Virtual patients in the acquisition of clinical reasoning skills: does presentation mode matter? A quasi-randomized controlled trial

Abstract

BackgroundThe objective of this study is to compare two different instructional methods in the curricular use of computerized virtual patients in undergraduate medical education. We aim to investigate whether using many short and focused cases – the key feature principle – is more effective for the learning of clinical reasoning skills than using few long and systematic cases.MethodsWe conducted a quasi-randomized, non-blinded, controlled parallel-group intervention trial in a large medical school in Southwestern Germany. During two seminar sessions, fourth- and fifth-year medical students (n = 56) worked on the differential diagnosis of the acute abdomen. The educational tool – virtual patients – was the same, but the instructional method differed: In one trial arm, students worked on multiple short cases, with the instruction being focused only on important elements (“key feature arm”, n = 30). In the other trial arm, students worked on few long cases, with the instruction being comprehensive and systematic (“systematic arm”, n = 26). The overall training time was the same in both arms. The students’ clinical reasoning capacity was measured by a specifically developed instrument, a script concordance test. Their motivation and the perceived effectiveness of the instruction were assessed using a structured evaluation questionnaire.ResultsUpon completion of the script concordance test with a reference score of 80 points and a standard deviation of 5 for experts, students in the key feature arm attained a mean of 57.4 points (95% confidence interval: 50.9–63.9), and in the systematic arm, 62.7 points (57.2–68.2), with Cohen’s d at 0.337. The difference is statistically non-significant (p = 0.214). In the evaluation survey, students in the key feature arm indicated that they experienced more time pressure and perceived the material as more difficult.ConclusionsIn this study powered for a medium effect, we could not provide empirical evidence for the hypothesis that a key feature-based instruction on multiple short cases is superior to a systematic instruction on few long cases in the curricular implementation of virtual patients. The results of the evaluation survey suggest that learners should be given enough time to work through case examples, and that caution should be taken to prevent cognitive overload.Electronic supplementary materialThe online version of this article (10.1186/s12909-017-1004-2) contains supplementary material, which is available to authorized users.

Comparative value of a simulation by gaming and a traditional teaching method to improve clinical reasoning skills necessary to detect patient deterioration: a randomized study in nursing students

“…Although our students were trained to use SCTs before the beginning of the session, the training lasted 5 min only and it may be that some students had not fully understood how to correctly answer the questions. Nevertheless, the mean student SCT score (57.8 to 58.9) and the mean expert SCT score (83.3) in our study are similar to those previously described in the literature, which suggests that our use of SCTs was correct [43]. In addition, self-assessment was equally used to assess the various steps of the nursing clinical reasoning process but this part is less validated, as it rests on student's perception only [20,24,39,47].…”

“…However, none of the abovementioned studies included a traditional educational modality as a control group. Moreover, an objective and quantitative assessment method such as SCT has rarely been used [43]. In education, the learning process can be explored using the learning levels described by Kirkpatrick [40].…”

“…In our study, we tried to explore the clinical reasoning skills and all different steps of the clinical reasoning process using firstly a method, i.e. SCT, which has been validated as an effective tool of assessing clinical reasoning skills [33][34][35][36]43]. The SCTs used in our study were related to the content and the educational objectives (clinical deterioration) of the serious games used by students.…”

“…This could be explained by the frequent online use of these games, which is more compatible with digital feedback [16,19,26]. In many studies, games are played in the presence of instructors who are able to interact with the players but surprisingly no standardized debriefing is performed [20,43]. It is therefore unknown if the addition of debriefing to the SG session is of any educational value or not.…”

A Rubric to Assess Students' Clinical Reasoning When Encountering Virtual Patients

“…Today, the dual process theory of clinical reasoning is often discussed in relation to clinical reasoning. The dual process can be broken down into two separate but interconnected processes that have been characterised as non-analytical (system 1) and analytical (system 2) reasoning (Audétat, Laurin, Dory, Charlin, & Nendaz, 2017;Croskerry, 2009;Norman et al, 2014;Schubach, Goos, Fabry, Vach, & Boeker, 2017) . The "non-analytical" (system 1) reasoning is a rapid, unconscious, intuitive process primarily driven by pattern recognition based upon prior experience.…”