Introduction

Welcome to the Physical Therapy Interactive Case Study for the knee. The case study is comprised of two sections: subjective and objective. Both sections are followed by a diagnosis phase.

How This Test Is Scored

This virtual case study records a number of factors that can be used by your instructor to form a final grade. The first factor is time. You must complete the test during one sitting, for a good time score. When assessing your times in the results, remember that you shouldn't expect that the test will take exactly the same amount of time as an actual clinical case. Moreover, students who elect to take the text-based test will probably complete it faster, which will be taken into account by the instructor. Additionally, penalties are assessed for any unnecessary questions you ask or tests you order. The less relevant the question/test, the greater the penalty. You may want to record your patients answers on a notepad, as reasking a question will result in a penalty. The scoring data returned to you at the end of the test is not equal to your final grade. The degree to which these factors will be used to form a grade is at the discretion of the instructor.

How to Use the Test

In the subjective section you will use your computer to conduct an interview with a virtual patient. You should ask questions using natural, spoken language. When you ask a question, the patient will respond by trying to clarify your question. If one of the options the patient gives you corresponds to the question you are asking, you can click on the link to get a full response. You will not be assessed any penalty for an irrelevant question unless you click on the link to see the answer (and hence, you will not be penalized for questions the virtual patient doesn't understand). There are a certain number of questions that you must ask in order to be able to make a good diagnosis, and you cannot proceed until you have asked them.

When you are ready to enter your differential diagnosis, proceed to the differential diagnosis selection menu by pressing the "Check Hypothesis" button on the subjective interview page. The differential diagnosis section works much like a shopping cart for hypotheses. You can check to see if a diagnosis is available by typing it into the text box and clicking "add." The next screen will show you the closest matches available for the diagnosis you have entered. If one of the options matches the diagnosis you were looking for, you can add it to your shopping cart by selecting the radio button to the left of its name and pressing the "Choose" button. You can select the "delete" checkbox next to an item already in the cart and press "Update List" to remove a diagnosis. You may put up to five hypotheses in the cart, and you must have a minimum of two. Your cart must contain the correct diagnosis to proceed, and it must not contain any hypotheses that are grossly inaccurate.

In the objective section you will order any tests and/or measures necessary to confirm your differential diagnosis. Ordering tests and measures in this section works similarly to asking a question in the subjective section. Once you have gathered enough information to be certain of your diagnosis, you may proceed to the final diagnosis page.

To enter your final diagnosis, type it into the Final Diagnosis textbox and press the submit button. If your diagnosis appears on the list of recognized diagnoses, select it using the radio button to its left and press the "Choose" button. The final diagnosis section only allows you to choose one hypothesis, so be sure that you have chosen the correct diagnosis before entering it. Again, if you have not ordered enough tests to conclusively make a final diagnosis, the system will not let you proceed.

After the test is complete, you will receive a brief summary of your test results. The report is a combination of the number of unnecessary questions you asked the patient, the degree to which those questions were unnecessary (the penalties), the amount of time it took you to complete each section, and the number of attempts it took you to reach a correct diagnosis.

Working With the Virtual Patient

If you are having trouble getting the virtual patient to understand your question, you should check your spelling, as the patient doesn't understand misspelled words. The same applies to tests: if you can't seem to order a seemingly relevant test, you may want to try checking your spelling. If your spelling is correct, then you may want to try rewording your query. Rather than just changing the order of the words in your sentence, try thinking about what words in your question prompt the virtual patient for information.

If the patient seems to be having trouble understanding you, you may also want to examine your use of indefinite articles, as they can be confusing. Instead, replace them with the actual subject/object (e.g. replace the word "it" with the word "knee" if that is what "it" is referring to).

For example: You are trying to find the local burger joint, Joe's Burger Shack. If the question, "How do I get there?" doesn't produce a response, you might want to try rephrasing the question as, "Where is Joe's Burger Shack?" The word "where" is a simpler way (than "How do I get to...") to indicate to the patient that you are asking them about a location, and "Joe's Burger Shack" provides much more information to the patient than the word "there." Simple, clear questions are more likely to help the patient understand what you are asking. If you are still having trouble, try thinking of more general terms, like, "Where is a fast food restaurant?" Alternately, depending on your original question, you may wish to be more specific (e.g. You might want to try "Where is a fast food restaurant?" rather than "Where can I get something to eat?").