Oncologist management of NTRK fusion-positive NSCLC improves after virtual patient simulation participation.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23008-e23008
Author(s):  
Michelle Arielle Worst ◽  
Brittany Cain ◽  
Tipp Nelson ◽  
Jacob Cohen ◽  
Alexander E. Drilon
Keyword(s):  
Targeted Therapies ◽  
Advanced Nsclc ◽  
Learning Experience ◽  
Patient Simulation ◽  
Virtual Patient ◽  
Current Evidence ◽  
P Value ◽  
Clinical Decisions ◽  
Academic Settings ◽  
Improved Performance

e23008 Background: Although relatively rare, neurotrophic receptor tyrosine kinase (NTRK) fusions, represent a clinically relevant subgroup of NSCLC that can derive benefit from targeted therapies. Relatively quick and durable responses have been achieved with these targeted therapies in advanced NSCLC and intracranial activity has also been observed. The objective of this study was to determine if an online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention improved performance of oncologists in using appropriate strategies to diagnose and manage patients with NTRK fusion-positive advanced NSCLC. Methods: The CME intervention consisted of two patient cases presented in a VPS platform that allowed learners to order lab tests, diagnoses and treatments in a manner matching the scope and depth of actual practice. Clinical decisions made by the learners using open field entries within an EHR interface were analyzed and, after each decision, tailored clinical guidance (CG) was provided based on current evidence and expert recommendation. Learner decisions were collected post-CG and compared with each user’s baseline (pre-CG) data using a McNemar’s test to determine P values. Results were then aggregated for the two cases based on clinical decisions and stratified by practice setting. The activity posted July 31, 2020; data were collected through December 1, 2020. Results: Overall significant improvements were seen after CG in clinical decisions made by oncologists in both the community and academic settings [reported as % absolute improvement (% correct pre-CG vs % correct post-CG); P value]. Conclusions: This analysis demonstrated that VPS that immerses and engages oncologists in an authentic and practical learning experience can significantly improve evidence-based clinical decisions related to the diagnosis and management of patients with NTRK fusion-positive advanced NSCLC. Despite the improvements, additional educational activities are needed to address any residual gaps and further increase oncologists’ ability in this clinical setting.[Table: see text]

Advancing evidence-based decisions in the management of EGFR-mutated metastatic NSCLC.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20663-e20663
Author(s):  
Tara Herrmann ◽  
Martin Warters ◽  
Douglas Blevins ◽  
Panos Fidias
Keyword(s):  
Learning Experience ◽  
Patient Simulation ◽  
Treatment Resistance ◽  
Educational Interventions ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Decisions ◽  
First Line ◽  
Metastatic Nsclc ◽  
Egfr Mutated

e20663 Background: In patients diagnosed with metastatic NSCLC it is now essential to identify targetable mutations and markers of treatment resistance in order to determine the appropriate therapy. A study was conducted to determine if simulation-based educational interventions to address clinical practice gaps could improve decisions of oncologists in the management of EGFR-mutated metastatic NSCLC. Methods: A cohort of US-oncologists who participated in a virtual patient simulation (VPS)-based education was evaluated. The VPS consisted of 2 cases that allowed oncologists to assess the patient and choose from a database of diagnostic possibilities matching the scope and depth of practice. Clinical decisions were analyzed using a decision engine, and instantaneous clinical guidance (CG) employing current evidence-based and expert faculty recommendations was provided after each decision. Oncologists were allowed a second chance at each decision point and decisions before and after CG were compared using a 2-tailed paired T-test to determine differences from pre- to post CG. P values are shown as a measure of significance; with P < .05 statistically significant. Results: 197 oncologists made clinical decisions within the simulation. As a result of CG, significant improvements were observed in: Ordering EGFR mutational testing (16%, P= 0.008) and making an accurate diagnosis (36%) Selecting an EGFR TKI in the first-line setting (24%, P< 0.001) Ordering a PET scan to assess disease progression (10%) and in diagnosing patients with EGFR T790M disease that is resistant (29% , P< 0.001) Evidence-based treatment selection for individuals whose disease progressed on first-line therapy (19%, P= .003) Number of oncologists who ordered adverse event education and counseling (23%, P< .001) Conclusions: This study showed improvements in evidence-based practices of oncologists in the diagnosis and management of EGFR-mutated NSCLC; demonstrating that VPS-based instruction that immerses and engages oncologists for an authentic, practical and16. consequence-free learning experience can result in an increase in appropriate clinical decisions. Therefore, VPS may have a role in improving the quality of patient care.

