iHuman Patients Guide Student Manual

i-Human Patients Case Player Student Manual

Table of Contents

1. Student introduction to the i-Human Patients Case Player 3–6
a. History-taking and physical examination
b. Problem list
c. Problem statement
d. Creating a differential diagnosis
e. Plan
f. Summary
g. References
h. Customized case flow and instructions


2. Getting started 7–9
a. Login instructions
b. Watching videos
c. How to find an assigned case
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1. Student Introduction to the i-Human Patients Case Player

The i-Human Patients (IHP) Case Player is an Internet (cloud) application which enables students to
interact with virtual patients for the purpose of learning patient-assessment and diagnostic-reasoning
skills. With IHP, you will be able to independently interview, examine, diagnose, and treat virtual
patients and receive expert feedback on your performance iHuman Patients Guide.

The program is designed to help you achieve the following goals:
 Learn how to assess a patient, to ask the right questions and perform the right physical exams
for the patient’s problem, and to identify and organize pertinent findings.
 Learn a structured diagnostic-reasoning process, write a concise problem statement, select
and rank hypotheses (differential diagnoses), and order and interpret tests.
 Develop a treatment/management plan.
 Learn basic-science concepts that underlie the clinical aspects of the case.

Within each major section of the case you will be able to compare your work with the expert’s version.

History-taking and physical examination

Most clinical interactions begin with taking the patient’s history, a process that should be systematic
and complete. IHP will help you to develop question efficiency: that is, to limit your questions to those
that are appropriate for the patient’s chief complaint, associated symptoms, and pertinent past
medical history. The patient’s history is the subjective portion of the assessment. It reflects the
patient’s self-assessment and memory of events.
The physical examination is the next component of the patient evaluation. You will select and perform
various exams, as driven by the history of the present illness and any supportive information.
Again, while it is important to be comprehensive, your goal is to perform a targeted and efficient
physical examination by selecting only those exam components relevant to, and otherwise suggested
by, the patient’s presentation iHuman Patients Guide. The physical examination is the objective portion of the assessment:
Your findings should be measurable, accurate, and reproducible.
Throughout the process of conducting the history and physical exam, you should add any/all pertinent
findings to the problem list located along the left-hand side of the screen. The problem list can be
updated at any time as you proceed through these sections.
You can achieve greater efficiency in conducting the history and physical examination by developing
the differential diagnosis as you go. The questions you pose to the patient and the exam components
that you select will, in turn, help to further characterize and refine the differential diagnosis.

Problem list

The problem list is located vertically along the left-hand side of the screen. You will add key findings to
the list as you progress through the history and physical sections of the case.
Each entry should have no more than five words. You should attempt to translate the findings into
more precise medical terminology. Here are some examples:
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Patient says                                    Translation
Came on suddenly last night………………  Acute onset
It comes and goes………………… Episodic; recurrent
The pain is 9/10……………… Severe pain
Red blood in my stool……………… Hematochezia
Shortness of breath while lying flat……………… Orthopnea

Physical examination                 Translation
Swollen legs…………… Edema
Red…………………………………… Erythematous
Sleepy and slow to respond……………… Lethargic
Slurring words……………… Dysarthric
Seeing things……………… Visual hallucinations

