J. Hurley Myers, Ph.D. Professor Emeritus of Physiology and Medicine

1. Using Computer Patient Simulations (Virtual Patients) and Standardized Patients Teach and Assess Clinical Practice Behavior J. Hurley Myers, Ph.D. Professor Emeritus of Physiology and Medicine Southern Illinois University School of Medicine AND President and CEO DxR Development Group, Inc. Carbondale, Illinois

2. Outline of Presentation Competency and the Healthcare Professional Current Trends in Medical Education Role of Simulations to Teach and Conduct Performance-Based Assessments of Clinical Competency--Examples: Computer-Based Virtual Patients (DxR Clinician) Standardized Patients with Clinical Competency Exam (CCX) software

3. Health Care Providers Must Be Competent Professionals

4. Health Care Professions Require Competency “the degree to which an individual can use the knowledge, skills, and judgment associated with the profession to perform effectively in the domain of possible encounters defining the scope of professional practice” Kane, M. The assessment of professional competence. Eval & the Health Professions 1992; 15: 163-82.

5. Health Care Professions Require Competency “the degree to which an individual can use the knowledge, skills, and judgment associated with the profession to perform effectively in the domain of possible encounters defining the scope of professional practice” Kane, M. The assessment of professional competence. Eval & the Health Professions 1992; 15: 163-82.

6. Health Care Professions Require Competency “the degree to which an individual can use the knowledge, skills, and judgment associated with the profession to perform effectively in the domain of possible encounters defining the scope of professional practice” Kane, M. The assessment of professional competence. Eval & the Health Professions 1992; 15: 163-82.

7. Goal of Health Care Education The primary goal of healthcare professional education institutions is to help students/trainees achieve the foundation of content knowledge, develop clinical skills, and gain the professional behaviors necessary to pursue further education as life-long learners.

8. Goal of Health Care Education The primary goal of healthcare professional education institutions is to help students/trainees achieve the foundation of content knowledge, develop clinical skills, and gain the professional behaviors necessary to pursue further education as life-long learners.

9. Goal of Health Care Education The primary goal of healthcare professional education institutions is to help students/trainees achieve the foundation of content knowledge, develop clinical skills, and gain the professional behaviors necessary to pursue further education as life-long learners.

10. Goal of Health Care Education The primary goal of healthcare professional education institutions is to help students/trainees achieve the foundation of content knowledge, develop clinical skills, and gain the professional behaviors necessary to pursue further education as life-long learners.

11. Methods of Instruction Instructional methods used to teach and assess our students in the 21st Century will differ from those we used to prepare students in the 20th Century

12. The Change “20th Century” Traditional, teacher-centered methods, in which instructors communicate subject matter content to students in a classroom, will be used less “21st Century”Student-centered, patient-centered learning experiences to be used more

13. Students’ Role Students will be encouraged to participate more in deciding what to learn and how to learn it, relying more on self-directed learning and self-assessment activities to acquire and test their content knowledge

14. Institution’sRole Provide small group, problem-based learning experiences Furnish internet-delivered interactive educational resources to facilitate knowledge acquisition and conduct team training Build and equip Clinical Skills Centers

15. Institution’s Role Provide students with access to virtual patient simulations, task and full body simulators, and standardized patients to improve: clinical decision-making develop psychomotor competence teach and assess clinical skills refine communications skills

16. The Institution’s Challenge How to design its educational programs to ensure that their students who are asked to take more responsibility for acquiring knowledge, do so without compromising their ability to provide effective healthcare to their patients

17. SIU Med School’s Solution The overall focus of the School of Medicine curriculum is on clinical case-based, student-directed learning in a small group setting. The goal of this curriculum is to foster integration of basic and clinical science knowledge as students solve patient problems. Additional clinical experiences provided throughout the curriculum help to ensure that all content may be learned in a clinical context.

18. Clinical Cases PBLM*, ePBLM, DxR Clinician *Problem-Based Learning Module

19. DxR Clinician Virtual Patients • Provides a patient database to examine online through: • >250 History Questions • >400 Physical Examination Procedures • >670 Laboratory Tests • Diagnostic/Treatment/Management Options

20. Southern Illinois Univ, School of Medicine Small Group Discussion Rooms Each room is equipped with a computer and big screen monitor or projection system used to access the “virtual patient” for group discussion and online learning resources.

21. Example of Virtual Patient DxR Clinician

34. DxR Clinician Simulation Collects a Record of the User’s Encounter With the Virtual Patient. This Record Can Be Imported into a Record Utility, Where It Is Analyzed By Comparing Items the User Selected With Required Criteria and Performance Items Selected By Instructors……

38. Performance-Based Learning and Assessment

39. SIUMED’s Educational Policy Committee In early 2000, the Educational Policy Committee recommended that a school-wide database of performance-based test results be created that allows student progress of key performance categories to be tracked across the curriculum…

40. Clinical Competency Examination • Faculty at SIUMED in collaboration with DxR Development Group developed the Clinical Competency Exam (CCX). • CCX is a performance-based examination designed to collect, analyze, and report data related to all major categories of competency associated with clinical practice behavior

41. SIU Medical School’s Clinical Skills Center

42. Southern Illinois Clinical Skills Laboratory Students practice clinical techniques, do self-directed learning, schedule resource sessions with faculty members, and/or work with a faculty member to develop specific clinical skills.

44. Standardized Patients

45. Clinical Competency Examination • Students “see” a standardized patient to obtain the history and conduct the physical examination • Students then go to the computer lab to complete workup

46. Document findings • List diagnostic hypotheses • Order lab tests and get the patient’s results • Make a diagnosis • Recommend a treatment plan (if required) • Answer 10-15 basic and clinical content questions

47. Clinical Competency Examination • CCX software generates a complete record of what each student enters • Standardize patient and faculty observers also complete a history and physical checklist and answers questions related to patient satisfaction • Student record is scored by the CCX software with the help of faculty reviewer(s) and a score is assigned to each performance category and the content questions associated the case

50. 2010 CCX Results Senior Exam