Intelligent virtual case learning system based on real medical records and natural language processing

Abstract

Background: Modernizing medical education by using artificial intelligence and other new technologies to improve the clinical thinking ability of medical students is an important research topic in recent years. Prominent medical universities are actively conducting research and exploration in this area. In particular, given the shortage of human resources, the need to maintain social distancing to prevent the spread of the epidemics, and the increase in the cost of medical education, it is critical to harness online learning to promote medical education. A virtual case learning system that uses natural language processing technology to process and present a hospital's real medical records and evaluate student responses can effectively improve medical students' clinical thinking abilities.

Objective: The purpose of this study is to develop a virtual case system, AIteach, based on actual complete hospital medical records and natural language processing technology, and achieve clinical thinking ability improvement through a contactless, self-service, trial-and-error system application.

Methods: Case extraction is performed on a hospital's case data center and the best-matching cases are produced through natural language processing, word segmentation, synonym conversion, and sorting. A standard clinical questioning data module, virtual case data module, and student learning difficulty module are established to achieve simulation. Students can view the objective examination and inspection data of actual cases, including details of the consultation and physical examination, and automatically provide their learning response via a multi-dimensional evaluation system. In order to assess the changes in students' clinical thinking after using AIteach, 15 medical graduate students were subjected to two simulation tests before and after learning through the virtual case system. The tests, which included the full-process case examination of cases having the same difficulty level, examined core clinical thinking test points such as consultation, physical examination, and disposal, and generated multi-dimensional evaluation indicators (rigor, logic, system, agility, and knowledge expansion). Thus, a complete and credible evaluation system is developed.

Results: The AIteach system used an internal and external double-cycle learning model. Students collect case information through online inquiries, physical examinations, and other means, analyze the information for feedback verification, and generate their detailed multi-dimensional clinical thinking after learning. The feedback report can be evaluated and its knowledge gaps analyzed. Such learning based on real cases is in line with traditional methods of disease diagnosis and treatment, and addresses the practical difficulties in reflecting actual disease progression while keeping pace with recent research. Test results regarding short-term learning showed that the average score (P < 0.01) increased from 69.87 to 85.6, the five indicators of clinical thinking evaluation improved, and there was obvious logical improvement, reaching 47%.

Conclusion: By combining real cases and natural language processing technology, AIteach can provide medical students (including undergraduates and postgraduates) with an online learning tool for clinical thinking training. Virtual case learning helps students to cultivate clinical thinking abilities even in the absence of clinical tutor, such as during pandemics or natural disasters.

Keywords: Architectures for educational technology system; Artificial intelligence; Clinical thinking ability; Distance education and online learning; Virtual medical records.

Fig. 1

Proposed AIteach cases

Fig. 2

Virtual medical record generation process

Fig. 3

Proposed AIteach extraction process

Fig. 4

Proposed AIteach teacher case review interface

Fig. 5

Natural language processing logic diagram

Fig. 6

Performance metrics for HMM, (CRF), and MEM models on colloquial words

Fig. 7

Information distribution for AIteach virtual cases

Fig. 8

AIteach system’s double-cycle learning mode. The questioning scene is mainly to obtain medical history collection information, including history of present illness, past history, personal history, family history, and obstetric history. Physical examination includes: vital signs, general conditions (development, nutrition, face type, expression, and other aspects), skin and mucous membranes, lymph nodes, and other systems

Fig. 9

AIteach App system home page. Students can choose the learning cases on this interface (left picture). Students have virtual consultations in this scenario (right picture)

Fig. 10

Overall performance changes of all students before and after the virtual case study. After using AIteach (left picture), the average value of the overall case simulation training evaluation has been significantly improved. It also significantly improved under the multi-dimensional index evaluation (right picture)

Fig. 11

One student’s performance changes before and after learning multiple virtual cases