MedSIM– Online Skills Lab and Virtual Patient Cases

(Medical Simulation platform for Medical Students)

The Covid-19 pandemic has dramatically changed the medical education environment and made the shift
to online learning inevitable. Close human contact that was the essence of clinical teaching now looks so
distant. The Covid-19 pandemic has forced to explore non-conventional ways of teaching-learning and
assessment. Medical colleges also need to prepare to train the next generation of digital learners using
virtual learning environments. This does not mean that traditional classroom teaching will become
obsolete, but there is now an opportunity to use both methods efficiently in a hybrid manner, to make the
process of learning efficient and effective. The National Medical Commission has mandated use of
computer technology as a part of its effort to implement skills labs in all medical colleges. In this context,
National Medical Commission (NMC) indicated to explore Online Teaching-learning and assessment
modalities. Further, a Module on Online Learning and Assessment was also developed by NMC to
address the need of Online Education in Medical colleges. The medical education in India about 606
medical colleges (as on date) and an intake of 92,065 students (Approx.) annually, India's medical
education sector is one of the largest in the world. Most of the medical institutions of higher education in
India are grappling with the financial justification to design, develop, and deploy costly training programs
involving education technologies.

2. Keeping above in view of above Ministry of Electronics and Information Technology (MeitY) has
approved a project MedSIM 2.0- Online Skills Lab and Virtual Patient Cases for development of Medical
Simulation platform for medical students after successful completion of the MedSIM 1.0. MedSIM is
simulation-based medical education platform that allows medical students to enhance their clinical
reasoning and judgement skills. Through MedSIM application medical students can virtually interact with
patient to obtain the history, conduct examinations, and make diagnostic and therapeutic decisions.
MedSIM has the potential to benefit medical education software that allows medical students to enhance
their clinical reasoning and judgement skills.

MedSIM 1.0 (www.medsim.in ) is an interactive and visually/simulation rich platform that encompassed
10 Clinical cases in 2 distinct domains - Respiratory and Cardiovascular systems. MedSIM 1.0 is a unique
learning platform covers seven modules from “History taking” to “Treatment” to allow for an efficient
and systematic understanding sequentially. There are subject-specific teaching tools and learning tools for
self-assessment and self-improvement. Another novel aspect of this platform is the “Differential
diagnosis” module which is crucial to improve thinking skills reduces errors and lab costs. Numerous
simulations, animations, actual videos are available to increase visual learning and practice. Due to the
tremendous interest from numerous medical colleges, multiple demonstrations and workshops were
conducted across India on MedSIM Online Skills Lab and Virtual Patient Cases. The feedback received
under MedSIM 1.0 showed an overwhelming response favouring the MedSIM system. MedSIM 1.0
project was completed within the stipulated three years (2013-2016), and a pilot study was conducted at
Government Medical College, Thiruvananthapuram. The MedSIM virtual patient case simulation
platform and 10 clinical case scenarios with over 95 simulations spread across 7 modules . The MedSIM
virtual patient case simulation platform, the portal with administrative, assessment, and reporting tools,
Medical Simulations in two broad areas (Cardiovascular and Respiratory Systems), and Virtual Patient
Cases enriched with Interactive 2D and 3D Simulations and animations were the significant outcomes
delivered.
MedSIM 2.0 is India’s first-ever medical-grade virtual patient case simulation platform created to cater to
the medical undergraduate curriculum.. It is designed to encourage a patient-centred approach to
examination and treatment, enhance safe health care and health promotion practices, improve
communication, decision-making, and interpersonal skills, and encourage lifelong learning and practice.
The MedSIM 2.0 eLearning platform provides an easy to use learning environment architected to assist
medical education students in their primary years of medical education. The platform utilizes simulation
aides to replicate clinical scenarios and allow features such as deliberate practice and feedback for skills
development, exposure to challenging procedures, protocols, and case studies using virtual patient cases.
The system enables the student to review the results and responses before making diagnostic clinical and
management choices. One of the primary objectives for developing MedSIM 2.0 is building a
comprehensive solution that supports all medical specialties that complement every medical student's
education. During the pilot study of MedSIM 2.0, workshops, and country-wide workshops, the
participants and attendees will be requested to add Virtual Patient Cases with a variety of symptoms,
including more disciplines, especially cases on surgery, central nervous system, gastrointestinal system,
enhance the treatment module with drug doses, drugs in alphabetical order, etc, and to add more
experiments to improve lab skills. Most of the available medical apps or simulation platforms follow
standards prescribed by US, UK, or European regulatory bodies. Though these apps provide limited
learning experiences for free and a majority of platform require paid subscriptions to access the complete
educational package.

