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Uno Fors - One of the best experts on this subject based on the ideXlab platform.
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A Virtual Patient model for students' interprofessional learning in primary healthcare.
PLOS ONE, 2020Co-Authors: Carrie Tran, Uno Fors, Eva Toth-pal, Solvig Ekblad, Helena SalminenAbstract:Objectives Interprofessional education is important for increasing the quality of Patient care, but organising it in primary healthcare is still challenging. The aim of this study was to develop and assess a Virtual Patient model for primary healthcare and to investigate students' perceptions of learning with this interprofessional Virtual Patient model. Methods The Virtual Patient case described a Patient with several medical conditions who had returned home after surgery. The Virtual Patient included text files, short videos, and links to illustrate different health professions' roles in home care. Ten interprofessional groups with 39 students assessed the Virtual Patient from four different study programmes: nursing, physiotherapy, medicine, and occupational therapy. The students answered a questionnaire about how they perceived the usability of the Virtual Patient and participated in group interviews. Qualitative content analysis was used to analyse the data from the semi-structured group interviews. Results The analysis of the interviews resulted in four main categories: The Virtual Patient model facilitated the learning process; It was beneficial to have students from different programmes in the group when working with the Virtual Patient; Working with the Virtual Patient helped the students to understand the roles and competencies of their own and other professions and All professions are needed in clinical work in order to help the Patient. The students perceived that the mixture of text and multimedia made the Virtual Patient seem authentic and stimulated their group discussions, which they valued most. The students gave generally high points for usability in the questionnaire, but they also gave input for improvement of the program in their comments. Conclusions The interprofessional Virtual Patient model facilitated interactions and discussions between students and may be a useful complement for interprofessional education in clinical contexts and might be a suitable tool in preparing students for future teamwork.
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using the Virtual Patient to improve the primary care of traumatized refugees
Academic Medicine, 2017Co-Authors: Richard F Mollica, Uno Fors, James Lavelle, Solvig EkbladAbstract:Background: Refugees who have experienced traumatic life experiences have entered into the United States’ primary health care system. Primary care providers (PCPs) have limited training in their diagnoses and treatment. Assessing and caring for the health and mental health of refugees in a culturally effective way in a time limited health care environment is challenging. We conducted a study on the role of the Virtual Patient (VP) as a training instrument for improving the diagnoses and treatment of refugee Patients. Methods: This was a descriptive and quantitative study of PCPs at a local neighborhood health care center in Massachusetts. A sample of PCPs initially reviewed an alpha Virtual Patient refugee prototype. An improved β-VP prototype was offered in training. The PCPs performance on pre- and post-diagnosis and treatment planning was assessed after studying the β-VP. 10 PCPs studied the alpha VP prototype; an additional 14 PCPs studied the β-VP prototype (N=24). The Karolinska Institutet Virtual Patient Learning Experience Questionnaire (KI-VP-LEQ) assessed feasibility, and motivation to use the VP. A Trauma-BPPS (Trauma -Bio-Psycho-Social- Spiritual scale) scale measured the PCP’s perception of the Patient’s trauma history, and medical, psycho-social and spiritual domains. Pre- and post-VP training using refugee paper clinical cases was performed. Concluding telephone interviews were conducted. Analysis included qualitative methods and significance testing. Results: PCPs were receptive and motivated to use the VP in training. Prior to VP training, respondents scored highly on medical diagnosis and treatment planning (Medical domain); followed by the psychological domain. Respondents scored lower on the social domain and lowest on the trauma and spiritual domains. All five domain scores significantly improved for those PCPs who devoted ≥90 minutes studying the VP. Telephone interviews conducted after training revealed PCPs felt they did not have enough time and/or clinical training to properly diagnose or treat refugee Patients in the primary health care setting. Conclusions: The PCPs in this pilot study demonstrated the ability to improve their treatment plan for traumatized refugee Patients in the medical and psychological domains after VP training. Devotion of time with the VP training instrument was significantly associated with improvement in all domains. Keywords: GLOBAL HEALTH, IMMIGRANT HEALTH, PRIMARY CARE, PSYCHOLOGY, TRAUMA-INFORMED CARE
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The effect of constructing versus solving Virtual Patient cases on transfer of learning: a randomized trial
Perspectives on Medical Education, 2016Co-Authors: Martin G Tolsgaard, Uno Fors, Lars C. Laursen, Maria B. Rasmussen, Rikke Malene Hartvigsen Grønholm Jepsen, Lars Kayser, Jesper Hastrup Svendsen, Charlotte RingstedAbstract:The purpose of this study was to explore the effect of actively constructing Virtual Patient (VP) cases compared with solving VP cases on knowledge gains, skills transfer and time spent on cases. Forty-five fourth-year medical students were randomized to constructing (VP-construction, n = 23) or solving (VP-solving, n = 22) four cardiopulmonary VP cases. Whereas the VP-solving group solved the cases, the VP-construction group only received the final diagnosis and had to complete the history, physical findings, and lab results. After a week, participants completed a transfer test involving two standardized Patients representing cardiopulmonary cases. Performances on the transfer test were video-recorded and assessed by two blinded raters using the Reporter, Interpreter, Manager, Educator (RIME) framework. Thirty-nine participants completed the transfer test. The VP-construction group spent significantly more time on the VP cases compared with the VP-solving group, p = 0.002. There were no significant differences in RIME scores between the VP-construction group and VP-solving group, p = 0.54. In conclusion, engaging novice students in active VP case construction may be more time consuming than solving VP cases, without resulting in superior skills transfer.
