© Springer International Publishing Switzerland 2016 59 S. Berretti et al. (eds.), Intelligent Systems Technologies and Applications, Advances in Intelligent Systems and Computing 384, DOI: 10.1007/978-3-319-23036-8_5

The Medical Virtual Patient Simulator (MedVPS) Platform

Prema Nedungadi and Raghu Raman

Abstract Medical Virtual Patient Simulator (MedVPS) is a cutting-edge eLearn-ing innovation for medical and other health professionals. It consists of a frame-work that supports various patient cases, tailored by interdisciplinary medical teams. Each virtual patient case follows the critical path to be followed for a spe-cific patient in a hospital. MedVPS takes the student on a journey that enables the student to interview, examine, conduct physical, systematic and ultimately reach a diagnosis based on the path that is chosen. After the interactions, the student must decide whether each response is normal or abnormal and use the virtual findings to identify multiple probable diagnoses or reexamine the virtual patient with the goal to narrow down to the correct disease and then provide treatment. We present the architecture and functionality of the MedVPS platform and include a pilot study with medical students.

Keywords E-learning · Medicine · Virtual patient · Simulation · Patient · case simulation · Medical simulation

1 Introduction *

Simulations provide a practical approach to acquiring and maintaining task-oriented and behavioral skills across the spectrum of medical specialties. Simula-tions offer clinicians a safe and credible means to acquire skills and practice managing manage clinical scenarios.

P. Nedungadi() · R. Raman Amrita CREATE, Amrita University, Coimbatore, India e-mail: prema@amrita.edu

R. Raman Amrita School of Business, Amrita University, Coimbatore, India e-mail: raghu@amrita.edu

60 P. Nedungadi and R. Raman

A recent study estimates the premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year [1]. This may be due to a lack of professional competence defined as, “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served” [2]. The causes for preventable errors include performing the wrong actions, improperly performing right actions, or not performing an action based on medical evidence. Diagnostic errors can also result in wrong or delayed treatment. Simulations offer learning of uncommon cases, and multiple disease symptoms of various diseases including accurate visual and auditory inputs. Simulations can be used for learning technical procedures, clinical skills or skills required in emer-gency care. The clinical realism of a simulation and the feedback provided within a simulation [3] helps improve learning and performance [4].

Simulations have many advantages such as improved learning [5,6,7] in student learning due to making medical errors without harming a patient [8] and learning in a realistic context [9,10]. While rich simulation technologies have been devel-oped in India for other domains in Engineering, Biotechnology [11] and for high school sciences [12], a complete simulation based learning and assessment plat-form for medical simulations has been lacking.

At present virtual patient cases offer reasonable learning about the procedures and the types of tests to perform but do not have accurate images, simulations and audio for accurate learning of patient symptoms and conditions. Other individual simulations and animations of various functions provide limited learning about the particular organ or exam.

Our Medical Virtual Patient Simulator (MedVPS) integrates real life images, audio, animations and simulations of the entire learning process into a virtual patient case to provide an end-to-end learning and assessment tool for medical students.

2 The MedVPS Platform

MedVPS consists of case based simulations that integrate medically accurate si-mulations, 2D and 3D animations, videos and assessments into virtual patient cases. It allows features such as the deliberate practice and feedback for skills development, exposure to difficult to visualize procedures, protocols and case studies using interactive virtual patient cases.

A typical MedVPS case consists of seven modules (Fig. 1), History Taking, Physical Examination, Systemic Examination, Investigation, Diagnosis, Treatment and Evaluation. Each module is further categorized as detailed examination pro-cedures. Students need to select only the relevant questions or procedures that they believe are relevant to the virtual patient. MedVPS logs all student actions along with the time taken and mark it as relevant /irrelevant for the diagnosis of the virtual patient.

The Medical Virtual Patient

The web-based, responsimulation seamlessly onInternet connectivity. It uLibrary for 3D Views andvarious screen sizes. MedThe simulation runs on HInternational Standards sueases, 10th Revision, CChemical classification syNames for generic drugMedVPS is designed to wand can be configured to r

Fig. 1 MedVPS Platform

3 Virtual Patient M

3.1 History Taking

The ‘medical history’ is ahensive picture of a patieuser ask such questions uprovided under each subsimulator. The user can se

Simulator (MedVPS) Platform 6

nsive, mobile first design for User Interface renders thn computers and various mobile and tablet devices wituses Scalable Vector Graphics for UI and Web Graphicd to make the animations and simulations responsive odVPS is built using the Python and Django frameworHtml5 Canvas, with JS and CSS3. MedVPS is based ouch as ICD-10-CM (International Classification of Di

Clinical Modification), ATC (Anatomical Therapeutystem for drugs) and INN (International Nonproprietars) and hence can be easily customized and localizework on highly modular and reusable medical activitierun various virtual cases.

Modules

g

a structured assessment conducted to generate a compreent’s health and health problems. This module helps thunder each category. The potential list of questions ar-section and can be accessed from the left pane of th

elect the questions to understand the patient history.

