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PubMed1978

Simulated patients.

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Education, Medical↗
PubMedDate not supplied

Case-based tutoring from a medical knowledge base.

The past decade has seen the emergence of programs that make use of large knowledge bases to assist physicians in diagnosis within the general field of internal medicine. One such program, Internist-I, contains knowledge about over 600 diseases, covering a significant proportion of internal medicine. This paper describes the process of converting a subset of this knowledge base--in the area of cardiovascular diseases--into a probabilistic format, and the use of this resulting knowledge base to teach medical diagnostic knowledge. The system (called KBSimulator--for Knowledge-Based patient Simulator) generates simulated patient cases and uses these cases as a focal point from which to teach medical knowledge. This project demonstrates the feasibility of building an intelligent, flexible instructional system that uses a knowledge base constructed primarily for medical diagnosis.

Artificial Intelligence↗
PubMed1992

An introduction to patient flow simulation for health-care managers.

Simulation of patient flow is a remarkably useful management tool. With today's software for personal computers, simulation is no longer just for academics and consultants. Senior and mid-level managers should actively seek out simulation as a problem-solving technique. This article provides health-care managers with the fundamental knowledge needed to individually initiate simulation studies of their departments.

Ambulatory Care Information Systems↗
PubMed1978

Experience with the simulated patient-physician encounter.

The development of computer-based simulations of the patient-physician encounter has made it possible to give students the opportunity to manage a case without jeopardizing a real patient's life. At the University of Wisconsin Medical School simulated patients have been an integral part of the third-year teaching program for the past five years. They have been used to permit the students to gain clinical experience, as part of a series of structured teaching conferences, and in a medical testing program. Student and faculty response to the program generally has been favorable.

Clinical Competence↗
PubMed1990

Probability modelling of a surgical probe for tumour detection.

Probability functions for the output counts from a radiation detector probe are needed to implement Bayesian detection strategies or to assess performance of the probe. This paper presents methods for simulating a surgical probe designed for tumour detection to obtain statistical information for modelling probability functions of output data. Statistical models of pharmaceutical uptake in normal organs and tumours were estimated from animal and human data, and these models were combined with a digitised human torso phantom to create a large set of simulated patients. With the simulated patients and with a spatial map of the probe response, computer simulations of intraoperative probe measurements provided a large set of simulated probe data. Probability models derived from these data using maximum-likelihood methods helped to formulate the detection strategy and to evaluate the performance of the surgical probe.

Computer Simulation↗
PubMed1991

Does competence of general practitioners predict their performance? Comparison between examination setting and actual practice.

OBJECTIVE: To study the differences and the relation between what a doctor actually does in daily practice (performance) and what he or she is capable of doing (competence) by using national standards for general practice. DESIGN: General practitioners were consulted by four standardised (simulated) patients portraying four different cases during normal surgery hours. Later the doctors participated in a controlled practice test, for which they were asked to perform to the best of their ability. In the test they saw exactly the same standardised cases but in different patients. The patients reported on the consultations. SETTING: Province of Limburg, the Netherlands. SUBJECTS: 442 general practitioners invited by a letter. 137 (31%) agreed to participate, of whom 36 were selected and visited. MAIN OUTCOME MEASURES: Number of actions taken during the consultations across complaints and for each category of complaint: the competence and performance total scores. Combination of scores with duration of consultations (efficiency-time score). Correlation between scores in the competence and performance part. RESULTS: Mean (SD) total score across complaints for competence was 49% higher than in the performance test (81.8 (11) compared with 54.7 (10.1), p less than 0.0001). The Pearson correlation across complaints between the competence total score and the performance total score of the participating physicians was -0.04 (not significant). When efficiency and consultation time of the consultations were taken into account, the correlation was 0.45 (p less than 0.01). CONCLUSIONS: Assessment of competence under examination circumstances can have predictive value for performance in actual practice only when factors such as efficiency and consultation time are taken into account. Below standard performance of physicians does not necessarily reflect a lack of competence. Performance and competence should be considered as distinct constructs.

Clinical Competence↗
PubMed1992

Continuing medical education software: a comparative review.