scholarly journals Virtual Patient Simulation in DKD: Successful Strategy for Improving Recognition and Management

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A423-A423
Author(s):  
Amy Larkin ◽  
Michael LaCouture
Keyword(s):  
Patient Education ◽  
Learning Experience ◽  
Sglt2 Inhibitor ◽  
Patient Simulation ◽  
Virtual Patient ◽  
Current Evidence ◽  
Patient Identification ◽  
Improve Performance ◽  
Ckd Stage

Abstract Intro: we sought to determine if virtual patient simulation (VPS)-based continuing medical education (CME) intervention could improve performance of diabetologists/endocrinologists related to recognition and management of diabetes kidney disease (DKD). Methods: The intervention comprised a patient presenting at two different time points in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity for the learner to modify to their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a McNemar’s test to determine P values. The activity posted August 30, 2019; initial data was collected through November 7, 2019. Results: 270 diabetologists/endocrinologists completed the activity (all decisions within at least 1 case) and were included. Significant improvements were observed after CG: 1st Patient: • Diagnose CKD stage 3b: 29% absolute improvement (5% pre-CG vs 34% post-CG; P&lt;.01) • Initiate SGLT2 inhibitor: 50% improvement (24% pre-CG vs 74% post-CG; P&lt;.01) • Order patient education: 19% improvement (52% pre-CG vs 71% post-CG; P&lt;.01) • Order follow-up appointment: 18% improvement (53% pre-CG vs 71% post-CG; P&lt;.01) 2nd Patient: • Diagnose CKD stage 3a: 49% absolute improvement (10% pre-CG vs 59% post-CG; P&lt;.01) • Initiate SGLT2 inhibitor: 36% improvement (51% pre-CG vs 87% post-CG; P&lt;.01) • Initiate ACE inhibitor: 11% improvement (85% pre-CG vs 96% post-CG; P&lt;.01) • Order patient education: 12% improvement (66% pre-CG vs 78% post-CG; P&lt;.01). Conclusion: VPS that immerses and engages specialists in an authentic and practical learning experience can improve evidence-based clinical decisions related to patient identification and management of DKD.

P222 SEVERE ASTHMA: VIRTUAL PATIENT SIMULATION IMPROVES CLINICAL DECISIONS OF ALLERGISTS AND PULMONOLOGISTS

2020 ◽  
Vol 125 (5) ◽  
pp. S35
Author(s):  
N. Mehta ◽  
A. Armagan ◽  
P. Chatterjee-Shin ◽  
J. Cohen
Keyword(s):  
Severe Asthma ◽  
Patient Simulation ◽  
Virtual Patient ◽  
Clinical Decisions

scholarly journals 28 How is Postpartum Depression Currently Diagnosed and Managed? Insights from a Virtual Patient Simulation

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 189-190
Author(s):  
Jovana Lubarda ◽  
Martin Warters ◽  
Piyali Chatterjee ◽  
Marlene P. Freeman ◽  
Roger S. McIntyre
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Postpartum Depression ◽  
Clinical Decision Making ◽  
Patient Simulation ◽  
Clinical Decision ◽  
Virtual Patient ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Practice Gaps

