When training medical students to assess for suicide risk and bipolar disorder, will they learn equally well from interacting with a virtual patient compared with watching a video interview?
Research has shown that teaching clinicians in both the physical and mental health services to assess suicide risk saves lives, but many clinicians lack that training. Simulation technology may be a better way to train more clinicians. It’s already used by emergency medicine, surgery, and internal medicine for both instruction and competency assessment, but adoption in mental health training has been slower. Virtual patients (VPs) provide an opportunity for active, standardized training that may lead to improved transfer of skills to the clinical setting.
Adriana Foster and her research team created a virtual patient named Denise using the Virtual People Factory platform. Denise is “a woman with bipolar disorder who seeks psychiatric care and soon attempts suicide.” Students interacted with Denise through a chat interface where they could ask questions like “How is your appetite?” or “Have you had thoughts about hurting yourself?” Denise analyzes the questions and selects a response from a database, able to match seven out of ten questions to an appropriate response. Over time, Denise can improve; if a student asks a new question, the script author can write a new response and add it to Denise’s database. The team also developed an online video module that showed a physician interviewing a patient with bipolar disorder in order to demonstrate a model suicide risk assessment. Medical students were randomly assigned to VP or video training, then both groups interacted with a live mock patient with bipolar disorder created by the team and blinded to which training the students received.
Sixty-seven medical students completed the study; 34 in the VP group, 33 in the video group. Both the VP and video modules were found to be feasible training methods for assessment of suicide risk. The students preferred the video training over the VP training, but the researchers found modest benefits in favor of the VP training. The VP group asked more questions in four out of the five suicide risk areas, and 11 out of 14 bipolar symptomatology areas, which suggests the VP-trained students would be more likely to ask the questions needed for a thorough assessment.
Virtual patients can be used effectively for training medical students, and the technology will only improve. The investigators suggest that because VP training involves active learning, using the VP could prove more effective in developing clinical skills than video modules. Medical students also now have access to both the VP and the interview training modules through the MedEdPORTAL.
Publications from AFSP grant
- Foster A, Chaudhary N, Murphy J, Lok B, Waller J, Buckley PF. The Use of Simulation to Teach Suicide Risk Assessment to Health Profession Trainees-Rationale, Methodology, and a Proof of Concept Demonstration with a Virtual Patient. Acad Psychiatry. 2014 Jul 16. DOI 10.1007/s40596-014-0185-9 PMID: 25026950
- Foster A, Robb A, Cordar A, Chaudhary N, Noseworthy D, Lok B. Denise: A Virtual Patient. MedEdPORTAL Publications; 2015. Available from: https://www.mededportal.org/publication/10145 http://dx.doi.org/10.15766/mep_2374-8265.10145 (available for free; registration required)
- Siddiqua A, Noseworthy D, Albritton J, Foster A. Denise/Dennis Jones the Standardized Patient with a Mood Disorder. MedEdPORTAL Publications; 2015. Available from: https://www.mededportal.org/publication/10046 http://dx.doi.org/10.15766/mep_2374-8265.10046 (available for free; registration required)
Dr. Foster is Professor and Vice-Chair for Clinical and Research Programs in the Department of Psychiatry and Behavioral Health at Herbert Wertheim College of Medicine, Florida International University. Click here to read about Dr. Foster’s Pilot Research Grant.
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