Abstract:
A method to assess the competency of a healthcare practitioner, wherein the method provides a learning object repository comprising a plurality of previously-created virtual objects, creates a first template and a second template by the second module, wherein the first template comprises one or more previously-defined learning objectives, and wherein the second template comprises one or more previously-defined competency assessments related to the one or more selected learning objectives. The method provides the first template and the second template to the learning object repository. The method displays on a visual display device a virtual clinical world comprising a plurality of virtual objects retrieved from the learning object repository. Further according to the method, a practitioner selects a virtual patient from the virtual clinical world, selects a series of interactions with the patient, and selects patient data. The method tracks the selected patient interactions, and the selected patient data.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    This Application claims priority from a U.S. Provisional Application having Ser. No. 61/162,597, which was filed on Mar. 23, 2009, and which is hereby incorporated by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates generally to assessing the complex clinical competencies of healthcare students and practitioners and more particularly to assessing such competencies while also improving students&#39; and practitioners&#39; skills and knowledge critical to improving clinical competencies. 
       BACKGROUND OF THE INVENTION 
       [0003]    In today&#39;s healthcare systems, worldwide, there is a need for healthcare providers with high levels of clinical competencies. This is true across the spectrum of healthcare systems, including systems in the United States such as individual hospitals, clusters of hospitals under health management organizations, outpatient clinics, primary care practices, and assisted living centers, but also the healthcare planning and delivery agencies such as the Local Health Integration Networks of Ontario, Canada, as well as in other regional healthcare planning and delivery agencies in other Provinces of Canada. 
         [0004]    Despite this clear and pressing need, there is still a lack of evidence-based frameworks for educational and training methods and materials that have a strong research base for developing such clinical competencies. The deficiencies of the prior art is a result from a plurality of factors. 
         [0005]    A first deficiency factor arises because care of patients occurs within clinical and home settings that have environments that vary in time and space, i.e. differing temporal and spatial heterogeneity. Extreme examples of temporal and spatial heterogeneity occur within battlefields as well as in emergency trauma environments. In both clinical and home settings, the circumstances of care, the number and types of care giving personnel, and the equipment used to deliver care may vary through time (e.g., moment to moment changes in circumstances as well as availability of personnel and equipment) and space (e.g., variation across location in terms of circumstances as well as availability of personnel and equipment). 
         [0006]    A second deficiency factor arises because an individual person with a disease or injury has physiological and psychosocial processes that also vary through time and within the space of their body. In short, there is tremendous complexity in the emergence of interactions between the temporal variability of both environment in which care is delivered and of the patient&#39;s physiological and psychosocial process. Evidence-based practice has been difficult to implement because of the multivariate nature of such emergence complexities between human physiological and psychosocial systems and the multivariate nature of healthcare interventions that must be implemented within the care giving setting for any particular disease or injury state. 
         [0007]    Yet, for healthcare students to become healthcare practitioners, and for healthcare practitioners to become clinical experts, both students and practitioners must develop higher order thinking that can be accurately applied in a timely fashion to make clinical decisions that improve patient outcomes. Together, such decisions constitute a domain of clinical judgment capacity for any healthcare providers and students. High quality clinical judgment is crucial for improved patient outcomes along the gradient from battlefields and emergency trauma units to healthcare settings that maintain a relatively stable quality of direct patient care and for patient&#39;s in such settings that have a disease or injury condition that is not rapidly changing. 
         [0008]    A third deficiency factor arises because the prior art does not provide solutions to the first two deficiencies in ways that allow measurement of at least two kinds of competencies, conceptual competencies and performance competencies. Here, we are using conceptual competencies as a thorough understanding of a knowledge and/or skills domain. Often conceptual competencies are further elaborated as: (1) competencies in which a person can describe how and why to use the knowledge or skill in different but appropriate contexts (generativity); and (2) competencies in which a person can describe how to use the knowledge or skill in situations that are unfamiliar (robustness). However, performance competencies are those competencies in which knowledge is acted on as an expression of a variety of behaviors and decisions or skills that are implemented in the real world or some very close simulation of the real world. In relation to the first two deficiency factors, within care delivery settings cognition will be shaped by the situated encounters in that workplace, which are dynamic and strongly influenced by social contexts as well as by a diverse array of other elements in the setting such as technology, temporal and spatial heterogeneity in the patient&#39;s condition, changing shifts of providers caring for the same patient, and ongoing coordination of many different tasks and decisions as well as health information management. Effective action requires development of pattern recognition capabilities as providers move from novice to expert. Such pattern recognition capabilities are critical to clinical judgment and decision-making during planning and implementing care. Often, the decision making unfolds in a “heuristically-guided” sequence. Yet, the prior art does not allow creation of customized environments in which healthcare students&#39; and practitioners&#39; conceptual and performance competencies can be measured automatically. Importantly, the prior art does not allow assessment of the completeness of pattern recognition development. For example, what is the probability that working in a serious game leads the student or practitioner users to tangential analyses and making decisions that are logical to the result of such analyses but that are flawed as pattern recognition? Importantly, the advances in social learning environment and social networking can be integrated into learning and training environment in the following ways: (1) focusing on students; (2) personalizing learning; (3) discovering experts; (4) distributing authorship; (5) liberating knowledge; (6) roaming and learning; and (7) creating accountability. Such integration opens new opportunities for building teaching-learning-assessment environments that may enhance competency development. 
         [0009]    A fourth deficiency factor arises because as healthcare students and practitioners engage in educational activities or training there must be adequate sampling of what they learn, what learning they retain, and what learning they can transfer into care giving practices. Interestingly, as both the care giving environment and the patient become more temporally and spatially heterogeneous, educators realize more completely the extreme importance of assessing spatial and temporal heterogeneity of the critical educational outcome variables that are supposed to measure an individual healthcare student&#39;s or practitioner&#39;s clinical judgment. 
         [0010]    A fifth deficiency factor arises because of the absence of a theoretical framework that drives an interpretive framework for development of clinical judgment that would inform selection of processes for data collection and analysis of students&#39; and practitioners&#39; learning outcomes, stability of these outcomes, and transferability of these outcomes to clinical practice. For example, even if the third problem described above can be addressed, current intelligence systems, data mining applications, and other analytical systems, have not captured the breadth and depth that temporal and spatial heterogeneity of care giving for complex patients in complex environments might have on development of clinical judgment. Furthermore, the prior art fails to provide empirically derived educational methods and materials that facilitate ongoing educational and training interventions likely to create opportunities for enhanced continuous quality improvement in clinical judgment. 
         [0011]    A sixth deficiency factor arises because even if the prior five deficiencies could be overcome, individual faculty members and staff educators do not agree on a singular theory of cognition or a theory of behavioral change. Consequently, the prior art fails to provide educational methods and materials that have the flexibility to accommodate any theory of cognition and a theory of behavioral change because each theory or theory combination would have particular types of educational activities and learning assessments as well as particular types and arrangements of educational scaffolding to support a learner within learning environments. 