Personal microcomputers can be used by physicians for continuing medical education (CME). Advantages of computerized CME include local control over the topic, time, place, and pace of instruction. Computers can be interactive, providing selected information that depends on the desires and needs of the physician. Learners have different preferred styles of receiving information, and computer programs can be written to appeal to a particular style of learning. Three examples of commercial software programs available for CME are reviewed. Cyberlog should appeal to those who like to learn from reading textbooks but also desire simple computer graphics and case simulations to reinforce key concepts. Patient Simulator II is a detailed patient simulation for those who learn best by doing. A subscription to Discotest provides patient management problems, and multiple choice questions (no graphics) based on information in Scientific American Medicine. No one program is suitable for all family physicians.

Computer Simulation↗
PubMed1988

Treatment of terminal cancer pain in Finland. A questionnaire survey.

A questionnaire concerning current practice in the treatment of cancer pain was sent to 783 Finnish physicians. This study is based on the replies from 421 physicians who stated that they at least sometimes see cancer patients. Three simulated patient cases were presented in the questionnaire, and the adequacy of the treatment suggestions was evaluated. The results indicated that drugs predominate in the treatment of cancer pain. The suggested doses of narcotic analgesics were well below the minimum effective daily doses. As many as half of the physicians failed to use the therapeutic modalities correctly, irrespective of the frequency of their seeing cancer patients. Education in effective pain treatment should therefore be intensified to ascertain that all physicians involved in clinical practice have satisfactory knowledge of the treatment of cancer pain.

Analgesics, Opioid↗
PubMed1989

Factors affecting outcomes of medication-history interviewing by pharmacy students.

Factors affecting outcomes of medication-history interviewing by pharmacy students were studied. Data were obtained from fourth-year pharmacy students enrolled in a required course in fall 1984. Each student conducted a medication-history interview with one of two simulated patients who presented a predetermined history; interviews were videotaped from behind a one-way mirror. Students also completed an interviewing-orientation survey and a personal report of communication apprehension (PRCA). Trained raters evaluated the videotaped interviews using measures of interview skill and interview completeness. The simulated patients completed a patient-satisfaction form after each interview. Two path models were developed that were identical except that one had completeness and one had patient satisfaction as the dependent variable. Interview skill was the final factor in each model, preceded by variables representing the student's background and orientation factors, PRCA, and simulated-patient gender. Of 112 students conducting the interview, 107 (95.5%) and 95 (84.8%) completed the PRCA and orientation surveys, respectively. The models explained 36% and 27% of the variance in patient satisfaction and completeness, respectively. Shown in parentheses are the significant direct predictors of variables in the model of patient satisfaction: satisfaction (skill, prepharmacy grade point average [preGPA], people and health-care [PHC] orientation); skill (interviewing orientation, preGPA); interviewing orientation PHC orientation, preGPA, PRCA); and (PHC orientation (student gender). All effects were positive except for PRCA on interviewing orientation. For the model of completeness, direct predictors were as follows: completeness (skill, PHC orientation, student gender, simulated-patient gender); skill (interviewing orientation, preGPA); interviewing orientation (PRCA, preGPA, PHC orientation); and PHC orientation (student gender). All effects were positive except for PRCA on interviewing orientation and PHC orientation on completeness. Results suggest that one path model reflects the patient's assessment of interviewer competence in terms of satisfaction, and the other reflects the clinician-rater's assessment of interviewer competence in terms of interview completeness. The interviewing process positively influences both patient satisfaction and interview completeness.

Female↗
PubMed1991

Effects of using two or more standardized patients to simulate the same case on case means and case failure rates.

The effects of using two or more standardized patients (multiple SPs) to simulate the same case in a performance-based examination were studied at the case level by comparing case means and case failure rates for multiple SPs simulating the same case, using data from the classes of 1988, 1989, and 1990 at the Southern Illinois University School of Medicine. For total scores and scores on the students' written answers, the effects on means and failure rates were negligible and could be explained as due to sampling error. For scores on the checklists completed by the SPs, there were more significant differences than would be expected by chance alone, even though the number of significant differences was relatively small. The results demonstrate a need for caution in the interpretation of scores obtained from a case checklist completed by multiple SPs, particularly in regard to making pass-fail decisions.

Achievement↗