An Avatar-Mediated Simulation CME Program: Improving Primary Care Physicians' Smoking Cessation Competencies

We propose augmenting a CME program for primary care practitioners (PCPs) using computer-based tutorials, interactive problem-solving exercises, and simulation with debriefing by pedagogical avatars, with the goal of improving PCPs' skills in smoking cessation. The pedagogical avatar — by improving credibility and persuasiveness — may enable physicians to review their interactions with virtual patients to evaluate their actions and receive feedback on how to improve future real-world clinical experiences with smokers. Additionally, it may augment an educational program that teaches physicians about smoking cessation strategies and together these approaches may constitute an effective, efficient method of evidence-based training that will influence behavior and improve patient outcomes. We will perform a needs assessment of physicians' practices in smoking cessation to provide an educational foundation for the training of PCPs in order to improve physician-driven cessation outcomes. This step will be followed by the design and development of an avatar-mediated simulation CME program in smoking cessation. We plan to evaluate the educational impact of the avatar-mediated simulation CME in smoking cessation on primary care physicians, and then disseminate the avatar-mediated simulation CME program. The project will directly target PCP's throughout the country that work with patients needing smoking cessation education. We will offer the convenience of online CME training with the added advantage of obtaining 4.0 AMA CME credits.


Virtual Avatar Coaches for Behavioral Therapy of Patients with Overactive Bladder

Health care provider-led behavioral therapy coaching, such as behavioral therapy for overactive bladder (OAB), is superior to static educational methods, but requires time and personnel. Avatars are digital representations of human (anthropomorphic) characters that can resemble (homophilous) study subjects present in a simulated three-dimensional virtual environment. As dynamic surrogate coaches, avatars can enhance and personalize static self care materials to modify behavior. Our objective is to evaluate the impact of customized virtual reality digital representations of humans using known effective therapy to modify behavior and improve outcomes. We will to test the effectiveness of avatar coaches in improving OAB quality of life and symptoms in middle age and older adults. The purpose of this study is to evaluate anthropomorphic and homophilous avatar-enhanced educational programs to teach patients behavioral therapy and compare it with versions of the program enhanced with non-homophilous avatars and versions without avatars with the goal of improving patients' quality of life, symptoms, self efficacy, and adherence to behavioral therapy.


An Avatar-Mediated Patient Self-management Program in Oral Anti-diabetic Medications

We propose to develop and evaluate an avatar-mediated intervention to train diabetic patients about their use of oral anti-diabetics (OADs) and test the intervention as a method to improve diabetes knowledge, problem solving skills, attitudes and beliefs regarding OADs. We propose augmenting patient interactions with mentoring and debriefing by pedagogical avatars, with the goal of improving their self-management knowledge and skills in managing OADs. The pedagogical avatar, by improving credibility and persuasiveness, may enable patients to review their interactions with the interactive program to evaluate their actions, and receive feedback on how to improve future real-world clinical experiences. It may augment a self-management program to teach patients about OADs constituting an effective, efficient method of self-management that influences behavior and improve patient outcomes.


Avatars-Mediated Training for Community Reintegration of Returning Veterans with PTSD

The aim of this pilot, single group design, with pre and post tests, is to assist the community reintegration of female veterans returning from Iraq and/or Afghanistan. Our goal is to answer the following question: Does an e-learning avatar-mediated multimedia training program improve veterans' identification and prevention of community reintegration problems? We will accomplish this through an avatar-based multimedia e-learning program that will provide coping strategies, present problem solving scenarios, and present real life simulated encounters. The veteran would navigate and interact with digital humans in everyday settings such as a grocery store, church, park, and while driving a motor vehicle. We will assess, learning, communication skills, arousal, and stress levels through real time physiologic monitoring, as well as through focus groups, semi-structured interviews, and open ended surveys. We believe this setting would provide for diverse community reintegration challenges for female veterans in a safe, engaging three dimensional environment that can replicated across the nation.


Computer Based Clinical Decision Support Enhanced by a Just-in-Time Training System for Continuum Professional Development (JIT CPD)

The goal of this project is to work with VA primary care practitioners (PCPs) to narrow gaps in the management of older veterans with modifiable cardiovascular risk factors. The intervention will consist of an innovative prototype CPRS-based Clinical Decision Support (CDS) system enhanced by a Just-in-Time training Continuous Professional Development (JIT-CPD) strategy that will result in improvement in PCP's competence, better practices in cardiovascular risk management and clinically meaningful improvements of veterans' health status. This project will consist of four defined periods: PREPARATION, including a workflow needs assessment, development of competency assessment tool, identification design and development of CDS and JIT CPD with AMA PRA Category 1 CME Credit; BASELINE, 6-month retrospective audit of medical records of 20 patients with one or more cardiovascular risk factors per PCPs; INTERVENTION, implementation of intervention in pre-post single group design including pretest competency assessment, training in the use of CDS and JIT CPD tools; and CLOSE UP, data collection and analysis of pre-post single group design. 


Self-Management Internet-Based Program for Older Adults with Overactive Bladder

Our team designed and developed the Overactive Bladder Self-Management Internet-based Program (OAB-SMIP) by incorporating proven behavioral interventions and social networking strategies into an internet based self-management program for older adults with OAB. The program combines internet-based multimedia e-learning tutorials with social networking and electronic tool components aimed at improving patient competencies for the management of OAB. The program trains older adults with OAB on: how to identify and modify the contributory factors of OAB; how to perform pelvic floor muscle exercises (PFME); and strategies to suppress urgency and recognize the side effects of medications. We have piloted our e-learning approach in patients with OAB and have found large positive effects in terms of pre-post changes in knowledge, self-efficacy, symptoms, and quality of life. We now propose a RCT to establish the efficacy of this approach and open the way to future studies of the equivalence of direct professional education of patient vs. e-learning methods combined with usual primary care.

We plan to conduct a randomized controlled trial among patients with overactive bladder comparing the effectiveness of the Overactive Bladder Self-Management Internet-Based Program (OAB-SMIP) with that of usual care for improving quality of life, knowledge, and self-efficacy and reducing OAB symptoms.