• DxR CASES – COMPUTERIZED PATIENT SIMULATIONS

Please work the following DxR cases while on this rotation:

• John Winter
• Carmen Rosette

DxR Cases

You can access the cases from any computer with Internet access.  The web site for the cases is:  http://dxr.lhl.uab.edu/. If you have any questions or need assistance, contact John Caldwell, PhD: email address jcaldwel@uab.edu or by phone 205-975-2479.

The following is a list of instructions and tips for completing the cases:

Each of your upcoming clerkships has a set of corresponding computerized patient simulations. These simulations are referred to as the DxR cases. The cases will provide you an opportunity  to practice your clinical reasoning and compare how you addressed the patient’s problem with how the clinician author addressed the patient’s problem.

A few thoughts to help your with the workups:

• You have NEVER seen these patients before
• You have NO previous medical records to give you information.
• The program will evaluate your workup by comparing it to the author’s workup.
• ALL program evaluations are biased towards THOROUGHNESS. Therefore be thorough.

What your computer needs to run the program:

• Internet Explorer 5.0 or better or Netscape 4.7 or better. With Netscape change the font size to 10 to see the “ask” button.
• You can get IE 5 and Netscape 4.7 through: http://www.dpo.uab.edu/software/
• Quick Time installed to hear heart and breath sounds or view video clips. If you don’t already have it, you can get it through: http://www.apple.com/quicktime/download/

Let me walk you through using the program:

• When you access the DxR, you will see a drawing of a patient examination room.
• On the right side of the door is a listing of the various clerkships with patients waiting for you to see them. YOU ONLY HAVE ACCESS TO PATIENTS FOR YOUR PARTICULAR CLERKSHIP. (Sorry to shout, but the capitalized info is important).
• Click on the name of your clerkship. A picture will appear with pictures of all the patients you can see. Click on one you would like to see.
• The next screen gives credit for the program & has a statement “Click here to see the patient”. Do so.
• A little screen will pop up telling you about the screen resolution.  The minimum setting for the program to run is 800x600 with 16-bit color. If necessary do as it says and click “OK”.
• The next screen will show your patients fold & ask for your name & password.
• USE YOUR FIRST & LAST NAME AS IT APPEARS IN YOUR STUDENT RECORDS. FIRST LETTERS ARE CAPITALIZED; REMAINDER IS LOWER CASE (just like you write it).
• YOUR PASSWORD IS THE LAST (4) DIGITS OF YOUR SS#.
• Click “enter” & you should see a “Start” or “Continue” appear on the left side of the screen. Click it & off you go.

TIPS

• There is an online help button that appears in the lower left corner when you are working with the patient. It is helpful.
• When questioning about “present illness”, you will need to select a question & then click ask.
• You will need to designate your hypothesis after you have entered them.
• Designate a hypothesis & hold the “alt” key down when you select a question & press “ask”.
• Keep the “alt” key down and you can ask another question in the particular category without selecting your hypothesis again.
• You will have to repeat the above when you switch categories.
• The same seems to be true with the physical exam and use of instruments.
• HOWEVER if you are doing something within a question/instrument category and you are testing a different hypothesis, you should designate which hypothesis you are considering when – this is true always.
• In the physical exam section, the name of the instrument you selected and its location on the body will appear in the little boxes just above the patient’s image.
• To position the patient to hear heart & breath sounds or find a particular lab, see the online help. Help is the button in the lower left & you may need to hide some of your browser toolbars to see it.
• You can use the computer’s clipboard to “write” notes during your patient encounter. Just highlight the info you want to save and use the copy/paste function to save it to your “notes” which pops up when you click the Notes button in the lower left of the screen. This feature is very helpful when you want to review your patient findings.
• You may leave a particular patient case and return at anytime. You are encouraged to do so, particularly if you want to go look up information elsewhere. These patients are much more patient than your real patients are.

If you have any questions send me an email or call me. I will get to your request ASAP. I do hope you enjoy them.

John A. Caldwell PhD

L210B Volker Hall

University of Alabama School of Medicine

UAB

Birmingham, AL 35294-0019

Phone 205.975.2479

Fax 205.934.3278

E-mail jcaldwel@uab.edu