The Center for Biomedical Informatics
State University of Campinas, Brazil


Research Abstracts


CARDIOPULMONARY PROPAEDEUTICS: A COMPUTERIZED SYSTEM FOR SUPPORTING MEDICAL EDUCATION

Aranalde, M.P.M.1; Freitas, N.C.1; Gago-Contreras, M.C.1; Sabbatini, R.M.E.2; Torresan, R.Z.1; Wanderley, J.S.3

1Undergraduate Course of Medicine; 2 Discipline of Medical Informatics, Department of Medical Genetics; 3Discipline of Medical Propaedeutics, Department of Clinical Medicine; School of Medical Sciences, State University of Campinas, Brazil


Among the potential applications of computers to medical education, the simulation of clinical cases through computers has found an increased application in the training of students of Health Sciences, particularly in the area of decision-making and patient management problems. This consists of a dialogue between the computer and the student, as the computer presents a real or fictitious clinical case in some area of Medicine, Nursing, etc. The case progresses according to the answers given by the students to questions and decision points posed by the program; with relation to the hypothetical diagnosis, therapeutic intervention, patient management, etc.; thus simulating the clinical encounter (e.g., patient-physician) and the methodology of clinical problem solving.

The objective of the present project is to develop a set of clinical simulations for supporting the teaching of medical propaedeutics in the area of cardiological and pulmonary semiology. The development of the simulations was made with the MEDTEST I system, which is a simple, flexible and effective generic authoring tool for IBM PC-compatible microcomputers, developed in the Center for Biomedical Informatics, by one of the authors (R.M.E.S.). It is ideally suited for the building and presentation of all kinds of interative case simulations, that are written into a "script" file, using any ASCII oriented text processing program. MEDTEST I processes the text and manages the presentation to the student according to the command lines defined into the script file. The command language is very simple with only 30 easy-to-use commands. The program allows several types of questions: single multiple choice, repeated multiple choice, logical answers (Y/N) and open scalar or string responses. Textual or graphical information are presented by frames. Conditional jumps to other questions or frames are possible to each user response. It allows also the display of scoring, feedback and critique texts, etc. Each case has the following structure: presentation of case, questions about the patient's history (present and past ilnesses), management, semiogenesis and physiopathology, observed signs and symptoms; and, at last, general and specific questions concerning the syndromic, nosological, anatomical and etiological diagnoses. For each question answered, the program immediately presents some correction feedback, in the form of critiquing texts, comments, tutorials and explanations, etc.; thus enriching the simulation and directing the student to the next phases of the simulation. Each decision/question receives a score, which is presented concomitantly at the screen, and accumulated and presented at the simulation's end. Scoring is categorized into three classes: physiopathology, management and data collection), so that the student and the teacher may have a detailed evaluation on the students's performance during the simulation.

In the module of pulmonary propaedeutics, several typical cases for each pulmonary syndrome were selected: cavitary, hyperinsuflatory, pleural, obstructive and condensating. Considerable care was taken to select illustrative clinical cases, comprising characteristic semiological signals for each syndrome, thus encompassing the majority of topics which are usually taught in this area. The pulmonary module consists of five simulations. The cardiological module is divided into two main sections: 1) physical propaedeutics (inspection, palpation, auscultation and pulse); and 2) physiopathology of some typical syndromes. The cases selected were: valvopathies, congestive cardiac insufficiency, miocardiopathies, cor pulmonale, congenital cardiopathies.

A detailed evaluation of the didactic effectiveness and value of this courseware is underway in our institution.


Presented at:

II Conferencia Internacional de Informatica Medica, Congreso Internacional de Informatica, La Habana, Cuba, Febr. 1992
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Last Updated: March 2, 1996

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