given the major findings from the history and phy- sic'l examination, and then ... and Fortran on a Digital Equipment Corporation. VAX 11/750 housed in the ...
ABIM COMPUTER-BASED EXAMINATION SYSTEM
David B. Swanson, Ph.D. and George D. Webster, M.D.
American Board of Internal Medicine,Philadelphia,Pennsylvania
We will demonstrate a computer simulation of
given the major findings from the history and phy-
the clinical encounter developed in conjunction
sic'l examination, and then orders laboratory
with the Computer-Based Examination (CBX) Project
and investigative procedures, begins drug thera-
at the American Board of Internal Medicine (ABIM).
pies, requests surgical procedures, and observes
Over the past ten years, this research and devel-
the impact of his/her patient management selections
opment project has investigated the potential of
on the patient's "condition" as it evolves over
computer-based testing for use in the ABIM Certi-
simulated case time.
fying, Examination in internal medicine.
apies are ordered, the patient model simulates
drug-drug, drug-test, and test-test interactions
a
The CBX system includes three programs:
as appropriate.
case entry program, a case review program, and a test administration program.
When multiple tests and ther-
The cases are programmed to pre-
sent reasonable clinical complications:
The first uses a
these may
menu-driven data base management system for entry
evolve naturally or result from mismanagement of
and revision of case material. The case review system provides a mechanism for automatically
the case.
running through numerous prespecified methods for
downhill clinical course.
"managing" the simulated "patient" and verifying
time, choice of ambulatory or inpatient management,
The physician must react to complica-
tions appropriately or, as in real life, face a
Passage of simulated
The
use of the intensive care unit, "stat" ordering of
test administration program is what we propose to
laboratory tests, and other features of the clini-
that the computer model behaves as intended.
exhibit at SCAMC.
This program simulates the
cal environment are under the physician's control.
clinical encounter, including a physiological
The simulation currently contains over 800
model of the patient, a broad arsenal of drug and
therapies and laboratory tests.
non-drug therapies, and simulated laboratory faci-
sponses (primarily changes in laboratory test
lities through which the clinical course of patients
values) of a normal 31-year-old male
with a variety of disease entities is depicted.
ed therapies are built into the patient model.
The simulated patient's clinical course is altered
Cases are constructed by supplementing these normal
over time as a function of the physician-user's
clinical responses with case-specific information
management decisions.
The physician is initially
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to the includ-
which details the response of the simulated
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The clinical re-
patient's disease to various appropriate and inappropriate management strategies.
The latter
information specifies the response of the patient to the most likely therapeutic choices,
with normal clinical responses used to model the less likely choices.
A very simple physiological
model is constructed for each case.
Management
activities affect the physiological status of the patient through this model, with laboratory test values indexed to physiological status. Every effort is made to insure that the simulated
patient responds to management in the same way that a real patient would, thus providing an accurate simulation of the clinical decision
making environment for testing purposes. The CBX programs are implemented in Pascal
and Fortran on a Digital Equipment Corporation VAX 11/750 housed in the Philadelphia offices
of the ABIM.
The demonstration will consist of
a terminal linked via telephone line to the VAX
system.
CBX cases will be available for SCAMC
participants to "manage".
The latest version of
the system differs substantially from the prior ones in its "user-friendly", menu-driven interface
for examinee-computer interactions, in the use of
physiological modelling as a basis for determining therapeutic impact on laboratory tests, and in the
"production system" control structure for implementation of the event-driven simulation.
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