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Volume 8, Number 4: January 16, 2002

Development and Evaluation of the Virtual Oncology Patient

by Jill M. Kolesar and Michael E. Pitterle,
School of Pharmacy, UW-Madison


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The authors gratefully acknowledge support by the Teaching Academy at the University of Wisconsin-Madison, the technical expertise of Mike Brown, and the pharmacotherapy laboratory participation of Beth Martin and Sandy Hoel.

Virtual patients are a novel teaching tool currently used in medical schools. Considered as effective in teaching and assessment as other widely used methods, in most cases, virtual and simulated patients are preferred by students. The following paper describes the development and evaluation of an oncology virtual patient in Pharmacotherapy Laboratory at the University of Wisconsin-Madison.

The Pharmacotherapy Laboratory is a four-semester course designed for the entry-level Doctor of Pharmacy program. The Oncology Pharmacotherapy Module is in the fourth and final semester. Students are in the second semester of their third year in the program.

Goals and Objectives

In developing the virtual patient, we devised the following goals: 1) to enhance learning of important concepts, 2) to provide an opportunity for development of critical thinking skills and problem-based learning, 3) to expose students to the continuum of care in an oncology patient; and 4) to encourage independent learning.

Content and Process

The Oncology Pharmacotherapy course is a four-week module, comprised of a didactic lecture series and weekly laboratory experience. The virtual breast cancer patient is contained on the School of Pharmacy network, with links to background material from an accompanying didactic course, power point slides, animations, simulations and digitized voice. The virtual patient contains extensive patient histories and demographics, interactive anatomy, pathology and diagnostics, and clinical scenarios and simulations. The student is expected to ask the virtual patient questions to assist in the assessment of the patient. The virtual patient provides students with the opportunity to interactively manage a breast cancer patient from diagnosis to death.

Prior to the laboratory, each student independently completed the assessment of the virtual patient. The pilot virtual patient was implemented in the Spring 2000 Oncology/Hematology Pharmacotherapy laboratory and expanded for Spring 2001. (See Table 1 for a comparison of Spring 2000 and 2001 virtual patient activities.)

For Spring 2001, the virtual patient was enhanced to randomly provide one of four clinical scenarios each week. Students were also required to complete their assessment and SOAP note (SOAP=Subjective, Objective, Assessment, and Plan) outside of class. Each student in the laboratory group then presented their patient as part of Pharmacy Rounds in the laboratory.

The various activities within the pharmacotherapy laboratory include:

Virtual Patient and Pharmacy Rounds: An interactive web based virtual patient that students interacted with prior to the laboratory. This problem-based activity presented students with a different problem each week. For example, during week 1, the students assessed the patient's risk of breast cancer. Four scenarios were built into the one assessment, with each student from a small group receiving a different scenario. Students then wrote their SOAP note, brought it to the laboratory and presented their patient to their small group during Pharmacy Rounds.

Prescription Counseling: The virtual patient received a different prescription each week. Students reviewed her profile prior to laboratory and came to class prepared to counsel on that prescription.

Therapeutic Controversies: Students read articles regarding a controversial area, were assigned to a Pro or Con position, and debated in a large group setting during laboratory.

Physical Assessment: Techniques of physical assessment appropriate to the weekly unit were taught in the weekly laboratory.

Weekly on-line quizzes:
Each student completed an open book quiz covering lecture and laboratory material within 24 hours of completing their laboratory section. Each quiz had 4 concept areas, with each concept area having four different questions. The electronic quizzes randomly generated different combinations of questions in each of the four concept areas. Quizzes were graded electronically, with the score given to the student immediately and the answers posted after all laboratory sections had completed the quiz.

(See also Table 2.)

Evaluation

Student learning was assessed by completion of SOAP notes, laboratory participation and content quizzes. The students also completed a satisfaction survey (See Table 3).

In Spring 2000, the effectiveness of teaching was assessed with a 24-point open book online vignette-based quiz that included six questions from the lectures, six from the virtual patient exercises, six questions that combined lecture and virtual patient concepts, and six questions from the laboratory. The quiz scores were compared to the overall score from the didactic course. All students (101) participated in the pilot project and completed the quiz and survey. Figure 1 shows the results of this comparison.