AbstractObjectivesThe goal of this study was to determine physician performance in diagnosis and management of postpartum depression (PPD) and to provide needed education in the consequence free environment of a virtual patient simulation (VPS).Methods∙ A continuing medical education activity was delivered via an online VPS learning platform that offers a lifelike clinical care experience with complete freedom of choice in clinical decision-making and expert personalized feedback to address learner’s practice gaps∙ Physicians including psychiatrists, primary care physicians (PCPs), and obstetricians/gynecologists (ob/gyns) were presented with two cases of PPD designed to model the experience of actual practice by including use of electronic health records∙ Following virtual interactions with patients, physicians were asked to make decisions regarding assessments, diagnoses, and pharmacologic therapies. The clinical decisions were analyzed using a sophisticated decision engine, and clinical guidance (CG) based on current evidence-based recommendations was provided in response to learners’ clinical decisions∙ Impact of the education was measured by comparing participant decisions pre- and post-CG using a 2-tailed, paired t-test; P <.05 was considered statistically significant∙ The activity launched on Medscape Education on April 26, 2018, and data were collected through to June 17,2018.Results∙ From pre- to post-CG in the simulation, physicians were more likely to make evidence-based clinical decisions related to:∙ Ordering appropriate baseline tests including tools/scales to screen for PPD: in case 1, psychiatrists (n=624) improved from 34% to 42% on average (P<.05); PCPs (n=197) improved from 38% to 48% on average (P<.05); and, ob/gyns (n=216) improved from 30% to 38% on average (P<.05)∙ Diagnosing moderate-to-severe PPD: in case 2, psychiatrists (n=531) improved from 46% to 62% (P<.05); PCPs (n=154) improved from 43% to 55% (P<.05); and, ob/gyns (n=137) improved from 55% to 73% (P<.05)∙ Ordering appropriate treatments for moderate-to-severe PPD such as selective serotonin-reuptake inhibitors: in case 2, psychiatrists (n=531) improved from 47% CG to 75% (P<.05); PCPs (n=154) improved from 55% to 74% (P<.05); and, ob/gyns (n=137) improved from 51% to 78% (P<.05)∙ Interestingly, a small percentage of physicians (average of 5%) chose investigational agents for PPD which were in clinical trials pre-CG, and this increased to an average of 9% post-CGConclusionsPhysicians who participated in VPS-based education significantly improved their clinical decision-making in PPD, particularly in selection of validated screening tools/scales, diagnosis, and pharmacologic treatments based on severity. Given that VPS immerses physicians in an authentic, practical learning experience matching the scope of clinical practice, this type of intervention can be used to determine clinical practice gaps and translate knowledge into practice.Funding Acknowledgements: The educational activity and outcomes measurement were funded through an independent educational grant from Sage Therapeutics, Inc.

Advancing evidence-based decisions in the management of pancreatic cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 506-506
Author(s):  
Tara Herrmann ◽  
Gwen Littman ◽  
Leah Piatt
Keyword(s):  
Pancreatic Cancer ◽  
Treatment Guidelines ◽  
Advanced Pancreatic Cancer ◽  
Patient Simulation ◽  
Educational Interventions ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Brca Mutations ◽  
P Values

506 Background: As a result of updates to pancreatic cancer treatment guidelines, oncologists face a host of escalating treatment challenges that may hinder their abilities to select the most appropriate regimen for patients. A study was conducted to determine if simulation-based educational interventions could improve decisions of oncologists in the management of pancreatic cancer. Methods: A cohort of US-practicing oncologists who participated in a virtual patient simulation (VPS)-based education initiative was evaluated. The VPS consisted of 2 cases presented on a platform that allowed oncologists to assess each patient and make decisions limited only by an extensive database of treatment possibilities matching the scope and depth of actual practice. Clinical decisions made by participants were analyzed using a decision engine, and instantaneous clinical guidance (CG) employing current evidence-based and expert faculty recommendations was provided immediately after each decision. Oncologists were allowed a second chance at each decision point; decisions before and after CG were compared using a 2-tailed paired T-test. P values are shown as a measure of significance; P values < .05 are statistically significant. Results: 410 oncologists made clinical decisions within the VPS. Significant improvements were observed in: Selecting the most appropriate first-line regimen in a patient with a PS of 2 (29%, P< 0.001); Ordering an anti-emetic in patients who are receiving chemotherapy (24% , P< 0.001); Evidence-based treatment selection for individuals whose disease progressed on therapy (17%, P= .003); and Ordering adverse event education and counseling (11% and 16%, P= .001). In addition, this study revealed that up to 55% of oncologists would test patients for BRCA mutations while 52% would consider enrolling a patient in a clinical trial if they have progressed on therapy. Conclusions: This study showed improvements in evidence-based practices of oncologists in the management of advanced pancreatic cancer across the continuum of care, thus demonstrating that VPS-based instruction can result in an increase in evidence-based clinical decisions. Therefore, VPS may have a role in improving the quality of care and patient outcomes.

scholarly journals Virtual patient simulation to improve nurses’ relational skills in a continuing education context: A convergent mixed methods study

2020 ◽  
Author(s):  
Geneviève Rouleau ◽  
Marie-Pierre Gagnon ◽  
José Côté ◽  
Lauralie Richard ◽  
Gabrielle Chicoine ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Continuing Education ◽  
Technology Acceptance ◽  
Learning Experience ◽  
Patient Simulation ◽  
Virtual Patient ◽  
Mixed Methods Study ◽  
Simulation Based ◽  
Post Test ◽  
Relational Skills

