Implementing tutoring strategies into a patient simulator for clinical reasoning learning

Objective: This paper describes an approach for developing intelligent tutoring systems (ITS) for teaching clinical reasoning. Materials and methods: Our approach to ITS for clinical reasoning uses a novel hybrid knowledge representation for the pedagogic model, combining finite state machines to model different phases in the diagnostic process, production rules to model triggering conditions for feedback in different phases, temporal logic to express triggering conditions based upon past states of the student's problem solving trace, and finite state machines to model feedback dialogues between the student and TeachMed. The expert model is represented by an influence diagram capturing the relationship between evidence and hypotheses related to a clinical case. Results: This approach is implemented into TeachMed, a patient simulator we are developing to support clinical reasoning learning for a problem-based learning medical curriculum at our institution; we demonstrate some scenarios of tutoring feedback generated using this approach. Conclusion: Each of the knowledge representation formalisms that we use has already been proven successful in different applications of artificial intelligence and software engineering, but their integration into a coherent pedagogic model as we propose is unique. The examples we discuss illustrate the effectiveness of this approach, making it promising for the development of complex ITS, not only for clinical reasoning learning, but potentially for other domains as well. (C) 2006 Elsevier B.V. All rights reserved.