Interactive Patient Simulations for Oral Pathology (ORPT 622)

2004

LICENSE AGREEMENT for the CD

CASE STUDIES – Dentistry – Oral Pathology Set (the CD)

By Louis M. Abbey, DMD and Dennis G. Page, DDS

©Virginia Commonwealth University

All intellectual property rights and copyrights are the sole property of the authors and Virginia Commonwealth University (VCU), and all rights are reserved. VCU and newMentor distribute this CD to you (the student and recipient) free of charge, exclusively for your personal use.

VCU grants you a non-exclusive license to use this copy of the 10 cases included on this CD. You may use this copy and related documentation under the terms outlined below. It is understood that, as the recipient, by accepting this CD, you agree to all the terms and conditions of this Agreement. If you do not agree to these terms you may return the CD and all associated materials to VCU at the time you receive it and read this Agreement.

TERMS AND CONDITIONS

1. VCU retains title and all other rights it may own, including copyrights, trade secret rights, and other intellectual property rights, in the program, the cases and other documentation associated with this Agreement.

2. You may use this CD for the course ORPT 622 and subsequently for your own personal use on a single, non-networked computer. You have the right to make a single copy of the information on the CD solely for the purpose of archiving. This single copy of the information must always remain in your personal possession and under your control. If you release possession of the computer for any reason, you must agree to erase any information on the computer that may have been on or pertain to the CD. You may not copy or make a copy of the information on this original CD onto another CD or any other medium for any reason what so ever.

3. You may not transfer, modify, translate, reverse engineer, decompile, disassemble, create derivative works based on or copy (except as noted above) the programs or the cases on the CD. You may not rent, lease, or transfer any of the rights in the programs or cases on the CD in any form what so ever without the prior written consent of VCU. VCU will prosecute violation of these terms aggressively, immediately and to the full extent of the law.

4. Warranty Disclaimer. The programs, cases and documentation on this CD are provided to you free of charge without warranty of any kind including errors and omissions of content.

VCU's sole liabilities are replacement of the CD in the case that it can be shown that the programs or cases do not function properly. In the case of malfunction, a new CD will not be reissued without return of the original. You are solely responsible for the function of the CD on your equipment or on equipment you choose to use, and no warranties as to proper function are implied by this Agreement. VCU shall not be liable for any consequential, direct or indirect damages, including injury or death, arising from the use or the results of use of this CD or its contents.

By accepting this CD, I signify that I agree to all of the above terms of licensure.

Research component:

I understand that my participation in this course this semester includes a research component designed to explore the influence of using new technologies on instruction. I understand that the research has been approved by the VCU Institutional Review Board and that use of my survey responses and any other personal records in the research is voluntary. I also understand that use of any and all records for research will remain completely anonymous and that I will not ever be identified individually in any way. I retain the right to refuse to participate in the results of this research at any time without penalty. I further understand that the results of this research will be available to me at the conclusion of the project. Finally I also understand that if I have any questions regarding the project or the research itself, I will be able to obtain answers from Dr. Abbey, the lead researcher. Unless I specifically withdraw from this project in writing or by contacting a member of the Oral Pathology Department, I understand that I will be a participant.

CASE STUDIES for Dentistry

Welcome to the 2004 Oral Pathology course. We are grateful to our publisher, newMentor, Inc. of San Francisco for providing CASE STUDIES simulations for part of your learning experience. Each interactive case was authored (by either Dr. Abbey or Dr. Page) with the CASE STUDIES Case Builder program that was developed over the past 7 years here at VCU (by Dr. Abbey). We hope this experience will prove useful and enjoyable for you.

There are two parts to this Oral Pathology Course (ORPT-622). One part will involve the lectures and regularly scheduled classes. The second part, simultaneous with the first part, involves studying the 10 simulated patients on the CASE STUDIES CD-ROM that you will receive. The focal point of organization for this second part will be this ORPT-622 Blackboard Site. This is where you will find course information, discussion forums, quizzes and assessments for this part of the course. Check your e-mail regularly since this is the way we will communicate with you. We are aware you get floods of e-mail, so when we send you e-mail about this portion of ORPT-622, we will put CASE STUDIES in the subject line.

How the CASE STUDIES part of the course will work:

1. You will each receive a CD containing 10 simulated interactive patients, each with a problem. You are required to complete all 10 cases by the end of the semester. You can work independently or in groups, and at your own pace. Talk with your classmates, use references, your book, the Web, other books etc. at will while interacting with and treating these patients.

