Safe Prescribing and Use of Opioids

April 10-12, 2012 Walt Disney World Swan Resort

Accepted Learning Objectives: 1. Analyze current professional education programs on safe use of opioids and new programs under development. 2. Explain a potentially transformative on-line educational tool for health professionals that enable them to train by interacting with “virtual patients.” 3. Describe a Massachusetts program for training physicians on safe opioid prescribing, and the curriculum developed to teach residents and faculty.

Disclosure Statement

•  Drs. Daniel P. Alford and Sarah Ball have  disclosed no relevant, real or apparent personal or professional financial relationships.

•  Dr. Benjamin Lok has disclosed that he has a relationship with Shadow Health, Inc.

Simulation-based training for health care providers on

prescription drug abuse

Benjamin Lok, Ph.D. Computer and Information Sciences and

Engineering University of Florida

National Prescription Drug Abuse Summit April 10-12th, 2012

Overview of talk

 Existing approaches  Level of integration  Costs and benefits

 New approaches  What’s coming down the pike  Defining the direction of simulation (what does

simulation look like in 5 years?)  Goals:

 Identifying how you can benefit from simulation today

 Identifying your part in shaping the future of education

Current Simulation Efforts

•  Humans – Lecture – Role-playing – Standardized patients – “gold standard”

•  Pros – Empathy – Emotion – Rapport

Current Computer Simulation Efforts

 Computer-based learning case studies  Passive –

multimedia presentation of information

 “Choose your own adventure”

Image from Harvard Medical School

Current state of simulation

 Simulation wings  UF-Jacksonville has dedicated

24,000 sq. ft.  UF-Jacksonville 55 simulators  Basic understanding of

integration into curriculums   [Huang 2007] Virtual patients

 Ad-hoc (26 of 108 schools building cases)

 Still images and video (83% of virtual patients)

 Expensive (each case $10,000-$50,000, 1-2 years to develop)

 Known education potential  Compliments classrooms

Human Patient Simulator – image from Samsun Lampotang

Current approaches have difficulty providing:

•  Sufficient opportunities for practice •  Exposure to infrequent – yet critical –

scenarios •  Tailoring for each student •  Standardization •  Patient variability •  Team-based learning •  Cultural competency •  Feedback

Addiction Management Challenges

•  Large scale deployment (40k+ learners)

•  Solution: virtual human simulation

•  Effective training using simulation – Track progress – Provide feedback –  Implement protocols

Serious Games

•  Interactive training exercises •  Using computer game engines and the

Internet

Image from Breakaway Ltd.

Example: Virtual Human

Can interacting with a virtual human make you a better person?

Dr. Gregory House Good with medical knowledge Not so good with interacting with people

Dr. Doug Ross Good with medical knowledge Good with interacting with people

Dr. Derek Shepherd Good with medical knowledge Good with interacting with people

Virtualpatientsgroup.com

•  6 universities, 35 researchers, 8 years of VP research •  Technologies to:

–  Create virtual patients –  Deploy virtual patients

•  Enable –  Curricular building and integration of training

scenarios –  Teaching and training with

•  Variety of scenarios •  Variety of patients •  After-action review systems

•  Looking for:  Research partners

Deployment - Continuum of Experiences

Virtual Worlds

Immersive Interaction

Video Conference Chat

Web Browser Instant Message

Mobile Deployment

Imm

ersi

on

Images from www.virtualpatientsgroup.com Fidelity, Learning efficacy

Virtual People Factory

•  www.virtualpeoplefactory.com •  Web-based interface to virtual

humans •  Deployed Early 2008 – 56 active developers – 2700 users – 105,000 utterances   Opiod patient

Mobile Distribution of Simulation

 Deploy simulations via mobile platforms

 Android app, released December 2010, over 4600 downloads

 In Android Market, search for “Virtual Patient”

Image from www.virtualpatientsgroup.com

Repositories

•  MedEdPORTAL – Peer reviewed medical education

resource

•  400 institution downloads in 10 months

Scripts at VPF General http://vpf.cise.ufl.edu/wiki/index.php/VPF_Script_Tracking

•  Anesthesia –  Pre-op OSA (UF) –  Conscious sedation (UF)

–  Myocardial Ischemia (UF)

•  Cancer –  Abnormal mammogram (UF) –  BRCA Pedigree (UCF) –  Clinical breast exam (UF/MCG) –  Clinical prostate exam (UF) –  Melanoma (MCG)

•  Pain –  Abdominal Pain (UF) –  Chest pain (UF) –  Gallstones (UCF) –  Lower back pain (UF) –  Lower back pain (PCOM) –  Opiod prescription (AAAP)

•  Psychiatry –  Failure to thrive (UF) –  Depression (MCG)

–  Bi-polar (MCG)

•  General –  Breaking bad news (MCG) –  Cranial Nerve (UF) –  Dysphagia (UF) –  Dyspepsia – Pharmacy (UF) –  Gastro-Band (UF)

–  GI Hemorrhage (UF) –  Handoff (UF) –  Meningitis (PCOM) –  Patient-Centered Counseling (USF) –  Pediatric Interview (UF) –  Post Operative Hemorrhage (UF) –  Sexually Transmitted Diseases (UF)

–  Contraceptive Counseling (UF)

NERVE: The Neurological Examination Rehearsal Virtual

Environment •  Virtual multi-tool interface –  Playstation Move

controls multiple virtual tools

–  Gestural and tool input, in addition to speech

•  Medical students –  Learn how to use

neurological tests to diagnose a patient with a vision disorder

–  Receive additional exposure to patients with abnormal findings (Cranial Nerve 2,3,4,5,6,7,12)

After-Action Review by Students

•  IPSViz –  Web-based interface –  Students received

email with link (automated)

–  Sample student (10158/00000)

–  Self-directed review of content, video, and feedback

•  Each student can review their performance and compare with experts

After-Action Review by Educators

•  IPSVizn –  Web-based

interface –  Educators can

review completed student interactions

–  Data from study –  Filter based on user

background •  Level of expertise •  Gender •  Educator-defined

metrics

•  Experts can –  Identify trends

(mean of class) –  Identify outliers

Physical Examinations of Virtual Human Patients

•  Mixed reality humans –  Passive-haptic

interface to life-sized virtual human

–  Applications •  Clinical breast exam •  Prostate Exam

•  Students can –  Practice physical

examination and communication skill sets

–  Get real-time feedback of exam performance •  Coverage •  Pressure •  Conversation topics

Getting Involved

 Now (<6 months)  Use systems to create web-deployable “cases”

 Case study-based  Adaptive raining – could branch depending on trainee’s selections   Example: http://www.md-inc.com/Products/product_details.cfm?

mm=2&sm=4027&courseno=172

 Near term (<2 years)  Work with developers to create interactive virtual patients

 Different levels of fidelity  Requires funding  More interactive

 Long term (3 years+)  Coordinated teaching/training/testing using simulation

 Valid and reliable training materials  Work with professional, licensing, continuing education groups

Demo of Creating Virtual Patient

•  www.virtualpatientsgroup.com

Thank You!

Build virtual patients: www.virtualpatientsgroup.com Contact: lok@cise.ufl.edu Support: National Science Foundation and National Institutes of Health