on each experimental scan. The Shapiro-Wilk test showed that the data was normally distributed. The trueness and precision data were analyzed using 2-way ANOVA followed by pairwise comparison Tukey tests (α = 0.05). RESULTS Two-way ANOVA showed that the number of teeth (p < 0.001) and the position of the virtual occlusal record (p < 0.001) were significant factors on the accuracy of the maxillo-mandibular relationship. Tukey test showed significant overall mean differences between the different groups tested: the 4-teeth group obtained the highest trueness, and the 2-teeth group showed the lowest trueness values (p < 0.001). Tukey test showed significant trueness differences between the virtual occlusal record locations. The 2-teeth record located more posteriorly obtained the lowest trueness. Significant differences in precision values were found among the subgroups tested (p < 0.001). The 2-teeth group obtained significantly more precision values than the 3- and 4-teeth groups. Additionally, there was a significant difference in precision values between the subgroup tested in which the first molar and second premolar location had the highest precision, while the first and second premolar's location obtained the lowest precision. CONCLUSIONS The number of teeth and the location of the bilateral virtual occlusal record influenced the accuracy of the virtual maxillo-mandibular relationship obtained by the intraoral scanner tested. The more teeth included in the bilateral virtual occlusal record, the higher the accuracy of the maxillo-mandibular relationship. Additionally, the more anteriorly located the virtual bilateral occlusal record involving 2 or 3 teeth was, the higher the accuracy mean value.
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Affiliation(s)
- Marta Revilla-León
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, WA.,Kois Center, Seattle, WA.,Revilla Research Center, Madrid, Spain
| | | | - Álvaro Zubizarreta-Macho
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Madrid, Spain
| | - Abdul B Barmak
- Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, NY
| | - Wael Att
- Department of Prosthodontics, Tuff University School of Dental Medicine, Boston, MA
| | - John C Kois
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, WA.,Kois Center, Seattle, WA.,Private Practice, Seattle, WA
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Tran C, Toth-Pal E, Ekblad S, Fors U, Salminen H. Medical Students' Learning About Other Professions Using an Interprofessional Virtual Patient While Remotely Connected With a Study Group: Mixed Methods Study. JMIR Med Educ 2023; 9:e38599. [PMID: 36649071 PMCID: PMC9890351 DOI: 10.2196/38599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/06/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Collaboration with other professions is essential in health care education to prepare students for future clinical teamwork. However, health care education still struggles to incorporate interprofessional education. Distance learning and virtual patients (VPs) may be useful additional methods to increase students' possibilities for interprofessional learning. OBJECTIVE This study had two aims. The first was to assess if an interprofessional VP case could facilitate medical students' learning about team collaboration in online groups. The second was to assess how students experienced learning with the VP when remotely connected with their group. METHODS A mixed methods design was used. The VP case was a 73-year-old man who needed help from different health professions in his home after a hip fracture. Questionnaires were answered by the students before and directly after each session. Qualitative group interviews were performed with each group of students directly after the VP sessions, and the interviews were analyzed using qualitative content analysis. RESULTS A total of 49 third-year medical students divided into 15 groups participated in the study. Each group had 2 to 5 students who worked together with the interprofessional VP without a teacher's guidance. In the analysis of the group interviews, a single theme was identified: the interprofessional VP promoted student interaction and gave insight into team collaboration. Two categories were found: (1) the structure of the VP facilitated students' learning and (2) students perceived the collaboration in their remotely connected groups as functioning well and being effective. The results from the questionnaires showed that the students had gained insights into the roles and competencies of other health care professions. CONCLUSIONS This study demonstrates that an interprofessional VP enabled insights into team collaboration and increased understanding of other professions among student groups comprising only medical students. The interprofessional VP seemed to benefit students' learning in an online, remote-learning context. Although our VP was not used as an interprofessional student activity according to the common definition of interprofessional education, the results imply that it still contributed to students' interprofessional learning.
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Affiliation(s)
- Carrie Tran
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Eva Toth-Pal
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
| | - Solvig Ekblad
- Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
- Cultural Medicine, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Helena Salminen
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
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15
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Gharib AM, Bindoff IK, Peterson GM, Salahudeen MS. Computer-Based Simulators in Pharmacy Practice Education: A Systematic Narrative Review. Pharmacy (Basel) 2023; 11:8. [PMID: 36649018 DOI: 10.3390/pharmacy11010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
Computer-based simulations may represent an innovative, flexible, and cost-efficient training approach that has been underutilised in pharmacy practice education. This may need to change, with increasing pressure on clinical placement availability, COVID-19 restrictions, and economic pressures to improve teaching efficiency. This systematic narrative review summarises various computer-based simulations described in the pharmacy practice education literature, identifies the currently available products, and highlights key characteristics. Five major databases were searched (Medline, CINAHL, ERIC, Education Source and Embase). Authors also manually reviewed the publication section of major pharmacy simulator websites and performed a citation analysis. We identified 49 studies describing 29 unique simulators, which met the inclusion criteria. Only eight of these simulators were found to be currently available. The characteristics of these eight simulators were examined through the lens of eight main criteria (feedback type, grading, user play mode, cost, operational requirement, community/hospital setting, scenario sharing option, and interaction elements). Although a number of systems have been developed and trialled, relatively few are available on the market, and each comes with benefits and drawbacks. Educators are encouraged to consider their own institutional, professional and curriculum needs, and determine which product best aligns with their teaching goals.
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Leung T, Cai Y, Cao J, He Q, Wang X, Lu Y, Liang H, Xu D, Liao J. The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China. J Med Internet Res 2022; 24:e40082. [PMID: 36459416 PMCID: PMC9758641 DOI: 10.2196/40082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/27/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. OBJECTIVE This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. METHODS Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted κ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. RESULTS Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, -0.03 (95% CI -0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted κ for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. CONCLUSIONS There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the "know-do" gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study.
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Affiliation(s)
| | - Yiyuan Cai
- Department of Epidemiology and Medical Statistics, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Jin Cao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Qianyu He
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaohui Wang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Lu
- Department of Preventive Medicine & Maternal and Child Health, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Huijuan Liang
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, China
| | - Dong Xu
- Center for World Health Organization Studies, Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.,ACACIA Lab for Implementation Research, Southern Medical University Institute for Global Health, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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17
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Woodruff AE, Chilbert MR, Prescott WA, Wilcox N, Marzouk O, Prescott GM, Slazak EM. Implementation and Assessment of a Heart Failure Virtual Patient Simulation in a Required Pharmacotherapy Course. Am J Pharm Educ 2022; 86:8650. [PMID: 34697012 PMCID: PMC10159431 DOI: 10.5688/ajpe8650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/08/2021] [Indexed: 05/06/2023]
Abstract
Objective. To assess second year Doctor of Pharmacy students' academic performance in and perceptions of a heart failure (HF) virtual patient simulation used in a required pharmacotherapy course.Methods. A heart failure virtual patient simulation was created to augment heart failure pharmacotherapy course material at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences in the fall of 2019. This was a retrospective, pre-post observational cohort study. The primary objective was to compare student performance on heart failure pharmacotherapy examination questions in a cohort of students who completed a virtual patient simulation in 2019 compared to a control cohort who completed a paper-based case activity in 2018. Student perceptions of the simulation experience were assessed via electronic survey.Results. Students completed either the virtual patient simulation (n=122) or a paper-based case activity (n=123). Overall, the proportion of correctly answered heart failure pharmacotherapy examination questions was 83.3% in the virtual simulation group compared to 79.2% in the paper-based case group. Survey results indicated that students would prefer that the virtual patient simulation be incorporated in the pharmacotherapy curriculum.Conclusion. Use of a heart failure virtual patient simulation was associated with improved examination performance and was well received by students.