There would be 38 dedicated Online Skills Labs for Pre- clinical & Para-clinical subjects. Around 100
new Virtual Patient Clinical Cases with medically accurate 2D/3D simulations, animations, images, and
videos would be included to improve the interaction of the platform. This simulation platform will also
support continuous learning through formative assessments rather than evaluating students learning at the
end of the course. It will help in self-directed learning and improve knowledge and skills through
deliberate practice and learning beyond the classroom. It is envisaged that MedSIM 2.0 will utilize
learning analytics to improve and optimize the education & teaching environment.

Under MedSIM 2.0, it is envisaged to design Online Skills Lab and Virtual Patient Cases considering
pedagogical considerations & UI considerations suitable for students of medicine and the subjects being
covered. These modules will be developed after in-depth discussion with specialists/experts in their
particular subjects/fields and with effective integration of pedagogy and suitable technologies. In
MedSIM 2.0 experts will involve right from the conceptualization, creation, and will play an active role in
reviewing each case before it is approved and added to the platform. The design of activities will be such
that these can also be used by faculty in classrooms, online sessions and for homework activities. The
content available at MedSIM 2.0 would be aligned with the National Medical Commission (NMC)
requirements for Student Practical Laboratories. The proposed new online MedSIM labs will make
modules accessible to students especially during the pandemic, when students have limited access to
physical lab facilities.

3- Scope of the MedSIM 2.0: To provide a comprehensive educational and evaluation platform during
the entire medical education (MBBS) course by developing case-based simulations for all relevant
courses in the programme.
(i) To create a new platform for Preclinical and Paraclinical teaching.
(ii) Identify appropriate cases in consultation with experts from the country’s premier medical
institutes to address requirements on medical situations.
(iii) Enhance the Virtual Patient Cases in all relevant disciplines identified (enclosed in Annexure).
(iv) Define the Outcomes and Architecture of the MedSIM 2.0.
(v) To train medical doctors on MedSIM 2.0 platform.
 (vi) To train medical students from different colleges regarding the usage of various modules
developed in MedSIM 2.0.
(vii) To develop and deploy the Assessment module for Medical Students during their curriculum.
(viii) Question Bank Management for the Online Assessment System
(ix) To display the learning analytics data in a dashboard

4- Broad Areas to be cover under MedSIM 2.0 based on Medical Education Curriculum: The list
of few areas in medical education to be covered in MedSIM 2.0 prepared based on input received from
medical faculty, specialists/expert etc. is given below. The list will be further refined based on
discussions with medical specialists/expert. It will be a comprehensive list including most of the
undergraduate subjects.

Proposed Broad Areas Priority list of cases

Preclinical
● Upper limb: Carpal bones- Scaphoid Fracture, Carpal tunnel
syndrome
● Lower limb: Specific area-Femoral Triangle - Femoral Hernia
● Thorax: Pleura- Pleural reflections, Pleural recesses & Applied
Anatomy Anatomy
● Abdomen: Portal Vein- Formation, course, sites of portocaval
anastomosis & applied anatomy related to Portal hypertension
● Head and neck: Thyroid gland- Capsule, Parts, Relations, Blood
supply, Nerve supply, Lymphatic drainage development and Applied
Anatomy
Paraclinical
● Tuberculosis: Identification, pathogenesis, susceptibility testing, lab
diagnosis, treatment, Prophylaxis
● S. aureus: Identification, susceptibility testing, Methicillin resistant S.
aureus, treatment
● Typhoid: Identification, pathogenesis, susceptibility testing, lab
diagnosis, treatment, Prophylaxis
● Dengue: Virology, serotype distribution, pathogenesis, Lab diagnosis,
complications.
● Sterilization and disinfection: Principle, types, uses, quality control
Microbiology ● Culture media: Principle, types, uses, quality control
● Malaria: Identification, pathogenesis, drug resistance, lab diagnosis,
treatment, complication, Prophylaxis
● Filariasis: Identification, pathogenesis, drug resistance, lab diagnosis,
treatment, complication, Prophylaxis
● Aspergillosis: Identification, pathogenesis, susceptibility testing, lab
diagnosis, drug resistance, treatment
● Candida spp.: Identification, pathogenesis, susceptibility testing, lab
diagnosis, drug resistance, treatment
● Cryptococcus spp.: Identification, pathogenesis, susceptibility
testing, lab diagnosis, drug resistance, treatment
● Neoplasia: Benign tumors, Malignant tumors
● Immunology: Hypersensitivity, Autoimmune, Primary
Pathology immunodeficiency
● Respiratory system: Interstitial lung disease, tuberculosis, lung cancer
● Liver: Autoimmune liver, Neonatal Cholestasis, Liver nodules,
● Renal: Glomerulonephritis, Tubulointerstitial Diseases
 ● Breast: Molecular Classification of Breast tumors
● Lymph nodes: Immunotyping of Lymphomas

Clinical

● Swelling: Examination of swelling or lump

● Ulcer: Examination of ulcer
General surgery ● Varicose vein: Examination of varicose vein
● Thyroid: Examination of thyroid
● Hernia: Examination of hernia
● Breast: Examination of breast
● Chest imaging: Principles and practice
● Ultrasound imaging: Principles and Practice
Radiodiagnosis ● Conventional radiology- GIT: Genitourinary and Hepatobiliary
systems
● Computer Tomography: Principles and Practices
● MRI: Principles and Practices