         [0012]    Prior art educational methods and materials have tried to couple learning activities to learning outcomes assessments using knowledge-based systems, data mining applications, and other analytical systems to measure what has been learned, the stability of the learning, and students&#39; and practitioners&#39; abilities to transfer the learning to practice activities. However, these prior art methods fail to adequately sample at any one time, let alone along the time series in order to provide sufficient information to portray the likely impacts of educational methods and materials on the development of, the stability of, and the application of clinical judgment by healthcare students and practitioners (as measured by either conceptual or performance competencies). Furthermore, prior art methods do not allow the flexibility to customize teaching-learning-assessment environments in ways that would accommodate different theories of cognition or behavioral change resulting from educational interventions. 
         [0013]    The six prior art deficiency factors in combination are fundamental parts of the problem and contribute to a general failure to collect sufficient and high quality data on educational methods and materials, wherein the interpretation of such data can enhance the management of educational and training interventions and allow moving sensibly towards educational methods and materials empirically founded on evidence-based learning. Thus using prior art methods, it is not possible to analyze the trajectories of critical variables that shape the clinical judgment of healthcare students and practitioners, the stability of such judgment, the transferability of such judgment, and the subsequent enhancement of such judgment as the theory and praxis of healthcare planning and delivery is advanced. 
       SUMMARY OF THE INVENTION 
       [0014]    A method to assess the competency of a healthcare practitioner is presented. Applicants&#39; method provides a learning object repository comprising a plurality of previously-created virtual objects; a first module comprising a first computer processor, a first computer readable medium, and first computer readable program code encoded in the first computer readable medium; and a second module comprising a second computer processor, a second computer readable medium, and second computer readable program code encoded in the second computer readable medium. 
         [0015]    Applicants&#39; method further creates a first template by the first module, and a second template by the second module, wherein the first template comprises one or more previously-defined learning objectives, and wherein the second template comprises one or more previously-defined competency assessments related to the one or more selected learning objectives. Applicants&#39; method further provides the first template and the second template to the learning object repository. 
         [0016]    Applicants&#39; method then displays on a visual display device a virtual clinical world comprising a plurality of virtual objects retrieved from the learning object repository. A practitioner selects a virtual patient from the virtual clinical world, selects a series of interactions with the patient, and selects patient data. Applicants&#39; method tracks the selected patient interactions, and the selected patient data. 
         [0017]    An article of manufacture, such as a computing device, is presented, wherein that article of manufacture comprises a microprocessor, a computer readable medium comprising computer readable program code disposed therein to assess the competency of a healthcare practitioner. The computer readable program code comprises a series of computer readable program steps to effect communicating with a learning object repository comprising a plurality of previously-created virtual objects; communicating with a first module comprising a first computer processor, a first computer readable medium, and first computer readable program code encoded in the first computer readable medium; and communicating with a second module comprising a second computer processor, a second computer readable medium, and second computer readable program code encoded in the second computer readable medium; 
         [0018]    The computer readable program code comprises a series of computer readable program steps to effect receiving from the first module a first template, wherein the first template comprises one or more previously-defined learning objectives; and receiving from the second module a second template, wherein the second template comprises one or more previously-defined competency assessments related to the one or more selected learning objectives. The computer readable program code comprises a series of computer readable program steps to effect displaying on a visual display device a virtual clinical world comprising a plurality of virtual objects retrieved from the learning object repository; receiving via a data input device a selection made by a practitioner of a virtual patient from the virtual clinical world; receiving via a data input device one or more selections made by a practitioner of representing a series of interactions with the patient; and receiving via the data input device patient data selections made by the practitioner. 
         [0019]    The computer readable program code further comprises a series of computer readable program steps to effect tracking the selected patient interactions. The computer readable program code further comprises a series of computer readable program steps to effect tracking the selected patient data. 
         [0020]    A computer program product, is presented, wherein that computer program product is encoded in a computer readable medium, and wherein that computer program product can be utilized by a programmable computer processor to assess the competency of a healthcare practitioner. Applicants&#39; computer program product comprises computer readable program code which causes said programmable processor to communicate with a learning object repository comprising a plurality of previously-created virtual objects; communicate with a first module comprising a first computer processor, a first computer readable medium, and first computer readable program code encoded in the first computer readable medium; and communicate with a second module comprising a second computer processor, a second computer readable medium, and second computer readable program code encoded in the second computer readable medium; 
         [0021]    Applicants&#39; computer program product further comprises computer readable program code which causes said programmable processor to receive from the first module a first template, wherein the first template comprises one or more previously-defined learning objectives; and receive from the second module a second template, wherein the second template comprises one or more previously-defined competency assessments related to the one or more selected learning objectives. Applicants&#39; computer program product comprises computer readable program code which causes said programmable processor to display on a visual display device a virtual clinical world comprising a plurality of virtual objects retrieved from the learning object repository; receive via a data input device a selection made by a practitioner of a virtual patient from the virtual clinical world; receive via the data input device one or more selections made by the practitioner representing a series of interactions with the patient; and receive via the data input device patient data selections made by the practitioner. 
         [0022]    Applicants&#39; computer program product comprises computer readable program code which causes said programmable processor to track the selected patient interactions. Applicants&#39; computer program product comprises computer readable program code which causes said programmable processor to track the selected patient data. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0023]    The invention will be better understood from a reading of the following detailed description taken in conjunction with the drawings in which like reference designators are used to designate like elements, and in which: 
           [0024]      FIG. 1  is a block diagram of the Applicants&#39; method showing the modules comprising Applicants&#39; Competency Assessment System; 
           [0025]      FIG. 2  illustrates the basis of using the Learning Object Repository to build a Virtual Clinical World for assessing competencies within computer-based simulations of clinical scenarios; 
           [0026]      FIG. 3  is a flow chart summarizing the steps of the MOLT, MALT, Pathfinder, and DATUM modules of one embodiment of Applicants&#39; method; 
           [0027]      FIG. 4  illustrates Applicants&#39; FAST Subsystem modular capacities for creating different Virtual Clinical Worlds; 
           [0028]      FIG. 5  provides details of the MAL—Multiattribute Assessment in Latent-class module; 
           [0029]      FIG. 6  shows the Pathfinder and DATUM modules for one embodiment of the invention; 
           [0030]      FIG. 7  depicts using the Virtual Clinical World module within the Applicants&#39; Gateway subsystem within one embodiment of the Applicants&#39; method; 
           [0031]      FIG. 8  graphically illustrates the framework of the Pathfinder module; 
           [0032]      FIG. 9  graphically illustrates Applicants&#39; DATUM module and feedback through the Preceptor Report Dashboard within Applicants&#39; Gateway subsystem. 
           [0033]      FIG. 10  shows two sample screenshots of integration of learning experiences with social networking environment online (i.e., Facebook.com and Renren.com). 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0034]    This invention is described in preferred embodiments in the following description with reference to the Figures, in which like numbers represent the same or similar elements. Reference throughout this specification to “one embodiment,” “an embodiment,” or similar language means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the present invention. Thus, appearances of the phrases “in one embodiment,” “in an embodiment,” and similar language throughout this specification may, but do not necessarily, all refer to the same embodiment. 
