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Virtual E-Scenario
Clinic™ The
Virtual Stroke Treatment Clinic
q
Interactive
Physician Decision Analysis Introduction—Effective
Stroke Treatment: The Physicians Challenge
Only one
treatment has been approved by the FDA for the acute treatment of
patients suffering ischemic stroke. The thrombolytic, tissue plasminogen
activator (tPA), has been proven effective if given within three hours
of symptom onset and administered to patients that meet patient
selection criteria. Determining
which patients are good candidates for receiving tPA is sometimes
routine, however many patients present with conditions and in
circumstances that make the decision to treat or not treat difficult. It is
well documented that tPA use as an acute treatment for stroke is
underutilized. Although the narrow treatment window remains a problem
and limits patient eligibility, appropriate selection of those patients
for treatment who do present within the three-hour intervention
window, is an additional and perhaps even greater factor limiting
treatment. To stay
current and be confident that the clinical decisions indicating stroke
treatment are optimal, the physician must constantly endeavor to read
medical journals, review practice standards from major medical
societies, reassess treatment successes and failures, and discuss
difficult cases with colleagues. On infrequent occasions, the physician
may gain insights from experts in the field, but this luxury is often
unavailable to frontline clinicians. Unfortunately, the time and
resources needed to pursue the above activities are very limited. Practice
guidelines typically fail to incorporate application of new information
strategies. Publishing constraints dictate that guidelines are general,
not specific. Guidelines usually lack examples to help clarify where
they apply. They ignore common clinical variables -- leading the reader
to be uncertain about whether they “fit” the clinical situation at
hand. They cite evidence of differing weights. In doing so, they risk
confusion by mixing strong recommendations with weak ones. Finally, they
do not engage the reader because they make for boring reading. In an
effort to address the shortcomings of practice guidelines, Virtual
E-Scenario Clinic™ software was
created. Virtual
E-Scenario Clinic™ software is a
computer-based tool that includes many of the above learning strategies.
It uses a simple interactive format that requires the user to commit to
dichotomous management decisions in specific, clinically relevant
scenarios. The scenarios themselves are built upon general
recommendations in published practice guidelines. Once a decision is
made, immediate text and graphic feedback become available, as does
access to the practice guideline from which the scenario was
constructed. The feedback includes the evidence-based “correct
answer” and a comment on the strength of the evidence. The independent
opinions from a panel of experts are also available. The user
may explore the scenarios in an ad-hoc manner for situations of personal
interest. An efficient,
iterative method of presenting the scenarios allows many scenarios to be
worked through quickly. Once a set of scenarios has been completed, the
user’s answers are stored and a detailed “report card” is
generated. This compares the user’s decisions against the
evidence-based recommendations and against the verdicts of the expert
panel. For these comparisons, Virtual
E-Scenario Clinic™ software calculates
a kappa score to correct for chance agreement. These
features can be useful to both the teacher and the student of
evidence-based medicine. For teachers, it provides a simple numerical
score indicating the student’s level of concurrence with
evidence-based recommendations. For researchers, the score can be used
to assess differences among groups and changes over time. For
students, Virtual
E-Scenario Clinic™ software offers
a “Virtual Clinic” in
which evidence-based practices can be inculcated. Efficiency and ease of
use allow the student to build evidence-based skills by encountering a
large number and variety of “virtual patients” in the low stress
environment of his or her own PC. Through
repeated variations on a theme Virtual
E-Scenario Clinic™ software can
reinforce evidence-based recommendations. In addition, Virtual
E-Scenario Clinic™ software can
be used to highlight clinical uncertainties. Scenarios can be crafted to
mirror the complex and controversial situations encountered in clinical
practice. In these, the evidence may be silent, and the expert consensus
may be evenly divided. Virtual
E-Scenario Clinic™ software can
thus teach both evidence-based recommendations and the limitations the
of evidence-based approach. Since the
half-life of “truth” in medicine is known to be finite (Poynard
2002), “best practice” is a continually moving target. Virtual
E-Scenario Clinic™ software can
be updated to reflect the latest iteration of best practice guidelines.
Adapting Virtual
E-Scenario Clinic™ software for
Internet access could provide organizations such as AAN with an
additional tool for up-to-the-moment continuing medical education. It
could be used as a of measure evidence-awareness among the
organization’s membership. It could measure the membership’s
consensus about difficult scenarios for which evidence is lacking. These
measures could be tracked over time and across organization-specified
variables. Finally, Virtual E-Scenario Clinic™ software
can be used to compliment and amplify the educational effect of
didactic lectures in grand rounds, conferences and similar group
settings. Recognizing
these challenges, we have applied a unique combination of technology,
medical education science, and consensus principles to create the new
Virtual E-Scenario Clinic™
software, incorporating both expert clinical knowledge
and published practice guidelines. We have created Virtual E-Scenario Clinic™
software as a user-friendly, interactive software
platform to aid physicians in optimizing their treatment decisions. Place Order: $95 includes Virtual E-Scenario Clinic™ CD, shipping and handling.