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Affiliation(s)
- Ashley E Woodruff
- University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York
| | - Maya R Chilbert
- University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York
| | - William A Prescott
- University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York
- Editorial Board Member, American Journal of Pharmaceutical Education, Arlington, Virginia
| | - Nicole Wilcox
- Children's Hospital of Richmond, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Omar Marzouk
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gina M Prescott
- University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York
| | - Erin M Slazak
- University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York
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18
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Lem WG, Kohyama-Koganeya A, Saito T, Oyama H. Effect of a Virtual Reality Contact-Based Educational Intervention on the Public Stigma of Depression: Randomized Controlled Pilot Study. JMIR Form Res 2022; 6:e28072. [PMID: 35499865 PMCID: PMC9112084 DOI: 10.2196/28072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/07/2021] [Accepted: 03/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Public stigma against depression contributes to low employment rates among individuals with depression. Contact-based educational (CBE) interventions have been shown to reduce this public stigma. Objective We investigated the ability of our Virtual Reality Antistigma (VRAS) app developed for CBE interventions to reduce the stigma of depression. Methods Sixteen medical students were recruited and randomized 1:1 to the intervention group, who used the VRAS app (VRAS group), and the control group, who watched a video on depression. The depression stigma score was assessed using the Depression Stigma Scale (DSS) and Attitudinal Social Distance (ASD) questionnaire at pre- and postintervention. Feasibility was assessed in both groups and usability was assessed only in the VRAS group after the intervention. A qualitative study was performed on the acquisition of knowledge about stigma in both groups based on participants’ answers to open-ended questions and interviews after the intervention. Results The feasibility score was significantly higher in the VRAS group (mean 5.63, SD 0.74) than in the control group (mean 3.88, SD 1.73; P=.03). However, no significant differences were apparent between the VRAS and control groups for the DSS (VRAS: mean 35.13, SD 5.30; control: mean 35.38, SD 4.50; P=.92) or ASD (VRAS: mean 12.25, SD 3.33; control: mean 11.25, SD 1.91; P=.92). Stigma scores tended to decrease; however, the stigma-reducing effects of the VRAS app were not significant for the DSS (pre: mean 33.00, SD 4.44; post: mean 35.13, SD 5.30; P=.12) or ASD (pre: mean 13.25, SD 3.92; post: mean 12.25, SD 3.33; P=.12). Qualitative analysis suggested that the VRAS app facilitated perspective-taking and promoted empathy toward the patient. Conclusions The CBE intervention using virtual reality technology (VRAS app) was as effective as the video intervention. The results of the qualitative study suggested that the virtual reality intervention was able to promote perspective-taking and empathy toward patients. Trial Registration University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000043020; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049109
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Affiliation(s)
- Wey Guan Lem
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ayako Kohyama-Koganeya
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toki Saito
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Oyama
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Li Y, Yu Y, Feng Y, Liu W. Predictable digital restorative workflow for minimally invasive esthetic rehabilitation utilizing a virtual patient model with global diagnosis principle. J ESTHET RESTOR DENT 2022; 34:769-775. [PMID: 35213088 DOI: 10.1111/jerd.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The conventional anterior esthetic treatment protocol is limited as it's time consuming and unreliable. A predictable digital workflow for minimally invasive anterior esthetic tooth rehabilitation with global diagnosis principle has been introduced in this report. CLINICAL CONSIDERATIONS A 23-year-old female patient with the chief complaint of unsatisfied shape and color of her anterior teeth visited our hospital for restorative consultation. Three-dimensional Digital Smile Design was used to integrate into a virtual patient model to provide rehabilitative esthetic planning with global diagnostic principle. 3D printer was used for communication and guidance preparation. Digital impression and computer-aided design/computer-aided manufacturing technologies were adopted for making the morphology of designed restorations that can precisely transfer to definitive prostheses. The esthetics, functional occlusion, and gingival tissues remained stable for over a follow-up period of 3 years. No signs of fractures within the restorations were observed. CONCLUSIONS Minimally invasive anterior esthetic tooth rehabilitation can be readily achieved using a predictable digital workflow with global diagnosis principle. CLINICAL SIGNIFICANCE This digital approach might promote diagnosis, enhance communication, reduce processing time, and increase the predictability of final outcomes with high comfort and esthetic effect.
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Affiliation(s)
- Yiyuan Li
- Department of Prosthodontics, School & Hospital of Stomatology, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Tongji University, Shanghai, China
| | - Yiqiang Yu
- Department of Prosthodontics, School & Hospital of Stomatology, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Tongji University, Shanghai, China
| | - Yue Feng
- Department of Prosthodontics, School & Hospital of Stomatology, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Tongji University, Shanghai, China
| | - Weicai Liu
- Department of Prosthodontics, School & Hospital of Stomatology, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Tongji University, Shanghai, China
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20
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Nota A, Chegodaeva AD, Ryakhovsky AN, Vykhodtseva MA, Pittari L, Tecco S. One-Stage Virtual Plan of a Complex Orthodontic/Prosthetic Dental Rehabilitation. Int J Environ Res Public Health 2022; 19:1474. [PMID: 35162496 DOI: 10.3390/ijerph19031474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 12/10/2022]
Abstract
In complex dental treatments, a preliminary virtual plan (VP) can minimise the probability of errors and increase the predictability of the achieved result. Digital technologies and artificial intelligence open more opportunities for such planning, as they can be applied at the early stages of clinical examination to develop a simultaneous VP of all stages of treatment. The present clinical case describes a one-stage entire VP combining all the stages of treatment: gnathological, orthodontic, and prosthetic rehabilitation, until the final result. This approach avoids the accumulation errors associated with multistage VP, in which one stage of planning follows the end of a previous stage. One-step VP also allows demonstrating to the patients the expected results of the restoration, which increases their motivation to initiate the treatment.
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21
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Li J, Chen Z, Decker AM, Wang HL, Joda T, Mendonca G, Lepidi L. Trueness and Precision of Economical Smartphone-Based Virtual Facebow Records. J Prosthodont 2022; 31:22-29. [PMID: 33876857 PMCID: PMC8526632 DOI: 10.1111/jopr.13366] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To investigate the trueness and precision of virtual facebow records using a smartphone as a three-dimensional (3D) face scanner. MATERIAL AND METHODS Twenty repeated virtual facebow records were performed on two subjects using a smartphone as a 3D face scanner. For each subject, a virtual facebow was attached to his/her maxillary arch, and face scans were performed using a smartphone with a 3D scan application. The subject's maxillary arch intraoral scan was aligned to the face scan by the virtual facebow fork. This procedure was repeated 10 times for each subject. To investigate if the maxillary scan is located at the right position to the face, these virtual facebow records were superimposed to a cone-beam computed tomography (CBCT) head scan from the same subject by matching the face scan to the 3D face reconstruction from CBCT images. The location of maxillary arch in virtual facebow records was compared with its position in CBCT. The "trueness" of the proposed procedure is defined as the deviation between maxilla arch position in virtual facebow records and the CBCT images. The "precision" is defined as the deviation between each virtual facebow record. The linear deviation at left central incisor (#9), left first molar (#14), and right first molar (#3), as well as angular deviation of occlusal plane were analyzed with descriptive statistics. Differences between two objects were also explored with Mann Whitney U test. RESULTS The 20 virtual facebow records using the smartphone 3D scanner deviated from the CBCT measurements (trueness) by 1.14 ± 0.40 mm at #9, 1.20 ± 0.50 mm at #14, 1.12 ± 0.51 mm at the #3, and 1.48 ± 0.56° in the occlusal plane. The VFTs deviated from each other by 1.06 ± 0.50 mm at #9, 1.09 ± 0.49 mm at #14, 1.11 ± 0.58 mm at #3, and 0.81 ± 0.58° in the occlusal plane. When all sites combined, the trueness was 1.14 ± 0.40 mm, and the precision was 1.08 ± 0.52 mm. Out of eight measurements, three measurements were significantly different between subjects. Nevertheless, the mean difference was small. CONCLUSIONS Virtual facebow records made using smartphone-based face scan can capture the maxilla position with high trueness and precision. The deviation can be anticipated as around 1 mm in linear distance and 1° in angulation.
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Affiliation(s)
- Junying Li
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Zhaozhao Chen
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Ann M. Decker
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Tim Joda
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Gustavo Mendonca
- Department of Biologic & Materials Sciences, Division of Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Luca Lepidi
- Department of Clinical and Experimental Medicine, University of Foggia School of Dentistry, Foggia, Italy
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Zhang C, Jin X, Luo D, Xu D, Liao J, Gong W. Using virtual patient to assess primary health workers ' competence to detect postpartum depression in Hunan, China. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46:1129-1137. [PMID: 34911844 PMCID: PMC10930235 DOI: 10.11817/j.issn.1672-7347.2021.210139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Primary health workers are the first fine to identify postpartum depression, which is important for patients with this disease to get early specialist diagnosis and treatment. The smartphone-based virtual patient is economical, convenient and effective, and has been applied extensively to evaluate the competency to detect postpartum depression, but there is no relevant application in China. This study aims to use virtual patient to assess the current status on the competency of detecting postpartum depression among primary maternal and child health workers in Hunan Province, and to explore potential influencing factors. METHODS A total of 222 primary maternal and child health workers from 3 regions with low, medium, and high economic levels in Hunan Province were enrolled, and smartphone-based virtual patients with postpartum depression were used for the assessment from May to July in 2018, and a self-designed questionnaire was used to investigate their demographic characteristics. The competency to detect postpartum depression was measured by 2 indicators: diagnostic accuracy and treatment accuracy. Descriptive statistical methods were used to describe the competency to detect postpartum depression among them and their demographic characteristics. A logistic regression analysis was used to explore the possible influencing factors for the diagnostic accuracy and treatment accuracy. RESULTS The diagnostic accuracy rate was 64.0%. There was no significant difference between the demographic characteristics and diagnostic accuracy rate (P>0.05). The treatment accuracy rate was 50.9%. The workers from the middle economic level area were more likely to make the correct treatment than those from the low economic level area (OR= 3.229, 95% CI 1.478 to 7.014).Apart from postpartum depression, the 3 most frequently diagnosed items were bipolar disorder (22.1%, 49/222), secondary depression disorder (13.5%, 30/222), and neurasthenia (5.4%, 12/222). Among the correctly diagnosed health workers, the proportion for correct treatment was 29.6% (42/142), and there was no significant difference between the diagnostic accuracy and treatment accuracy (P>0.05). CONCLUSIONS About half of the primary maternal and child health workers in Hunan Province, China have basic competency to detect postpartum depression, but the overall results are not satisfactory. The regional economic level is correlated with the competency of detecting postpartum depression, and the competency of detecting postpartum depression is stronger in more developed areas. Moreover, for the patients who have been identified as postpartum depression, the rate of correct treatment is low, which warrants particular attention in the follow-up training.