2. On the Blackboard Web site for ORPT-622, there are 10 Discussion Forums, one for each of the cases in the order you do them. Feel free to use these discussion forums to post questions, answer questions or generally discuss the cases with your class members. One advantage of a discussion forum is that if you have an idea or question, probably someone else has one too, and you can get interesting viewpoints and perhaps learn something you did not expect through the postings. The instructors will monitor the discussions for interest and to see if problems are developing, but we will not answer or comment on specific questions. This discussion forum is for you to help each other with issues pertaining to the cases. If you need to ask a specific question of an instructor, the best way to get an answer is to send e-mail (through Blackboard). If the question is of general interest, we will answer it on the discussion forum.

3. The Blackboard Web Site will contain this manual, the discussion forums, and quizzes for each case, the grade book and the assessment form. Please refer to the Blackboard site and this manual first to answer any questions you have. If you can’t find what you need, contact one of the instructors in the course. Send e-mail to the instructor if the question is not urgent, or call the Oral Pathology office if the question is urgent (828-1778).

4. After you complete a case, you must take the quiz for that case on the Blackboard site. In addition, you must hand in the Case Summary that prints out when you finish your case. The quiz and the Case Summary are both required to receive credit for the case. You can hand in your Case Summary to the Department Secretary, Sandra Gobourne, at the Department of Oral Pathology, Room 315 Lyons. The feedback on many items in the cases asks you questions that you must find answers to on your own. These questions are important, and are the source of some of the questions on the quizzes. Some, but not all, of the cases have a supplementary document you must read that will both help you with the case, and with future patients who have similar problems. The quiz will have a question or two from the supplementary reading. Don’t forget to read any supplementary documents that are available for the case on which you are working.

5. To help you plan your progress for the semester and to help us handle the volume of case summaries and quizzes, we have set a deadline for completing the first 5 cases and a deadline for completing the last 5 cases. These deadlines will be implemented as follows:

· Complete the simulations in the following order:

Case 2

Case 5

Case 1 First 5 quizzes and Case Summaries due March 22, 2004 5PM

Case 3

Case 4________________________________________________

Case 8

Case 9

Case 6 Second 5 quizzes and Case Summaries due May 6, 2004 5PM

Case 7

Case 10

· Quiz Schedule:

1. Jan 9, 2004 – First 5 quizzes (Cases 2, 5, 1, 3 & 4) posted on Blackboard site.

2. March 22, 2004, 5PM – Deadline to turn in Case Summaries and take quizzes for Cases (2, 5, 1, 3, & 4).

3. March 24, 2004, 9AM - Remaining 5 cases (8, 9, 6, 7, & 10) posted on Blackboard site. (all 10 quizzes are up at this time)

4. May 6, 2004, 5PM - Deadline to turn in Case Summaries and take quizzes for Cases (8, 9, 6, 7, & 10). All 10 quizzes taken down.

· Quizzes for the first 5 cases (Cases 2, 5, 1, 3, & 4) will remain on the Blackboard site for the entire semester until 5 PM May 6. We will not accept quizzes or case summaries for the first 5 cases after March 22 at 5 PM. Grades of “0” will be entered for any of the first 5 quizzes not completed by March 22, even though all 10 quizzes will remain up until May 6. As of March 24, the remaining 5 cases (Cases 8, 9, 6, 7, & 10) will be posted. You will have until Thursday, May 6 at 5PM to complete the quizzes and turn in Case Summaries for the last 5 cases (Cases 8, 9, 6, 7, & 10). After May 6, the quizzes for all 10 cases will be removed from the site.

· You may take the quizzes any way you choose. Use books, references and other resources, including your colleagues, if you wish. Or, take the quizzes on your own by yourself. It is totally up to you. The reason for this is that (believe it or not) the quizzes are supposed to be learning experiences. The questions and situations posed in the quizzes will teach you that you can apply what you learned from each case. Hopefully they will reinforce the learning experience on each simulation.

· Your total score on the 10 cases will count 10% of your final grade in ORPT-622.

· On the ORPT-622 final exam there will be some questions dealing with the specific diseases affecting the patients in the CASE STUDIES simulations. You will be expected to use some of the same skills, information gathering, decision-making, questioning etc., that you had to use in these cases.

6. Finally, there is a Student Assessment on the Blackboard site for the CASE STUDIES patient simulation portion of ORPT-622. This assessment is separate from the overall evaluation of the ORPT-622 course. Please fill out both. You access this Assessment form in the “Assignments” section of the Blackboard site. Please fill in this assessment form and give us robust feedback. It is essential that we know how you perceived the cases and what you feel you learned. As usual, all assessments are anonymous. All we see is cumulative percentages of the ratings in each category, and summary lists of written comments. The fact that you filled out an assessment form is recorded as a check mark in the grade book. We never see your individual form because it doesn’t exist and we have no interest in it, only the cumulative ratings. All we gain from knowing whether or not you completed an assessment is that we then know the “N” of the class that finally rated the course. This is important from the standpoint of establishing the validity of the ratings. An assessment is not required and no student should feel pressured to fill out one. We hope, however, that you see our need for your constructive criticisms and comments, and that you appreciate the value of your rating of this course. We very much appreciate your participation in this course.