61

he th cs on rk. on is-tic ry d.

es,

e-he re he

62

The key to reaching anpatient’s symptoms and mintroduction, understandinpast medical history, aller

Fig. 2 Screen showing the H

3.2 Physical Exam

The physical examinationhealth. This module helpstem. The module is classtion, Vitals, Examination

Fig. 3 Screen showing the Ph

P. Nedungadi and R. Rama

n accurate diagnosis is to extract a detailed description omedical conditions. A typical sequence comprises of thng the complaint, history of the illness, systemic enquirrgies and personal and family history.

History Taking Module

ination

n helps the doctor determine the status of the patients the user perform an overall review of the patient’s sysified into four sub modules/segments - General Inspecof Eye and ENT.

hysical Examination Module

an

of he ry,

t’s ys-c-

The Medical Virtual Patient

The user can click on tamine the patient. The sypressure meter (sphygmodo the physical examinarelevant physical examinbased on the history takin

3.3 Systemic Exam

Systemic examination renervous system, the respstrointestinal system. Thties relevant for the given

Fig. 4 Screen showing JVP b

3.4 Investigation

The student can select varneed to be performed on trequired lab test.

3.5 Differential Dia

A major challenge facing care through proper diagn(DDx) module ranks disethe virtual patient. Studenview the patient as needed

Simulator (MedVPS) Platform 6

the desired segment and access the tools/simulator to exystem provides suitable tools such as thermometer, blooomanometer), and stethoscope under each sub-section ttion of the virtual patient. The doctor can choose th

nation he/she needs to perform with the virtual patienng that is already performed.

mination

eviews the major systems of the body like the centrpiratory system, the cardiovascular system and the gahe student should both determine and perform the activ

virtual case to diagnose correctly.

being taken in the Systemic Examination Module

rious tests such as a blood test, x-ray, ECG and so on ththe patient. The result of test is shown upon selecting th

agnosis

the medical fraternity is the provision of quality medicnosis based on the symptoms. The Differential Diagnosases based on the probability of the disease symptoms onts can review the shortlisted diagnosis, go back and rd until they arrive at the correct diagnosis.

63

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ral a-

vi-

hat he

al sis of e-

64

Fig. 5 Screen showing a Tes

Fig. 6 Screen showing the D

3.6 Treatment Mod

The treatment module alpatient. Depending on thtions are displayed on scrtion of drugs. An importasystem to help doctors crate for a treatment.

P. Nedungadi and R. Rama

t Report in the Investigation Module

Differential Diagnosis Module

dule

llows the user to prescribe several drugs on the virtuhe drug, drug-to-drug interactions, drug-to-food interacreen to guide the student administer the correct combinaant goal is to incorporate medical score calculators to thcalculate the effectiveness of the treatment and surviv

an

ual c-a-he

val

The Medical Virtual Patient Simulator (MedVPS) Platform 65

4 Pilot Study and Findings

The pilot study on MedVPS was conducted with 15 participants who were third year MBBS students from the Government Medical College at Trivandrum.

The workshop was designed to incorporate beginners to advanced users of computer technology. MedVPS being user friendly could be used easily and effortlessly. The whole program was catered to hold the interest of the partici-pants, by evoking their curiosity, and making them aware of the different poten-tials and possibilities of the MedVPS project. The workshop was for two hours and had three sessions.

Fig. 7 A Few Responses from the Online Feedback

66 P. Nedungadi and R. Raman

The first session consisted of a brief fifteen minutes introduction to the medical simulation project and on what the workshop intended to achieve. This was fol-lowed by a fifteen minutes demo of five activities taken from more than the sixty activities developed for the project.

The second session was a sixty minutes hands-on one where the participants used the MedVPS system to diagnose virtual patients. The MedVPS cases used in the study were in the Respiratory and the Cardiology domains.

The final session was a thirty minutes one where the participants discussed their thoughts and gave their feedback orally and filled in an online survey.

5 Conclusions

Unlike other medical simulations, MedVPS uniquely integrates case based virtual patients with realistic images and medically accurate simulations to provide a learning experience for the student. Our challenges included getting real reference images and videos for patient medical conditions. These were partially overcome by re-creating images using Scalable Vector Graphics (SVG) with guidance and approval by medical experts.

We focused on learning, authenticity and assessment in developing MedVPS. Students said it was a game like environment, where they got authentic informa-tion that they rarely see in real patients. In the differential diagnosis module, students were able to learn from their errors and go back to previous modules and re-examine the patients to arrive at the proper diagnosis.

Acknowledgement This work derives its inspiration and guidance from Amrita University’s Chancellor Amma. The project is funded by the Department of Electronics and Information Technology (DeitY), Government of India. We acknowledge the efforts of Rathish G and Dr. Romita and others at Amrita CREATE team, the subject guidance from faculty at Amrita Schools of Medicine and Trivandrum Medical College. We thank our partner, CDAC Trivandrum, for organising the pilot studies with the medical students.

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