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Affiliation(s)
- Chao Zhang
- Department of Maternal, Child and Adolescent Health, Xiangya School of Public Health, Central South University, Changsha 410005.
| | - Xin Jin
- Department of Maternal, Child and Adolescent Health, Xiangya School of Public Health, Central South University, Changsha 410005
| | - Dan Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410005.
| | - Dong Xu
- Center for World Health Organization Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou 510080
- Institute for Global Health and Dermatology Hospital, Southern Medical University, Guangzhou 510080
| | - Jing Liao
- Global Health Institute, School of Public Health, Sun Yat-sen University, Guangzhou 510080
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080
| | - Wenjie Gong
- Department of Maternal, Child and Adolescent Health, Xiangya School of Public Health, Central South University, Changsha 410005.
- Institute of Applied Health Research University of Birmingham, Birmingham B152 TT, UK.
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Alkarkoukly S, Rajput AM. An openEHR Virtual Patient Template for Pancreatic Cancer. Stud Health Technol Inform 2021; 285:292-5. [PMID: 34734890 DOI: 10.3233/SHTI210618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
openEHR is an open-source technology for e-health, aims to build data models for interoperable Electronic Health Records (EHRs) and to enhance semantic interoperability. openEHR architecture consists of different building blocks, among them is the "template" which consists of different archetypes and aims to collect the data for a specific use-case. In this paper, we created a generic data model for a virtual pancreatic cancer patient, using the openEHR approach and tools, to be used for testing and virtual environments. The data elements for this template were derived from the "Oncology minimal data set" of HiGHmed project. In addition, we generated virtual data profiles for 10 patients using the template. The objective of this exercise is to provide a data model and virtual data profiles for testing and experimenting scenarios within the openEHR environment. Both of the template and the 10 virtual patient profiles are available publicly.
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Tsai TC. [The Development and Application of Virtual Patient in Clinical Training: The New Horizon for Nursing Education]. Hu Li Za Zhi 2021; 68:24-29. [PMID: 34549405 DOI: 10.6224/jn.202110_68(5).05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Clinical problem-solving training that involves hands-on practice with patients is regarded as an important yet challenging aspect of medical education. A majority of schools around the world have suspended face-to-face classes because of the COVID-19 pandemic. Although remote digital classes represent a widely adopted alternative approach to education, the format of these classes is poorly suited to clinical learning and examination. With advances in virtual technology using natural language processing and multimedia, virtual patients bring vivid clinical encounters with records and feedback and are able to facilitate learning in the realm of clinical problem-solving. Virtual patients may be used to replace paper cases, human patients, and standardized patients in clinical education. The related applications include virtual problem-based learning in group training, clinical skill examination, and cloud-based virtual training. Integrating online meeting systems with virtual patient systems effectively overcomes the barriers of learning related to distance and isolation. The cloud model is especially important in the pandemic period, as this model allows clinical team work training to continue outside of actual hospital settings. In conclusion, technology-assisted simulation has innovated clinical training and assessment. The success of technology-enhanced education relies on its alignment with students' level of training and targeted learning objectives, especially when coupled with observation and feedback. The success of clinical education will guarantee the improvement of students' clinical competency.
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Affiliation(s)
- Tsuen-Chiuan Tsai
- PhD, MD, Professor, Post Baccalaureate Medicine, Kaohsiung Medical University, and Pediatrician, Department of Pediatrics, Kaohsiung Medical University Hospital, and Co-Founder of Innova Medical Technology, Inc, Taiwan, ROC.
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Walter S, Speidel R, Hann A, Leitner J, Jerg-Bretzke L, Kropp P, Garbe J, Ebner F. Skepticism towards advancing VR technology - student acceptance of VR as a teaching and assessment tool in medicine. GMS J Med Educ 2021; 38:Doc100. [PMID: 34651058 PMCID: PMC8493843 DOI: 10.3205/zma001496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/17/2021] [Accepted: 06/25/2021] [Indexed: 05/11/2023]
Abstract
Objective: The high didactic potential of Virtual Reality (VR) contrasts with the point of view of students that the technology only has a relatively low significance for current and future teaching. This discrepancy was studied in a differentiated manner in order to gear the further development and implementation of VR towards the target group. Methods: From January 2020 to July 2020, medical students (N=318) were asked to watch ten videos online and rate them on the basis of acceptance indicators (e.g., fun and fairness). Using obstetrics as an example, the videos demonstrated five levels of VR technology functionality (e.g., haptic and adaptive feedback), some of which were visionary, in two use scenarios (teaching and the OSCE). The individual and aggregate indicators were compared with non-parametric testing procedures across application scenarios, functional levels and genders. In addition, correlations between the acceptance and the factors of semester, age, computer affinity, and previous VR experience were analyzed. Results: Across all functional levels, VR was more likely to be accepted in the classroom than in the OSCE. Comparisons across functional levels also revealed that the VR ready to be marketed was significantly more accepted than the visionary functions. This skepticism toward advancing VR technology was most pronounced with regard to the vision of autonomous VR examinations and among female students with a low computer affinity. Conclusion: The results suggest that the students' reservations are due to a lack of experience with the VR technology. In order for young physicians to become familiar with the technology and to be able to use it competently in the everyday clinical practice in the future, VR should not only be used as a teaching tool but also be part of the curriculum. Practical examinations using VR, on the other hand, are only recommended once the technology has become established in teaching and has been proven to be reliable.
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Affiliation(s)
- Steffen Walter
- Ulm University Hospital, Department of Psychosomatic Medicine and Psychotherapy, Medical Psychology Section, Ulm, Germany
| | - Robert Speidel
- University of Ulm, Faculty of Medicine, Competence Center eEducation in Medicine, Ulm, Germany
| | - Alexander Hann
- University Hospital Würzburg, Medical Clinic and Policlinic II, Gastroenterology, Würzburg, Germany
| | - Janine Leitner
- Ulm University Hospital, Department of Psychosomatic Medicine and Psychotherapy, Medical Psychology Section, Ulm, Germany
| | - Lucia Jerg-Bretzke
- Ulm University Hospital, Department of Psychosomatic Medicine and Psychotherapy, Medical Psychology Section, Ulm, Germany
| | - Peter Kropp
- Rostock University Medical Center, Institute for Medical Psychology and Medical Sociology, Rostock, Germany
| | - Jakob Garbe
- Halle University Hospital, Department of Internal Medicine I, Halle, Germany
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Abbiati RA, Pourdehnad M, Carrancio S, Pierce DW, Kasibhatla S, McConnell M, Trotter MWB, Loos R, Santini CC, Ratushny AV. Quantitative Systems Pharmacology Modeling of Avadomide-Induced Neutropenia Enables Virtual Clinical Dose and Schedule Finding Studies. AAPS J 2021; 23:103. [PMID: 34453265 PMCID: PMC8397660 DOI: 10.1208/s12248-021-00623-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/03/2021] [Indexed: 01/02/2023] Open
Abstract
Avadomide is a cereblon E3 ligase modulator and a potent antitumor and immunomodulatory agent. Avadomide trials are challenged by neutropenia as a major adverse event and a dose-limiting toxicity. Intermittent dosing schedules supported by preclinical data provide a strategy to reduce frequency and severity of neutropenia; however, the identification of optimal dosing schedules remains a clinical challenge. Quantitative systems pharmacology (QSP) modeling offers opportunities for virtual screening of efficacy and toxicity levels produced by alternative dose and schedule regimens, thereby supporting decision-making in translational drug development. We formulated a QSP model to capture the mechanism of avadomide-induced neutropenia, which involves cereblon-mediated degradation of transcription factor Ikaros, resulting in a maturation block of the neutrophil lineage. The neutropenia model was integrated with avadomide-specific pharmacokinetic and pharmacodynamic models to capture dose-dependent effects. Additionally, we generated a disease-specific virtual patient population to represent the variability in patient characteristics and response to treatment observed for a diffuse large B-cell lymphoma trial cohort. Model utility was demonstrated by simulating the avadomide effect in the virtual population for various dosing schedules and determining the incidence of high-grade neutropenia, its duration, and the probability of recovery to low-grade neutropenia.
