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Several authors have proposed modifications in the contents and in the educational methods in Medicine, by using resources that allow for more individual instruction and interaction on the part of the students, thus developing their criativity and boosting their active participation. In this way, personal computers have demonstrated its efficacy, combining low costs, high availability, easeaness to operate and to program, and offering sophisticated resources for educational aplications, such as colour graphs, sound effects and others. Among many other possibilities of aplication of the computers for educational purposes in the health sciences, clinical simulations is considered one of the most useful, and have been developed for specialized training and continuing education, on basis of its interactive mode and diversity of resources. The authors report here the development of a suite of computer-based simulations of medical management of burned patients in a plastic surgery service. The development of the simulations was made with the MEDTEST I system, which is a simple, flexible and effective generic authoring tool for IBM PC compatible microcomputers, developed in the Center for Biomedical Informatics, by one of the authors (R.M.E.S.). It is ideally suited for the building and presentation of all kinds of interative case simulations, that are written into a "script" file, using any ASCII oriented text processing program. MEDTEST I processes the text and manages the presentation to the student according to the command lines defined into the script file. The command language is very simple with only 30 easy-to-use commands. The program allows several types of questions: single multiple choice, repeated multiple choice, logical answers (Y/N) and open scalar or string responses. Textual or graphical information are presented by frames. Conditional jumps to other questions or frames are possible to each user response. It allows also the display of scoring, feedback and critique texts, etc.
The MEDTEST program was used to develop a set of 5 patient encounter simulation in plastic surgery emergency care: 1) thermal burns; 2) electrical burns; 3) chemical burns; 4) burns affecting the face; and 5) complications in burns. They represent common cases observed in a plastic surgery unit in our country and have been partly based on the experience of the second co-author of this paper. Approximately 20 hours of development were spent on each clinical case, including case generation, keyboarding and testing which is quite reasonable for the scope intended for the simulations. The simulations will be tested in an educational context directed to the plastic surgery students of an especialization course, using a pre defined protocol.
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