VP Creation

Creating Virtual Patients

At SGUL we use two virtual Patient (VP) authoring systems:

  1. vpSim, a licence-based tool developed by JB McGee at the University of Pittsburgh, USA; and
  2. OpenLabyrinth, an open source tool developed by Rachel Ellaway at the University of Northern Ontario, Canada.

Both are online case-based authoring and playback systems intended for medical education and assessment, but are suitable for any type of scenario-based learning and teaching.

The linear route through the case

To create  a  case in vpSim we firstly use the inbuilt visual editing tool  to create a series of boxes which outline the narrative for the case (Figure 1), for example patient presentation, history, examination etc  This does not have to be the only way through the case, but represents the ideal pathway e.g. the start of a stage of the patient’s management – for instance triage in A+E, completion of resuscitation, admission to the ward, cardiac catheterisation and discharge home for a patient with a myocardial infarction. The text of the case narrative is entered into the boxes.

Additional ‘branching boxes’

At key points in the case, (points at which the practitioner needs to make a decision and then take a management action), extra boxes are put in to contain the choices that the practitioner may consider. The choices reflect a realistic representation of real life. Further connections may also be made to these choices, building up alternative routes through the case (Figure 2). A short case may typically require approximately  10 steps and take approximately  10-20 person-hours.


Pruning the case, enriching with media.

If the alternative pathways described above do not return to the ideal pathway, then these ‘dead’ branches provide an explanation, and the student is redirected back to an earlier node or to the start. The skeleton of the case is now complete. Depending on time and resources, the case can now be complemented with additional features – e.g. clinical photography, video, sound. It can be linked to other sources of information, such as on-line course materials and relevant websites.

Finished cases can be played directly from vpSim or OpenLabyrinth, displayed as a sequence of web pages that can be accessed through the online browser.