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Computerized Training & Virtual Patients

Computerized education modules for training (and re-training/continuing education) have come and gone over the years and I have reviewed a couple of them for IFW in the past.? Some were good, and some just were adequate but almost every one always left the provider wanting more than what the program and ancillary materials (if any were even offered) could provide.? They just came up short.? Not bad per se, but they just left us saying "that's it, it's over?"? So the real trick then is to balance the computer program (the interactive program itself never seems to be enough), with enough educational support (that's the ancillary material I was speaking about) to fully drive the educational objectives to maximize the real learning potential.? Given the often high costs of producing these "whiz-kid" programs you really have to go the distance.? After saying all of that, now they have to bring us this product at a cost that even the most frugal of EMS managers or education coordinators can stomach without running to the can and losing lunch once they tell you the cost!? After all, we do have to be able to plug this into the budget and anything that will strain or break a budget (tried to buy a high tech manikin lately?) will get pushed to the back burner and eventually forgotten.

Enter the world of Virtual Patient Encounters? (VPE), a new program from the people at Mosby Jems, an imprint of Elsevier.? I have no interest in this company, nor do I have any ulterior motives other than giving you a fair appraisal of this product for your review and consideration.? My interests in presenting this information is strictly in the arena of getting the information out to you so you will know what is out there and available for your training needs.? In the Industrial Fire Protection and Safety areas, much of the needed training materials are neglected by the major companies as they view this as "too small" a market to pursue and invest time and energy, therefore you often do NOT even hear about these products unless someone with an avenue into these areas raises the alert flag.? They also do not market to the huge Continuing Medical Education (CME) community that is out there and always struggling to find new and innovative ways to challenge existing providers!? Consider me waving a big red flag now!

This VPE? is HOT!? The education starts with a workbook that assigns a lesson and objectives for the student to accomplish prior to diving into the electronic program.? The program is essentially "workbook driven" and I find this refreshing as the student is prepped appropriately prior to attempting the unit, therefore at least setting the student up for the best chance of success although not guaranteeing it.? The computer program has video intros (fig.1) and then takes you to a patient care screen (fig.2).? The patient care section is detailed, VERY detailed, and allows all types of assessment and treatments.? In fact, the only thing that is offered without asking (or "assessing") really is the history and that is not much more than was given in the video intro.? So, you really have to interact with the program in order to get it to perform.? These force the students to DO all of the things that they often take for granted and reminds them of that step-by-step approach that can be so beneficial when approaching patients.? This, IF they have done the appropriate unit in the workbook, gives them the best chance for success.

The workbook is interesting in its approach.? When I reviewed the ALS copy (there are going to be BLS and ILS versions available) it begins with a text reading assignment (of course, it's their text, but in my opinion, any comparable high quality text should equally supplement for the same educational value), then, clearly outlines the lesson objectives and begins by giving the student a short writing "activity".? The student then begins the electronic case on the CD-ROM and has a short follow-up written assignment after the case.? The student merely has to print out a log of the activity and submit it to the instructor for review. ALL of this can be submitted electronically. This will help our off-site brothers and sisters AND those with global operations but monitor their education from one location. For the particular unit that I reviewed, Airway Management and Ventilation, there were four electronic cases that were offered and four workbook scenarios to compliment the electronic offerings.? Four clearly different cases and each were challenging.? The program actually lets you "kill" the patient, or at least watch them deteriorate, if your treatments are improper.? This was extremely valuable within an educational model as students are allowed to make the mistakes in the virtual world where the safety of the "classroom" is available and the student can be truly challenged and charge ahead without fear.? Hesitation and mistakes in real life can be costly, and here, only electronic people die.

The program is really complex, while the assessments are pretty standard, the ALS version allows you to place EKG leads, start IV infusions (fig. 3), and administer medication via various routes.? The program offers various airway options from the simple oral/nasal airways to the complex endotracheal intubation, combitube and even a cricothyrotomy or LMA if your protocols might allow.? The options for treatment seemed varied and sometimes endless.? If you take your eyes off the patient and their condition deteriorates, the program may prompt you to "check your patient" but not much more.? When the patient has responded appropriately OR the time for transport has arrived (yes, some of these you need to Load and Go!) you can elect to transport and all treatments after that will occur "in transit". (fig.4)? When you arrive at the hospital you off-load the patient and the scenario stops, the patient care is wrapped up, and the case log is generated.? All-in-all a nifty little set-up and it holds the interest of the student all the way through to the end, which is essential as you are responsible for the patient until you transfer the care and they can "crap out" on you at any time if you are riding the edge in your therapeutics and treatment modalities.? It keeps you on your toes.

Of course the program and the modules are not without issues.? As an educator, one of the first things that popped out was that there was no immediate feedback for the student.? No warning marks on the logs for possible errors, no flags noting lapses in clinical judgment, nothing of the sort.? It might even have been beneficial to have a "scenario" mode and then a "testing" mode for the program for drilling and practice, and then examinations, I'm not sure.? This was one of the areas that I felt I wanted right away, a critique of how the scenario had gone and some guidance as to how their therapeutic dynamics could have improved patient outcome.? This may be asking too much given the relative complexity of the program and the various, even multiple ways a scenario might end up based on how it was "played".? But this is no video game and should not be viewed as one in any stretch of the imagination.? It is an intricate and very dynamic tool for teaching students.? I also would have liked to have "heard" the lung sounds and had a little more audio possibilities once the program got into the patient care section.? Even EKG beeps would have been nice, but the program is virtually silent once you are in the 'care mode'.

This is a high quality product that is not even on the general market yet.? It is still only in BETA version (and there may be improvements) and a tentative final release is slated for May 2007.? That's what they are shooting for anyway.? They are still working out some of the bugs and tweaking the final edition.? I really had to twist some arms and swear to give up my first born for sacrifice if it got out, all just to get the draft copy of the electronics.? Now comes the best part of all.? I actually expected this to fall somewhere toward the high end/middle end of the pricing scale but when they told me the ticket on it I about fainted.?? Now get this.? The cost with the workbook and the VPE? is going to be $49.95 for the ALS, $44.95 for the ILS, and $39.95 for the BLS.? For that you get the Workbook and the CD all in one package.? At that price I can put one in the hands of every student and not worry about the budget.? If you are buying the major textbook that companions the whole package then VPE? and workbook are even cheaper.? I was pleasantly surprised by this product and intend to utilize it as soon as it's available.? I think the student's will find it challenging and clearly "something different".? You may contact Sherie at Mosby Jems for more information.? Try her at This may be something to add to your training portfolio!


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