Safe Prescribing and Use of Opioids National Rx Drug Abuse Summit 4-11-12

1. Safe Prescribing and
Use of Opioids
April 10-12, 2012
Walt Disney World Swan Resort

2. Accepted Learning Objectives:
1. Analyze current professional education
programs on safe use of opioids and new
programs under development.
2. Explain a potentially transformative on-line
educational tool for health professionals that
enable them to train by interacting with “virtual
patients.”
3. Describe a Massachusetts program for training
physicians on safe opioid prescribing, and the
curriculum developed to teach residents
and faculty.

3. Disclosure Statement
• Drs. Daniel P. Alford and Sarah Ball
have disclosed no relevant, real or
apparent personal or professional
financial relationships.
• Dr. Benjamin Lok has disclosed that he
has a relationship with Shadow Health,
Inc.

4. Simulation-based training
for health care providers on
prescription drug abuse
Benjamin Lok, Ph.D.
Computer and Information Sciences and
Engineering
University of Florida
National Prescription Drug Abuse Summit
April 10-12th, 2012

5. Overview of talk
 Existing approaches
 Level of integration
 Costs and benefits
 New approaches
 What s coming down the pike
 Defining the direction of simulation (what does
simulation look like in 5 years?)
 Goals:
 Identifying how you can benefit from simulation
today
 Identifying your part in shaping the future of
education

6. Current Simulation Efforts
• Humans
– Lecture
– Role-playing
– Standardized patients – gold standard
• Pros
– Empathy
– Emotion
– Rapport

7. Current Computer Simulation
Efforts
 Computer-based
learning case
studies
 Passive –
multimedia
presentation of
information
Image from Harvard Medical School

Choose your own
adventure

8. Current state of simulation
 Simulation wings
 UF-Jacksonville has dedicated
24,000 sq. ft.
 UF-Jacksonville 55 simulators
 Basic understanding of
integration into curriculums
 [Huang 2007] Virtual patients
 Ad-hoc (26 of 108 schools
building cases)
 Still images and video (83% of
virtual patients)
 Expensive (each case $10,000-
$50,000, 1-2 years to develop)
 Known education potential
 Compliments classrooms
Human Patient Simulator – image
from Samsun Lampotang

9. Current approaches have
difficulty providing:
• Sufficient opportunities for practice
• Exposure to infrequent – yet critical –
scenarios
• Tailoring for each student
• Standardization
• Patient variability
• Team-based learning
• Cultural competency
• Feedback

10. Addiction Management
Challenges
• Large scale deployment (40k+
learners)
• Solution: virtual human simulation
• Effective training using simulation
– Track progress
– Provide feedback
– Implement protocols

11. Serious Games
• Interactive training exercises
• Using computer game engines and the
Internet
Image from Breakaway Ltd.

12. Example: Virtual Human

13. Can interacting with a virtual
human make you a better person?
Dr. Gregory House Derek Shepherd
Dr. Doug Ross
Good with medical knowledge Good with medical knowledge
Not so good with interacting with people
Good with interacting with people

14. Virtualpatientsgroup.com
• 6 universities, 35 researchers, 8 years of VP research
• Technologies to:
– Create virtual patients
– Deploy virtual patients
• Enable
– Curricular building and integration of training
scenarios
– Teaching and training with
• Variety of scenarios
• Variety of patients
• After-action review systems
• Looking for:
 Research partners

15. Deployment - Continuum of
Experiences
Immersive
Interaction
Virtual Worlds
Immersion
Video Conference
Chat
Web Browser
Instant Message
Mobile
Deployment
Images from www.virtualpatientsgroup.com
Fidelity, Learning efficacy

16. Virtual People Factory
• www.virtualpeoplefactory.com
• Web-based interface to virtual
humans
• Deployed Early 2008
– 56 active developers
– 2700 users
– 105,000 utterances
 Opiod patient

17. Mobile Distribution of
Simulation
 Deploy simulations via
mobile platforms
 Android app, released
December 2010, over
4600 downloads
 In Android Market, search for
Virtual Patient
Image from www.virtualpatientsgroup.com

18. Repositories
• MedEdPORTAL
– Peer reviewed medical education
resource
• 400 institution downloads in 10 months

19. Scripts at VPF General
http://vpf.cise.ufl.edu/wiki/index.php/VPF_Script_Tracking
• Anesthesia • Psychiatry
– Pre-op OSA (UF) – Failure to thrive (UF)
– Conscious sedation (UF) – Depression (MCG)
– Myocardial Ischemia (UF) – Bi-polar (MCG)
• Cancer • General
– Abnormal mammogram (UF) – Breaking bad news (MCG)
– BRCA Pedigree (UCF) – Cranial Nerve (UF)
– Clinical breast exam (UF/MCG) – Dysphagia (UF)
– Clinical prostate exam (UF) – Dyspepsia – Pharmacy (UF)
– Melanoma (MCG) – Gastro-Band (UF)
• Pain – GI Hemorrhage (UF)
– Abdominal Pain (UF) – Handoff (UF)
– Chest pain (UF) – Meningitis (PCOM)
– Gallstones (UCF) – Patient-Centered Counseling (USF)
– Lower back pain (UF) – Pediatric Interview (UF)
– Lower back pain (PCOM) – Post Operative Hemorrhage (UF)
– Opiod prescription (AAAP) – Sexually Transmitted Diseases (UF)
– Contraceptive Counseling (UF)

20. NERVE: The Neurological
Examination Rehearsal Virtual
•
Environment
Virtual multi-tool
interface
– Playstation Move
controls multiple
virtual tools
– Gestural and tool
input, in addition to
speech
• Medical students
– Learn how to use
neurological tests to
diagnose a patient
with a vision disorder
– Receive additional
exposure to patients
with abnormal
findings (Cranial
Nerve 2,3,4,5,6,7,12)

21. After-Action Review by
Students
• IPSViz
– Web-based interface
– Students received
email with link
(automated)
– Sample student
(10158/00000)
– Self-directed review
of content, video,
and feedback
• Each student can review
their performance and
compare with experts

22. After-Action Review by
Educators
• IPSVizn
– Web-based
interface
– Educators can
review completed
student interactions
– Data from study
– Filter based on user
background
• Level of expertise
• Gender
• Educator-defined
metrics
• Experts can
– Identify trends
(mean of class)
– Identify outliers

23. Physical Examinations of Virtual
Human Patients
• Mixed reality humans
– Passive-haptic
interface to life-sized
virtual human
– Applications
• Clinical breast exam
• Prostate Exam
• Students can
– Practice physical
examination and
communication skill
sets
– Get real-time
feedback of exam
performance
• Coverage
• Pressure
• Conversation topics

24. Getting Involved
 Now (<6 months)
 Use systems to create web-deployable cases
 Case study-based
 Adaptive raining – could branch depending on trainee s selections
 Example: http://www.md-inc.com/Products/product_details.cfm?
mm=2&sm=4027&courseno=172
 Near term (<2 years)
 Work with developers to create interactive virtual patients
 Different levels of fidelity
 Requires funding
 More interactive
 Long term (3 years+)
 Coordinated teaching/training/testing using simulation
 Valid and reliable training materials
 Work with professional, licensing, continuing education groups

25. Demo of Creating Virtual
Patient
• www.virtualpatientsgroup.com

26. Thank You!
Build virtual patients: www.virtualpatientsgroup.com
Contact: lok@cise.ufl.edu
Support: National Science Foundation and National Institutes of
Health