         [0035]    The described features, structures, or characteristics of the invention may be combined in any suitable manner in one or more embodiments. In the following description, numerous specific details are recited to provide a thorough understanding of embodiments of the invention. One skilled in the relevant art will recognize, however, that the invention may be practiced without one or more of the specific details, or with other methods, components, materials, and so forth. In other instances, well-known structures, materials, or operations are not shown or described in detail to avoid obscuring aspects of the invention. 
         [0036]    Many of the functional units described in this specification have been labeled as subsystems or as modules in order to more particularly emphasize their implementation independence. In one embodiment of the invention, Applicants&#39; apparatus comprises two subsystems, the Architect and the Gateway. In such an embodiment, for example, a module of a subsystem may be implemented as a hardware circuit comprising custom VLSI circuits or gate arrays, off-the-shelf semiconductors such as logic chips, transistors, or other discrete components. A module may also be implemented in programmable hardware devices such as field programmable gate arrays, programmable array logic, programmable logic devices, or the like. 
         [0037]    Subsystems or modules may also be implemented in software for execution by various types of processors. An identified module of executable code may, for instance, comprise one or more physical or logical blocks of computer instructions which may, for instance, be organized as an object, procedure, or function. Nevertheless, the executables of an identified module need not be physically collocated, but may comprise disparate instructions stored in different locations which, when joined logically together, comprise the module and achieve the stated purpose for the module. 
         [0038]    Indeed, a module of executable code may be a single instruction, or many instructions, and may even be distributed over several different code segments, among different programs, and across several memory devices. Similarly, operational data may be identified and illustrated herein within modules, and may be embodied in any suitable form and organized within any suitable type of data structure. The operational data may be collected as a single data set, or may be distributed over different locations including over different storage devices, and may exist, at least partially, merely as electronic signals on a system or network. 
         [0039]    The schematic diagrams included are generally set forth as logical diagrams. As such, the depicted order and labeled steps are indicative of one embodiment of the presented method. Other steps and methods may be conceived that are equivalent in function, logic, or effect to one or more steps, or portions thereof, of the illustrated method. Additionally, the format and symbols employed are provided to explain the logical steps of the method and are understood not to limit the scope of the method. 
         [0040]    Although various arrow types and line types may be employed in the flow diagrams, they are understood not to limit the scope of the corresponding method. Indeed, some arrows or other connectors may be used to indicate only the logical flow of the method. For instance, an arrow may indicate a waiting or monitoring period of unspecified duration between enumerated steps of the depicted method. Additionally, the order in which a particular method occurs may or may not strictly adhere to the order of the corresponding steps shown. 
         [0041]    Recognizing that inadequacies of the prior art contribute to a general failure to collect sufficient and high quality data on educational methods and materials, the Applicants&#39; invention provides a computer-implemented method that: (1) allows a healthcare educator or trainer to select the parameters of a clinical simulation in which students or practitioners can work; (2) express the simulation as suites of learning activities, learning assessments, and educational scaffolding customized to fit dominant theories of cognition and behavioral change; (3) allows end users to engage in the simulation and collects data on each student&#39;s or practitioner&#39;s decisions within a simulation, analyzes these data, and provides as output a set of competency measures based on the students&#39; or practitioners&#39; decisions within the clinical simulations and, in some embodiments, while working within a social learning environment; (4) makes recommendations based on the interpretation of such data in ways that enhance the management of educational and training interventions and allow moving sensibly towards educational methods and materials empirically founded on evidence-based learning; and (5) makes it possible to analyze the trajectories of the critical variables that shape the clinical judgment of healthcare students and practitioners, the stability of such judgment, the transferability of such judgment, the potential for misconceptions being developed related to such judgment, and the subsequent enhancement of such judgment as the theory and praxis of healthcare planning and delivery is advanced. 
         [0042]    The Applicants&#39; invention is a system, a Competency Assessment System, comprised of two subsystems, the Architect and the Gateway. The Architect subsystem  200  comprises a plurality of modules. More particularly, embodiments of Applicants&#39; Architect subsystem  200  provide computer-implemented environments that effectively couple teaching, learning, and learning assessment opportunities with a research engine that allows rigorous development of evidence-based learning frameworks for education. Applicants&#39; method has been specifically designed for the education of healthcare students and practitioners. Applicants&#39; Architect subsystem  200  will meet the need for:
       1. Customization of learning environments to reflect educators&#39; and trainers&#39; preferences for certain theories of cognition or theories of behavioral change.   2. Learning environments that help healthcare students and practitioners develop broadly based clinical competencies in physiological and psychosocial domains (both conceptual and performance) within a framework of interprofessional collaborative patient-centered care, and along the gradient from relatively simple care to care delivered in situations of complex temporal and spatial heterogeneity in patient condition and in care planning and delivery.   3. Learning environments that use adaptive strategies to probe healthcare students&#39; and practitioners&#39; preferences to create customized learning solutions, but that also provide diagnostic feedback for improving learning, especially when particular preferences are maladaptive for learning.   4. Learning environments that do not increase workloads for faculty members or staff trainers, but instead allow instructors to refocus their attention and time on strategies that improve learning outcomes and retention and professional development of students and practitioners.   5. Learning environments that complement extant teaching-training systems such as manikin simulators and standard patient scenarios while at the same time providing authentic assessments of complex clinical complexities that have construct validity.   6. Evidence-based development of learning management system environments that meet rigorous standards for teaching, leaning, and assessment, such as those delineated by the Interprofessional Care Project of HealthForce Ontario as well as the US National Research Council, the Federation of American Scientists, and the US Institute of Medicine.   7. Coupled teaching-learning-assessment environments that automatically provide a research platform useful for developing and evaluating instructional methods and materials within a framework for evidence-based learning.       
 
         [0050]    By “practitioner,” Applicants mean a licensed healthcare provider. Such licensed healthcare providers include, without limitation, licensed physicians, licensed nurses, licensed paramedics, licensed nurse-practitioners, licensed physicians assistants, and licensed emergency medical technicians. 