Every CASE STUDIES patient is a friendly, interactive, multimedia simulation in which the computer serves as both the patient and a teacher. CASE STUDIES simulations are learning modules, not tests or contests. The clinical problems, dialog, quizzes, answers and feedback are designed to teach, guide and stimulate you to think, be analytical about your thoughts and make decisions based on evidence. You will never fail or hurt the patient and you will always arrive at the correct answer. You, the doctor, should approach the case just like you would a real patient. The patient in each case has all the information you need to make a diagnosis and treat. Your job is use your investigative skills and imagination to find it. Ask the patient questions, perform examinations, order lab tests and radiographs and look at old records, if available, to uncover information that helps you solve the problem. Propose a differential diagnosis, make a diagnosis and plan treatment. With each patient you should strive to get from Chief Complaint through the Treatment Plan in the most direct and efficient manner. Take into account all the pertinent information you need along the way to make responsible decisions in your patient's best interest. The pathway you take with your patient should form an unbroken train of logical steps with each step built upon the one before. You will be asked questions by the computer, and will have to complete some sections before you can proceed to others. Once you have become oriented to the "routine" of CASE STUDIES, you should be able to complete a case in 25-40 minutes. Have fun while you learn to help these patients solve their problems. If you relax and enjoy it, you will become proficient sooner than you think.

It may seem that you need some background before you attempt to work through a CASE STUDIES patient. You already have more background than you realize. It’s fine if you want to wait a while to get your feet on the ground in Oral Pathology before starting the first case, but don’t loose track of time. You need to get on with the cases to complete the first five by the Monday after Spring Break. Try to learn as you go, and work intuitively through a case. After all, several of the people who have tested CASE STUDIES were lawyers and others with no health care background. You can make mistakes and correct your mistakes, and you can go through a case as many times as necessary until you feel you have done it to your satisfaction. These cases are meant to be learning tools on which you can practice over and over again. So relax, feel free to “dive right in on day one,” if you’re so inclined. You might enjoy the experience.

Goal of CASE STUDIES Cases

The goal for CASE STUDIES simulations is for you to learn, within the context of dental practice, an orderly process for helping a patient who has come to you with a problem. In accomplishing this goal, you will do the following activities:

· Gather and analyze information.

· Make decisions based on evidence.

· Develop a differential diagnosis (DDx) list based on information you have gathered.

· Refine your DDx list to arrive at a final diagnosis.

· Plan treatment and follow-up.

We hope you will find CASE STUDIES cases interesting, stimulating and fun. Please provide us with robust feedback.

Objectives

After completing a series of CASE STUDIES cases you should be able to:

1. Recognize a patient’s problem(s) from the chief complaint.

2. Obtain information from physical examinations including:

· Head and neck

· Intra-oral

· Percussion, hot/cold, electric pulp tests

3. Clarify a patient’s problem by asking questions about:

· The chief complaint

· The medical history

· The physical examination

4. Synthesize a differential diagnosis from the gathered information.

5. Order appropriate laboratory tests to refine your differential diagnosis:

· Biopsy

· Smear

· Hematological examination

· Serum chemistries

· Microbiological culture

6. Correctly interpret the results of the above laboratory tests.

7. Use the results of laboratory tests to include/exclude items on the differential diagnosis list.

8. Make a final diagnosis.

9. Utilize resources to identify medicines, their uses, indications, contraindications and interactions.

10. Prescribe the appropriate treatment for the patient’s problem.

11. Evaluate the results of treatment and decide on follow-up.

12. Complete the case in a thorough, efficient, and direct manner that yields positive, useful results for the patient.

You have received a CD that contains 10 cases constructed with the CASE STUDIES authoring system.

Minimal operating system requirements:

IBM-PC - Windows 95, 98, 2000 or NT,

Pentium processor 300 MHz or faster,

CD-ROM drive

48 MB of RAM or greater

True color (24 bit) display or higher

Macintosh - Model G-3 or greater

System 7.5.1 or higher

300 MHz processor or faster

32 MB of RAM or greater

CD-ROM drive

Thousands of colors display

The CD you received contains both the PC and Mac versions of the program. The appropriate version will function on your equipment.

To begin using your cases, do the following if you have a PC or a Macintosh:

1. Make sure your computer is attached to a printer and the printer is turned on.

2. Turn your computer on.

3. After the computer boots, insert the CD in the CD-ROM player.

4. After a few seconds the CD will play and the opening sequence begins.

5. After the first screen, you will be asked to type in your first and last name and then confirm that the computer has read your name correctly.