On the lecture (L) only questions the mean score was 60%, on the lecture and virtual patient (L+VP) questions the mean score was 68%, on the virtual patient alone (VP) the mean score was 73.16, and on the laboratory only questions (TC) the mean score was 74.91. On the exam final (E),covering the entire course the mean score 82.2. Figure 1: Comparison of test scores

All methods of reinforcement where better than the lecture alone (p< 0.05 by one-way ANOVA), however both the reinforcement techniques (laboratory, virtual patient) were equivalent as was using the virtual patient alone as a teaching method. Based on this data, we concluded that the virtual patient was an effective teaching tool.

Proposed Modifications

We are enhancing and expanding the database to make the virtual patient more "real" and able to answer questions that are not limited to the case. This allows the student to interact more extensively with the patient and enhances student learning.

The software will be updated to include comments from students provided during the testing phase of the virtual patient in Spring 2001. Most of the changes will be corrected by updates to information in the database. Also questions asked by students, not currently in the virtual patient database, will be added.

A template of common questions for the virtual patient will be developed, allowing for quicker develoment of virtual patient simulations. The template will include the common normal values for some of the questions. It will also allow faculty to have students work with them on the development of a virtual patient.

Additionally, we will test and modify the template and database entry software with the prostate cancer virtual patient as well as other malignancies. This will allow us to expand our teaching to other malignancies and also enhance student learning.


In summary, we developed, implemented and evaluated the oncology virtual patient this semester. The faculty in the Pharmacy Practice Division at the School of Pharmacy support the virtual patient simulations. They want to develop additional virtual patient scenarios in other pharmacotherapy lab modules. We conclude that the virtual patient is effective in teaching and that students generally like it, but that there is room for improvement in the software.

Summary and Conclusions

In summary, we developed, implemented and evaluated the oncology virtual patient this semester. The faculty in the Pharmacy Practice Division at the School of Pharmacy support the virtual patient simulations. They want to develop additional virtual patient scenarios in other pharmacotherapy lab modules. We conclude that the virtual patient is effective in teaching and that students generally like it, but that there is room for improvement in the software.

Editor's note: Jill Kolesar and Michael Pitterle recently received the American Association of Colleges of Pharmacy's prestigious Innovations in Teaching Award for their virtual oncology patient project. TTT congratulates them!

If you would like to respond to this article or comment on their project, they can be reached at: School of Pharmacy, University of Wisconsin, 777 Highland Avenue, Madison WI 53705-2222, or by emailing Jill Kolesar.

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Table 1.


Spring 2000 Spring 2001
Content

SOAP Group Activity Individual Activity
Rx Consultation Group Individual
Therapeutic Controversies Group Group
Physical Assessment Individual Individual
On-line Quiz
Individual
Possible Cases 1 4
Medium School of Pharmacy Server Web-Based or SOP Server




Table 2.

Weekly 3-hour pharmacotherapy laboratory
Week

Virtual Patient SOAP
Pharmacy Rounds

Prescription Counseling

Therapeutic Controversies

Physical Assessment

On-line Quiz

1 Assessment of breast cancer risk

Individual patient presentations in small group
Tamoxifen
Tamoxifen vs reloxifine for metastatic breast cancer
Breast and testicular self exam
Lecture and lab content
2 Selection of adjuvant therapy for breast cancer and management of toxicity
Individual patient presentations in small group
Proclorperazine
BMT for breast cancer
Starting IVs, extravasations
Lecture and lab content
3 Selection of therapy for metastatic breast cancer and management of toxicity
Individual patient presentations in small group
Erythropoietin
Adherance to clinical practice guidelines
Slide review, comparison of patients to students (normal) peripheral smear
Lecture and lab content
4 Cancer pain in the palliative setting Individual patient presentations in small group
Morphine Opioid conversions Brief pain inventory Lecture and lab content




Table 3.

Survey Questions

Student Response
(1-4, 1=strongly agree- 4=strongly disagree,
5=no basis for judgment, and 6=NA)

I spent too much time
2.92 (2.8-3.04)
I spent too much time waiting for a computer
2.78 (2.61-2.95)
I could learn at my own pace
2.17 (2.01-2.33)
Can see results immediately
2.2 (2.02-2.38)
This is a unique learning experience
2.6 (2.42-2.77)
I am at a disadvantage because of poor computer skills
3.39 (3.27-3.52)
I am at a disadvantage because of poor typing skills
3.39 (3.27-3.52)
I am acquiring useful skills
2.52 (2.34-2.69)
VP has increased my understanding of Pharmacotherapy
2.54 (2.34-2.73)
I would like to use VP again 2.54 (2.37-2.70)

Answers of 5 and 6, not calculated in the mean and standard deviation.

 

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