gary tabas, md university of pittsburgh upmc shadyside
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Provost’s ACIE Award . A Novel Approach to Teaching The Management of Diabetic Ketoacidosis Using Virtual Patient Technology. Gary Tabas, MD University of Pittsburgh UPMC Shadyside. Background. - PowerPoint PPT PresentationTRANSCRIPT
A Novel Approach to Teaching The Management of Diabetic Ketoacidosis
Using Virtual Patient Technology
Gary Tabas, MDUniversity of Pittsburgh
UPMC Shadyside
Provost’s ACIE Award
Background
• Diabetic ketoacidosis (DKA) – Associated with significant morbidity and
mortality– Management involves complex decision
making • LCME ‘educational gap’
– Only a minority of students will encounter a patient with DKA during ward rotation
Liaison Committee for Medical Education. LCME considers proposed changes in accreditation standards. December 2006. Available at: http://www.lcme.org/hearing.htm.
Current Educational Methods
• Lecture
• Small group discussion
• PBL (Problem-based Learning)
But management and decision making during
direct patient care are often suboptimal.
New Educational ApproachSimulation would allow students to learn and practice DKA management skills in a safe environment Increasing role of simulation in student training recognized by LCME, ACGME
Carnegie Foundation report - Educating Physicians: A Call for Reform of Medical School and Residency
“Content of curriculum derived from patients seen”
Project Goals1. Implement a newly created web-based virtual
patient (VP) simulation to teach the management of DKA.
2. Pilot test its effectiveness in teaching DKA-specific clinical decision making.
3. Assess students’ perceptions of the effectiveness of the DKA VP compared to other instructional methods.
Virtual Patient Simulation• Virtual patients are computer-based
simulations of medical cases for education and assessment
Branched-Narrative VPs• Multiple pathways through the simulated casePathway determined by learner’s management choices
Learning with branched-narrative VPs• The learner acts as the practitioner who performs
H&P, requests and interprets lab values and makes management decisions.
• The learner sees the consequences of those decisions and adjusts management
DKA Branched-Narrative VP• Diagnose DKA • Manage fluids, electrolytes, and insulin• Transition the patient from continuous IV insulin to
subcutaneous insulin
Methods
Program Development• VP content sources
– Diabetes Care 2006; Kitabchi A. – In The Clinic; Annals Int Med 2010– Content review: Endo attending specializing in
DM
• Pretest/posttest: – Case-based; single best answer; NBME type
aligned with teaching goals– Content review: Endo attendings and fellows
• Survey: from literature; expert validation
Learning Management system
• VpSim created by the University of Pittsburgh Laboratory for Educational Technology
• Flash-based visual interface• Author creates screens and management
choices using a map of nodes and branches. • Adds patient data to each node.
Hypovolemic DKA patient
Bettervolume status
saline
D5W
Persistenthypovolemia
oral fluids
Insulin & D5W
Insulin & saline
Stop insulin
Insulin & D5W
Track students' pathways through the case
Track students' pathways through the case
Advantages of VP Simulation
• Exposure to rare patients• Incorporates adult learning theory:
– Active engagement
– Visualization/rehearsal (neurobiology of learning)
– Adaptive learning (individualized instruction)
– Self-reflection
– Feedback (formative)
Findings To Date
Participants
• 51 Third year medical students– AIMC
• 84 pharmacy students– Clinical pharmacology course
• 11 Endocrine fellows
Pretest
VP (path score, time-on-task)
Posttest
Survey
Pre-Posttest Scores *P = .026
† P< .001 vs all posttest
†
Selected Posttest Questions
NS
*
†
* P = .01 † P<.001
Scores (%)
VP Learning Path Score
* P< .001 vs med students
VP Time-On-Task
* P = .004 vs other groups
CorrelationsOutcomes *Correlation P value
VP learning path score with posttest
score
.31 .0002
Time-On-Task with VP learning path
score
.21 .013
* Spearman’s ρ
Survey Data
The ability to see and react to the consequences of my decisions in this module was more effective in teaching me clinical decision making than with other learning methods
All differences NS
The module was effective in helping me learn how to adjust therapy in patients with DKA who are not
responding appropriately
* P = .02 vs Med students
*
The module improved my confidence in managing DKA.
* P = .01 vs other groups
*
The module was of high educational value
Summary
• It is feasible to create a interactive branched-narrative VP to teach the management of a complex medical illness
• One way to fill an educational gap• Effectiveness was significant as evidenced by pre-
posttest score improvement• Students felt that the VP was effective in
teaching management of DKA and preferred the VP over other teaching methods
Limitations
• Expensive, time consuming• Expertise• Pilot study• One case• Two schools but in one institution• No patient outcomes
Future Research
Compare effectiveness of branched-narrative VP
to traditional VP with only one learning path
Questions?Funding: University of Pittsburgh Provost’s
Innovations in Education AwardAcknowledgements:Harsha RaoMary KorytowskiNeil BenedictMike ElnickiDario TorreJB McGeeLaboratory for Educational Technology
The problem
GLU
∆
HCO3
2 AM 4 AM 6 AM 8 AM 10 AM
Insufficient insulin
~200
~15
~16
What do we know about the effectiveness of web-based education?• Superior to no intervention• Probably equal to non-internet education for
knowledge gain• Superior to non-internet education for
learning efficiency– (knowledge gained per time spent)
• Superior for learning satisfaction
Cook