         [0051]    The method of the invention combines teaching, learning, learning assessment, and research components that are integrated into a computer-implemented educational system that in some embodiments may be nested within social networking environments. In  FIG. 1 , we show one preferred embodiment of Applicants&#39; method in which the method of the invention is established within a Web-based that may be coupled to or nested within a social networking environment. Applicants&#39; method utilizes the Architect subsystem  200  that allows an instructor to create templates for clinical simulations within a Virtual Clinical World module  800 . A unique feature of this embodiment is its capacity for allowing an instructor to create customized clinical simulations for any group of end users, such as healthcare students and practitioners at different states of prior skills development or knowledge. These simulations are populated by learning objects from a Learning Object Repository  810 , with learning objects mapping into the customized templates. The Virtual Clinical World is then deployed through the Applicants&#39; method Gateway subsystem  900  ( FIG. 1 ) where the clinical simulations can be accessed by the target end users (i.e., healthcare students or practitioners). Applicants&#39; Architect subsystem  200  comprises computer readable program code encoded in one or more computer readable media encoding a series of data structures, such as and without limitation relational databases, flat files, HTML files, spreadsheet files, and the like, and user interfaces for Applicants&#39; FAST— Faculty Assembler for Specifications and Templates module  300  ( FIG. 1 ) that allow as shown in  FIG. 1  setting parameters in Applicants&#39;:
       1. MOLT—Mapping Ontology of Learning Templates module  400 ,   2. MALT—Multiattribute Assessment Latent-class Templates module  500 ,   3. Pathfinder—Adaptive Behavior Templates module  600 , and   4. DATUM—Data Analysis Templates for Ultrastructure Mining module  700 .       
 
         [0056]    In some embodiments of the invention, there also are distinct interfaces for the MOLT, MALT, Pathfinder, and DATUM modules that allow setting of parameters that increase customization of templates for clinical simulations. Applicants&#39; invention further comprises computer readable program code encoded in one or more computer readable media specific to each of the Pathfinder and DATUM modules ( 600  and  700  in  FIG. 1 ) of the invention to analyze the collected data from end users (i.e., healthcare students and practitioners) in order make data-driven decisions for improving learning and competency outcomes of these end users. The analytical algorithms include statistical procedures for establishing sampling regimes of end users&#39; choices as well as mapping and analyses of an end user&#39;s learning outcomes and competency performance within a clinical simulation. 
         [0057]    To provide more detail for this preferred embodiment, we describe how an instructor uses components of the Applicants&#39; Architect subsystem  200  as an authoring system for simulations within a Virtual Clinical World. The method of the invention establishes the FAST module  300  ( FIG. 1 ) as an authoring and management system, wherein that FAST module comprises a Faculty Assembler for Specifications and Templates. An instructor utilizes the FAST module to set parameters in four simulation modules: (1) MOLT module  400 —Mapping Ontology of Learning Templates; (2) MALT module  500 —Multiattribute Assessment Latent-class Templates; (3) Pathfinder module  600 —Adaptive Behavior Templates; and (4) DATUM module  700 —Data Analysis Templates for Ultrastructure Mining. 
         [0058]    MOLT module  400 .—This module receives input from Applicants&#39; FAST module and configures a learning map template for a clinical simulation. The MOLT module searches a catalogue of databases that provide modular sets of educational goals, objectives, and learning activities related to developing clinical competencies in healthcare. As an instructor establishes parameters in Applicants&#39; FAST module, instructions are received by MOLT to search for designated modular sets and then assemble a set of educational goals, and for each goal a set of learning objectives. 
         [0059]    For each established objective, Applicants&#39; MOLT module searches for and assembles a suite of learning activities. For each learning activity established, Applicants&#39; MOLT module interfaces with Applicants&#39; MALT module  500 , wherein the MALT module searches for a suite of learning or competency assessments related to the respective learning activity. Applicants&#39; MOLT module searches and queries a plurality of databases that associate educational goals, objectives, and learning activities. 
         [0060]    Using Applicants&#39; FAST module  300 , an instructor can select one or more parameters that allow Applicants&#39; MOLT module to establish the linkages that collect and collate a specific set of goals, objectives, and learning activities of interest to the instructor and appropriate for a particular end user audience. Because the FAST module also allows setting parameters for the MALT module and its learning-competency assessments, the MOLT module searches for and assembles the learning-competency assessments in MALT that were selected by the instructor in FAST. These learning-assessment competencies are then linked with their respective learning activities and become part of a learning map. 
         [0061]    The learning map is completed when the instructor finishes making selections using Applicants&#39; FAST module. That learning map comprises a template that is implemented in a Virtual Clinical World module (see  FIGS. 1 ,  300 ,  400  to  800 ). This implementation can vary across embodiments of the invention, but in one preferred embodiment, the learning map template is a hypervolume of linkages creating clinical simulations in the Virtual Clinical World. The hypervolume is populated by learning objects from Applicants&#39; Learning Object Repository  810 . Applicants&#39; Architect subsystem  200  employs search and mapping algorithms to locate the metadata or tagging of the learning objects, to select the tags that apply to specific template linkages, and then to populate the linkages to create the clinical simulations in the Virtual Clinical World. 
         [0062]    MALT module  500 —The Multiattribute Assessment Latent-class Templates module comprises an array of algorithms, relational databases, and other databases that contain learning and competency assessment suites. Although MALT&#39;s capacities could be nested within MOLT, in some embodiments of the invention a separate MALT module allows instructors more flexibility to select learning-competency assessments that best meet the needs of a particular group of end users. MALT is constructed as a set of search algorithms and a searchable catalogue of modular sets of learning-competency assessments, with each set containing learning and competency assessments items that fall along a gradient from novice to expert in clinical care. 
         [0063]    For example, in FAST an instructor might set MOLT to select goals, objectives, and learning activities suitable for teaching basic physical examination to beginning (novice) nursing students. Still working in FAST, the instructor might then set MALT to provide only a particular type of learning-competency assessment that is suitable for evaluating performance of beginning nursing students conducting a physical examination in a clinical simulation. In this embodiment, the separation of MOLT and MALT allows an instructor to select assessments more finely tuned to an end user&#39;s prior knowledge and skills levels. Furthermore, the flexibility of distinct MOLT and MALT modules would allow creation of different configurations of learning maps and assessments to provide different types and patterns of learning activities, learning assessments, and educational scaffolding specific to different cognitive and behavioral change theories. 
         [0064]    Pathfinder module  600 .—The Pathfinder module monitors end users as they work within a virtual clinical simulation. Pathfinder can be set within FAST to provide adaptive behavior and modification of the Virtual Clinical World in response to an end user&#39;s patterns of choices within the simulation. The Pathfinder module of Applicants&#39; Architect subsystem  200  responds to two real-world factors: (1) users of a system and the system&#39;s designers often have different expectations about the system; and (2) different users may have different preferences for to how move through a system. Such differentials can be reflected in users having to perform “costly” tasks in order to reach their goal. By “costly tasks,” Applicants mean that the number of steps involved is large, or some subtasks are difficult to understand or perform. In addition, such differentials can be reflected in different users having different navigational and problem-solving strategies while working in a clinical simulation. In various embodiments of the invention, Pathfinder improves the end user&#39;s movement through a simulation by modifying the simulation based on inferred semantics. 
         [0065]    As those skilled in the art will appreciate, a well-designed simulation avoids irrelevant and costly tasks, saves time to users, allows users&#39; choices to shape navigational schema, and increases users&#39; satisfaction. Applicants&#39; Pathfinder module identifies usage patterns and mutates the Applicants&#39; Virtual Clinical World in response to individual users&#39; access patterns. In certain embodiments, Applicants&#39; Pathfinder module assigns extra hyperlinks (called hotlinks) to simulation components. 
