Multimedia medical case authorship and simulator program

For the last several years, third and fourth year medical students rotating on the rheumatology/immunology service at the University of North Carolina School of Medicine have been using a laptop computer as a teaching adjunct to their formal training in rheumatology. The laptop contains diagnostic programs, reference management and clinical note generation facilities, remote medline access, and most recently, multimedia case simulations. These simulations have been created by the use of a case authoring and simulation system which is presented in this demonstration. The program is divided into simulator and designer modules and uses graphics and sound to portray such data as physical examination findings, blood smears, radiographs, heart sounds, etc. The simulator module includes diagnostic sections with feedback to the student as well as robust patient management trees with an occasional circuitous route for patient outcome. The student receives a numerical score based on deviations from the correct path and optimal cost as designated by the case designer. The system simulates complete management of a patient from the first encounter until treatment is complete. During each encounter, a student obtains the patient's history, physical examination findings, orders tests and reviews their results, makes a differential diagnosis, and treats the patient. The patient's progress and further treatment options at any time are dependent on the treatment option selected by the student at an earlier stage. Students are given the costs of ancillary tests and hospitalization before they order them. Words or phrases can be marked as hypertext and the student can get more information about the marked words by a mouse click. The designer interface of the program creates the clinical case by prompts and requests for information from the designer who needs no programming skills. The designer is almost always an expert faculty member who bases the simulated case on a real patient. Default and normal values for clinical findings and tests facilitate the case design. Graphics and sound files are easily incorporated into any historical, physical examination or test window. Management trees are automatically generated during the case design and the author is able to rapidly change to a new management scene for editing with a mouse click. Optimal critical path to correct cost effective diagnoses and treatment is designated and used as the standard to which the students' choices are compared. The software runs on PC's with 386 or better processors and is based in either Windows or OS/2 operating environments. The display can be VGA or SVGA, color or monochrome. Sound is played from 8 or 16 bit sound files. It can be readily extrapolated to any clinical medical specialty in the medical school or postgraduate curricula. The capabilities of this system to create unlimited, branched management and multiple clinical scenarios combined with the ease of authorship make this program unique and an excellent teaching tool.