Centre for Virtual Patients

Repurposing virtual patients for

clinical reasoning
Development of a guideline and
assessment of time and effort
Benjamin Hanebeck, Burkhard Tönshoff, Sören Huwendiek
Department of General Paediatrics, University Hospital for Paediatric and Adolescent Medicine and Centre for
Virtual Patients, Medical Faculty of Heidelberg University, Heidelberg, Germany

ICVP Krakau, 06.06.2009

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Clinical reasoning

• Taught through experience by seeing

patients (Eva, 2005)
• Strategies to facilitate learning (Bowen, 2006)

But:
• Patient encounters are limited, virtual
patients increasingly used as a
supplement
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Virtual patients and clinical

reasoning
• VPs should be designed and used to
promote clinical reasoning skills (Cook, 2009)
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VP design principles to foster

clinical reasoning (Huwendiek, 2009)
• Interactivity
• Specific elaborated feedback
• Questions to enhance clinical reasoning
– Summary of presenting problem
– Differential diagnoses
– Defining and discriminative features
• Recapitulation of key learning points (questions,
comments)
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Virtual patients and clinical

reasoning
But:
• Virtual patients are costly to make from
scratch (Huang, 2005)

 Repurposing to save resources (Ellaway, 2008)

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CAMPUS Virtual Patient system

• Vocabulary based VP system

• Possibility to enhance with questions at
any given point of the case
• 15 cases in German language:
– specific selection of older cases
– duration 45-60min each
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Guideline
• 1. Case selection, definition of learning objectives
• 2. Literature review
• 3. Development of a repurposing concept
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3. Repurposing concept
• Refinement of learning objectives

• Visualization of clinical reasoning process with

mind map
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3. Repurposing concept
Defining and  Defining and 
descriminating  descriminating 
Dx 1 features features
Feature A
Dx 2 Dx 1
Features E + F
Dx 3 Dx 3
Features A, B + C
Dx 4
Dx 4 Dx 4 Feature D

Dx 5 Feature C

Dx 6 Feature A
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Guideline
• 1. Case selection, definition of learning
objectives
• 2. Literature review
• 3. Development of a repurposing concept
• 4. Enrichment for fostering clinical reasoning
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4. Enrichment for fostering clinical

reasoning
• Implementation of questions according to the
mind map
• Summary of problem representation in abstract
terms
• Prompt for differential diagnosis
• Elaborate feedback / comments on important
aspects of the case
• Inclusion of clinical reasoning map at end of
case
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Guideline
• 1. Case selection, definition of learning objectives
• 2. Literature review
• 3. Development of a repurposing concept
• 4. Enrichment for fostering clinical reasoning
• 5. Reduction of cognitive load
• 6. Final checks including review by expert and
completion
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Efforts
Activity hours

1. Case selection, definition of learning objectives 2

2. Literature review 4
3. Development of a repurposing concept 4
4. Enrichment for fostering clinical reasoning 11
5. Reduction of cognitive load 5
6. Final checks including review by expert and completion 7
Total 33
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Conclusions
• Guideline for implementation of strategies
to foster clinical reasoning
• More time consuming and costly than
expected
• But: students value these strategies as
ideal preparation for encounters with real
patients
 worth the effort, increase in value
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Perspective
• Comparison of repurposed vs. original
VPs
– Evaluation with questionaire specifically
designed for clinical reasoning
– Controlled study with electronic key-feature
cases to assess clinical reasoning
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Thank you!

Contact:
www.campusvirtualpatients.com