A safe space to practice clinical decision-making

November 11, 2021

If a person goes to the emergency department with chest pain, there are a number of conditions that could be responsible. It could be a muscular issue, a heart attack, anxiety or even stomach-related. Physicians must consider the likelihood of each of these potential causes as well as the consequences if a serious condition goes undetected.

As a result, physicians use a “differential diagnosis” process to narrow down the possibilities and come to a final diagnosis. It starts with taking a patient’s clinical history and performing a physical examination. From there, doctors and specialists can use various labs and tests to get closer to a diagnosis.

Becoming proficient at this thought process takes time. Jump Simulation Medical Visualization and the University of Illinois College of Medicine Peoria (UICOMP) collaborated to develop a mobile application that gives medical students the opportunity to hone these skills.

Digi-DDx

The Digi-DDx mobile application allows medical students to practice diagnosing a patient by choosing the right tests to get to the right diagnosis in a safe space. Once learners open the app, they are presented with a patient’s concern, such as acute pain on their right side.

Using medical history information and physical exam results, participants are challenged to make clinical decisions that impact the progression to a final diagnosis.

“This includes intervening immediately after seeing the patient’s vital signs or choosing to make a hypothesis on the organ system impacted,” said Dr. Lisa Barker, an emergency medicine physician, a member of the UICOMP faculty and the medical director for Jump Simulation, a part of OSF Innovation. “Users can then order lab tests and imaging modalities they must interpret to support the decision-making process.”

Following those initial tests, participants can choose whether to stick with their original hypothesis and gain feedback on their differential diagnosis from experienced clinicians. They can then order follow up labs and advanced imaging to verify their assumptions.

“While labs and imaging are often needed to make a differential diagnosis, we also want to teach learners to be mindful of over-testing which can be costly for the patient,” said John Farmer, XR and mobile developer for Jump Medical Visualization. “As a result, there are costs associated with each test to help clinicians make better decisions.”

At the end of the session, learners are able to make a final diagnosis and then are required to determine the underlying cause of that condition. They then get to see how much they spent compared to that of an experienced clinician.

“We all learn best from the mistakes we make,” said Dr. David Pinson, DVM, PhD, a member of the UICOMP faculty. “The Digi-DDx app allows medical students to practice making clinical judgments around refining a differential diagnosis while at the same time reinforcing key clinical concepts.”

Dr. Barker and Dr. Pinson wrote all of the content for the app and designed the flow chart of the differential diagnosis process. Jump Medical Visualization developed the structure of the app in a way that allows for new cases to be added without the need for an app update. This work was made possible through a UICOMP Dean’s Award.

What’s next?

While additional cases are still being developed for Digi-DDx, it is already available on the Apple and Android app stores. Anyone who downloads the app is encouraged to provide feedback through a survey link.

In the meantime, plans are in place to add videos of simulated patients who will present their symptoms, medical history and physical exams in a more visual way. Dr. Barker and Dr. Pinson are applying for another Dean’s Award to continue this work.

And the Jump Medical Visualization team will present the Digi-DDx app at the 2022 International Meeting on Simulation in Healthcare (IMSH) conference in Los Angeles.

Featured Author

Denise Molina-Weiger is a Creative and Digital Writer for OSF HealthCare, where she has worked since March 2015. She initially came to OSF to write about the work taking place at the Jump Trading Simulation & Education Center, one of the largest simulation and innovation centers in the world, and went on to become the Media Relations Coordinator for OSF Innovation which was developed to help the hospital system lead the way in transforming care. Before joining the OSF HealthCare team, Denise was a reporter for Peoria Public Radio for ten years, writing on everything from politics, housing and transportation issues to hospital care in the region.