Virtual patient
Encyclopedia
The term virtual patient is used to describe interactive computer simulations
used in health care
education. The special focus is targeted on the simulation of clinical processes with virtual patients. Virtual patients combine scientific excellence, modern technologies and the innovative concept of game-based learning
. Virtual patients allow the learner to take the role of a health care professional and develop clinical skills such as making diagnoses and therapeutic decisions The use of virtual patient programmes is increasing in healthcare education, partly in response to increasing demands on health care professionals and education of students but also because they allow opportunity for students to practice in a safe environment
There are many different formats a virtual patient may take. However the overarching principle is that of interactivity
- a virtual patient will have mechanisms for the learner to interact with the case and material or information is made available to the learner as they complete a range of learning activities The interactivity is non-sequential
.
Despite their efficacy simulated patients are still a tangent and a prosthesis to reality. They should be viewed as augmenting existing modes and methods of clinical teaching.
.
If more tests can be done on Artificial patients to filter out possibly unnecessary tests or experiments, fewer subjects pharmacovigilance
maybe needed.
The Artificial patients insilico modeling are still in the early to middle developmental stages. It will require continual updates and development with the endless availability of new data.
This standard has been very successful and is now widely adopted, eg in major projects like eViP.
In 2010, this standard attained status as an ANSI standard. American National Standards Institute
Simulators
Virtual physiology
Computer simulation
A computer simulation, a computer model, or a computational model is a computer program, or network of computers, that attempts to simulate an abstract model of a particular system...
used in health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
education. The special focus is targeted on the simulation of clinical processes with virtual patients. Virtual patients combine scientific excellence, modern technologies and the innovative concept of game-based learning
Game-based learning
Game-based learning is a field of research and game design based on observations that play, structured or unstructured, conditions the human brain for transformation and learning...
. Virtual patients allow the learner to take the role of a health care professional and develop clinical skills such as making diagnoses and therapeutic decisions The use of virtual patient programmes is increasing in healthcare education, partly in response to increasing demands on health care professionals and education of students but also because they allow opportunity for students to practice in a safe environment
There are many different formats a virtual patient may take. However the overarching principle is that of interactivity
Interactivity
In the fields of information science, communication, and industrial design, there is debate over the meaning of interactivity. In the "contingency view" of interactivity, there are three levels:...
- a virtual patient will have mechanisms for the learner to interact with the case and material or information is made available to the learner as they complete a range of learning activities The interactivity is non-sequential
Sequence (medicine)
In medicine, a sequence is a series of ordered consequences due to a single cause.It differs from a syndrome in that seriality is more predictable: if A causes B, and B causes C, and C causes D, then D would not be seen if C is not seen...
.
Forms of Virtual Patients
Virtual patients may take a number of different forms:- Artificial patients: computer simulations of biochemical processes such as the effect of drugs in organisms, the physiologic processes of a given organ or entire systems (systems biology) in a given organism. These can be used in different phasesClinical trialClinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
of a compound or drug in development in a given pharmacologicalPharmacologyPharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function...
research as a preliminary to testing on animals and humans for the drug developmentDrug developmentDrug development is a blanket term used to define the process of bringing a new drug to the market once a lead compound has been identified through the process of drug discovery...
processes.
- Real patients: reflected in data e.g. electronic health recordElectronic Health RecordAn electronic health record is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations...
s (EHRs). In this case the virtual patient is the reflection of the real patient in terms of data held about them. These are sometimes called e-patients.
- Physical simulators: mannequins (sometimes spelled 'manikins'), models or related artefacts.
- Simulated patientSimulated patientA simulated patient, standardized patient or sample patient , in health care, is an individual who is trained to act as a real patient in order to simulate a set of symptoms or problems. Simulated patients have been successfully used in medical education, nursing education, evaluation, and...
s: where the patient is recreated by humans or computer-generated characters and Virtual Humans acting as such or engaging in other kinds of role-play.
- Electronic case-studiesCase studyA case study is an intensive analysis of an individual unit stressing developmental factors in relation to context. The case study is common in social sciences and life sciences. Case studies may be descriptive or explanatory. The latter type is used to explore causation in order to find...
and scenarioScenarioA scenario is a synoptical collage of an event or series of actions and events. In the Commedia dell'arte it was an outline of entrances, exits, and action describing the plot of a play that was literally pinned to the back of the scenery...
s where users work through problemProblemA problem is an obstacle, impediment, difficulty or challenge, or any situation that invites resolution; the resolution of which is recognized as a solution or contribution toward a known purpose or goal...
s, situations or similar narrativeNarrativeA narrative is a constructive format that describes a sequence of non-fictional or fictional events. The word derives from the Latin verb narrare, "to recount", and is related to the adjective gnarus, "knowing" or "skilled"...