The problem list should include all key findings (abnormalities) throughout the entire history-gathering
 Chief complaint
 History of current illness, including all associated symptoms
 Review of systems
 Past medical history
 Family history
 Social history
The iHuman Patients Guide problem list should also be inclusive of all key findings (abnormalities) throughout all aspects of
the physical examination:
 Vital signs
 Mental status
 General exam
Pertinent negatives, while clinically important, should not be listed on the problem list. They may be
entered in the Notes Section for your own review and planning purposes.
Each entry on the problem list is then ranked relative to the specific patient’s presentation:
 Most significant active problem (MSAP)
 Related
 Unrelated
 Unknown
 PMH/Resolved
Problem statement
The problem statement is a succinct paragraph that synthesizes the following:
 Patient identifiers; i.e., age, gender, race/ethnicity (if pertinent), critical PMH
Example: The patient, a 74-year-old black male with known coronary artery disease, presents
with . . .
 Presenting complaint/s
 Key findings translated into medical terminology
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The problem statement should be concise and complete, but not a simple restatement of the problem
list. Rather, key findings should be consolidated if they relate to the same problem or potential
diagnosis. For example, chest pain, shortness of breath, and smoking history might all be addressed
in the same sentence.
The number of words allowed in the problem statement will be limited. Do not construct the differential
diagnosis here, as it will be addressed in the sections that follow.
Selecting hypotheses: Creating the differential diagnosis
The next sections of the i-Human case involve the creation of a rank-ordered and prioritized
differential diagnosis. There are several steps in this process: iHuman Patients Guide
You will choose the organ systems relevant to the differential diagnosis for this specific case.
You will next select specific hypotheses (disease states or diagnoses) which would explain, or
account for, the patient’s presentation.
Hypothesis ranking:
After selecting your hypotheses, you will next rank them:
 Leading; i.e., the one (or two, maximum) hypotheses highest on the differential diagnosis
 Alternative; i.e., possible, but less likely hypotheses
 Additionally, each hypothesis may be marked as must-not-miss; i.e., a disease/condition,
which, if missed, could result in severe consequences, including the patient’s death.
Next you will choose appropriate diagnostic studies to test your hypotheses. You are not expected to
be an expert in diagnostic testing; in fact, you may have had little or no formal training in this regard.
However, much of this will call upon common sense. For example, if you are concerned that the
patient may have pneumonia or lung cancer, then ordering a chest x-ray may give you vast amounts
of information. Also, it can be academically rewarding to “virtually jump in” and diagnose patients in a
structured learning environment.
Associate tests with hypotheses:
After selecting diagnostic tests, you will be asked to associate each selected test with one or more of
your hypotheses. A test may not be ordered unless it is testing a hypothesis; that is, each test that you
order must have a purpose.
You will see how data derived from diagnostic testing can support or detract from a given hypothesis
and/or differentiate between various diagnoses.
The final step in the hypothesis selection and testing section is to designate the final diagnosis, as
based upon clinical data generated throughout the case development.
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It is the synthetic interpretation of all case data (history, physical, and test results) that allows you to
diagnose your patient!
In the world of i-Human Patients, it is the clinical reasoning leading up to the point of diagnosis that is
more important than obtaining the correct diagnosis. Uncertainty is a natural part of the practice of
Treatment / management plan
You will next write a treatment plan and, if appropriate, a long-term management plan.
The summary section contains the learning objectives for the specific case, important “take-away”
considerations and pearls — both clinical and basic-science — and a brief case summary and patient
The references section cites resources used by the case author, as well as useful media resources for
the student.
Customized case flow and student instructions
Student instructions are set at the time the case is assigned, not when the case is authored.
A given case can be used to satisfy many different learning objectives. For example, one instructor
might choose to emphasize the quality of a student’s patient-assessment skills; he/she might choose
to grade the student’s ability to select only history questions and physical-exam components
appropriate for the given patient’s chief complaint.
Another instructor might choose to emphasize the quality of the student’s problem statement; while
yet instructor might emphasize the student’s performance on embedded questions and exercises.
Cases need not utilize all of the features of the i-Human program. For example, a case can consist of
just a history, physical exam and problem statement. Similarly, a case can provide a preconstructed
history and physical exam and have the student focus solely on hypothesis selection and ranking.
A case can be assigned in learning mode or test mode. In learning mode, students will receive stepby-step feedback. Such feedback compares the student’s work product with that of the expert. As
well, the student’s selections are updated and brought into line with those of the expert so as to avoid
deviation too far from the design of the case. In test mode, no feedback is provided and the student’s
choices are not corrected.
Lastly, instructors can indicate whether embedded quizzes and exercises must be completed before
proceeding to the next section; and, within a given exercise group, whether the questions must be
completed in a set sequence, or completed by the student in any order.
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Getting Started
Login instructions
1. A link will be sent to your email address. Click on the link and select a unique password.
2. Go to www.i-human.com and click on the LOGIN button.
3. Enter your email address and password. If you forgot your password, click on the Forgot your
password? link and follow the instructions.
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Watch the training videos
Watch the five screencast video tutorials to learn how to play an i-Human Patients case. Familiarizing
yourself with the complete student experience first will help you become a better case navigator!
Find and select your case assignments
To find your case assignment, click on the Assignments tab.
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To select your case assignment, click on the green arrow.
To launch your case assignment, click on Start Case. iHuman Patients Guide