VP authoring with vpSIM

• Choices, consequences and branching

• Choosing a case

• Starting - the ideal pathway

• Developing choices

• Dealing with consequences

• Narrative

• Finishing

A 47-yr-old teacher, Ms. Heidi Fox comes to see you in A&E. She seems exhausted and tired with dark circles under her eyes. She tells you that since she returned from Senegal 5 days ago she has been suffering from diffuse headaches on and off. She has had temperatures up to 39.6°C rectally, but overall with great undulation. Her GP prescribed Paracetamol which did not help at all. He also took blood and she shows you the results:

(Normal values in parenthesis):

Haemoglobin 9.5 g/dl (12-16)Erythrocytes 3.8 T/l (3.9-5.3)Haematocrit 35% (35-47)MCV 92 fl (78-98)MCH 32 pg (28-34)Leucocytes 2.4 G/l (4-11)Platelets 75 G/l (150-400)Sodium 141 mmol/l (135-150)Potassium 4.4 mmol/l (3.5-5.5)Creatinine 1.8 mg/dlGPT 98 U/L (5-19)GOT 76 U/l (5-15)GGT 80 U/l (<28)LDH 440 U/l (80-240)Bilirubin 3.2 mg/dl (<1.0)TPZ (Quick) 85% (70-100)aPTT 25 s (20-35)

Because she has been to Senegal you ask a few more questions and Mrs. Fox says that she had shots for yellow fever and hepatitis and took malaria prophylaxis (Chloroquin).

You perform a blood film and Malaria tropica with a parasite density of >2 percent is diagnosed. Due to the laboratory findings this is classified as complicated malaria.

Mrs. Fox is transferred to ICU and started on i.v. quinine and doxycycline.

Choices, consequences and branching

A 47-yr-old teacher, Ms. Heidi Fox comes to see you in A&E. She seems exhausted and tired with dark circles under her eyes.

Choices, consequences and branching

A 47-yr-old teacher, Ms. Heidi Fox comes to see you in A&E. She seems exhausted and tired with dark circles under her eyes.

Patient hasa name anda character

Locationestablished

The player’s Involvement

beginsHook line

Choices, consequences and branching

A 47-yr-old teacher, Ms. Heidi Fox comes to see you in A&E. She seems exhausted and tired with dark circles under her eyes.

She tells you that since she returned from Senegal 5 days ago she has been suffering from diffuse headaches on and off. She has had temperatures up to 39.6°C rectally.

Choices, consequences and branching

A 47-yr-old teacher, Ms. Heidi Fox comes to see you in A&E. She seems exhausted and tired with dark circles under her eyes.

What would you like to do now?

• Ask about travel history• Complete medical history• Proceed to examination

Choices, consequences and branching

A 47-yr-old teacher, Ms. Heidi Fox comes to see you in A&E. She seems exhausted and tired with dark circles under her eyes.

She tells you that since she returned from Senegal 5 days ago she has been suffering from diffuse headaches on and off. She has had temperatures up to 39.6°C rectally.

Give gameaway

Unrealistic

Choices, consequences and branching

A 47-yr-old teacher, Ms. Heidi Fox comes to see you in A&E. She seems exhausted and tired with dark circles under her eyes.

What would you like to do now?

• Ask about travel history• Complete medical history• Proceed to examination

Rather too obvious

Choices, consequences and branching

You chose to start the examination.

This is the wrong response. Please try again.

•Ask about travel history•Complete medical history•Proceed to examination

Clearly stateswhat has been

done

Instant negativefeedback - no

learning

Presentingproblem Travel

More history

Examination

Branching

• Allows real choices that make a difference

• Learning from having to make a choice

• Learning from the consequences

BranchingQuickTime™ and a

Graphics decompressorare needed to see this picture.

QuickTime™ and aGraphics decompressor

are needed to see this picture.

Choosing a case

Relevant to the user and course

In an area you know

Enough choices to make

Starting - ideal pathwayPresents with

fever + headache

Improving on Quinine

Travel

Examination

Thick/thin film

Developing choicesPresents with

fever + headache

Improving on Quinine

Travel

Examination

Thick/thin film

CT scan

Lumbar puncture

Symptomaticmanagement

Developing choices

• Realistic

• Related to learning objectives

• Cued by text

• Must require thought by player or players

Consequences

The logical result of your choice

Potent promotor of learning

Allow realism in the VP

Exponential increase in VP complexity

Consequences

Model real life -

some mistakes can be redeemed

multiple mistakes often disastrous

Narrative

1. To give clear instructions for the player

2. To involve the player - emotionally, intellectually

3. To make choices taxing

NOT to waffle!

Finishing

Checking links

Peer review

plausibility

choice realism

consequence realism

learning objectives