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The effect of constructing versus solving Virtual Patient cases on transfer of learning: a randomized trial
Perspectives on medical education, 2016Co-Authors: Martin G Tolsgaard, Uno Fors, Lars C. Laursen, Rikke Malene Hartvigsen Grønholm Jepsen, Lars Kayser, Jesper Hastrup Svendsen, Maria Rasmussen, Charlotte RingstedAbstract:The purpose of this study was to explore the effect of actively constructing Virtual Patient (VP) cases compared with solving VP cases on knowledge gains, skills transfer and time spent on cases. Forty-five fourth-year medical students were randomized to constructing (VP-construction, n = 23) or solving (VP-solving, n = 22) four cardiopulmonary VP cases. Whereas the VP-solving group solved the cases, the VP-construction group only received the final diagnosis and had to complete the history, physical findings, and lab results. After a week, participants completed a transfer test involving two standardized Patients representing cardiopulmonary cases. Performances on the transfer test were video-recorded and assessed by two blinded raters using the Reporter, Interpreter, Manager, Educator (RIME) framework. Thirty-nine participants completed the transfer test. The VP-construction group spent significantly more time on the VP cases compared with the VP-solving group, p = 0.002. There were no significant differences in RIME scores between the VP-construction group and VP-solving group, p = 0.54.
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Virtual Patient simulation what do students make of it a focus group study
BMC Medical Education, 2010Co-Authors: Mihaela Botezatu, Hakan Hult, Uno ForsAbstract:Background The learners' perspectives on Virtual Patient Simulation systems (VPS) are quintessential to their successful development and implementation. Focus group interviews were conducted in order to explore the opinions of medical students on the educational use of a VPS, the Web-based Simulation of Patients application (Web-SP).
Andrzej A Kononowicz - One of the best experts on this subject based on the ideXlab platform.
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Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration
Journal of Medical Internet Research, 2019Co-Authors: Andrzej A Kononowicz, David Davies, Luke Woodham, Samuel Edelbring, Natalia Stathakarou, Nakul Saxena, Jan Carlstedt-duke, Nabil ZaryAbstract:BACKGROUND: Virtual Patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education. OBJECTIVE: The goal of this study was to evaluate the effectiveness of Virtual Patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of Virtual Patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction. METHODS: We performed a systematic review on the effectiveness of Virtual Patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. RESULTS: A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared Virtual Patients with traditional education, 11 studies investigated Virtual Patients as blended learning, 5 studies compared Virtual Patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of Virtual Patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI -0.17 to 0.39, I2=74%, n=927) and favored Virtual Patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I2=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing Virtual Patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence. CONCLUSIONS: Low to modest and mixed evidence suggests that when compared with traditional education, Virtual Patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of Virtual Patients. Further research should explore the utility of different design variants of Virtual Patients.
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The Cochrane Library - Virtual Patient simulations for health professional education
Cochrane Database of Systematic Reviews, 2016Co-Authors: Andrzej A Kononowicz, David Davies, Luke Woodham, Carina Georg, Samuel Edelbring, Natalia Stathakarou, Italo Masiello, Nakul Saxena, Lorainne Tudor Car, Josip CarAbstract:his is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this review is to evaluate the effectiveness of Virtual Patient simulation as an educational intervention versus traditional learning, other types of e-Learning interventions and other forms of Virtual Patient simulation interventions for delivering pre-registration and post-registration healthcare professional education. We will primarily assess the impact of these interventions on learners’ knowledge, skills and attitudes. Our secondary objective is to assess the cost-effectiveness of these interventions.