         [0066]    The hotlink assignment process consists of a set of algorithms that are executed in three stages. The first stage uses the access logs of the simulation to infer user access&#39;s patterns. The second stage consists of building complex data structures that represent the hyperlink structure of the simulation. The third stage assigns hotlinks to the simulation in such a way that the most popular paths for an individual user or group of users become shorter and thus more accessible to users. 
         [0067]    Applicants have discovered that, particularly in educational and training simulations within the Virtual Clinical World, it is desirable to provide a hotlink assignment algorithm to create mutations of a simulation based on the semantics dictated by user access patterns. Furthermore, in certain embodiments such virtual scenario mutations reflect important differences in users&#39; preferences for working within the simulation and these preferences can be mapped against best practices in clinical decision making that allow performance evaluation of the end user in a clinical simulation. 
         [0068]    In certain embodiments, a faculty member may want control over the degree of adaptive behavior of a simulation. Consequently, Applicants&#39; FAST module allows enabling the Pathfinder module to impose the instructor&#39;s choice of degree of adaptive behavior and subsequent simulation mutation in response to an individual end user&#39;s or groups of end users&#39; patterns of choice while working in the simulation. 
         [0069]    DATUM module  700 .—The DATUM module comprises a data collection and analysis engine for studying an individual or group of end users in regards to patterns of choices in a clinical simulation, as well as more complex mapping and mining of end user data related to learning-competency outcomes as complex functions of choices within simulations. Instructors using one preferred embodiment of the Applicants&#39; invention would use Applicants&#39; FAST module  300  ( FIG. 1 ) to set sampling regimes for data collection and the analyses of data collected. Applicants&#39; DATUM module receives the sampling parameters established by an instructor, and creates Data Analysis Templates of Ultrastructure Mining. These templates establish the sampling and analysis of data resulting from end users&#39; interactions within a clinical simulation in the Virtual Clinical World. Importantly, these templates also establish the sampling and analysis of end users&#39; choices about moving through the Virtual Clinical World and the mutations implemented by the Pathfinder templates 
         [0070]    To summarize, and with reference to  FIG. 1 , within Applicants&#39; Architect subsystem  200 , the FAST module  300  creates four customized templates, one each from the MOLT module  400 , the MALT module  500 , the Pathfinder module  600 , and the DATUM module  700 . In certain embodiments, each of the MOLT module  400 , the MALT module  500 , the Pathfinder module  600 , and the DATUM module  700 , comprises a computer processor, a computer readable medium, and computer readable program code encoded in the computer readable medium, wherein the computer processor utilizes the computer readable program code to perform the module functions described herein. 
         [0071]    Applicants&#39; MOLT module provides an educational framework of goals, objectives, and learning activities. Applicants&#39; MALT module provides learning assessments for each learning activity in the MOLT template. Applicants&#39; Pathfinder module establishes adaptive learning capacities for the end user working in the simulations of the Virtual Clinical World. DATUM provides a research template that establishes data collection and analysis frameworks for learning outcomes and adaptive behaviors of the end user working in the simulations of the Virtual Clinical World. 
         [0072]    Applicants&#39; four modules create a Virtual Clinical World  800  comprising clinical simulations. Applicants&#39; four modules search for and link to learning objects in the Learning Object Repository  810 . The Virtual Clinical World is then deployed within the Gateway subsystem  900 , which comprises a portal for end users to engage within the virtual world and its clinical simulations. 
         [0073]    In  FIG. 2  one embodiment of a Virtual Clinical World is partially portrayed. The MOLT, MALT, Pathfinder, and DATUM modules have linked to learning objects in the Learning Object Repository  810 . In this example, the linkages build the Virtual Clinical World as an outpatient clinic  815 , within which a patient can be selected  820 , and the patient visited in any of several clinic rooms, such as an exam room  825 . FAST would have been used to create a MOLT learning map, and educational goals, objectives, and learning activities would have been embedded in a MOLT module. The MOLT module would then have searched for these learning activities in the Learning Object Repository and assembled them as potential choices within the exam room in which a particular patient is nested. 
         [0074]    In  FIG. 2 , a student/practitioner could choose to select any of a plurality of learning activities, and then follow that first choice by a series of choices of other learning activities. However, the sequence of learning activities demonstrating the best clinical judgment would have been selected by an instructor who used the FAST module to enable MALT to provide opportunities to demonstrate clinical judgment. MALT would search for and assemble good and poor choices for working with the virtual patient and would create a multiattribute latent class assessment environment within the Virtual Clinical World. 
         [0075]    More specifically, there are multiple attributes of a particular clinical judgment that are latent (or hidden) to the student/practitioner. The student/practitioner must select from among essential and nonessential interactions with the patient and patient data, must correctly sequence activities, and must complete each activity with proficiency and demonstrate mastery of learning and skills outcomes or demonstrate a particular clinical competency. 
         [0076]    Tracking the student/practitioner choices within a teaching-learning-assessment environment becomes critical. By “tracking choices,” Applicants mean monitoring and saving the choices made by the student/practitioner. As the student/practitioner is working within the Virtual Clinical World and a particular simulation in that world, as shown in  FIG. 2 , Pathfinder is following the student&#39;s/practitioner&#39;s choices. Such tracking allows a trace of the student&#39;s/practitioner&#39;s movement through and engagement with various elements of a simulative environment. However, such tracking also can be used to create a more adaptive environment that adjusts the navigation in the Virtual Clinical World based on user preferences as demonstrated by prior choices in navigation and selection of learning activities, such as those shown in the navigation bar at the left of the GUI shown in the Virtual Clinical World exam room  825  as depicted in  FIG. 2 . 
         [0077]    In certain embodiments, as in  FIG. 2 , the Virtual Clinical World is expressed as an environment created within a Flex application. For this embodiment, the Virtual Clinical World is accessed by the student/practitioner through the Gateway which is connected to a learning management system hosted by an Educational Services Provider. 