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Affiliation(s)
- Roberto A Abbiati
- Bristol Myers Squibb, Center for Innovation and Translational Research Europe (CITRE), Seville, Spain.
| | | | | | | | | | | | - Matthew W B Trotter
- Bristol Myers Squibb, Center for Innovation and Translational Research Europe (CITRE), Seville, Spain
| | - Remco Loos
- Bristol Myers Squibb, Center for Innovation and Translational Research Europe (CITRE), Seville, Spain
| | - Cristina C Santini
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center, Basel, Switzerland
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Jacklin S, Maskrey N, Chapman S. Shared Decision-Making With a Virtual Patient in Medical Education: Mixed Methods Evaluation Study. JMIR Med Educ 2021; 7:e22745. [PMID: 34110299 PMCID: PMC8235293 DOI: 10.2196/22745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/11/2021] [Accepted: 04/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Shared decision-making (SDM) is a process in which clinicians and patients work together to select tests, treatments, management, or support packages based on clinical evidence and the patient's informed preferences. Similar to any skill, SDM requires practice to improve. Virtual patients (VPs) are simulations that allow one to practice a variety of clinical skills, including communication. VPs can be used to help professionals and students practice communication skills required to engage in SDM; however, this specific focus has not received much attention within the literature. A multiple-choice VP was developed to allow students the opportunity to practice SDM. To interact with the VP, users chose what they wanted to say to the VP by choosing from multiple predefined options, rather than typing in what they wanted to say. OBJECTIVE This study aims to evaluate a VP workshop for medical students aimed at developing the communication skills required for SDM. METHODS Preintervention and postintervention questionnaires were administered, followed by semistructured interviews. The questionnaires provided cohort-level data on the participants' views of the VP and helped to inform the interview guide; the interviews were used to explore some of the data from the questionnaire in more depth, including the participants' experience of using the VP. RESULTS The interviews and questionnaires suggested that the VP was enjoyable and easy to use. When the participants were asked to rank their priorities in both pre- and post-VP consultations, there was a change in the rank position of respecting patient choices, with the median rank changing from second to first. Owing to the small sample size, this was not analyzed for statistical significance. The VP allowed the participants to explore a consultation in a way that they could not with simulated or real patients, which may be part of the reason that the VP was suggested as a useful intervention for bridging from the early, theory-focused years of the curriculum to the more patient-focused ones later. CONCLUSIONS The VP was well accepted by the participants. The multiple-choice system of interaction was reported to be both useful and restrictive. Future work should look at further developing the mode of interaction and explore whether the VP results in any changes in observed behavior or practice.
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Affiliation(s)
- Simon Jacklin
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
| | - Neal Maskrey
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
| | - Stephen Chapman
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
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Sun A, Yang Y, Gao H, Lin WS, Chen L, Tan J. Integrating Facial and Intraoral Scans for Digital Esthetic and Occlusal Design: A Technical Report. J Prosthodont 2021; 30:729-733. [PMID: 34109701 DOI: 10.1111/jopr.13397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/30/2022] Open
Abstract
The provisional prosthesis is a prerequisite for prosthodontic rehabilitation. The purpose of this technique was to register facial and intraoral scans predictably. A 3D virtual patient was created through facial scans, intraoral scans, digital face-bow transfer, and digital cross-articulation technique. This virtual patient allowed predictable positioning of intraoral scans to a virtual articulator by using digital face-bow transfer. The resulting virtual patient facilitated the design of definitive prostheses following a facially generated treatment planning principle. In addition, the virtual articulator was used to improve occlusal design on the definitive prostheses and reduce the need for intraoral adjustment.
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Affiliation(s)
- Ao Sun
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China.,Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Yang Yang
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Hanqi Gao
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Wei-Shao Lin
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, IN
| | - Li Chen
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Jianguo Tan
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
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29
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Pérez-Giugovaz MG, Park SH, Revilla-León M. 3D Virtual Patient Representation for Guiding a Maxillary Overdenture Fabrication: A Dental Technique. J Prosthodont 2021; 30:636-641. [PMID: 33942953 DOI: 10.1111/jopr.13374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/01/2022] Open
Abstract
This report describes a technique to obtain a 3D virtual representation of a maxillary edentulous patient guided by an additively manufactured intraoral scan body. The intraoral scan body incorporated a custom tray and occlusion rim which facilitated the acquiring of a digital definitive cast, maxillary occlusion rim position, interocclusal registration, and guided the integration of the facial scans. The technique simplified the design and manufacturing of the maxillary overdenture.
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Affiliation(s)
| | | | - Marta Revilla-León
- Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, TX
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30
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Bahrami M, Hadadgar A, Fuladvandi M. Designing Virtual Patients for Education of Nursing Students in Cancer Course. Iran J Nurs Midwifery Res 2021; 26:133-136. [PMID: 34036060 PMCID: PMC8132870 DOI: 10.4103/ijnmr.ijnmr_327_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/27/2020] [Accepted: 12/27/2020] [Indexed: 11/05/2022]
Abstract
Background: One of the best approaches to promote clinical reasoning in nursing education is Virtual Patient (VP). The purpose of this study was to design and implement VPs for nursing student's education in caring for cancer patients. Materials and Methods: In the first stage, through a descriptive-exploratory qualitative study using a focus group method, topics with higher priority in cancer nursing were identified. Then, based on the VP Nursing Design Model (VPNDM) for each of these topics, a scenario and then an interactive VP was designed and implemented in the Open Labyrinth application. The content validity of VPs was evaluated by eight experts and then the face validity was examined in the pilot group including 15 nursing students. Results: Topics with higher priority in cancer nursing courses were mastectomy, chemotherapy, radiotherapy, hypercalcemia, spinal cord compression, cardiac tamponade, and superior vena cava syndrome. For five scenarios based on the nursing process in three sequences (signs and symptoms, diagnosis and interventions) the VPs were designed. In this process, learning objectives, determining the critical path, adding branches at the decision point, adding feedback, completing the clinical course and related data, and adding multimedia were considered. VPs were revised based on the proposed modifications following face and content validity. Conclusions: This article presents VP design steps for use in a nursing student training course. The researchers were able to provide and validate five VPs to care for cancer patients based on the VPNDM.
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Affiliation(s)
- Masoud Bahrami
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Hadadgar
- Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Fuladvandi
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Fink MC, Reitmeier V, Stadler M, Siebeck M, Fischer F, Fischer MR. Assessment of Diagnostic Competences With Standardized Patients Versus Virtual Patients: Experimental Study in the Context of History Taking. J Med Internet Res 2021; 23:e21196. [PMID: 33661122 PMCID: PMC7974754 DOI: 10.2196/21196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/01/2020] [Accepted: 12/27/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Standardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research. OBJECTIVE The aim of this study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy. METHODS We conducted an experimental study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this study used equivalence testing to investigate the absence of meaningful effects. RESULTS Perceived authenticity (1-tailed t81=11.12; P<.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (r=0.05) and neither equivalent (P=.09) nor statistically significant (P=.32). Cognitive load was equivalent in both assessment methods (t82=2.81; P=.003). Intrinsic cognitive load (1-tailed r=-0.30; P=.003) and extraneous load (1-tailed r=-0.29; P=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed r=0.38; P<.001); this finding did not hold for SPs (1-tailed r=0.05; P=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed t85=2.49; P=.01). CONCLUSIONS The results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students' grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods.
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Affiliation(s)
- Maximilian C Fink
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Victoria Reitmeier
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Stadler
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Center of the Learning Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Matthias Siebeck
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
- Munich Center of the Learning Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Frank Fischer
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Center of the Learning Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin R Fischer
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
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Abstract
BACKGROUND Lack of treatment adherence can lead to life-threatening health complications for people with type 2 diabetes (T2D). Recent improvements and availability in continuous glucose monitoring (CGM) technology have enabled various possibilities to monitor diabetes treatment. Detection of missed once-daily basal insulin injections can be used to provide feedback to patients, thus improving their diabetes management. In this study, we explore how machine learning (ML) based on CGM data can be used for detecting adherence to once-daily basal insulin injections. METHODS In-silico CGM data were generated to simulate a cohort of T2D patients on once-daily insulin injection (Tresiba®). Deep learning methods within ML based on automatic feature extraction including convolutional neural networks were explored and compared with simple feature-engineered ML classification models for adherence detection. It was further investigated whether fused expert-dependent and automatically learned features could improve performance, resulting in a comparison of six different detection models. Adherence was detected throughout each day with an increasing amount of CGM data available. RESULTS The adherence detection accuracy improved as more CGM data became available on the day of classification. The three classification models based on expert-engineered features obtained mean accuracies of 78.6%, 78.2%, and 78.3%. The classification model based purely on learned features obtained a mean accuracy of 79.7%. The two classification models fusing expert-engineered and learned features obtained mean accuracies of 79.7% and 79.8%. All the mentioned results were obtained 16 hours after time of injection. CONCLUSION The results suggest that adherence detection based on CGM data is feasible. Even though our study based on in-silico data indicates only slightly improved performance of more complex models, the question remains whether advanced models would outperform the simple in a real-world setting. Thus, future studies on adherence monitoring using real CGM data are relevant.
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Affiliation(s)
- Daniel N. Thyde
- Department of Applied Mathematics and Computer Science, DTU Compute, Kgs. Lyngby, Denmark
| | - Ali Mohebbi
- Department of Applied Mathematics and Computer Science, DTU Compute, Kgs. Lyngby, Denmark
- Novo Nordisk A/S, Device R&D, Hillerød, Denmark
| | | | | | - Morten Mørup
- Department of Applied Mathematics and Computer Science, DTU Compute, Kgs. Lyngby, Denmark
- Morten Mørup, PhD, Danmarks Tekniske Universitet, Richard Petersens Plads, Building 321, 2800 Kgs., Lyngby, Denmark.