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A qualitative analysis of Virtual Patient descriptions in healthcare education based on a systematic literature review
BMC Medical Education, 2016Co-Authors: Inga Hege, Andrzej A Kononowicz, Samuel Edelbring, Daniel Tolks, Katja KuehlmeyerAbstract:Background: Virtual Patients (VPs) have been in the focus of research in healthcare education for many years. The aim of our study was to analyze how Virtual Patients are described in the healthcare education literature, and how the identified concepts relate to each other. Methods: We performed a literature review and extracted 185 descriptions of Virtual Patients from the articles. In a qualitative content analysis approach we inductively-deductively developed categories and deducted subcategories. We constructed a concept map to illustrate these concepts and their interrelations. Results: We developed the following five main categories: Patient, Teacher, Virtual Patient, Curriculum, and Learner. The concept map includes these categories and highlights aspects such as the under-valued role of Patients in shaping their Virtual representation and opposing concepts, such as standardization of learner activity versus learner-centeredness. Conclusions: The presented concept map synthesizes VP descriptions and serves as a basis for both, VP use and discussions of research topics related to Virtual Patients.
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effects of introducing a voluntary Virtual Patient module to a basic life support with an automated external defibrillator course a randomised trial
BMC Medical Education, 2012Co-Authors: Andrzej A Kononowicz, Pawel Krawczyk, Grzegorz Cebula, Marta Dembkowska, E Drab, Bartosz Frączek, Aleksandra Stachon, Janusz AndresAbstract:Background: The concept of Virtual Patients (VPs) encompasses a great variety of predominantly case-based elearning modules with different complexity and fidelity levels. Methods for effective placement of VPs in the process of medical education are sought. The aim of this study was to determine whether the introduction of a voluntary Virtual Patients module into a basic life support with an automated external defibrillator (BLS-AED) course improved the knowledge and skills of students taking the course. Methods: Half of the students were randomly assigned to an experimental group and given voluntary access to a Virtual Patient module consisting of six cases presenting BLS-AED knowledge and skills. Pre- and post-course knowledge tests and skills assessments were performed, as well as a survey of students' satisfaction with the VP usage. In addition, time spent using the Virtual Patient system, percentage of screen cards viewed and scores in the formative questions in the VP system throughout the course were traced and recorded. Results: The study was conducted over a six week period and involved 226 first year medical students. The voluntary module was used by 61 (54%) of the 114 entitled study participants. The group that used VPs demonstrated better results in knowledge acquisition and in some key BLS-AED action skills than the group without access, or those students from the experimental group deliberately not using Virtual Patients. Most of the students rated the combination of VPs and corresponding teaching events positively. Conclusions: The overall positive reaction of students and encouraging results in knowledge and skills acquisition suggest that the usage of Virtual Patients in a BLS-AED course on a voluntary basis is feasible and should be further investigated.
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Estimation of time efforts for repurposing Virtual Patients – empirical data from the electronic Virtual Patient Project (eViP)
2010Co-Authors: D Kempkens, Uno Fors, Andrzej A Kononowicz, Inga Hege, C Balasubramaniam, Sören Huwendiek, Muntean, FischerAbstract:Estimation of time efforts for repurposing Virtual Patients – empirical data from the electronic Virtual Patient Project (eViP)
Homlay Wang - One of the best experts on this subject based on the ideXlab platform.
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indirect digital workflow for Virtual cross mounting of fixed implant supported prostheses to create a 3d Virtual Patient
Journal of Prosthodontics, 2020Co-Authors: Luca Lepidi, Tim Joda, Matthew Galli, Aldo Grammatica, Homlay WangAbstract:Mounting dental casts in an articulator is an important prerequisite for prosthodontic rehabilitation cases where the design of an accurate static and dynamic occlusion is needed. Virtual mounting can be achieved through the superimposition of various 3D images acquired from the hard and soft tissues of the Patient. The purpose of this technical report is to describe a digital cross-mounting technique for Patients undergoing implant-supported fixed prosthetic treatment. Through the use of face scanning, intraoral scanning, and cone beam computed tomography, this technique enables creation of a 3D Virtual Patient with occlusal registration in centric relation. Ultimately, the described methodology allows for the fabrication of definitive full-mouth implant-supported fixed prostheses.