         [0078]    The Pathfinder suite of algorithms for this embodiment has compiled the Virtual Clinical World with embedded programming code in the Flex application. Pathfinder recognizes and uses the code to track the user&#39;s presence in some portion of the n-dimensional space of the Virtual Clinical World. As an example of a specific embodiment, consider a Flex application compiled to provide a Virtual Clinical World for training healthcare students in interprofessional care, which for this embodiment we will call IPSim and which is deployed in the learning management system of the Educational Services Provider. The path tracking functionality of the IPSim system is achievable within the FAST module as the instructor selects Pathfinder options and Pathfinder then automatically inserts program code within the IPSim Flex application. This code will collect data on certain variables (e.g., location in simulation, time spent in a location) and send these data to databases within the server of the Educational Services Provider. In this example embodiment, the embedded data gathering code in the IPSim grabs information based on the code&#39;s intent, for example, educational module accessed, current page or position in n-dimensional space, time spent in that space. Such code may be written as below in Actionscript: 
         [0000]                                //Creates a new update track event with IPSim variables       var updateTrackEvt:UpdateTrackEvent = new       UpdateTrackEvent(model.curModuleId.toString( ) +“_”+       curNavigationID.toString( ) +“_”+ curPage.attribute(“id”).toString( ),       model.currSession);                    
This type of code shown above creates an object and then this object is dispatched to a data collating functionality in the server of the Educational Services Provider. In this embodiment, the data collating functionality captures the data sent by the code within the Flex application educational simulation as a student/practitioner is working within a particular part of this simulation. In this embodiment, the server of the Educational Services Provider would then organize the data for database functionality. A portion of such coding is shown below:
 
         [0000]                                            //Stores up UID           $uid = $_REQUEST[‘UID’];           //Build table name with uid and session number           $table = “uid”.$uid.“sn”.$_REQUEST[‘curSession’];                        
In this embodiment, the data collating functionality in the server then builds a SQL query entry with the obtained data and inserts these data as new database row entry, suggested by a portion of code shown below:
 
         [0000]                                            $insert = “INSERT INTO “.$table.” VALUES           (“‘.$_REQUEST[‘PID’].”’,CURRENT_TIMESTAMP(0));”;                        
Additional coding establishes connection between the data collation functionality in the server and the database functionality in the server. Once the connection is established, code inserts the data into the database.
 
         [0079]    The embodiment described above is a simple example. A unique and unobvious facet of the Architect subsystem is that the applicants use Model-driven Software Engineering to create multiple Domain Specification Languages (DSLs). These DSLs can be built for a large number of different types of simulative educational environments and become the foundation for the templates described for MOLT, MALT, Pathfinder, and DATUM modules. For the Pathfinder module, the DSLs provide multiple simulative environments with the most appropriate embedded tracking codes for the respective environment. Consequently, the Pathfinder templates represent a catalogue of different tracking patterns that are mapped to the templates for MOLT, MALT, DATUM, and so used to compile the Virtual Clinical World Module. 
         [0080]    Thus, the Pathfinder module allows the option to track a student&#39;s/practitioner&#39;s movement through a simulative environment and study that movement in the context of the each individual&#39;s performance on the MALT learning assessments. Additionally, the Pathfinder has an option to engage adaptive behavior functionality for the learning environment so that the environment adapts to an end user&#39;s preferences, with embedded tracking codes adjusting for a mutation in the navigational schema. 
         [0081]    Simultaneously with Pathfinder tracking of a student&#39;s/practitioner&#39;s engagement in learning activities within any part of a simulative environment, DATUM is following and recording both learning-competency assessment outcomes during student/practitioner interactions with simulated patients and patient data as well as following and recording Pathfinder&#39;s delineation of usage patterns and mutations of navigation to match these patterns. The parameters governing Pathfinder and DATUM were set by the instructor in the FAST module. 
         [0082]      FIG. 3  illustrates an instructor working within the Architect subsystem  200 . Applicants&#39; FAST module comprises an authoring and management system to define the templates that will create the Virtual Clinical World and how that world will behave in response to student/practitioner choices within the clinical simulations of that world.  FIG. 3  shows the MOLT module  400  being accessed and educational goals chosen by the instructor  410 . For each education goal, a set of learning outcomes 420 are selected and for each outcome a suite of learning activities  430 . Such choices create a MOLT learning map template, with choices by the instructor based on the specific educational needs of or training program designed for a target group of end users. 
         [0083]    The MOLT module also maps learning-competency assessments required for each learning activity into the MALT module  500 . Then, the instructor would use FAST to select particular learning-competency assessment items or clusters to create a MALT template. From the metadata or tagging of learning activities, their associated learning-competency assessments are collated for the instructor. Because the assessment items range in suitability from novice to expert, the instructor sorts the assessment items by level of prior knowledge and skill, choosing those assessment items most suitable for the particular student/practitioner. The instructor selects assessment items for each learning activity using the Assessment Builder  510 . These items are then loaded into a MALT functionality  520  that establishes a cognitive taxonomy for the assessment items, as chosen by the instructor or staff trainer. In addition MALT establishes from the suite of assessment items a mapping to detailed item-specific feedback arrays for each item that will be available to the student/practitioner after they complete a learning assessment. Assessment items and their respective diagnostics feedback arrays are then placed into the Assessment Delivery Template  550  that interfaces with the Virtual Clinical World and simulations are deployed. 
         [0084]    In the illustrated embodiment of  FIG. 3 , the MALT module is integrated with the Pathfinder  600  and the DATUM  700  modules. The metadata and tagging of the selected assessment items allows a mapping into the DATUM module  700  and allows the instructor to set the types of data collection and analyses of the learning-competency assessments desired for the respective student/practitioner audience. 
         [0085]    The MALT module also interfaces with the Pathfinder module  600  providing the information from both MALT and MOLT on the levels of navigation within the simulations of the Virtual Clinical World. Instructor choices within FAST establish the MOLT, MALT, Pathfinder, and DATUM templates. These templates then create the substantive choices available in the Virtual Clinical World  800 . This process allows an instructor to create clinical simulations within a Virtual Clinical World that have been customized by the faculty member or staff educator for any individual student/practitioner or to any group of students or group of practitioners. 
         [0086]      FIG. 4  illustrates different instructor choices in one embodiment for the FAST module to create multiple clinical simulations ( 870 ,  871 ,  872 , and  873 ). A unique and unobvious feature of this capacity is that the FAST module in combination with a diverse Learning Object Repository can be used to create simulations with interfaces linked to the learning activities and learning-competency assessments ( 870 ,  871 ) that provide a variety of navigational levels as well as patient-end user interactions that include interactive video, text, images, and so on. However, FAST and a diverse Learning Object Repository can also be used to create 3-dimensional simulations wherein the student/practitioner moves, encountering and caring for simulated patient ( 872 ,  873 ). 
         [0087]      FIG. 5  illustrates elements of MALT module in one embodiment of Applicants&#39; invention.  FIG. 5  illustrates use of Applicants&#39; FAST module to select particular learning-competency assessment items or clusters to create a MALT template. Applicants&#39; MALT module has an Assessment Builder and within this Builder there is an element  520  that provides an authoring interface that allows an instructor to build assessment items as well as combine these items into learning-competency assessments. In the authoring interface  525  through  540 , as depicted in  FIG. 5 , an instructor codes assessment items by Category and Levels, which allow creation of a knowledge or skills-based taxonomy for any learning-competency assessment. The Categories and Levels can be chosen and modified by the instructor or staff educator by selection of parameters to allow expression of the teaching-learning-assessment environment within the framework of an of the dominant theories of cognition and/or dominant theories of behavioral change. 
