Computer-based patient simulation programs are dynamic computer packages that permit an interactive clinical assessment of a patient problem.  The programs make use of the power of computer technology to provide a multimedia rich environment.  They have the advantage of providing a common, controlled experience for a large number of students in a short time frame at minimal expense.  Some of these programs are easily adapted to assess the foundation science knowledge as it relates to the diagnostic skills and interpretations as well as the clinical skills and knowledge.

A variety of computer-based patient simulation programs are available.  Some are only Web-based and designed predominately for continuing medical education for practicing clinicians while others are better suited for more novice students and clinicians.  Some of the programs are available for a variety of uses including networks and stand-alone computer systems.

All of the programs have similar components:  presenting information, physical examination data, laboratory data, diagnosis and (often) management options.  Many include some form of feedback information, though not all will be based upon the actual input of the student.

The characteristics of these components are the distinguishing features among the programs.  The method of soliciting information is a crucial element in the design.  Some will simply provide the information in text form or offer a selective and limited menu of categories for obtaining the pertinent information.  The more realistic programs will require the student to obtain the information by using a rational approach of questioning and careful selection of physical examination and laboratory procedures from a wide array of choices.  This wider set of choices creates an environment more akin to what would be experienced when dealing with a human patient in a true clinical setting.  The options need to be linked to realistic results, whether pertinent or not.  A few programs require interpretation by the student of the information provided, e.g., x-ray, ECG.  This requirement forces the student to be an active participant and provides another element for assessment of understanding.  The use of multimedia (images, sound, video), while enriching, needs to be judicious and contribute to the case.  These elements do require time for downloading and can be distracting.  The quality programs will allow for editing and incorporation of questions that can be linked to some action or element in the program.  These question items (of varying types) can be constructed to assess the foundation science relating to the case or diagnostic action.

A powerful component is the ‘assessment’ tool.  Only a few of the available programs actually provide a useful assessment module.  The Diagnostic Reasoning (DxR) program uses an assessment module that provides a variety of measures of both individual student and group performance.

A variety of simulation programs were presented during the workshop session.  In particular the Diagnostic Reasoning (DxR) and ClinicSoft programs were examined.  A number of resources for interactive cases were identified (see slides).