An online case-based teaching and assessment program on clinical history-taking skills and reasoning using simulated patients in response to the COVID-19 pandemic

Abstract

Background The COVID-19 pandemic has created unprecedented challenges for medical students and educators worldwide. Groups 1, 2 and 3 of year 3, semester 2 medical students at the Royal College of Surgeons in Ireland (n = 275) had only completed 2, 5 and 7 weeks, respectively, of their scheduled 10-week clinical medicine and surgery attachments, prior to the Irish shutdown of all in-person non-essential activities, including medical student education. Methods We developed and delivered an online case-based program, focused on history-taking skills and clinical reasoning, using simulated patients and video technologies. 12 tutorials were delivered over 6 weeks to 35 subgroups of 8 students in line with program learning outcomes. Both simulated patients (n = 36), and tutors (n = 45, from retired clinical professors to newly graduated physicians), were rapidly upskilled in Blackboard Collaborate and Microsoft Teams, and also in the provision of constructive feedback. We evaluated this newly developed program by the following three criteria: student attendance, achieved grades, and student feedback. Results Attendance at the 12 tutorials was higher amongst group 1 and 2 students (75 and 73%) by comparison with group 3 students (60%) (p = < 0.001). Of the 273 students that sat the Year 3 Semester 2 online long case assessment, 93% were successful. Despite group 1 students having the least prior clinical experience, results were similar to those of groups 2 and 3 (1st honors, 2nd honors, pass, and fail grades for group 1, 39%, 33%, 23% and 6%; group 2, 34%, 41%, 17% and 8%; group 3, 39%, 25%, 28% and 7%) (p = 0.48). An increased attendance rate at tutorials was associated with higher numbers of honors grades (p = < 0.001). Anonymous feedback from the students demonstrated considerable satisfaction with program: > 85% agreed that the online program was interactive and very educational. Conclusions Use of online video technology, tutors of varied experience, and simulated patients were demonstrated to replicate patient encounters, and to facilitate the development of clinical skills remotely during the COVID-19 pandemic.

The effect of case-based mobile virtual patient application on students’ academic achievement in clinical reasoning skills

“…The students, who mentioned more than one positive factor related to the practice, stressed its contribution to the learning of the story organization, along with their opinions that the presented stories and cases create a perception of reality. These findings provide additional evidence of the effectiveness of case-based learning in enhancing clinical reasoning skills, corroborated by studies [ 47 , 50 , 51 ]. According to the findings, the use of narrated case-based scenarios in the mobile virtual patient application actively engaged students in clinical reasoning and critical thinking before encountering real patients, aligning with Cook and Triola’s (2019) observations.…”

“…Furthermore, the results of our study align with existing literature in the field of health professions education, reinforcing the growing body of evidence that supports the effectiveness of digital tools in enhancing clinical reasoning skills. Similar improvements in clinical reasoning and other cognitive skills among students using interactive and technology-assisted learning methods have been reported (e.g [ 25 , 47–49 ]). This consistency with prior research not only validates our findings but also contributes to the broader understanding of how innovative educational technologies can be effectively integrated into healthcare education.…”

“…Considering the effectiveness of technology-mediated learning, student satisfaction has been identified as a critical factor [ 18 , 52 ], and student satisfaction is generally reflected in the academic success of clinical reasoning skills. Moreover, studies have shown that virtual patients enhance active learning, thereby fostering the development and assessment of clinical reasoning skills [ 25 , 47 , 53 ]. Based on all these results, it can be argued that in today’s world where mobile learning has become a new trend in health education, mobile learning can be an assistive technology to eliminate integration problems and to equip future health professionals with high-level knowledge and skills on subjects such as learning new medical procedures and treatment planning.…”

Student perception of the effectiveness of online comprehensive patient care teaching (Compact) tool.

“…Plenty of data is available on online/ web based skills learning in health professions education and there is ample evidence that learning individual skills is not only possible but also augmented by using such an approach. 3,11,12 However, our study is unique in the sense that no previous study has published student feedback data on teaching holistic patient care activities after integrating all the secondary skills in a single case on an online platform. Another study similar to ours has published data after online implementation of a similar case based approach but the management ComPaCT Professional Med J 2024;31(06):999-1003.…”

Adaptability of technology to address the learning gaps generated by the COVID-19 pandemic

“…493 cerse con los evaluadores, estudiantes y pacientes simulados o maniquíes en ubicaciones remotas o de manera virtual. Los ECOE pueden transformarse en VECOE (ECOE virtual), los pacientes simulados a distancia pueden facilitar el proceso de enseñanza-aprendizaje de habilidades de razonamiento clínico, comunicación y autoconfianza (7,8,9) . Será vital la recolección de las evidencias generadas por estos cambios y adaptaciones, así como las percepciones de los estudiantes, docentes, pacientes e instituciones a fin de identificar cuáles áreas de aprendizaje y evaluación de competencias representan un punto de quiebre y la posibilidad de mejora (10) .…”