5- Key Objectives of the MedSIM 2.0:

o Students tolearn, practice andbe observedperformingskillsin a simulatedenvironment
o Design and develop Preclinical and Paraclinical Online Skills Lab
o Develop New Virtual Patient Case Simulations to cover the entire MBBS curriculum
o Aligned with MBBS Regulations 2020, National Medical Commission
o Enhance existing MedSIM platform with Authoring tool, Learning Analytics, Assessment &
Feedback
o Develop online training modules and conduct training
o 5000 medical students and 1000 medical faculty from about 500 medical colleges recognized by
National Medical Commission (NMC) 2020 will be trained with the use of MedSIM in their
curriculum. The system will be hosted with free access and can easily be used without formal
training
6- Implementing Agency of MedSIM 2.0
i. All India Institute of Medical Sciences, Bhubaneswar
ii. CDAC, Thiruvananthapuram
iii. Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala (Private Medical college hospital
under the National Medical Commission)
7- YouTube Videos of MedSIM 2.0:
⮚ Link for Video of existing project MedSIM 1.0:
https://www.youtube.com/watch?v=vqHk5O4AgXE
⮚ Link for Video of proposed MedSIM 2.0: https://www.youtube.com/watch?v=PF7ntEHGEOc
8- MedSIM publications:
⮚ https://ehealth.eletsonline.com/2013/06/medsim-medical-simulation-based-learning-using-virtual-
patients/
⮚ https://www.researchgate.net/publication/328654296_The_Medical_Virtual_Patient_Simulator
_MedSIM_-_an_initiative_under_eHealth_Digital_India
9- To improve the quality and simulation content (i.e. list of cases) of the MedSIM- Online Skills Lab
and Virtual Patient Cases system, a feedback form has been prepared for seeking the suggestion/views
on MedSIM enclosed at Annexure I.
Snapshots of MedSIM- Online Skills Lab and Virtual Patient Cases

MedSIM Home Page

 MedSIM Preclinical Online Skills Lab

MedSIM 2.0 Paraclinical Online Skills Lab

Key Highlights of MedSIM

 [Annexure I]

[MedSIM 2.0 Feedback/consultation for Medical Institutes]

Name of the Medical Institutes: _________________________________________________________

1. Can technology supplement enhanced learning of clinical skills in undergraduate medical

education? Select all that apply.
○ Virtual Patients can supplement Skills Lab
○ As a part of preclinical or paraclinical courses
○ As a part of clinical postings
○ All the above
○ Any other ________________________________________

2. Would simulation based platform helpful for medical students to enhance their clinical
reasoning and judgement skills?

(a) Yes (b) No

3. Interactive medical simulations and animations can increase the visual learning experience
and support training of medical students in your medical institutes.
a) Yes
b) No (Please give reason:__________________________________)

4. It is important to include Differential Diagnosis in Virtual Patients to learn to think

differentially about other similar diseases.
a) Strongly agree
b) Agree
c) Neither agree or disagree
d) Disagree
e) Strongly disagree (Please give reason:_____________________________________)

5. How did your institute conduct clinical teaching and practicals during the COVID-19
pandemic? Select all that apply.
○ Interactive platform with medically-accurate animations, simulations, videos, images (such
as https://medsim.in/ or any other)
○ Online meeting platforms (i.e. G Suite, Microsoft Teams, Zoom)
○ PowerPoint presentations
○ Digital pen and slate
○ Any other _____________________________________

6. Have you ever seen / visited MedSIM 1.0 portal ( https://medsim.in)?

(a) Yes (b) No
7. What other features would you like to have in MedSIM 2.0? Select all that apply.
○ Virtual Patients should be medically accurate, interactive
○ Clinical Cases using augmented reality, virtual reality
○ Differential diagnosis module
○ Short expert tutorial videos
○ Real-life interactive simulations
○ 2 D and 3 D animations
○ Others______________________

8. In what way can the MedSIM platform provide value in evaluating undergraduate medical
education? Select all that apply.
○ Clinical Formative Evaluation of Clinical Competencies using Medsim’s Virtual Patients
○ Summative Evaluation of Clinical Competencies
○ Formative Evaluation of pre and paraclinical skills competencies with MedSim
○ Summative Evaluation of pre and paraclinical competencies
○ Other ________________________________________

9. Please suggest a list of additional clinical cases you feel are important to add in MedSIM 2.0.
Project.

a. ________________________________________________________

b. ________________________________________________________

c. ________________________________________________________

10. Would your institution be interested in providing expert support to develop the pre-, para-
or clinical modules under the MedSIM 2.0
○ Yes
○ No
In case 'Yes', please provide name, contact details (Email, Mobile etc.)

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