Comments on Scenario Based Learning and Virtual Patients

Terry Poulton’s keynote led seamlessly into the first session, which was about the use of scenario-based learning and VPs in particular in medical education. Collectively the session components had a very clear focus, providing a coherent and logical progression from theory to practice. Two presentations, respectively from Terry Poulton and Nabil Zary, provided the preliminary overview and contextualisation of the concept of VPs. These were followed by a hands-on workshop with preliminaries from Ella Iskrenko , who described her practical experiences with using VP for medical  education, and Eleni  Dafli, who introduced software tools (VUE and Openlabrynth) for designing and creating a VP scenario with branching pathways. Participants then used those tools to create a VP scenario with a branching pathway.
Terry addressed, in his presentation, “why use VPs?”.  In particular, he identified their use as interactive simulations of real life clinical scenarios and the ability of the medic to learn from these by killing and curing VPs rather than real ones.  Terry used the recent emergency landing of an aeroplane in the Hudson River as an analogy to illustrate effective use of VP technology, the pilot had previously learned how to land on water using a flight simulator so he knew what to do and thus saved lives. The argument was those in medicine can similarly save lives by developing their skills with simulated patients using VP tools.  Within a spectrum of competency, ranging  from core knowledge to hands-on experience, that  VP has a role in developing  clinical reasoning, through a progression of doing, failing, reasoning, try again, well-told stories and just-in-time-instruction. Further, VP overcomes a limitation of traditional problem based learning, since the latter is essentially linear whereas a VP includes branching such that learners can explore many pathways, including bad decisions that will kill the patient. Terry also presented some experimental evidence of that VP with branching scenarios can be more effective than without branching He concluded by considering other tools, including interactive clinical images,  virtual worlds (interesting but “clunky” technology which does not yet engage for student), and iPhone app  (a major innovation).
The second talk, by Nabil Zary, covered much of the same territory as the preceding one. He reviewed definition of VPs, including:  record of real patient; computer simulation;  scenarios in which the learner acts as a professional ; and tools for training, education and assessment. He discussion then followed the VP life cycle, i.e., designed  (tools,  branching, debate (not guided), mobile app VP (very popular), case simulator to enable students to create their own VPs, and immersive VP); authoring  (user or model centric, templates, authoring environment to create cases , patient, involve different communities, and models which can creates many cases).
The two speakers took question. These covered, when VPs should be used within the curriculum, difficulties in the introducing of VP because of resistance to changing curriculum, and criteria by which modality is chosen (different types of modalities are good for different purposes, e.g., branching for collaborative study, lone student needs VP with MCQ tests).  It also emerged from the questioning the views  that students should be encouraged to make mistakes when designing VP, and that two drawbacks are the need to putting things online and that momentum of VP can hide the fact that other modes of learning may be more appropriate.
Comments: In general this was an effective session. The presentation from Terry and Nabil  were excellent and informed and  thefollowing hands-on session successfully gave delegates experience in using VP tools to develop a scenario with branching.