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Thompson J, White S, Chapman S. Interactive Clinical Avatar Use in Pharmacist Preregistration Training: Design and Review. J Med Internet Res 2020; 22:e17146. [PMID: 33155983 PMCID: PMC7679212 DOI: 10.2196/17146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Virtual patients are interactive computer-based simulations that are being increasingly used in modern health care education. They have been identified as tools that can provide experiential learning and assessment in a standardized and safe environment. However, the study of high-fidelity virtual patients such as interactive clinical avatars within pharmacy is limited. OBJECTIVE The aim of this paper is to describe the design and review of three interactive clinical avatar simulations as part of pharmacist preregistration training. METHODS A multistep design approach was taken to create interactive clinical avatar simulations on the topics of emergency hormonal contraception (EHC), calculation of renal function, and childhood illnesses. All case studies were reviewed by registered pharmacists to establish content and face validity. The EHC case study and data collection questionnaire were also reviewed by a purposive sample of preregistration trainees and newly qualified pharmacists. The questionnaire used Likert ranking statements and open-ended questions to obtain users' feedback on the design, usability, and usefulness of the interactive clinical avatars as learning tools. Descriptive statistics and content analysis were undertaken on the data. RESULTS Ten preregistration trainees and newly qualified pharmacists reviewed the EHC interactive clinical avatars and data collection questionnaire. The data collection questionnaire was associated with a Cronbach alpha=.95, demonstrating good reliability. All three interactive clinical avatar simulations were reported as usable and appropriately designed for preregistration training. Users perceived they were developing skills and knowledge from the simulations. The high-fidelity nature of the avatars and relevance of the simulations to real-life practice were reported as aspects that encouraged the application of theory to practice. Improvements were suggested to ensure the simulations were more user-friendly. CONCLUSIONS The design and creation of the interactive clinical avatar simulations was successful. The multistep review process ensured validity and reliability of the simulations and data collection questionnaire. The in-depth explanation of the design process and provision of a questionnaire may help widen the use and evaluation of interactive clinical avatars or other simulation tools in pharmacy education. The interactive clinical avatars were reported as novel learning tools that promoted experiential learning and allowed users to feel like they were engaging in real-life scenarios, thus developing transferable knowledge and skills. This may be potentially beneficial for many health care training courses as a way to provide standardized experiences promoting active learning and reflection.
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Affiliation(s)
- Jessica Thompson
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
| | - Simon White
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
| | - Stephen Chapman
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
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Johnson KS, Schmidt AM, Bader JD, Spallek H, Rindal DB, Enstad CJ, Fricton JR, Asche SE, Kane SM, Thirumalai V, Godlevsky OV, Johnson NJ, Acharya A, Rush WA. Dental Decision Simulation (DDSim): Development of a virtual training environment. J Dent Educ 2020; 84:1284-1293. [PMID: 32702778 DOI: 10.1002/jdd.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/11/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022]
Abstract
PURPOSE Case-based simulations are powerful training tools that can enhance learning and drive behavior change. This is an overview of the design/development of Dental Decision Simulation (DDSim), a web-based simulation of an electronic dental record (EDR). The purpose was to use DDSim to train dentists to make evidence-based treatment planning decisions consistent with current evidence. This simulated EDR provides case-based information in support of a set of defined evidence-based learning objectives. METHODS The development of this complex simulation model required coordinated efforts to create several components: identify behavior changes, case authoring mechanism, create virtual patient visits, require users to make treatment plan decisions related to learning objectives, and a feedback mechanism to help users recognize departures from those learning objectives. This simulation was evaluated in a 2-arm, clinic-randomized, controlled pilot study examining the extent to which DDSim changed dentists' planned treatment to conform to evidence-based treatment guidelines relative to change in dentists not exposed to DDSim. Outcomes were measured by comparing preintervention and postintervention patient EDR treatment data. RESULTS Changes in behavior over time did not favor intervention or control clinics. CONCLUSION DDSim provides a standardized learning platform that cannot be achieved through the use of live patients. Both live patients and case-based simulations can be used to transfer knowledge and skill development. DDSim offers the advantage of providing a platform for developing treatment planning skills in a low-risk environment. However, further research examining behavior change is needed.
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Affiliation(s)
| | | | - James D Bader
- Department of Operative Dentistry, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA
| | - Heiko Spallek
- Dean, University of Sydney School of Dentistry, Sydney, Australia
| | - D Brad Rindal
- HealthPartners Institute, Minneapolis, Minnesota, USA
| | | | | | | | - Sheryl M Kane
- HealthPartners Institute, Minneapolis, Minnesota, USA
| | | | | | - Neil J Johnson
- HealthPartners Institute, Minneapolis, Minnesota, USA.,Centennial Lakes Dental Group, Minneapolis, Minnesota, USA
| | - Amit Acharya
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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Rouleau G, Pelletier J, Côté J, Gagnon MP, Martel-Laferrière V, Lévesque R, Fontaine G. Codeveloping a Virtual Patient Simulation to Foster Nurses' Relational Skills Consistent With Motivational Interviewing: A Situation of Antiretroviral Therapy Nonadherence. J Med Internet Res 2020; 22:e18225. [PMID: 32672679 PMCID: PMC7391166 DOI: 10.2196/18225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/01/2020] [Accepted: 06/03/2020] [Indexed: 01/20/2023] Open
Abstract
Background Although helping people living with HIV manage their antiretroviral therapy is a core competency of HIV nursing care, no educational intervention has sought to strengthen this competency. Thus, we codeveloped a simulation of a virtual patient (VP) having difficulty adhering to treatment to foster the relational skills that nurses require in such situations. Objective This viewpoint paper aims to describe the codevelopment process and the content of VP simulation, as well as the challenges encountered and the strategies used to overcome them. Methods We use a collaborative and iterative approach to develop the simulation based on qualitative evidence, theoretical approaches (strengths-based nursing, motivational interviewing [MI], and adult learning theories), and expert recommendations. We carried out 2 main phases: (1) planning the simulation development and (2) designing the simulation content, sequence, and format. We created the script as if we were writing a choose-your-own-adventure book. All relational skills (behavior change counseling techniques derived from MI) were integrated into a nurse-patient dialogue. The logic of the simulation is as follows: if the nurse uses techniques consistent with MI (eg, open-ended questions, summarizing), a dialogue is opened up with the VP. If the nurse uses relational skills inconsistent with MI (eg, providing advice without asking for permission), the VP will react accordingly (eg, defensively). Learners have opportunities to assess and reflect on their interventions with the help of quizzes and feedback loops. Results Two main challenges are discussed. The most salient challenge was related to the second phase of the VP simulation development. The first was to start the project with divergent conceptions of how to approach the VP simulation—the simulation company’s perspective of a procedural-type approach versus the clinical team’s vision of a narrative approach. As a broad strategy, we came to a mutual understanding to develop a narrative-type VP simulation. It meshed with our conception of a nurse-patient relationship, the values of strengths-based nursing (a collaborative nurse-patient relationship), and the MI’s counseling style. The second challenge was the complexity in designing realistic relational skills in preprogrammed and simulated nurse-patient dialogue while preserving an immersive learning experience. As a broad strategy, we created a collaborative and work-in-progress writing template as a shared working tool. Conclusions Our experience may be helpful to anyone looking for practical cues and guidance in developing narrative VP simulations. As relational skills are used by all nurses—from novices to experts—and other health care practitioners, focusing on this clinical behavior is a good way to ensure the simulation’s adaptability, sustainability, and efficiency.
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Affiliation(s)
- Geneviève Rouleau
- Research Chair in Innovative Nursing Practices, Montréal, QC, Canada.,Faculty of Nursing, Université Laval, Quebec, QC, Canada
| | - Jérôme Pelletier
- Faculty of Nursing, Université Laval, Quebec, QC, Canada.,Université du Québec à Rimouski, Rimouski, QC, Canada
| | - José Côté
- Research Chair in Innovative Nursing Practices, Montréal, QC, Canada.,University of Montreal Hospital Research Centre, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Quebec, QC, Canada.,University Hospital Centre of Quebec, Laval University Research Centre, Quebec, QC, Canada.,Institute of Health and Social Services in Primary Care, Research Centre on Healthcare and Services in Primary Care, Quebec, QC, Canada
| | - Valérie Martel-Laferrière
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.,University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Rock Lévesque
- University of Montreal Hospital Centre, Montreal, QC, Canada
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- Please see acknowledgements for a list of collaborators,
| | - Guillaume Fontaine
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Research Centre, Montreal Heart Institute, Montreal, QC, Canada
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Tenório da Silva D, Pereira AM, de Oliveira Santos Silva R, Menéndez AS, Dos Santos C, de Lima Florentino Júnior I, Felizardo Neves SJ, Dósea MB, Lyra DP. Using Virtual Patient Software to Improve Pharmacy Students' Knowledge of and Attitudes Toward Geriatric Patients. Am J Pharm Educ 2020; 84:7230. [PMID: 32577027 PMCID: PMC7298220 DOI: 10.5688/ajpe7230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/24/2019] [Indexed: 05/13/2023]
Abstract
Objective. To evaluate the effect of using a virtual patient software program to improve pharmacy students' knowledge of and attitudes toward geriatric patients. Methods. The Virtual Patient for Geriatric Education (VIPAGE) software program was used in two Bachelor of Pharmacy (BPharm) degree programs in Brazilian universities. The virtual consultations were divided into an initial evaluation, care plan, letter of referral to another professional, and evaluation of follow-up. Each weekly session lasted two hours. Students answered questionnaires before and after using the virtual patient software relating to the following: demographics, geriatric experiences, Geriatric Attitudes Scale, and the Facts on Aging Quiz. Results. Of the 128 students who completed the baseline questionnaires, 109 students also completed the second questionnaire. The mean Geriatric Attitudes Scale score before the intervention was 3.7 (SD=0.8) and after was 3.9 (SD=0.7). Significant improvements in Geriatric Attitudes Scale scores after using the virtual patient software were seen in students who were male, whose grandparents were still alive, or whose parents were elderly, who had frequent contact with the elderly, who did not have frequent contact with the elderly, and who did not have professional contact with the elderly. The average score on geriatrics knowledge was 44.7 (SD=12.0) before completing the virtual patient consultations and 52.6 (SD=11.9) after. The mean score measuring students' lack of geriatrics knowledge was 27.3 (SD=15.8) before and 19.1 (SD=12.8) after using the software. Conclusion. Completing virtual patient consultations using the VIPAGE software positively impacted pharmacy students' geriatrics knowledge and attitudes.
