How To Come To Deliberate Practice With Virtual Patients For Clinical Reasoning?

How to come to deliberate practice with virtual patients for clinical reasoning? School of Health Professions Education

Bas de Leng, Jeroen Donkers, Soeren Huwendiek, Andrzej Prof. dr. Albert Scherpbier Kononowicz Krakow, June 5th, 2009

Faculty of Health, Medicine and Life Sciences

VPs for clinical reasoning  The virtual patients are based on a real cases where ‘premature closure’ had occurred.  Video of physical examination together with sounds of results.  No feedback on performance during work-up of case.  Built in CAMPUS, a cross platform and web-based program developed at Heidelberg University  Feature to rank diagnoses in the DD. Faculty of Health, Medicine and Life Sciences

Educational scenario: integration  All residents simultaneously worked out the same virtual patient.  Three times during the work-out a ‘time out’ was scheduled in which the residents discussed their diagnostic reasoning.  The logged actions of the residents and their notes were point of departure. Faculty of Health, Medicine and Life Sciences

Feedback tool  Feedback tool developed at Maastricht University compiled and fed back the logged actions of the individual residents.

Faculty of Health, Medicine and Life Sciences

Questionnaire on VPs Students’ questionnaire to evaluate their experiences with virtual patients. It contains twelve 5-point Likert Scale statements on the issues: 1. 2. 3. 4. 5.

Authenticity Professional approach Coaching Learning effect Overall judgment

Faculty of Health, Medicine and Life Sciences

Recidents perceptions of VP Issues that jeopardize the authenticity of VPs:  the impossibility to phrase your own questions during the history taking  the absence of a real observation of a sick patient to get an impression of the seriousness of the situation, and  that cases are contrived for educational purposes, making users feel that there has to be a catch. Faculty of Health, Medicine and Life Sciences

Questionnaire on Educational Scenarios Students’ questionnaire to evaluate their experiences with the integration of virtual patients. It contains twenty 5-point Likert Scale statements on the issues 1. 2. 3. 4. 5.

Teaching presence Cognitive presence Social presence Learning effect Overall judgment

Faculty of Health, Medicine and Life Sciences

Recidents perceptions of scenario  The small group discussions stimulated argumentation about clinical reasoning, and gave residents an impression of clinical reasoning of their peers.  During the group discussions the residents felt secure enough to openly discuss their shortcomings.

Faculty of Health, Medicine and Life Sciences

Conclusions  Both residents and clinical supervisor of a medical specialist training perceived a session combining individual virtual patient workup with ‘time out’ moments of small group discussions as a valuable learning activity for clinical reasoning.  The clinical supervisor found the presented teaching approach feasible for the medical specialist training at the workplace.

Faculty of Health, Medicine and Life Sciences