PTSD/TBI: Using a Computer Tutorial to Teach Diagnostic Factors Jared Higley
What is PTSD? PTSD is an anxiety disorder that some people get after seeing or living through a dangerous event. National Institute of Mental Health There is a natural reaction to stressful or traumatic situations the so called fight or flight response In individuals who have PTSD, this response is abnormal or it is evoked in situations that are not usually perceived as threatening or stressful to the general population
Who is afflicted with PTSD? ANYONE! In general any person can be affected by PTSD However, it is generally seen in a few sub-populations of people War Veterans Sexual/Physical Assault Victims Accidents/Injuries Abuse Disasters Really anything that could cause a high stress load could potentially cause PTSD
PTSD and the Military According to the Veterans Administration, PTSD occurs in. 11%-20% of Iraq/Afghanistan War Veterans 10% of Gulf War Veterans 30 % of Vietnam Veterans Military Sexual Trauma (MST) 23% of women reported sexual assault when in military 55% of women and 38% of men reported sexual harassment while in military
What is a TBI? Traumatic Brain Injury The CDC describes it as A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain Can range from mild, a brief change in mental status or consciousness or severe, a extended change in mental status or consciousness Majority are the mild form
What causes TBIs? According to the CDC Falls (35.2%) Motor Vehicle Accidents (17.3%) Struck by/against Events (16.5%) Assaults (10%) cdc.gov
Who is at risk? ~18% of TBI related Emergency Department Visits are for children aged 0-4 years old ~22% of all TBI related hospitalizations occur in patients over the age of 75 Males are more often diagnosed (59%)
TBI and the Military Obviously because of the circumstances surrounding military conflict, soldiers are at a increased risk of developing a brain injury as compared to the average person It is estimated that between 10%-20% of the soldiers returning home from Iraq/Afghanistan have suffered a mild TBI.
Why do we care?
The Problem These diseases are often hard to diagnosis given that they usually don t present with a physical symptom. A missed diagnosis can lead to tragic outcomes for not only the sufferer but also those around them. All health care providers should be able to recognize the symptoms of these diseases and how to correctly address them
Our Solution We are developing a computer based tutorial to help teach the diagnostic factors. Our goal is to be able to have a student/provider use our tutorial, and in future be able to recognize the symptoms of PTSD/TBI
Development In order to develop the computer program, we first needed to collect data Led by John Linck, Ph.D., we have solicited opinions from experts in the field of brain injuries. They provided us with what they consider to be the symptoms that present most often in each particular disease
Symptoms
Calculating Probability Using Bayes Theorem we further analyzed our data to assess the probability that a particular symptom would correspond with a specific disease.
Bayesian Probability
Inter-correlations Next we inter-correlated the data in two ways Inter-correlations of the diagnosis Inter-correlations of the symptoms We did this in order to see how similar the data was to one another and also to compare with previous tutorials In order for the tutorial to work correctly there needs to be some distinguishability between the symptoms to facilitate a correct diagnosis
Inter-correlations
Inter-correlations
Tutorial Consists of Prototypes of each category that define the disease Exception being Unspecified Psychological Disorder 28 case vignettes Ordered in difficulty from easiest to most difficult Cases vary between individual users Gives feedback after every vignette Gives feedback at end of tutorial Percentage of questions in each category you answered correctly
Tutorial
Tutorial
Tutorial
Correct Response
Incorrect Response
How will we use this? We want to know how effective this tutorial is at teaching the diagnosis of these diseases. Measure how much the participant knows previously about the disease categories Complete the tutorial Measure how much the participant knows about the disease categories after completing the tutorial The difference in scores is theoretically the difference in knowledge gained from the tutorial
Pre/Post Test Utilizing the same examination to determine their previous knowledge and their knowledge after the tutorial Consists of 20 questions 13 were generated by the KBIT software Same format as the tutorial 7 were generated ourselves Different Format from what was generated by the tutorial
Results
Pre-Test Measurement of participants knowledge about subject previously Participants (n=13) on average answered 8.9 questions correctly out of 20 possible questions (44.5%) Standard Deviation of 2.2
Pre-Test
Post-Test We had ~6 people complete the pretest, tutorial, and post test. Not enough data to generate a definitive answer to our question However, every one who completed the tutorial had increased scores on their post test. On average, participants improved their score by ~75% over their pre-tutorial test
Post-Test
Post-Test
Post-Test While the tutorial is more well suited to help the participant become more adept at KBIT style questions. We also saw improvement in cases in which we generated ourselves. This table shows the percentage of questions participants got correct, broken down into categories
One thing to note The tutorial software itself can interpret how difficult a particular case is and its called the typicality of the case We looked at the questions regarding Depression that were generated by the KBIT software and included in the pre/post test examination One question had a typicality of 12.4 and 4 people answered correctly, and another had a typicality of 37.2 and 6 people answered correctly A general trend that the higher the typicality was, the more likely it was to be answered correctly, although not proportionally
Feedback about Tutorial Participants provided us with some feedback, and areas to improve The Unspecified Psychological Disease category Arbitrary distinction left up to participants judgment No prototype Malingering Category Difficult to say that about someone from just a vignette without more background information
The Future Have more participants in the pilot study Be able to make changes to tutorial before using it on a larger scale Look at the confusability of a particular question If people are missing the question, which answer are they most likely to pick? And Why? Be able to confirm that the tutorial is a legitimate way to teach this subject mater More data on the difference between how people score on the pretest vs. post-test
Questions?? https://dev.acdet.com/inst/ User: tutor003 PW: seatclip