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Affiliation(s)
- Daniel Tenório da Silva
- Federal University of Vale do São Francisco, College of Pharmacy, Petrolina, Pernambuco, Brazil
| | - André Mascarenhas Pereira
- Federal University of Sergipe, Laboratory of Teaching and Research in Social Pharmacy, Faculty of Pharmacy, São Cristóvão, Sergipe, Brazil
| | - Rafaella de Oliveira Santos Silva
- Federal University of Sergipe, Laboratory of Teaching and Research in Social Pharmacy, Faculty of Pharmacy, São Cristóvão, Sergipe, Brazil
| | - Andrés Silva Menéndez
- Federal University of Sergipe, Department of Computing, São Cristóvão, Sergipe, Brazil
| | - Cleverton Dos Santos
- Federal University of Sergipe, Department of Computing, São Cristóvão, Sergipe, Brazil
| | | | | | - Marcos Barbosa Dósea
- Federal University of Sergipe, Department of Computing, São Cristóvão, Sergipe, Brazil
| | - Divaldo Pereira Lyra
- Federal University of Sergipe, Laboratory of Teaching and Research in Social Pharmacy, Faculty of Pharmacy, São Cristóvão, Sergipe, Brazil
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Jacklin S, Chapman S, Maskrey N. Virtual patient educational intervention for the development of shared decision-making skills: a pilot study. BMJ Simul Technol Enhanc Learn 2019; 5:215-217. [PMID: 35521483 PMCID: PMC8936636 DOI: 10.1136/bmjstel-2018-000375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/24/2018] [Accepted: 09/27/2018] [Indexed: 11/03/2022]
Abstract
Background Shared decision-making (SDM) involves a healthcare professional and a patient forming a congruent partnership, within which information is shared and decisions are made which align with the patient's values. SDM does not occur to the extent it ought to; SDM requires practice. Virtual reality could help facilitate this practice. Objective To pilot an interactive, high-fidelity virtual patient (VP) who simulates SDM within a primary care consultation. Method Academic pharmacists and doctors were recruited from the Keele University. Participants completed prequestionnaires and postquestionnaires. Results 18 participants (14 pharmacists and 4 medical doctors) completed the study. 89% (n=16) suggested the VP was 'enjoyable' or 'highly enjoyable' to use and 72% (n=13) suggested it was 'very accessible'. There were diverse views about the way in which the user made their reply to the VP with ratings ranging from 'very poor' (n=2) to 'very good' (n=5); the modal rating was indifference (n=7). It seemed the multiple choice system caused the participants to feel restricted but it was unclear why those who liked the system did so. Conclusions The VP was found to be enjoyable and thought-provoking. The data suggest that this type of intervention could be useful at many different stages of a professional's career although the multiple-choice conversation style may be too restrictive for more experienced consulters.
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Alsalemi A, Tanaka L, Ogino M, Disi MA, Alhomsi Y, Bensaali F, Amira A, Alinier G. A skills acquisition study on ECMOjo: a screen-based simulator for extracorporeal membrane oxygenation. Perfusion 2019; 35:110-116. [PMID: 31303136 DOI: 10.1177/0267659119859120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation relies heavily on didactic teaching, emphasizing on essential cognitive skills, but overlooking core behavioral skills such as leadership and communication. Therefore, simulation-based training has been adopted to instill clinical knowledge through immersive experiences. Despite simulation-based training's effectiveness, training opportunities are lessened due to high costs. This is where screen-based simulators come into the scene as affordable and realistic alternatives. AIM This article evaluates the educational efficacy of ECMOjo, an open-source screen-based extracorporeal membrane oxygenation simulator that aims to replace extracorporeal membrane oxygenation didactic instruction in an interactive and cost-effective manner. METHOD A prospective cohort skills acquisition study was carried out. A total of 44 participants were pre-assessed, divided into two groups, where the first group received traditional didactic teaching, and the second used ECMOjo. Participants were then evaluated through a wet lab assessment and two questionnaires. RESULTS The obtained results indicate that the two assessed groups show no statistically significant differences in knowledge and efficacy. Hence, ECMOjo is considered an alternative to didactic teaching as per the learning outcomes. CONCLUSION The present findings show no significant dissimilarities between ECMOjo and didactic classroom-based teaching. Both methods are very comparable in terms of the learner's reported self-efficacy and complementary to mannequin-based simulations.
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Affiliation(s)
| | - Len Tanaka
- Kapiolani Medical Center for Women & Children, Honolulu, HI, USA.,University of Hawaii, John A. Burns School of Medicine, SimTiki Simulation Center, Honolulu, HI, USA
| | - Mark Ogino
- Critical Care Services, Nemours/Alfred I duPont Hospital for Children, Wilmington, DE, USA
| | - Mohammed Al Disi
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - Yahya Alhomsi
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - Fayçal Bensaali
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - Abbes Amira
- Department of Computer Science and Engineering, Qatar University, Doha, Qatar
| | - Guillaume Alinier
- Ambulance Service, Hamad Medical Corporation, Doha, Qatar.,University of Hertfordshire, Hatfield, UK.,Weill Cornell Medicine - Qatar, Doha, Qatar
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Weis M, Baillie R, Friedrich C. Considerations for Adapting Pre-existing Mechanistic Quantitative Systems Pharmacology Models for New Research Contexts. Front Pharmacol 2019; 10:416. [PMID: 31057411 PMCID: PMC6482345 DOI: 10.3389/fphar.2019.00416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/02/2019] [Indexed: 12/21/2022] Open
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Padilha JM, Machado PP, Ribeiro A, Ramos J, Costa P. Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial. J Med Internet Res 2019; 21:e11529. [PMID: 30882355 PMCID: PMC6447149 DOI: 10.2196/11529] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 12/04/2022] Open
Abstract
Background In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students’ intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple “lecturers” and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. Objective This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students. Methods A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers. We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students’ levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention. Results The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054). Conclusions The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.
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Affiliation(s)
| | | | - Ana Ribeiro
- Nursing School of Porto; CINTESIS - NursID, Porto, Portugal
| | - José Ramos
- Nursing School of Porto, Porto, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, ICVS / 3B's-PT Government Associate Laboratory, Braga / Guimarães, Portugal, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Jacklin S, Maskrey N, Chapman S. Improving Shared Decision Making Between Patients and Clinicians: Design and Development of a Virtual Patient Simulation Tool. JMIR Med Educ 2018; 4:e10088. [PMID: 30401667 PMCID: PMC6246962 DOI: 10.2196/10088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Shared decision making (SDM) involves the formation of a collaborative partnership between the patient and clinician combining both of their expertise in order to benefit decision making. In order for clinicians to be able to carry out this skilled task, they require practice. Virtual reality, in the form of a virtual patient, could offer a potential method of facilitating this. OBJECTIVE The objective of this study was to create a virtual patient that simulated a primary care consultation, affording the opportunity to practice SDM. A second aim was to involve patients in the design of a virtual patient simulation and report the process of the design. METHODS We employed a multistep design process drawing on patient and expert involvement. RESULTS A virtual patient, following a narrative style, was built, which allows a user to practice and receive feedback; both clinical and communication skills are required for the simulation. The patient group provided multiple insights, which the academic team had overlooked. They pertained mostly to issues concerning the patient experience. CONCLUSIONS It is possible to design a virtual patient that allows a learner to practice their ability to conduct SDM. Patient input into the design of virtual patient simulations can be a worthwhile activity.