         [0088]    Within the authoring interface MALT  520  an instructor can access libraries of folders containing assessment items  525  and within each folder locate specific sets of assessment items  530 . For each assessment item, an instructor can select or create a learning object associated with the respective item as well as detailed feedback for an end user. The feedback to end users includes but is not limited to: (1) information about why one or more responses were correct but others were not; (2) possible clinical or patient-care implications of not responding correctly to the respective assessment item; (3) learning resources to help the student/practitioner better understand the topics being assessed for learning mastery or competency demonstration; (4) the rationale for use of learning objects nested within an assessment item; (5) diagnostic information on strategies for working within the Virtual Clinical World; and (6) learning resources to help improve the student&#39;s/practitioner&#39;s understanding of clinical competencies explored within the Virtual Clinical World. 
         [0089]    From the metadata or tagging of learning activities in MOLT  400 , associated learning-competency assessments are automatically collated in MALT ( 500  to  540  in  FIG. 5 ) by an instructor setting parameters in MALT. Because the assessment items in MALT range in suitability across the gradient of users from novice to expert, the MALT authoring and management capacities allow the instructor to sort the assessment items by level of prior knowledge and skill, choosing those assessment items most suitable for the target student/practitioner, and organizing those assessment items into an assessment taxonomy. Again, such flexibility allows a faculty member or staff educator to use a preferred theory of cognition or behavioral change as a model for the educational framework expressed in the educational simulations with their respective learning activities, learning resources, and learning assessments. 
         [0090]    In so doing, the instructor associates assessment items for a learning-competency assessment, mapped directly to the learning activities chosen within MOLT, and tied to a diagnostic taxonomy that shows results of performance on the learning-competency assessment as well as providing diagnostic feedback to the student/practitioner in a taxonomic framework  540  selected by the instructor. Referring once again to  FIG. 3 , Applicants&#39; MOLT module  400  and MALT module elements  520 - 540  then each become a template added to the Assessment Delivery Template  550  in  FIG. 5 , which in turn feeds information to the Pathfinder  600  template and the DATUM  700  template. MOLT, MALT, Pathfinder, and DATUM then provide the algorithms and linkages to create a Virtual Clinical World  800 . 
         [0091]      FIG. 6  illustrates how an instructor would work on the FAST module  300 , engaging to set parameters in MOLT module  400  and MALT module  500 . Such settings establish the learning map in MOLT and the learning-competency assessments in MALT. In MALT  500 , we see MALT Templates, which comprise the information and algorithms necessary to create individual assessment items and to assemble the assessment items into a learning-competency assessment. The MOLT  400  learning map template and a MALT  500  template for a learning-competency assessment are then coupled to the Pathfinder  600  and DATUM  700  components. As shown in the embodiment of the invention represented by  FIG. 6 , FAST, MOLT, MALT, Pathfinder, and DATUM modules could reside in a single server or in connected servers organized in ways that permit a Virtual Clinical World to be loaded with learning objects from the Learning Object Repository in the Applicants&#39; Architect subsystem  200  (see  FIG. 1 ). The assemblage of these learning objects as directed by the algorithms of the MOLT, MALT, Pathfinder, and DATUM modules creates clinical simulations comprising Applicants Virtual Clinical World. The clinical simulations of the Virtual Clinical World can then be deployed from the Gateway subsystem  900 . Students/practitioners access the Gateway  900  through Web-based systems such as learning management systems or dedicated Websites. 
         [0092]    Furthermore, and as shown in  FIG. 6  for one preferred embodiment of the Applicants&#39; invention, the instructor can select parameter settings in the Pathfinder module  600  and thereby establish the characteristics of the adaptive response of Applicants&#39; Architect subsystem to student/practitioner patterns of choices within the clinical simulations of the Virtual Clinical World. These selections by an instructor create the Adaptive Behavior Templates  610  which then establishes the ability of Applicants&#39; Architect subsystem to monitor student/practitioner choices and adjust the clinical simulations. In some preferred embodiments of the invention, the monitoring and adjustment is implemented for each individual student/practitioner. However, other embodiments of the invention allow settings for individual students/practitioners, for subsets of the student/practitioner population for a particular set of clinical simulations, or for the entire population for a particular set of clinical simulations. 
         [0093]      FIG. 6  illustrates Adaptive Behavior Template  610  which delineates a set of pathways and navigational schema  620 . These pathways and navigational schema are based on the MOLT learning map as created by an instructor in FAST. The template for monitoring and adjustment then establishes the Adaptive Behavior Set  630 , which is loaded into the Virtual Clinical World  800 . 
         [0094]    In one of the preferred embodiments and as shown in  FIG. 6 , an instructor will set the parameters of the DATUM component  700 . The instructor&#39;s choices in FAST allow selection of a template  710  from within an array of algorithm suites for data collection and analysis. Applicants&#39; data collection and analytical algorithms comprise capacities for setting sampling regimes for sampling end users&#39; choices within a simulation as well as numerous types of statistical procedures that provide mapping and analyses of student/practitioner learning outcomes and competency performance within a clinical simulation. 
         [0095]    The template selection sets Sampling and Data Mining Patterns  720 . The Sampling and Data Mining Patterns establish patterns of Data Collection and Analysis  730  of data from students/practitioners as they work within the clinical simulations created in the Virtual Clinical World. The DATUM module is further modified by the instructor working in FAST so that an element of DATUM called Privacy-Protected Data Mining  740  allows privacy layers may be placed around the data mining of student/practitioner performance data and analyses of such data. The DATUM template then is combined with the MOLT, MALT, and Pathfinder modules such that the templates generated become the organizing principles for the Virtual Clinical World  800 . The templates drive construction of clinical simulations within the Virtual Clinical World by searching for and assembling the learning objects from the Learning Object Repository that map onto the parameters set by the instructor within FAST. 
         [0096]    In a preferred embodiment of the invention, an instructor creates a customized Virtual Clinical World that is then deployed through the Gateway subsystem  900 , as depicted in  FIG. 7 , which illustrates a diagrammatic representation of this deployment. Applicants&#39; Architect subsystem  200  interconnects to the Gateway subsystem  900 , and a student/practitioner utilizes a computing device that accesses the Gateway  900 . Applicants&#39; Architect subsystem  200  also opens a linkage between Gateway subsystem  900  and Learning Object Repository ( 200  to  910  in  FIG. 7 ) because the MALT module may comprise assessment items that use some of the learning objects that have not been loaded into the clinical simulations but exist in the Repository. The student/practitioner then can access and work within the clinical simulations of the Virtual Clinical World  920 . Within the Gateway subsystem, there are components that gather data on student/practitioner choices. One of these components is the MALT Data Acquisition Template  930 . This template monitors the assessment items of the learning-competency assessment established by MALT and loaded into the Virtual Clinical World along with learning objects used in the assessment items but not found in the clinical simulations of the virtual world. As a student/practitioner encounters, engages with, and responds to assessment items, a performance record is maintained and sent to a second Gateway component, the DATUM Data Interpretation Template  950 . The DATUM Interpretation Template analyzes the performance record and creates the diagnostic feedback from the information provided by MALT. 
         [0097]    A third component nested in the Gateway subsystem as shown in  FIG. 7  is the Pathfinder Data Acquisition Template  940 . This Pathfinder template monitors student/practitioner navigational choices and selection sequences for engaging with simulation learning activities. This template analyzes these choices, places them into a sequence representing a map of the end user&#39;s choices, used weighted probability of location-time mapping, and then reconfigures the simulation navigation and learning activities to fit student/practitioner patterns of choice. 