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registering maxillomandibular relation to create a Virtual Patient integrated with a Virtual articulator for complex implant rehabilitation a clinical report
Journal of Prosthodontics, 2020Co-Authors: Zhaozhao Chen, Homlay Wang, Bo Dong, Tim JodaAbstract:The Virtual Patient, a unique computer simulation of the Patient's face, teeth, oral mucosa, and bone, provides an extraordinary mechanism for digital dental implant surgery planning and prosthetic design. However, the seamless registration of digital scans with functional information in the context of a Virtual articulator remains a challenge. This report describes the treatment of a 47-year-old male with full-mouth guided immediate implant placement and immediate loading of CAD/CAM interim prostheses. Utilizing a novel digital workflow, a multifactorial registration of the vertical dimension of occlusion, centric occlusion, and facebow record were completed digitally and paired within a digital articulator. Utilizing this innovative approach, a complex treatment plan and procedure was executed smoothly with a successful prosthetic outcome demonstrating good fit, occlusion, esthetics, and Patient reported satisfaction.
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creating a Virtual Patient for completely edentulous computer aided implant surgery a dental technique
Journal of Prosthetic Dentistry, 2020Co-Authors: Junying Li, Celia Sommer, Homlay Wang, Luca Lepidi, Tim Joda, Gustavo MendoncaAbstract:Abstract A fully digital workflow for generating a Virtual Patient for completely edentulous computer-aided implant surgery is described. Existing dentures are temporarily relined with a radiopaque dental silicone material, and a cone beam computed tomography scan is made with the relined denture inserted. Then, scans of the relined denture are made with an intraoral scanner. The radiopaque silicone material increases the stability of the dentures and allows the a cone beam computed tomography images and the scans of the dentures to be superimposed to create a Virtual Patient. This technique may reduce laboratory work steps, clinical chairside time, and treatment costs.
Charlotte Ringsted - One of the best experts on this subject based on the ideXlab platform.
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The effect of constructing versus solving Virtual Patient cases on transfer of learning: a randomized trial
Perspectives on Medical Education, 2016Co-Authors: Martin G Tolsgaard, Uno Fors, Lars C. Laursen, Maria B. Rasmussen, Rikke Malene Hartvigsen Grønholm Jepsen, Lars Kayser, Jesper Hastrup Svendsen, Charlotte RingstedAbstract:The purpose of this study was to explore the effect of actively constructing Virtual Patient (VP) cases compared with solving VP cases on knowledge gains, skills transfer and time spent on cases. Forty-five fourth-year medical students were randomized to constructing (VP-construction, n = 23) or solving (VP-solving, n = 22) four cardiopulmonary VP cases. Whereas the VP-solving group solved the cases, the VP-construction group only received the final diagnosis and had to complete the history, physical findings, and lab results. After a week, participants completed a transfer test involving two standardized Patients representing cardiopulmonary cases. Performances on the transfer test were video-recorded and assessed by two blinded raters using the Reporter, Interpreter, Manager, Educator (RIME) framework. Thirty-nine participants completed the transfer test. The VP-construction group spent significantly more time on the VP cases compared with the VP-solving group, p = 0.002. There were no significant differences in RIME scores between the VP-construction group and VP-solving group, p = 0.54. In conclusion, engaging novice students in active VP case construction may be more time consuming than solving VP cases, without resulting in superior skills transfer.
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The effect of constructing versus solving Virtual Patient cases on transfer of learning: a randomized trial
Perspectives on medical education, 2016Co-Authors: Martin G Tolsgaard, Uno Fors, Lars C. Laursen, Rikke Malene Hartvigsen Grønholm Jepsen, Lars Kayser, Jesper Hastrup Svendsen, Maria Rasmussen, Charlotte RingstedAbstract:The purpose of this study was to explore the effect of actively constructing Virtual Patient (VP) cases compared with solving VP cases on knowledge gains, skills transfer and time spent on cases. Forty-five fourth-year medical students were randomized to constructing (VP-construction, n = 23) or solving (VP-solving, n = 22) four cardiopulmonary VP cases. Whereas the VP-solving group solved the cases, the VP-construction group only received the final diagnosis and had to complete the history, physical findings, and lab results. After a week, participants completed a transfer test involving two standardized Patients representing cardiopulmonary cases. Performances on the transfer test were video-recorded and assessed by two blinded raters using the Reporter, Interpreter, Manager, Educator (RIME) framework. Thirty-nine participants completed the transfer test. The VP-construction group spent significantly more time on the VP cases compared with the VP-solving group, p = 0.002. There were no significant differences in RIME scores between the VP-construction group and VP-solving group, p = 0.54.