Overview
of Virtual E-Scenario
Clinic™
Software The
Virtual E-Scenario Clinic™ software provides
an efficient, interactive means of gaining a deeper understanding of the
application and limitations of evidence-based medicine. It is the only
platform to combine:
Clinically
relevant cases, ranging from routine to complex Interactive
simulations, supported by the best medical evidence and thought-leader
consensus opinion enable the physician to rapidly improve his or her
ability to select optimal treatment approaches in complex clinical
situations. Design
of
Virtual E-Scenario Clinic™
software Don
Smith, MD, the creator of Virtual E-Scenario Clinic™ software
has integrated novel features into computer technology to create
a new prototype for improving clinical decision-making. Virtual
E-Scenario Clinic™ software is designed
as a self-paced learning platform, which can be easily used on any
modern PC-compatible computer. Clinical
Scenarios A
minimum of twenty (20) clinical cases or scenarios is included. The
number of scenarios is dependent upon sponsor funding, as well as the
clinical complexity of the disease. Construction of the scenarios is
guided by an expert panel. The number of scenarios can subsequently be
expanded via upgrades that may be downloaded from the Internet. Information
in the Scenarios For
each scenario, the physician is provided with the following information
fields or domains about the case: Clinical
Presentation:
Each scenario begins by providing the user with a realistic clinical
situation, including pertinent details surrounding the symptomology. Initial
Evaluation:
This domain gives essential initial diagnostic information about the
patient’s condition including medical exam, labs, imaging, etc. Course:
The patient’s clinical course and clinical status over time are
provided. Scenario
Variations:
Once the basic scenario has been read, variations, which increase
treatment complexity, are efficiently presented by making small changes
in the information domains. A color-coded key allows the user to quickly
recognize the changes in the scenario. Interactive
Questions to Physician User For
each scenario, the physician must make a yes-no choice about a
therapeutic option. The physician is then prompted to compare his or her
decision Evidence-Based
Recommendations:
This feature presents an answer to each question based upon current
published practice guidelines. A literature reference for the guideline is given, as is the
strength of the recommendation, based upon an internationally accepted
medical evidence rating system. Expert
Consensus:
A panel of approximately 8-10 thought leaders and experts on the disease
area addressed by Virtual E-Scenario Clinic™ software
is drawn from academic and clinical practice settings. These
authorities provide guidance in developing each scenario and offer their
independent opinion about the best answer for each question. Their
responses to each question are based upon both didactic and experiential
knowledge. The user may easily compare each of his or her answers to the
consensus of the expert panel. Analysis
of Physician Answers:
The user’s responses are saved and can be analyzed as a group, against
the medical evidence and expert consensus. A graphic display of overall
and question-by-question answers to the scenarios is shown, with
comparisons to expert-consensus answers. A kappa statistic is applied to
correct for chance agreement. Compare
Your Virtual E-Scenario Clinic™
Score to Other Clinicians Using Virtual E-Scenario Clinic™
Software Log
onto the Virtual
E-Scenario™ Clinic Scoreboard
to compare your score to other clinicians using Virtual
E-Scenario Clinic ™ software. Virtual
E-Scenario
Clinic™
Scoreboard Navigation
and User Interface
Virtual
E-Scenario Clinic™ software uses a
graphical display that is efficient and intuitive, allowing the
physician to quickly learn how to use the software. All interaction with
Virtual E-Scenario Clinic™ software can
be accomplished with the use a mouse; keyboard entry is not required.
Color-coded display areas, prompts and other user focused formatting are
employed to optimize successful user/program interactivity.
Additional user assistance features include: Credits:
Allows one to know the author of a particular scenario and the expert
panelists who voted on the scenarios. Note, however, an individual
expert’s opinion is not displayed. System:
Offers information about the user’s computer, which may be needed for
troubleshooting. Help
gives:
Find:
Offers searching for and filtering scenarios: by category, by number,
and by words in a thumbnail sketch. This allows the user to quickly find
for the scenarios of greatest interest to him or her.
The View-All-Scenarios option
removes the filter and restores a view of all scenarios. File:
Allows
user to:
Target Audiences
Virtual
E-Scenario Clinic™ software is
applicable to physicians at any level of competency, from medical
student to medical expert. It presents difficult cases and sophisticated
scenarios based upon relevant clinical experiences. It supports clinical
decisions with best practice guidance and expert consensus opinion. In
so doing, it challenges and informs users at all levels of medical
expertise. Use
with Groups Virtual
E-Scenario Clinic™ software may
be used in group settings, as well. It is an excellent means of
generating thoughtful discussion about issues in patient management.
Examples
of settings for this application include hospital Grand Rounds, medical
schools, and residency training programs. Virtual E-Scenario Clinic™
software may also be employed in larger, more formal meetings.
For example, in educational conferences, one may determine the group’s
consensus about the answer to a given scenario by a simple show of hands
or through more sophisticated electronic means. Group-consensus answers
may be saved. Virtual E-Scenario Clinic™ software
will generate a report showing both overall agreement and
scenario-by-scenario agreement of the group with the evidence and the
experts. Finally,
Virtual
E-Scenario Clinic™ software may
be used in teaching institutions as a tool for assessing the
evidence-based awareness of students. Answers are saved with the date of
entry, so that one may track changes in the performance of individuals
or groups, over time.
Virtual
E-Senario Clinic™
Software
Initial Platform The
first clinical area to which Virtual
E-Scenario Clinic™ software has
been applied and software developed is the acute management of stroke
patients and the appropriate use of t-PA and antithrombotic therapy.
This version is available for preview and demonstration. Testing
and Response This
initial version of Virtual
E-Scenario Clinic™ software has
been tested in individual and large group settings. It has been
demonstrated to members of the American Academy of Neurology as well as
other medical organizations. Without exception, it has received strongly
positive reviews. Ownership of Virtual E-Scenario Clinic™
Software and System
The
Virtual E-Scenario Clinic™ system, trademark and patent pending
software are owned by The Stroke Group. The goal of the company is to
develop relevant applications of the Virtual E-Scenario Clinic™
platform for a diversity of medical topics.
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The information
contained in this website is not intended to be a substitute for sound
medical advice, clinical judgment or informed treatment decisions. |
