Use of a structured approach and virtual simulation practice to improve diagnostic reasoning

Abstract

Objectives In 2015, the National Academy of Medicine IOM estimated that 12 million patients were misdiagnosed annually. This suggests that despite prolonged training in medical school and residency there remains a need to improve diagnostic reasoning education. This study evaluates a new approach. Methods A total of 285 medical students were enrolled in this 8 center, IRB approved trial. Students were randomized to receive training in either abdominal pain (AP) or loss of consciousness (LOC). Baseline diagnostic accuracy of the two different symptoms was assessed by completing a multiple-choice question (MCQ) examination and virtual patient encounters. Following a structured educational intervention, including a lecture on the diagnostic approach to that symptom and three virtual patient practice cases, each student was re-assessed. Results The change in diagnostic accuracy on virtual patient encounters was compared between (1) baseline and post intervention and (2) post intervention students trained in the prescribed symptom vs. the alternate symptom (controls). The completeness of the student’s differential diagnosis was also compared. Comparison of proportions were conducted using χ 2-tests. Mixed-effects regressions were used to examine differences accounting for case and repeated measures. Compared with baseline, both the AP and LOC groups had marked post-intervention improvements in obtaining a correct final diagnosis; a 27% absolute improvement in the AP group (p<0.001) and a 32% absolute improvement in the LOC group (p<0.001). Compared with controls (the groups trained in the alternate symptoms), the rate of correct diagnoses increased by 13% but was not statistically significant (p=0.132). The completeness and efficiency of the differential diagnoses increased by 16% (β=0.37, p<0.001) and 17% respectively (β=0.45, p<0.001). Conclusions The study showed that a virtual patient platform combined with a diagnostic reasoning framework could be used for education and diagnostic assessment and improved correct diagnosis compared with baseline performance in a simulated platform.

Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice

“…From the 92 published studies, VS was reported to be applied in the educational practice involving undergraduate medical students across 25 countries including the United States [26 studies ( 15 – 40 )], the United Kingdom [9 studies ( 41 – 49 )], Germany [7 studies ( 50 – 56 )], China [6 studies ( 10 , 57 – 61 )], Denmark [6 studies ( 62 – 67 )], France [4 studies ( 68 – 71 )], Japan [4 studies ( 72 – 75 )], Sweden [3 studies ( 76 – 78 )], Canada [3 studies ( 79 – 81 )], Netherlands [3 studies ( 82 – 84 )], Spain [3 studies ( 85 – 87 )], Australia [2 studies ( 88 , 89 )], Singapore [2 studies ( 90 , 91 )], Korea [2 studies ( 92 , 93 )], Finland [1 study ( 94 )], Italy [1 study ( 95 )], Ireland [1 study ( 96 )], Colombia [1 study ( 97 )], Pakistan [1 study ( 98 )], Thailand [1 study ( 99 )], Iran [1 study ( 100 )], Poland [1 study ( 101 )], Mexico [1 study ( 102 )], Norway [1 study ( 103 )], Saudi Arabia [1 study ( 104 )], and Switzerland [1 study ( 105 )]. The distribution of included studies among different continents was shown in Figure 1 .…”

“…This finding suggested that VR might be a typical and popular representative of modern VS technology used in medical education. Moreover, only one third of (31) articles ( 15 , 16 , 22 , 26 , 31 – 33 , 38 , 47 , 48 , 52 , 53 , 56 , 58 , 60 – 62 , 64 , 65 , 67 , 71 , 73 , 75 , 76 , 78 – 80 , 95 , 96 , 101 , 105 ) included in this review were based on the commercially available or free VS softwares/platforms, the rest used the self-developed ones.…”

“…In addition to the above learning contexts and practical aspects, the remaining 18 articles ( 15 , 21 , 24 , 27 , 40 , 41 , 43 , 54 , 73 , 77 , 83 , 87 , 89 , 95 , 100 , 102 , 103 , 105 ) reported the integration of VS into other case-based learning experiences in virtual patient-care settings. Despite the diversity of virtual patient systems and clinical scenarios, these studies generally showed that VS-integrated case-based learning as a feasible teaching approach ( 54 ) could result in students’ learning gains, retention of information, and transfer of knowledge to clinical application ( 89 , 95 , 100 , 102 ), help future physicians improve diagnostic accuracy thus enhance the clinical reasoning teaching ( 15 , 27 , 43 ), extend students’ preparedness level for their future clinical experiences ( 40 , 83 ), facilitate empathy ( 24 ), cultural competence ( 77 ) and comprehensive clinical skills such as communication-based skills ( 21 ), clinical decision-making skills ( 78 ) within undergraduate medical education, and improve students’ confidence in managing clinical scenarios ( 41 ), thus was highly received by students ( 89 , 95 , 105 ).…”

“…Especially during the COVID-19 pandemic, this pedagogical modality avoided training interruption and was highly valued ( 41 , 87 , 95 , 105 ). Due to risk of COVID-19 exposure and required social distancing, the students’ clinical placements, face-to-face teaching and practical/lab sessions have all been limited even canceled in the pandemic situations, and a sudden and complete disruption in medical education has occurred ( 15 , 16 , 106 , 110 ). The restrictions due to COVID-19 raise the need for innovative medical VS teaching methods, which provide educational contents in a learning environment where lecturers and students separated by space or time or both ( 41 ).…”

Planning a Collection of Virtual Patients to Train Clinical Reasoning: A Blueprint Representative of the European Population

“…During the process, multimedia elements add authenticity to the VP scenario. Overall, several studies indicated that VPs have the potential to train students in clinical reasoning [7][8][9].…”