         [0098]    The capacities for such analyses and mutations are built into the algorithms of the Pathfinder Adaptive Behavior Set that was used to construct the Virtual Clinical World (see  FIG. 6  pathway from  610  to  800 ). The Pathfinder Data Acquisition Template  940  in the Gateway subsystem diagram shown in  FIG. 7  also sends data to the DATUM Data Interpretation Templates  950 . Such Pathfinder data are analyzed through data mining methodologies that examine complex relationships between an end user&#39;s leaning-competency performance outcomes and that respective end user&#39;s navigational and sequence choices within the simulations. 
         [0099]    The DATUM Data Interpretation template  950  receives data streams from both the MALT Data Acquisition Template  930  and the Pathfinder Data Acquisition Template  940 . After analyses, the DATUM module feeds information about an end user&#39;s performances within a simulation to a Preceptor Report Dashboard  960 . This dashboard provides summary and diagnostic information on learning and competency outcomes to the end user. 
         [0100]      FIGS. 8 and 9  illustrate Applicants&#39; Architect subsystem  200  providing teaching, learning, learning assessment, and research capacities.  FIG. 8  illustrates Pathfinder module  600  monitoring different end user&#39;s choices through a clinical simulation.  FIG. 8  shows three Healthcare students interacting with a virtual patient within a clinical simulation. Once a patient has been selected, there are three available pathways a student could follow, A-C. Each of these pathways has five levels of navigation (1°-5°, in  FIG. 8 ). Student 1  selects pathway A  621 . Student 2  selects pathway B  622 . And, Student 3  selects pathway C  623 , with a crossover to pathway B. Pathfinder module  600  monitors each student and records usage patterns within the simulation. After a student works within a simulation a few times, Pathfinder reconfigures the simulation and navigation to meet usage pattern preferences of each student. Such reconfiguration or adjustment is mapped to a student identifier and when prompted or when a student subsequently re-enters the Virtual Clinical World the simulation will adapt to that student&#39;s usage patterns. 
         [0101]    However, although adaptive learning has many advantages, one disadvantage is that an end user may select a pattern of usage that is maladaptive for developing the higher order reasoning necessary for certain types of learning and competency outcomes. High resolution diagnostics for students/practitioners in a computer-implemented learning environment have been difficult to develop in educational materials, as evidenced by deficiencies in the prior art. Applicants&#39; Architect and Gateway subsystems combine data collection and analyses of end users&#39; choices with data collection and analyses of student&#39;s/practitioner&#39;s learning and competency outcomes. As depicted in  FIGS. 7 &amp; 8 , end user data from the Pathfinder Data Acquisition template  940  ( FIGS. 7 &amp; 8 ) flow into the DATUM Data Interpretation template  950  ( FIGS. 7 &amp; 8 ). Because of the complexity of exploring relationships between choices made within a clinical simulation and learning-competency outcomes, the DATUM module provides broader and deeper data mining and analytical frameworks for studying such complexity. 
         [0102]      FIG. 9  provides a diagrammatic representation of how:
       1. Parameters for MALT module  500  and Pathfinder module  600  are set through the FAST module  300  to create templates that become organizing algorithms for a Virtual Clinical World.   2. Parameters for the DATUM module  700  are set through the FAST module  300  to become a template of organizing algorithms for data analysis of end users&#39; choices and performances within the Virtual Clinical World.   3. Applicants&#39; Architect subsystem  200  comprises a DATUM element DATUM Data Interpretation Template  950 , which handles the data analysis of student&#39;s/practitioner&#39;s choices and performances within the Virtual Clinical World.   4. MALT Data Acquisition Template  930  and the Pathfinder Data Acquisition Template  940  direct collection of data from a student/practitioner using the Gateway subsystem and stream these data to the DATUM Data Interpretation Template  950 .   5. The DATUM Data Interpretation Template  950  sends information to the Preceptor Report Dashboard  960  within Gateway subsystem. This dashboard provides high resolution, detailed feedback and educational scaffolding to support improved learning and competency outcomes by end users.   6. The Preceptor Report Dashboard  960  within the Gateway subsystem provides a variety of support options, including but not limited to:
           a. detailed debriefing for end users;   b. analysis of the paths taken through simulations and the sequences of encounters and engagement with learning activities;   c. a study guide that provides diagnosis of performances on learning outcomes assessments as well as on competency demonstration assessments;   d. educational scaffolding to help end users find leaning resources related to the learning activities; and   e. suites of remediation and self assessment tools to help end users improve performance within the simulations.   
                 
         [0114]      FIG. 10  provides an example of three embodiments of the Applicants&#39; method in which a Virtual Clinical World has been complied and nested within a social networking environment on the Web. In  FIG. 10 , three social networking systems are shown with an example of a Virtual Clinical World nested within each. The graphic user interface (GUI) in the foreground shows a Virtual Clinical World nested within “facebook” environment. The GUI in the middle shows a Virtual Clinical World nested within “Kaixin,” while the GUI in the background shows a Virtual Clinical World nested within “Renren.” Since users in mainland China were blocked from using “facebook,” two Chinese corporations have partnered to produce “Renren” and “Kaixin” to provide social networking environments with much the same functionality as “facebook.” In the embodiments shown in  FIG. 10 , the teaching-learning-assessment activities of the Applicants&#39; method can be sensibly nested within social learning environments manifest within social networking capacities of “facebook,” “Renren,” and “Kaixin,” but the important point is that the Applicants&#39; method provides the flexible customization of competency assessment environments for healthcare students/practitioners in a diverse array of embodiments. 
         [0115]    In certain embodiments, Applicants&#39; invention includes an article of manufacture, such as for example and without limitation, a computing device, wherein that computing device includes computer readable program code comprising instructions residing in one or more computer readable media, wherein those instructions are executed by one or more processors to implement Applicants&#39; modules and methods as described and claimed herein. 
         [0116]    In other embodiments, Applicants&#39; invention includes computer readable program code comprising instructions residing in any other computer program product, where those instructions are executed by one or more computing devices external to, or internal to, Applicants&#39; server farm  310  ( FIG. 6 ) or Management Server encoding FAST  300  ( FIG. 6 ), to implement Applicants&#39; modules and methods as described and claimed herein. In either case, the instructions may be encoded in an information storage medium comprising, for example and without limitation, a magnetic information storage medium, an optical information storage medium, an electronic information storage medium, and the like. By “electronic storage media,” Applicants mean, for example and without limitation, one or more devices, such as and without limitation, a PROM, EPROM, EEPROM, Flash PROM, compactflash, smartmedia, and the like. 
         [0117]    While the preferred embodiments of the present invention have been illustrated in detail, it should be apparent that modifications and adaptations to those embodiments may occur to one skilled in the art without departing from the scope of the present invention as set forth in the following claims.