-based activities.
Types of Interaction with Simulated or Electronic Patients
A number of different modes of virtual patient delivery have been defined:- Predetermined scenario [directed mode]
- The learner may build up the patient or case data from observations and interactions [blank mode]
- The learner may view and appraise or review an existing patient or scenario [critique mode or rehearsal mode]
- The VP may be used as a mechanism to address particular topics [context mode]
- The learner may use a scenario or patient to explore personal/professional dimensions [reflective mode]
- Banks of patients or scenarios may collectively address broad issues of healthcare [pattern mode]
Types of Interaction with Artificial Patients
- To create and run a mathematical quantitativeQuantitative researchIn the social sciences, quantitative research refers to the systematic empirical investigation of social phenomena via statistical, mathematical or computational techniques. The objective of quantitative research is to develop and employ mathematical models, theories and/or hypotheses pertaining to...
simulation of a healthy person (physiologyPhysiologyPhysiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
) and diseased person to test multiple hypothesis against known and unknown processes in a given set or sets of processes to help fill gaps in knowledge of the physiology or system under investigation.
Possible Benefits of Physical Simulators and Simulated Patients
Simulated patients increase the availability of training opportunities for medical students, making them less dependent on actual cases to learn how to handle different situations. Unlike real patients, simulated patients can be accessed on demand and they can be endlessly replayable to allow the user to explore different options and strategies. They can be structured with narratives that represent real situations while challenging the user with a wide range of tasks.Despite their efficacy simulated patients are still a tangent and a prosthesis to reality. They should be viewed as augmenting existing modes and methods of clinical teaching.
Possible Benefits of Artificial Patients
Artificial patients increase the possibility of exploring millions of hypothesis driven experiments on known areas of biological systems to extrapolate the unknown, which enables efficient exploration, informed research and development predictive simulation, which must also be proven by real patient studies clinical trialClinical trial
Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
.
If more tests can be done on Artificial patients to filter out possibly unnecessary tests or experiments, fewer subjects pharmacovigilance
Clinical trial
Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
maybe needed.
The Artificial patients insilico modeling are still in the early to middle developmental stages. It will require continual updates and development with the endless availability of new data.
Virtual Patient Data Standards
The MedBiquitous consortium established a working group in 2005 to create a free and open data standard for expressing and exchanging virtual patients between different authoring and delivery systems. This was in part to address the problem of exchanging and reusing virtual patients and in part to encourage and support easier and wider use of virtual patients in general.This standard has been very successful and is now widely adopted, eg in major projects like eViP.
In 2010, this standard attained status as an ANSI standard. American National Standards Institute
American National Standards Institute
The American National Standards Institute is a private non-profit organization that oversees the development of voluntary consensus standards for products, services, processes, systems, and personnel in the United States. The organization also coordinates U.S. standards with international...
Examples
Electronic Cases- http://med-U.org (SIMPLE, CLIPP, fmCASES, WISE-MD)
- WebSP from Karolinska Institutet
- Virtual Patients from Harvard Medical School
- Virtual Patient Project from New York University
- Virtual Patients from Centre for Virtual Patients (University of Heidelberg)
- OpenLabyrinth from Canada
- Labyrinth from the University of Edinburgh
- TUSK Case Simulator from Tufts University
- Virtual Patient from Keele University School of Pharmacy
- Virtual Patients Group Consortium at the University of Florida, University of Central Florida, Medical College of Georgia, and University of Georgia
- http://www.inmedea-simulator.net (A whole virtual clinic with 25 different faculties and offer 250 virtual patients)
Simulators
- Limbs and Things simulators
- SimMan simulator
- “Harvey” mannequin
Virtual physiology
See also
- CAVEmanCAVEmanCAVEman is a 4D high-resolution model of a functioning human elaborated by University of Calgary. It resides in a cube-shaped virtual reality room, like a cave, also known as the "research holodeck", in which the human model floats in space, projected from three walls and the floor below.-External...
- InVesaliusInVesaliusInVesalius is a free medical software used to reconstruct structures of the human body. Based on two-dimensional images, acquired using Computed tomography or Magnetic resonance imaging equipments, the software generates virtual three-dimensional models correspondent to anatomical parts of the...
- Visible Human ProjectVisible Human ProjectThe Visible Human Project is an effort to create a detailed data set of cross-sectional photographs of the human body, in order to facilitate anatomy visualization applications. A male and a female cadaver were cut into thin slices which were then photographed and digitized. The project is run by...
- Virtual Physiological HumanVirtual Physiological HumanThe Virtual Physiological Human is a methodological and technological framework that, once established, will enable collaborative investigation of the human body as a single complex system...