Tim Joda - One of the best experts on this subject based on the ideXlab platform.
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indirect digital workflow for Virtual cross mounting of fixed implant supported prostheses to create a 3d Virtual Patient
Journal of Prosthodontics, 2020Co-Authors: Luca Lepidi, Tim Joda, Matthew Galli, Aldo Grammatica, Homlay WangAbstract:Mounting dental casts in an articulator is an important prerequisite for prosthodontic rehabilitation cases where the design of an accurate static and dynamic occlusion is needed. Virtual mounting can be achieved through the superimposition of various 3D images acquired from the hard and soft tissues of the Patient. The purpose of this technical report is to describe a digital cross-mounting technique for Patients undergoing implant-supported fixed prosthetic treatment. Through the use of face scanning, intraoral scanning, and cone beam computed tomography, this technique enables creation of a 3D Virtual Patient with occlusal registration in centric relation. Ultimately, the described methodology allows for the fabrication of definitive full-mouth implant-supported fixed prostheses.
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registering maxillomandibular relation to create a Virtual Patient integrated with a Virtual articulator for complex implant rehabilitation a clinical report
Journal of Prosthodontics, 2020Co-Authors: Zhaozhao Chen, Homlay Wang, Bo Dong, Tim JodaAbstract:The Virtual Patient, a unique computer simulation of the Patient's face, teeth, oral mucosa, and bone, provides an extraordinary mechanism for digital dental implant surgery planning and prosthetic design. However, the seamless registration of digital scans with functional information in the context of a Virtual articulator remains a challenge. This report describes the treatment of a 47-year-old male with full-mouth guided immediate implant placement and immediate loading of CAD/CAM interim prostheses. Utilizing a novel digital workflow, a multifactorial registration of the vertical dimension of occlusion, centric occlusion, and facebow record were completed digitally and paired within a digital articulator. Utilizing this innovative approach, a complex treatment plan and procedure was executed smoothly with a successful prosthetic outcome demonstrating good fit, occlusion, esthetics, and Patient reported satisfaction.
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creating a Virtual Patient for completely edentulous computer aided implant surgery a dental technique
Journal of Prosthetic Dentistry, 2020Co-Authors: Junying Li, Celia Sommer, Homlay Wang, Luca Lepidi, Tim Joda, Gustavo MendoncaAbstract:Abstract A fully digital workflow for generating a Virtual Patient for completely edentulous computer-aided implant surgery is described. Existing dentures are temporarily relined with a radiopaque dental silicone material, and a cone beam computed tomography scan is made with the relined denture inserted. Then, scans of the relined denture are made with an intraoral scanner. The radiopaque silicone material increases the stability of the dentures and allows the a cone beam computed tomography images and the scans of the dentures to be superimposed to create a Virtual Patient. This technique may reduce laboratory work steps, clinical chairside time, and treatment costs.
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the Virtual Patient in dental medicine
Clinical Oral Implants Research, 2015Co-Authors: Tim Joda, German O GallucciAbstract:OBJECTIVES The aim of this Short Communication was to present a workflow for the superimposition of intraoral scan (IOS), cone-beam computed tomography (CBCT), and extraoral face scan (EOS) creating a 3D Virtual dental Patient. MATERIAL AND METHODS As a proof-of-principle, full arch IOS, preoperative CBCT, and mimic EOS were taken and superimposed to a unique 3D data pool. The connecting link between the different files was to detect existing teeth as constant landmarks in all three data sets. RESULTS This novel application technique successfully demonstrated the feasibility of building a craniofacial Virtual model by image fusion of IOS, CBCT, and EOS under 3D static conditions. CONCLUSIONS The presented application is the first approach that realized the fusion of intraoral and facial surfaces combined with skeletal anatomy imaging. This novel 3D superimposition technique allowed the simulation of treatment planning, the exploration of the Patients' expectations, and the implementation as an effective communication tool. The next step will be the development of a real-time 4D Virtual Patient in motion.
