Algorithmization and procedural management of the therapeutic process has become very popular as quality management systems have developed and health care quality has been assessed. It is obvious that a procedurally-thinking physician can react more efficiently, promptly and economically to critical situations which are so abundant in acute medicine. The interactive educational algorithms on the portal AKUTNE.CZ have been developed with the aim of simulating decision processes in acute patients. The ultimate aim of the algorithms is to make students remember the correct procedures which are necessary for the management of acute situations. This comprehensive work contains 24 interactive algorithms both in Czech and English language which deal with various acute medicine topics. It covers acute medicine from prehospital care to highly specialized hospital care.
When dealing with acute patients, algorithmic thinking should be an essential characteristic of each physician. Process flowcharts and algorithmic flowchart form an integral part of modern textbooks and are perceived as very illustrative by the students. Linking algorithms and multimedia materials creates unique teaching objects which make it possible for students to comprehend the issue more thoroughly and to remember it better. Interactive algorithms or decision trees have been described in detail in guidelines issued by expert medical societies; such algorithms are aimed to help the student make sure that he/she is able to manage acute conditions, to react accurately and to avoid distraction by secondary problems. If the student makes a bad choice, he/she is informed about possible consequences of his/her decision on the patient's condition. A serious wrong procedure is labelled as fatal and the algorithm is terminated. In real-life situations, however, wrong steps often just delay establishing the correct diagnosis and planning the right treatment. In interactive algorithms, this fact is taken into consideration using the time factor, which in fact works as a real stressor. Algorithms have been designed in a way that makes it possible to monitor a wide range of laboratory quantities and to see results of physical examinations. On one hand, these quantities can indicate the correct procedure to be done; on the other hand, unnecessary examinations can delay the solution of an acute condition.
Software background of algorithm creation
Our algorithms have been created using the Flash technology, which is currently available to a vast majority of users. Each algorithm on the AKUTNE.CZ portal is realized through one basic flash object which is composed of key nodes – and their number depends on how many decision nodes the respective algorithm contains. Each key node involves other supporting objects in the form of separate files with multimedia contents (picture, sound, video). Additionally, a separate clip is read for each node in order to monitor the time passing. Its value is transferred between separate nodes and is also modified with respect to the actions performed at a given node: in most cases, this is a time loss when the user opts for unneccessary actions, such as redundant examination etc. The logic of passage between the nodes, time axis management as well as the upload of multimedia contents into individual nodes is run by scripts programmed in the ActionScript language. When creating a substantial amount of these teaching tools, efforts are made to achieve a better and more definite formalization of individual algorithms in order to facilitate the process of their creation. In order to achieve this goal – and based on our experience from previous implementations – forms have been created into which authors write all information relevant for individual nodes, i.e. description of the situation, question, possible answers, variants of passage, links to multimedia files, intervals of laboratory values or values displayed on the vital function monitor. The resulting entries, which are realized via PDF forms, are subsequently converted into a structure in the XML markup language. The algorithm formalized in this way into a XML file then serves as the data background for a single key node which is realized in each new algorithm.
Interactive algorithms are very attractive teaching tools which, apart from checking various conditions in sequential nodes in the process flowchart, navigate the student with the use of photos and short videosequences. A move on the time axis is a side effect of each action taken by the student, which lends authenticity to the process and creates a stress effect, which is very much pronounced in real-life situations when dealing with acute patients. Continuous change of various numerical parameters reflecting the development of patient's condition in time (such as blood pressure, pulse, oxygen saturation etc.) is also available. Led by their teachers, students of the Faculty of Medicine at Masaryk University participate significantly in the algorithm creation.
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Keywords: acute medicine, post-dural puncture headache, analgesia, allergic reaction, toxic reaction, local anaesthetics, acute coronary syndrome, water rescue, hypothermia, car accident, head injury, craniocerebral trauma, central venous catheter, basic life support, sepsis
citation: Štourač Petr, team of students and teachers creating the educational contents of the AKUTNE.CZ portal: Interactive algorithms in the education of selected acute medicine topics. Multimedia support in the education of clinical and health care disciplines :: Portal of MU’s Faculty of Medicine [online] , [cit. 19. 10. 2019]. Available from WWW: https://portal.med.muni.cz/article-606-interactive-algorithms-in-the-education-of-selected-acute-medicine-topics.html. ISSN 1801-6103.