Missed or delayed diagnoses occur in approximately 15% of patient cases. Can case simulation be used to better train clinicians to avoid errors and improve accuracy?
Traditionally, diagnosis is taught using patient cases presented in a variety of formats: paper or powerpoint based, oral presentations (such as Grand Rounds), or via the use of standardized patients. Of course, diagnosis is also learned by taking care of real patients and learning from our attendings and our peers…and, unfortunately, more often than we would like, from our mistakes. It is all part of the apprenticeship model of medical education that has been around for years. Now i-Human Patients is making the process of teaching diagnostic skills virtual via its i-Human case player that simulates a wide variety of cases using virtual patients.
Learning to diagnose
The most important part of diagnosis is asking the right questions in the first place. This was brought front and center by the initial misdiagnosis of Thomas Eric Duncan, the Liberian man who died of Ebola in a Texas hospital. Failure to take a travel history evidently led the emergency physician down the wrong path and Mr. Duncan ended up being discharged with a diagnosis of sinusitis and a prescription for antibiotics.
i-Human Patient cases confront learners with what are called undifferentiated cases. That is, the student does not already know the patient’s current diagnosis or medical history. It must be elicited by asking the right questions. The students are also able to do a virtual physical exam including listening to heart and breath sounds. And, they can order and interpret labs and construct a differential diagnosis. They can do all of this without the need for standardized or real patients.
The company has about 100 clinical cases in their toolkit so far. These are written by clinicians, many of them on staff at academic institutions. The cases can be customized to meet the teaching needs of the different programs employing them in their training programs. In addition, medical educators can craft their own cases and share them on the site. This flexibility means that eventually, there will be many hundreds of cases with varying levels of difficulty and different learning objectives, that students and practicing clinicians can access from anywhere in the world. Now that is big!
Informing the skills training process
In addition, according to James Carlson, PhD, PA-C, Vice Dean, College of Health Professions and Associate Vice President for Healthcare Simulation at Rosalind Franklin University of Medicine and Science, as published in MedSim Magazine March 2014:
“Missed or delayed diagnoses occur in approximately 15% of patient cases and efforts are underway to better understand how to train providers to avoid errors and improve accuracy. [But] understanding, studying, and measuring the decision-making process is challenging. Virtual patient technology offers a powerful platform to study and address this need.”
According to Dr. Carlson, they are putting protocols in place to use i-Human case player to study the diagnostic reasoning process and use the findings to inform both teaching and practice, hopefully making a dent in the unacceptably high rate of diagnostic errors – and that would be a very good thing.