6. On the next screen you will see a list of cases. Follow instructions at the bottom of the screen.

7. Click on the case you want to start with and hit “return.” Click “Continue” and you are on your way.

Some points to remember when working in the cases:

1. When you are clicking to make a choice anywhere, the arrow cursor must turn into a hand with the pointing index finger before your click will work.

2. Keep an eye on the gray instruction bar at the bottom of the screen. This bar will always tell you what your choices are in regard to what to do next. If you want more detailed instructions, roll the cursor over the yellow light bulb in the dark red bar at the top of the screen.

3. Take careful note of the Feedback on each question, choice and decision you make throughout your encounter with your patient. You will find questions embedded in the feedback. These questions are meant to stimulate you to look further and learn more about the patients and their diseases. Look up the answers to these questions if you don’t know them. You may see some of these questions or their variations on future quizzes and examinations. The answers to these questions can be the subjects of discussion on the discussion forums for each case.

4. If you finish a case and want to begin another, click “Menu” at the top of the screen to get back to the case list so you can choose another. There is no need to quit the program to start a new case.

5. A Case Summary will print out on your printer automatically when you quit a case or finish a case and return to the menu. You don’t have to do anything except have your printer turned on. If you quit in the middle of a case, the Case Summary will also print out. In the CID lab, the main lab printer is the one that prints out your Case Summary. In the library or the CBIL lab you will have to ask where the default printer is located. The Case Summary contains important information that will help us help you to achieve the maximum benefit from CASE STUDIES cases. You can’t edit the Case Summary.

6. If you have to quit a case in the middle before you finish, there is no way you can save your data. A Case Summary will print, however. Save it and you will know exactly where you stopped. To start over again the next time just make all the choices recorded in the previous case summary and you’ll be right back where you left off.

7. Feedback is very important to us for making improvements. We have placed an assessment instrument on the Blackboard site (“Assignments” section where the quizzes are). Please fill out and submit it electronically. It will be scored and recorded automatically. You may also give us feedback any time either in person or by e-mail (lmabbey@vcu.edu).

8. It is not expected to happen, but if the program freezes your computer, there is no alternative but to reset the computer. You will not damage the program, but you will lose your data. If this happens, we would appreciate knowing about it. Please take note of exactly what you were doing when it happened, what other software you were running at the time in addition to CASE STUDIES, and if any unusual activity seemed to occur before or at the same time the computer froze.

CASE STUDIES Icons

Icons are used throughout CASE STUDIES cases to designate specific options available to you as you progress through a case. When icons are "active" they are bright and clear on the screen. When you click an "active" icon, it will respond and allow you to do something. When icons are "inactive," they are dull or grayed out. "Inactive" icons do not respond to clicks. The major icons are explained below.

Light Bulb - gives detailed directions and is positioned in the bar at the top of the screen. The gray bar at the bottom of the window gives abbreviated directions or the same directions if they are brief.

Doctor - represents you as you ask the patient a question.

Patient - represents the patient in an exchange with the doctor.

Mentor - represents the teacher giving you feedback on some point or answer to a question in the case. This icon is also used for feedback on decisions you make, for example, choosing what tooth to percuss.

Dr. Question - appears active when there are questions available that you can ask the patient. When you wish you could ask the patient a question, look for this icon and you probably can. Clicking this icon will open up a series of questions from which you may want to pick one or more to ask the patient. This icon serves the same function as the “?” icon described below. This one is bigger, however, and will show up in some environments where the one below would be lost.

Question Mark - appears in various places throughout a CASE STUDIES case, such as in front of items in the medical history. Clicking on this icon opens a list of questions from which you can select one or more to ask the patient. This icon turns red after you have clicked on it to show that the question has been viewed. This icon serves the same function as the Dr. Question icon described above.

Back Arrow - transfers you back to the previous screen.

Yes box - appears in the Medical History and Differential Diagnosis. This box in front of an item in the Medical History indicates that the patient would have answered in the affirmative. In the Differential Diagnosis, this icon indicates a correct choice, one of the possible diagnoses.

No box - appears in the Medical History and Differential Diagnosis. This box in front of an item in the Medical History indicates that the patient would answer in the negative, i.e. they have not had the disease or condition. In the Differential Diagnosis, this icon indicates an improbable choice, one that should not be included in the differential diagnosis.

Drug Information - This is a small book icon that appears beside medications the patient has entered in the medical history and beside types or classes of medications that are in the medical history. If you click this icon, a book will open on the screen to the page that gives you information on that medication or a definition of that class of medication.