Clinical Encounters started as a clinical skills training in pain management experienced in the format of a simulated electronic health record. We began developing Clinical Encounters using jQuery, guided by a foundation in medical education theory and research, in order to integrate interactive and experiential learning with mobile accessibility. Each component of the rendering was crafted around specific needs for clinical training for students in the healthcare professions in pain management. As we expanded our development, we explored how to make the case entry tool adaptable for a number of different medical topics and the sophistication relevant to practicing health care professionals in addition to the initial student target audience.

In light of the need for greater flexibility, the next model of Clinical Encounters was developed in Unity using C#. We selected Unity because we knew it was very flexible and made for easy deployment to various platforms while also providing a visual interface for creating the user interface. Using Unity also gives access to a database of assets so that we could grab packages of scripts for specific purposes without having to spend the resources necessary to reinvent the wheel, so to speak.

The user experience of reviewing the case in the this version of the app included the following stages of a typical patient encounter in a primary care clinic:

  1. Case basic data (vitals, chief complaint, history of present illness (HPI)) with:
    • Basic ID (name, age, gender)
    • Past medical history (PMH), review of systems (ROS), Family/Social Hx)
    • Medications –
    • Labs
  2. Select clinical evaluations and interpret results
  3. Make diagnostic decisions and receive feedback
  4. Choose a treatment approach and receive feedback on potential clinical outcomes.
  5. Review a case summary outlining the salient points and take home messages

Feedback was provided immediately on all simulated clinical choices. For each of the above sections of a typical patient encounter, there were two additional features:

  1. The transcript of a dialogue between the provider and the patient
  2.  A quiz question at the end of each section with one or two questions about what had been learned.

The cases that we selected to demonstrate the product covered the basic concepts and skills needed for clinical management of a specific medical condition or type of pain. The prototype is optimized for tablets and is currently available on GooglePlay. It is also available online.

In addition to the two cases presented in the current prototype, one acute pain case and one chronic pain case, we built cases in the product covering a wide range of other cases, from smoking cessation to oral cancer, and in different settings, from primary care to the emergency room, in order to test the ability of this tool to fit a variety of case scenarios. Testing included translating two medical school problem-based learning cases to this alternative educational approach. All cases were developed based on current medical practice guidelines, evidence-based learning, and taking a patient-centered approach.

We are currently looking towards the future in our development of Clinical Encounters to include more realistic experience and more interactivity and will detail where we are headed in an upcoming blog. Training health professionals in the skills of a patient encounter is essential in ensuring a strong medical framework for our future.

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