Interactive clinical case as a modern virtual educational method for differential diagnosis of proteinuria in children

The article demonstrates the possibility of using the case method for teaching the diagnosis of rare diseases. The virtual diagnosis is based on clinical observation of a child with hiluria (ICD code: R82.0), which is caused by the formation of a lymphoureteral fistula against the background of a malformation of the lymphatic ducts. The difficulties of differential diagnosis of chyluria are due to the fact that it can manifest itself as high-level proteinuria with a decrease in albumin, blood immunoglobulins and the development of edema, i.e. a symptom complex of nephrotic syndrome.
The authors have developed a web application that allows a trained doctor to walk through the stages of the virtual diagnostic process, at each of which it is necessary to analyze the information provided about the patient and make a decision: determine a plan for further examination, «refer» the patient for consultations with specialists, while forming diagnostic hypotheses. The program allows you to evaluate the correctness of the choice of the student’s course of action and explain the error in making the wrong decision. As a result of completing the case, an integral score is calculated and displayed on the screen — the sum of points for correct answers to the questions asked. Repeated passage of virtual diagnostics, as a rule, increases the quantitative criterion, and most importantly, helps to consolidate the knowledge necessary for proper diagnosis. The interactive clinical case can be used to improve the skills of pediatricians, as well as in the process of teaching medical students and clinical residents as an additional tool. The use of the interactive case in the educational process makes it possible to acquire the skills of differential diagnosis within the framework of the presented clinical observation, in particular, to pay attention to the nature of changes in the lipid profile of blood and the physical properties of urine, especially in the case of atypical complaints in the patient. In addition, the presence of a training module in an interactive program, including animation to explain the pathogenesis, allows you to replenish knowledge on many aspects of hiluria.

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