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Affiliation(s)
- Simon Jacklin
- School of Pharmacy, Keele University, Keele, United Kingdom
| | - Neal Maskrey
- School of Pharmacy, Keele University, Keele, United Kingdom
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Timmis J, Orlu M, Park S. Educational potential of using virtual patients for promoting interprofessional learning between medical and pharmacy students: A qualitative study. J Interprof Care 2018; 32:794-796. [PMID: 30142278 DOI: 10.1080/13561820.2018.1513461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Interprofessional learning (IPL), involving various professions within healthcare, has been proven to improve the quality of patient care by encouraging collaboration between professionals. Careful consideration of appropriate educational tools and content is required in order to facilitate the effective IPL. This study aimed to explore medical and pharmacy students' preconceptions of the role of virtual patients (VPs) as a learning tool for IPL within their education. A secondary aim was to elicit feedback to inform the development of new VP cases. Two focus groups (one with medical students and the other with pharmacy students), consisting of six students in each, were recruited. Participant perceptions regarding VP-based IPL were explored. Data were analysed using a thematic approach. Participants thought that there were some potential learning benefits of using VPs as part of their curriculum. Pharmacy students held increased value in VPs due to their limited access to patients during their education. Medical students challenged the role of VPs in their clinical development and concerned that VPs lack the flexibility required by doctors to use their judgement and work with uncertainty. Limited understanding of team members' roles in patient care and self-reported ignorance of the overlap in curricula appear to be key barriers for students in valuing the knowledge base of each other's profession and possible benefits of using VPs in joint learning. This study generated a number of key implications which need to be considered when introducing VP-based IPL.
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Affiliation(s)
- Jessica Timmis
- a Royal Free General Practice Vocational Training Scheme , Royal Free London NHS Foundation Trust , London , UK
| | - Mine Orlu
- b UCL School of Pharmacy , Department of Pharmaceutics , London , UK
| | - Sophie Park
- c UCL Research Department of Primary Care and Population Health , UCL , London , UK
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Abstract
Liver resection is an important clinical intervention to treat liver disease. Following liver resection, patients exhibit a wide range of outcomes including normal recovery, suppressed recovery, or liver failure, depending on the regenerative capacity of the remnant liver. The objective of this work is to study the distinct patient outcomes post hepatectomy and determine the processes that are accountable for liver failure. Our model based approach shows that cell death is one of the important processes but not the sole controlling process responsible for liver failure. Additionally, our simulations showed wide variation in the timescale of liver failure that is consistent with the clinically observed timescales of post hepatectomy liver failure scenarios. Liver failure can take place either instantaneously or after a certain delay. We analyzed a virtual patient cohort and concluded that remnant liver fraction is a key regulator of the timescale of liver failure, with higher remnant liver fraction leading to longer time delay prior to failure. Our results suggest that, for a given remnant liver fraction, modulating a combination of cell death controlling parameters and metabolic load may help shift the clinical outcome away from post hepatectomy liver failure towards normal recovery.
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Geerts H, Gieschke R, Peck R. Use of quantitative clinical pharmacology to improve early clinical development success in neurodegenerative diseases. Expert Rev Clin Pharmacol 2018; 11:789-795. [PMID: 30019953 DOI: 10.1080/17512433.2018.1501555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The success rate of pharmaceutical Research & Development (R&D) is much lower compared to other industries such as micro-electronics or aeronautics with the probability of a successful clinical development to approval in central nervous system (CNS) disorders hovering in the single digits (7%). Areas covered: Inspired by adjacent engineering-based industries, we argue that quantitative modeling in CNS R&D might improve success rates. We will focus on quantitative techniques in early clinical development, such as PharmacoKinetic-PharmacoDynamic modeling, clinical trial simulation, model-based meta-analysis and the mechanism-based physiology-based pharmacokinetic modeling, and quantitative systems pharmacology. Expert commentary: Mechanism-based computer modeling rely less on existing clinical datasets, therefore can better generalize than Big Data analytics, including prospectively and quantitatively predicting the clinical outcome of new drugs. More specifically, exhaustive post-hoc analysis of failed trials using individual virtual human trial simulation could illuminate underlying causes such as lack of sufficient functional target engagement, negative pharmacodynamic interactions with comedications and genotypes, and mismatched patient population. These insights are beyond the capacity of artificial intelligence (AI) methods as they are many more possible combinations than subjects. Unlike 'black box' approaches in AI, mechanism-based platforms are transparent and based on biologically sound assumptions that can be interrogated.
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Affiliation(s)
- Hugo Geerts
- a In Silico Biosciences, Computational Neuropharmacology , Berwyn , PA , USA
| | - Ronald Gieschke
- b Early Development , Clinical Pharmacology, Roche Innovation Center , Basel , Switzerland
| | - Richard Peck
- b Early Development , Clinical Pharmacology, Roche Innovation Center , Basel , Switzerland
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Pan X, Collingwoode-Williams T, Antley A, Brenton H, Congdon B, Drewett O, Gillies MFP, Swapp D, Pleasence P, Fertleman C, Delacroix S. A Study of Professional Awareness Using Immersive Virtual Reality: The Responses of General Practitioners to Child Safeguarding Concerns. Front Robot AI 2018; 5:80. [PMID: 33500959 PMCID: PMC7805796 DOI: 10.3389/frobt.2018.00080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/12/2018] [Indexed: 11/13/2022] Open
Abstract
The art of picking up signs that a child may be suffering from abuse at home is one of those skills that cannot easily be taught, given its dependence on a range of non-cognitive abilities. It is also difficult to study, given the number of factors that may interfere with this skill in a real-life, professional setting. An immersive virtual reality environment provides a way round these difficulties. In this study, we recruited 64 general practitioners (GPs), with different levels of experience. Would this level of experience have any impact on general practitioners' ability to pick up child-safeguarding concerns? Would more experienced GPs find it easier to pick up subtle (rather than obvious) signs of child-safeguarding concerns? Our main measurement was the quality of the note left by the GP at the end of the virtual consultation: we had a panel of 10 (all experienced in safeguarding) rate the note according to the extent to which they were able to identify and take the necessary steps required in relation to the child safeguarding concerns. While the level of professional experience was not shown to make any difference to a GP's ability to pick up those concerns, the parent's level of aggressive behavior toward the child did. We also manipulated the level of cognitive load (reflected in a complex presentation of the patient's medical condition): while cognitive load did have some impact upon GPs in the “obvious cue” condition (parent behaving particularly aggressively), this effect fell short of significance. Furthermore, our results also suggest that GPs who are less stressed, less neurotic, more agreeable and extroverted tend to be better at raising potential child abuse issues in their notes. These results not only point at the considerable potential of virtual reality as a training tool, they also highlight fruitful avenues for further research, as well as potential strategies to support GP's in their dealing with highly sensitive, emotionally charged situations.
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Affiliation(s)
- Xueni Pan
- Department of Computing, Goldsmiths, University of London, London, United Kingdom
| | | | - Angus Antley
- Department of Computer Science, University College London, London, United Kingdom
| | | | - Benjamin Congdon
- Department of Computer Science, University College London, London, United Kingdom
| | - Olivia Drewett
- Medical School, University College London, London, United Kingdom
| | - Marco F P Gillies
- Department of Computing, Goldsmiths, University of London, London, United Kingdom
| | - David Swapp
- Department of Computer Science, University College London, London, United Kingdom
| | - Pascoe Pleasence
- Faculty of Laws, University College London, London, United Kingdom
| | - Caroline Fertleman
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Whittington Health, London, United Kingdom
| | - Sylvie Delacroix
- Birmingham Law School, University of Birmingham, Birmingham, United Kingdom
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Tait L, Lee K, Rasiah R, Cooper JM, Ling T, Geelan B, Bindoff I. Simulation and Feedback in Health Education: A Mixed Methods Study Comparing Three Simulation Modalities. Pharmacy (Basel) 2018; 6:E41. [PMID: 29751528 DOI: 10.3390/pharmacy6020041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 11/17/2022] Open
Abstract
Background. There are numerous approaches to simulating a patient encounter in pharmacy education. However, little direct comparison between these approaches has been undertaken. Our objective was to investigate student experiences, satisfaction, and feedback preferences between three scenario simulation modalities (paper-, actor-, and computer-based). Methods. We conducted a mixed methods study with randomized cross-over of simulation modalities on final-year Australian graduate-entry Master of Pharmacy students. Participants completed case-based scenarios within each of three simulation modalities, with feedback provided at the completion of each scenario in a format corresponding to each simulation modality. A post-simulation questionnaire collected qualitative and quantitative responses pertaining to participant satisfaction, experiences, and feedback preferences. Results. Participants reported similar levels satisfaction across all three modalities. However, each modality resulted in unique positive and negative experiences, such as student disengagement with paper-based scenarios. Conclusion. Importantly, the themes of guidance and opportunity for peer discussion underlie the best forms of feedback for students. The provision of feedback following simulation should be carefully considered and delivered, with all three simulation modalities producing both positive and negative experiences in regard to their feedback format.
