Benjamin Lok


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

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Benjamin Lok

  1. 1. Safe Prescribing and Use of Opioids April 10-12, 2012 Walt Disney World Swan Resort
  2. 2. Accepted Learning Objectives:1. Analyze current professional educationprograms on safe use of opioids and newprograms under development.2. Explain a potentially transformative on-lineeducational tool for health professionals thatenable them to train by interacting with “virtualpatients.”3. Describe a Massachusetts program for trainingphysicians on safe opioid prescribing, and thecurriculum developed to teach residentsand faculty.
  3. 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. 4. Simulation-based training for health care providers on prescription drug abuse Benjamin Lok, Ph.D. Computer and Information Sciences and Engineering University of FloridaNational Prescription Drug Abuse Summit April 10-12th, 2012
  5. 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. 6. Current Simulation Efforts•  Humans –  Lecture –  Role-playing –  Standardized patients – gold standard•  Pros –  Empathy –  Emotion –  Rapport
  7. 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. 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. 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. 10. Addiction Management Challenges•  Large scale deployment (40k+ learners)•  Solution: virtual human simulation•  Effective training using simulation –  Track progress –  Provide feedback –  Implement protocols
  11. 11. Serious Games•  Interactive training exercises•  Using computer game engines and the Internet Image from Breakaway Ltd.
  12. 12. Example: Virtual Human
  13. 13. Can interacting with a virtualhuman make you a better person?Dr. Gregory House Derek Shepherd Dr. Doug RossGood with medical knowledge Good with medical knowledgeNot so good with interacting with people Good with interacting with people
  14. 14.•  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. 15. Deployment - Continuum of Experiences Immersive Interaction Virtual WorldsImmersion Video Conference Chat Web Browser Instant Message Mobile Deployment Images from Fidelity, Learning efficacy
  16. 16. Virtual People Factory••  Web-based interface to virtual humans•  Deployed Early 2008 –  56 active developers –  2700 users –  105,000 utterances   Opiod patient
  17. 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
  18. 18. Repositories•  MedEdPORTAL –  Peer reviewed medical education resource•  400 institution downloads in 10 months
  19. 19. Scripts at VPF General•  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. 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. 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. 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. 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. 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: 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. 25. Demo of Creating Virtual Patient•
  26. 26. Thank You!Build virtual patients: www.virtualpatientsgroup.comContact: lok@cise.ufl.eduSupport: National Science Foundation and National Institutes ofHealth