Avatar-based simulation in the evaluation of diagnosis and management of mental health disorders in primary care

Abstract

Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD) are highly prevalent illnesses, but the literature suggests they are under-detected and suboptimally managed by primary care practitioners (PCPs). In this paper, we propose and use an evaluation method, using digitally simulated patients (avatars) to evaluate the diagnostic and therapeutic reasoning of PCPs and compared it to the traditional use of paper-based cases. Verbal (think-aloud) protocols were captured in the context of a diagnostic and therapeutic reasoning task. Propositional and semantic representational analysis of simulation data during evaluation, showed specific deficiencies in PCP reasoning, suggesting a promise of this technology in training and evaluation in mental health. Avatars are flexible and easily modifiable and are also a cost-effective and easy-to-disseminate educational tool.

Diagnosing Mental Health Disorders in Primary Care: Evaluation of a New Training Tool

“…This research provides a foundation for improving delivery of care. Of particular relevance to the current study, is that expert subjects were better able to selectively attend to information relevant to the generation of a correct diagnostic solution than the resident PCPs and seasoned faculty PCPs (amongst other findings; Satter et al, 2012). Research in clinical text comprehension suggests that selective recall of relevant information is a defining characteristic of expertise (Patel & Groen, 1991).…”

“…Results indicated that PCPs, overall, did not perform as well as the experts in diagnosing and treatment planning (Satter et al, 2012). In some instances it appeared as though the PCPs from the text-based group were able to recall more and draw inferences more often than the PCPs in the avatar simulation group.…”

“…However, many PCPs do not refer to or adhere to such guidelines (Nutting et al, 2002;Schulberg et al, 1995Schulberg et al, , 1996. Furthermore, the nature of PCPs diagnostic and therapeutic reasoning in the context of these disorders has not been studied until recently (Satter et al, 2012). Recent research provides a greater understanding of the cognitive, socio-cultural and environmental factors that facilitate and impede correct diagnosis and treatment (Satter et al, 2012).…”

“…Studies conducted by Patel and colleagues compared primary care providers, which included internal medicine and family medicine specialists in primary care environments, and psychiatrists on their ability to diagnose and treat mental health disorders presented in realistic text-based case form or avatar simulation form (Satter et al, 2012). Each PCP was assigned to be in either one of two experimental treatment groups.…”

“…While many patients with these disorders present in primary care, research suggests that physicians under-detect and suboptimally manage MDD and PTSD in their patients Satter et al, 2012). The development of more effective training interventions to aid primary care providers in diagnosing mental health disorders is of the utmost importance.…”