Abstract Background Nurses must meet professional standards by attending continuing education activities. Despite the potential of virtual patient simulation in nursing education, it has rarely been used in nurses’ continuing education to address relational skills. We developed an automated virtual patient simulation informed by motivational interviewing to enhance nurses’ relational skills. The simulation features an HIV-positive man struggling to adhere to his medication. Quizzes and feedback loops embedded in the simulation allow learners to observe the consequences of their choices. This study aimed to assess nurses’ perception of simulation’s acceptability. Specific objectives were: to measure the simulation design elements, its role in supporting practice, its quality and technology acceptance, and the achievement of learning objectives; to explore nurses’ learning experience. Methods We performed a convergent mixed methods study by combining a quantitative pre-experimental, one-group post-test design and a qualitative exploratory study. We used convenience and snowball sampling approaches to select registered nurses (n=49) working in Quebec, Canada, who self-reported as having basic computer literacy skills. Participants completed an online sociodemographic questionnaire, consulted the simulation, and filled out an online post-test survey. Descriptive statistics (mean, SD, median, interquartile range) were used to present quantitative findings. From the 27 participants who completed the simulation and post-test survey, five participated in a focus group to explore their learning experience. The discussion transcript was subjected to thematic analysis. Results Nurses perceived the simulation to be highly acceptable. They rated the global system quality and the technology acceptance with high scores. They reported having enjoyed the simulation and recommended other providers use it. Four qualitative themes were identified: motivations to engage in the simulation-based research; learning in a realistic, immersive, and non-judgmental environment; perceived utility of the simulation; and perceived difficulty in engaging in the simulation-based research. Conclusions The simulation contributed to knowledge and skills development on motivational interviewing and enhanced nurses’ self-confidence in applying relational skills. Simulation holds the potential to change practice, as nurses become more self-reflective and aware of the impact of their relational skills on patient care. Relational skills are fundamental to high-quality nursing care.Trial registration:ISRCTN18243005, retrospectively registered on July 3 2020.

scholarly journals Virtual patient simulation to improve nurses’ relational skills in a continuing education context: A convergent mixed-methods study

2020 ◽  
Author(s):  
Geneviève Rouleau ◽  
Marie-Pierre Gagnon ◽  
José Côté ◽  
Lauralie Richard ◽  
Gabrielle Chicoine ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Motivational Interviewing ◽  
Technology Acceptance ◽  
Learning Experience ◽  
Patient Simulation ◽  
Virtual Patient ◽  
Mixed Methods Study ◽  
Simulation Based ◽  
Post Test ◽  
Relational Skills

Abstract Background: Some nurses may feel ill-equipped to support people living with HIV who do not optimally adhere to their antiretroviral therapy. In response, to enhance the relational skills nurses require in situations of non-adherence, we developed a virtual patient simulation that features an HIV-positive man struggling to adhere to his therapy. The simulation is informed by a strengths-based nursing approach, motivational interviewing, and adult learning theories This study aimed to assess nurses’ perception of simulation’s acceptability. Specific objectives were: to measure the simulation design elements, its role in supporting practice, its quality and technology acceptance, and the achievement of learning objectives; to explore nurses’ learning experience.Methods: We conducted a convergent mixed methods study by combining a quantitative pre-experimental, one-group post-test design and a qualitative exploratory study. We used convenience and snowball sampling approaches to select Canadian registered nurses (n=49). who self-reported as having basic computer literacy skills. Participants completed an online sociodemographic questionnaire, consulted the simulation, and filled out an online post-test survey. Descriptive statistics (mean, SD, median, interquartile range) were used to present quantitative findings. From the 27 participants who completed the simulation and post-test survey, five participated in a focus group to explore their learning experience. The discussion transcript was subjected to thematic analysis. At the final stage of the study, we used a comparison strategy for integrating the quantitative and qualitative results.Results: Nurses perceived the simulation to be highly acceptable. They rated the global system quality and the technology acceptance with high scores. They reported having enjoyed the simulation and recommended other providers use it. Four qualitative themes were identified: motivations to engage in the simulation-based research; learning in a realistic, immersive, and non-judgmental environment; perceived utility of the simulation; and perceived difficulty in engaging in the simulation-based research.Conclusions: The simulation contributed to knowledge and skills development on motivational interviewing and enhanced nurses’ self-confidence in applying relational skills. Simulation holds the potential to change practice, as nurses become more self-reflective and aware of the impact of their relational skills on patient care. Relational skills are fundamental to high-quality nursing care.Trial registration: ISRCTN18243005, retrospectively registered on July 3 2020.

scholarly journals Establishing the acceptability and usability of an animated virtual patient simulation

2021 ◽  
pp. 100069
Author(s):  
Charlotte Lucy Richardson ◽  
Stephen Chapman ◽  
Simon White
Keyword(s):  
Patient Simulation ◽  
Virtual Patient
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