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Fleiszer D, Hoover ML, Posel N, Razek T, Bergman S. Development and Validation of a Tool to Evaluate the Evolution of Clinical Reasoning in Trauma Using Virtual Patients. J Surg Educ 2018; 75:779-786. [PMID: 28927667 DOI: 10.1016/j.jsurg.2017.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Undergraduate medical students at a large academic trauma center are required to manage a series of online virtual trauma patients as a mandatory exercise during their surgical rotation. PURPOSE Clinical reasoning during undergraduate medical education can be difficult to assess. The purpose of the study was to determine whether we could use components of the students' virtual patient management to measure changes in their clinical reasoning over the course of the clerkship year. In order to accomplish this, we decided to determine if the use of scoring rubrics could change the traditional subjective assessment to a more objective evaluation. BASIC PROCEDURES Two groups of students, one at the beginning of clerkship (Juniors) and one at the end of clerkship (Seniors), were chosen. Each group was given the same virtual patient case, a clinical scenario based on the Advanced Trauma Life Support (ATLS) Primary Trauma Survey, which had to be completed during their trauma rotation. The learner was required to make several key patient management choices based on their clinical reasoning, which would take them along different routes through the case. At the end of the case they had to create a summary report akin to sign-off. These summaries were graded independently by two domain "Experts" using a traditional subjective surgical approach to assessment and by two "Non-Experts" using two internally validated scoring rubrics. One rubric assessed procedural or domain knowledge (Procedural Rubric), while the other rubric highlighted semantic qualifiers (Semantic Rubric). Each of the rubrics was designed to reflect established components of clinical reasoning. Student's t-tests were used to compare the rubric scores for the two groups and Cohen's d was used to determine effect size. Kendall's τ was used to compare the difference between the two groups based on the "Expert's" subjective assessment. Inter-rater reliability (IRR) was determined using Cronbach's alpha. MAIN FINDINGS The Seniors did better than the Juniors with respect to "Procedural" issues but not for "Semantic" issues using the rubrics as assessed by the "Non-Experts". The average Procedural rubric score for the Senior group was 59% ± 13% while for the junior group, it was 51% ± 12% (t(80)= 2.715; p = 0.008; Cohen's d = 1.53). The average Semantic rubric score for the Senior group was 31% ± 15% while for the Junior group, it was 28% ± 14% (t(80) = 1.010; p = .316, ns). There was no statistical difference in the marks given to the Senior versus Junior groups by the "Experts" (Kendall's τ = 0.182, p = 0.07). The IRR between the "Non-Experts" using the rubrics was higher than the IRR of the "Experts" using the traditional surgical approach to assessment. The Cronbach's alpha for the Procedural and Semantic rubrics was 0.94 and 0.97, respectively, indicating very high IRR. The correlation between the Procedural rubric scores and "Experts" assessment was approximately r = 0.78, and that between the Semantic rubric and the "Experts" assessment was roughly r = 0.66, indicating high concurrent validity for the Procedural rubric and moderately high validity for the Semantic rubric. PRINCIPLE CONCLUSION Clinical reasoning, as measured by some of its "procedural" features, improves over the course of the clerkship year. Rubrics can be created to objectively assess the summary statement of an online interactive trauma VP for "procedural" issues but not for "semantic" issues. Using IRR as a measure, the quality of assessment is improved using the rubrics. The "Procedural" rubric appears to measure changes in clinical reasoning over the course of 3rd-year undergraduate clinical studies.
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Affiliation(s)
- David Fleiszer
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Departments of Surgery and Oncology, McGill University Health Center, Montreal, Quebec, Canada
| | - Michael L Hoover
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Nancy Posel
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; McGill University Health Center, Montreal, Quebec, Canada.
| | - Tarek Razek
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Montreal General Hospital, Montreal, Quebec, Canada
| | - Simon Bergman
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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Marei HF, Al-Eraky MM, Almasoud NN, Donkers J, Van Merrienboer JJG. The use of virtual patient scenarios as a vehicle for teaching professionalism. Eur J Dent Educ 2018; 22:e253-e260. [PMID: 28691267 DOI: 10.1111/eje.12283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES This study aimed to measure students' perceptions of virtual patient scenarios (VPs) for developing ethical reasoning skills and to explore features in VP design that are necessary to promote professionalism. METHODS Sixty-five dental students participated in learning sessions that involved collaborative practice with five VPs (four high fidelity and one low fidelity), followed by reflection sessions. Students' perceptions towards the use of VPs in developing ethical reasoning skills were assessed using a questionnaire that involved 10 closed and three open-ended questions. RESULTS High-fidelity VPs were perceived as significantly better for developing ethical reasoning skills than low-fidelity VPs. Analyses of answers to open-ended questions revealed two new features that are specific for VPs intended for teaching professionalism, which are VP dramatic structure and how it should end. CONCLUSION VPs intended for teaching professionalism need to have high fidelity, follow a specific dramatic structure and should include multiple plausible endings. The use of VPs as part of a collaborative activity that is followed by a reflection session is perceived as an effective tool for the development of ethical reasoning skills in dental education.
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Affiliation(s)
- H F Marei
- College of Dentistry, University of Dammam, Dammam, Saudi Arabia
- Faculty of Dentistry, Suez Canal University, Ismailia, Egypt
| | - M M Al-Eraky
- Directorate for Development and Academic Initiatives, University of Dammam, Dammam, Saudi Arabia
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - N N Almasoud
- College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - J Donkers
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - J J G Van Merrienboer
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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Courteille O, Fahlstedt M, Ho J, Hedman L, Fors U, von Holst H, Felländer-Tsai L, Möller H. Learning through a virtual patient vs. recorded lecture: a comparison of knowledge retention in a trauma case. Int J Med Educ 2018; 9:86-92. [PMID: 29599421 PMCID: PMC5951773 DOI: 10.5116/ijme.5aa3.ccf2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/10/2018] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To compare medical students' and residents' knowledge retention of assessment, diagnosis and treatment procedures, as well as a learning experience, of patients with spinal trauma after training with either a Virtual Patient case or a video-recorded traditional lecture. METHODS A total of 170 volunteers (85 medical students and 85 residents in orthopedic surgery) were randomly allocated (stratified for student/resident and gender) to either a video-recorded standard lecture or a Virtual Patient-based training session where they interactively assessed a clinical case portraying a motorcycle accident. The knowledge retention was assessed by a test immediately following the educational intervention and repeated after a minimum of 2 months. Participants' learning experiences were evaluated with exit questionnaires. A repeated-measures analysis of variance was applied on knowledge scores. A total of 81% (n = 138) of the participants completed both tests. RESULTS There was a small but significant decline in first and second test results for both groups (F(1, 135) = 18.154, p = 0.00). However, no significant differences in short-term and long-term knowledge retention were observed between the two teaching methods. The Virtual Patient group reported higher learning experience levels in engagement, stimulation, general perception, and expectations. CONCLUSIONS Participants' levels engagement were reported in favor of the VP format. Similar knowledge retention was achieved through either a Virtual Patient or a recorded lecture.
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Affiliation(s)
- Olivier Courteille
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Madelen Fahlstedt
- Unit of Neuronic Engineering, School of Technology and Health, Royal Institute of Technology, Huddinge, Stockholm, Sweden
| | - Johnson Ho
- Unit of Neuronic Engineering, School of Technology and Health, Royal Institute of Technology, Huddinge, Stockholm, Sweden
| | - Leif Hedman
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Hans von Holst
- Unit of Neuronic Engineering, School of Technology and Health, Royal Institute of Technology, Huddinge, Stockholm, Sweden
| | - Li Felländer-Tsai
- Department of Clinical Science, Intervention and Technology, Division of Orthopaedics and Biotechnology, Karolin-ska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Hans Möller
- Department of Clinical Science, Intervention and Technology, Division of Orthopaedics and Biotechnology, Karolin-ska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Bergeron D, Champagne JN, Qi W, Dion M, Thériault J, Renaud JS. Impact of a Student-Driven, Virtual Patient Application on Objective Structured Clinical Examination Performance: Observational Study. J Med Internet Res 2018; 20:e60. [PMID: 29472175 PMCID: PMC5843791 DOI: 10.2196/jmir.7548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/22/2017] [Accepted: 11/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Peer-assisted learning (PAL) refers to a learning activity whereby students of similar academic level teach and learn from one another. Groupe de perfectionnement des habiletés cliniques (Clinical Skills Improvement Group), a student organization at Université Laval, Canada, propelled PAL into the digital era by creating a collaborative virtual patient platform. Medical interviews can be completed in pairs (a student-patient and a student-doctor) through an interactive Web-based application, which generates a score (weighted for key questions) and automated feedback. Objectives The aim of the study was to measure the pedagogical impact of the application on the score at medical interview stations at the summative preclerkship Objective Structured Clinical Examination (OSCE). Methods We measured the use of the application (cases completed, mean score) in the 2 months preceding the OSCE. We also accessed the results of medical interview stations at the preclerkship summative OSCE. We analyzed whether using the application was associated with higher scores and/or better passing grades (≥60%) at the OSCE. Finally, we produced an online form where students could comment on their appreciation of the application. Results Of the 206 students completing the preclerkship summative OSCE, 170 (82.5%) were registered users on the application, completing a total of 3133 cases (18 by active user in average, 7 minutes by case in average). The appreciation questionnaire was answered online by 45 students who mentioned appreciating the intuitive, easy-to-use, and interactive design, the diversity of cases, and the automated feedback. Using the application was associated with reduced reported stress, improved scores (P=.04), and improved passing rates (P=.11) at the preclerkship summative OSCE. Conclusions This study suggests that PAL can go far beyond small-group teaching, showing students’ potential to create helpful pedagogical tools for their peers.
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Affiliation(s)
- David Bergeron
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | | | - Wen Qi
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Maxime Dion
- Département de mathématiques et statistiques, Université Laval, Québec, QC, Canada
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