Can Virtual Patients Be Used To Promote Reflective Practice?

Can virtual patients p be used to promote p reflective practice p as part p of pediatric p t i trainees’ trainees ’ diagnostic di ti reasoning i strategies? t t i ? 3 4, Jörn 3,4 B de Bas d Leng L g1, Rene R van Gent G t2, Jeroen J D Donkers k 1, Frank F k Hess H Jö Heid H id4, JJean van Berlo B l 1, Cees C van der d Vleuten Vl t 1. 1

Questions

P Procedure d

How do H d residents id t perceive p i the th value l off a virtual i t l patient p ti t for f learning l i g clinical reasoning? How do residents perceive the value of a combination of small group di discussions i with ith virtual i t l patients ti t for f learning l i g clinical li i l reasoning? i g? How does H d the th clinical li i l supervisor i perceive i the th value l off a virtual it l patient a feedback tool and small group discussions for teaching patient, clinical li i l reasoning? i ? How does the clinical supervisor judge the feasibility of this teaching approach for the pediatric specialist training at the workplace?

Instruments 1 Two questionnaires developed within the e 1. e-ViP ViP project ((www.virtualpatients.eu) p ) a) Students Students’ questionnaire to evaluate their experiences with virtual patients. p i IIt contains i twelve l 5-point p i Lik Likert S Scale l statements on the h issues:  Authenticity A th ti ity  Professional approach  Coaching C hi g  Learning effect  Overall O ll judgment j dg t b) Students Students’ questionnaire to evaluate their experiences their experiences i with ith the th integration i t ti off virtual i t l patients. ti t It contains t i twenty 5-point 5 point Likert Scale statements on the issues:  Teaching T hi presence  Cognitive presence  Social S i l presence  Learning effect  Overall judgment

 All residents simultaneously worked out the same virtual patient, patient based on a real case where ‘premature premature closure’ closure during clinical reasoning had occurred.  Three times during the work work-out out of the virtual patient a ‘time time out’ out was scheduled sc edu ed in which c the t e residents es de ts discussed d scussed ttheir e d diagnostic ag ost c reasoning easo g together with the supervisor supervisor. The logged actions of the residents and their notes were starting g points p for the discussion.

M t i l Materials Virtual Vi t l patient ti t Based Based on a real case where ‘ ‘premature t closure’ l ’ had h d occurred occurred. Built in CAMPUS CAMPUS, a cross platform and web web-based based program developed at Heidelberg University, Germany. Feedback F db k ttooll  The logged actions of the individual residents were compiled and fed b kb back by y a web-based bb dp program g d developed l p d att M Maastricht t i ht U University, i ity the th Netherlands Netherlands.

2 A structured interview with the clinical supervisor 2.

Results 

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Issues that jeopardize the authenticity of VPs are:  the impossibility to phrase your own questions during g the historyy taking g  the absence of a real observation of a sick patient to g p get an impression p off the seriousness of the situation situation, and  that th t cases are contrived t i d for f educational d ti l purposes making users feel that there has to be purposes, a catch. t h

 The small group discussions made the session lively, stimulated argumentation about clinical reasoning and gave residents an impression of reasoning, clinical reasoning of their peers.  During the group discussions the residents felt secure enough to openly discuss their shortcomings shortcomings.

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Supervisor p perceptions p p “VPs VPs gave the possibility to design a case that p pinpointed p to a specific p learning goal: in a ‘clear clear-cut cut’ case, case f findings g slightly g y deviating g from f a usual presentation must trigger the resident to t k a more comprehensive take p h i approach.” pp h” “VPs VPs obliged all participants to be i di id lly active individually ti in i the th workup k p off th the same case case. This stimulated their thi ki g p thinking prior i tto th the di discussion i off th the case and made them eager to tell what th y had they h d done.” d ” “The The feedback tool gave a good overview i off the th development d l t off diagnostic idea’s idea s over time time, supported th moderator the d t iin organizing i i the th discussions but the slow performance discussions, impeded the flow of actions actions.”” “Developing Developing 40 VPs and applying them biweekly combined with small group discussions in 45 minutes sessions, would be a feasible teaching approach for the pediatric specialist training. training.”

Conclusion    1

Both residents and clinical supervisor of a medical specialist training perceived a session combining individual virtual patient workup with ‘time time out’ out moments t off smallll group di discussions i as a valuable l bl learning l i activity ti it ffor clinical li i l reasoning. i If we can speed up the procedure and/or the performance of the feedback tool tool, this instrument has great potential to facilitate the discussions on clinical reasoning. reasoning The clinical supervisor found the presented teaching approach feasible for the medical specialist training at the workplace.

Department of Educational Development and Research, Maastricht University, The Netherlands. 2 Máxima Medical Centre,, Department p of Pediatrics,, Veldhoven,, The Netherlands. 3 Center for Virtual Patients,, Medical Faculty y of Heidelberg g University, y, Germany. y 4 Heilbronn University, Germany.