Intelligent virtual case learning system based on real medical records and natural language processing
Authors: Wang Mengying , Sun Zhen , Jia Mo , Wang Yan , Wang Heng , Zhu Xingxing , Chen Lianzhong , Ji Hong 
Published: March 2022

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

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

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

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

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