InSimu Patient App, a simulator for medical students and doctors to diagnose virtual patients

Medical providers nowadays have more resources than ever when it comes to patient treatment and diagnosis thanks to the advancements in technology. 

A virtual patient is one of those technological advancements that can vastly improve patient care. It is a form of interactive computer simulation that is widely used by medical students as well as seasoned providers to simulate various aspects of patient care in contexts of healthcare education, electronic patient records, and clinical research. 

Virtual patients may take a number of different forms ranging from case presentations and interactive patient scenarios to manikins and AI patients.

As mobile devices are making their way into the medical field, the concept of virtual patient is being transferred to smartphones and tablets via numerous mobile apps.

We already reviewed few such apps that serve as clinical case simulations and virtual patient learning platforms for medical students and professionals, including Resuscitation app and Prognosis: Your Diagnosis app.

The app we review today, called InSimu Patient is similar. It works as a gamified virtual patient simulator for medical students and doctors helping them diagnose various clinical cases on their mobile device.

The app is free to download on Android and iOS, and this free version includes the limited number of available cases.

To unlock full functionality, users are required to purchase a Premium option which is available through monthly, half-yearly and yearly subscriptions ranging from $6.17/month to $9.85/month.

Each of the subscription plans offers a limited free trial period. For example, if users choose the monthly plan, they have the option to try all functionalities for 3 days, or if they've chosen the yearly subscription, they could try the app for free for two weeks. This is a good way to test the app and what it offers before the actual purchase.

Upon downloading and installing the InSimu app, the users would be presented with the first case of a 5-year old girl with a severe abdominal pain, mild fever, and vomiting.

The first suggested step is to check complaints, i.e. what the patients tell you (in case they are responsive). Here you can learn more about the onset, site, and time course of the symptoms the patient complained about.

In the next step, users can tap on the blue 'Plus' icon to order diagnostic tests or to make a diagnosis. Examinations are grouped under several categories, including History, Physical, Laboratory, Imaging, and Others.

History exams include various patient history tests, such as HEENT history, past medical history, general patient parameters and complaints, and so on.

Physical includes exams to test patient's general appearance, vital signs, and other physical exams related to the patient's symptom presentation (in the case of a 5-year old girl it is an abdominal exam).

In the 'Laboratory' category users can order various lab tests, such as blood work, endocrinology tests, fecal analysis, etc.
Imaging tests include all available diagnostic imaging techniques ranging from ultrasound to MRI to endoscopy, while 'Others' category offers various specialized tests such as biopsy, tuberculin skin test, and more.

Each of the tests that users can order has an estimated time required to be ordered and performed as well as the cost in USD $.
This is important because some of the cases feature patients with acute conditions that require urgent attention and diagnosis, so ordering unnecessary tests that may waste precious time would affect the patient outcome and the user's result.

After completing all necessary tests or figuring out what could be a problem with a patient, users can select the correct diagnosis from the list of the International Classification of Diseases (ICD-10). There's a search field that is more convenient than browsing through the alphabetical list of diseases.

After they selected the diagnosis, the app would inform the users if their diagnosis is correct, wrong, or not specific enough, with spent time and money, and list of performed and missed tests.

Users would also be rewarded with badges and experience (XP) points, which are calculated based on several factors, including the correct diagnosis, time and cost of the performed diagnostic tests compared to optimal, missed tests, and harmful tests ordered.

After completing the first case, the InSimu app will ask you to provide your educational status to help the app provide you with better content.

All available practice content is listed on the main page grouped into various categories,  some of which cover various specialties such as  Internal Medicine or neurology, while others cover specific diseases such as IBD, Overdose, or Difficult Ones (yes, that's the name of the category).

Choosing the category is reserved only for Premium users, while free users can pick a random patient/case. Users can also unlock some Premium cases by inviting up to 5 friends and receiving 7 days of Premium per invitee.

Besides cases available in the 'Practice' tab, users can choose to solve various challenges, such as Daily challenge, Pulmo mystery, Nephro mystery, and so on. To be able to complete some of these challenges, users need to perform certain steps, such as registering an account, completing their profile, or verifying their email address.

Solving these challenges may give users 100 to 500 XP points that will be added to the user's profile and help them level up.

Users can check their current achievements, diagnosed patients, and leaderboard with top users in the 'Profile' tab.

Besides access to various specializations the Premium subscription also provides users with a detailed feedback information after selecting the diagnosis.

However, one important thing is missing from both free and Premium version of InSimu app – the treatment recommendation after making the diagnosis.

Simply learning about the diagnosis is not enough, so a brief paragraph with treatment guidelines after a diagnosis is made would be an improvement.

Also, giving the investigation hints during the examination would be more than helpful to medical students.

Another problem I've noticed is repetitive cases. Despite the claims from the app developers that the users would get unlimited access to a pool of an infinite number of virtual patients, some of them with the same disease, but not the same symptoms, during the test I've only got cases that cover gastrointestinal diseases – two acute appendicitis, viral enteritis, and lactose intolerance.

Maybe this happened because I was using the app as a free user. However, it would be nice to see some diversity, even in a free version of the app.

The InSimu app is very easy to use, but there is a huge problem with the user experience. Each time after you completed the case, you'd get a full-screen pop-up ad to buy Premium. If you choose to skip it, you'd get another asking you to invite up to 5 friends. And this happens all the time.

Ok, I understand that you have Premium and that you need users to purchase it to keep the app going, there's plenty of apps who have that option too, but they do not remind us every second about it. This obtrusive approach becomes annoying really fast.  

Users should keep in mind that the app requires an Internet connection to work, which limits its use and scope.

The InSimu Patient Simulator is a fun app still a step behind other virtual patient simulator apps. 
There's a room for improvement, particularly the part with treatment recommendations which are an essential part of the diagnosis process, but currently missing from the app. Fixing this, as well as obtrusive Premium ads and case diversity, would certainly improve the app's overall impression.

Benefit: The app is intended for medical students, as well as seasoned clinicians