How to tell a patient’s story? Influence of the case narrative design on the clinical reasoning process in virtual patients

In the country presently, preclinical medical students are not routinely exposed to real patients. Thus, when they start clinical postings, they are found to have poor clinical reasoning skills. Simulated virtual patients (SVPs) can improve clinical skills without endangering real patients. This pilot study describes the development of two SVPs in endocrine physiology and their validation in terms of acquisition of clinical knowledge and student engagement. Two SVPs, Nandini Sharma (unintentional weight gain) and Sunil Yadav (polyuria), were created and published on the i-Human Patients platform through an iterative, interdisciplinary, and transdisciplinary collaborative process using the conceptual framework of Kim et al. (Kim S, Phillips WR, Pinsky L, Brock D, Phillips K, Keary J. Med Educ 40: 867–876, 2006). After internal and external peer validation, the SVPs were piloted on 40 students (20 students per virtual patient) over 2 wk. A cognitive pretest was conducted before exposure, and a posttest soon after. Faculty and student feedback were collected. Faculty found SVPs authentic, helpful as teaching-learning tools, and useful for giving feedback and for assessment. Students found SVPs more engaging than paper cases and helpful in developing clinical reasoning and in imparting clinical exposure. Pretest and posttest scores indicated knowledge gain ( P < 0.01). Although challenging to create, SVPs created on the i-Human Patients platform improved learning in endocrine physiology and were well accepted by students and faculty as a means to provide early clinical exposure. More SVPs can be developed through collaboration between stakeholder departments and integrated into the curriculum for greater benefit.

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Competency In Critical Care Nursing With Approach Methods Journal Sharing of Critical Care (JSCC) In Nursing Profession Students

STRADA JURNAL ILMIAH KESEHATAN ◽

10.30994/sjik.v9i2.361 ◽

2020 ◽

Vol 9 (2) ◽

pp. 686-693

Author(s):

Heru Suwardianto ◽

Vitaria Wahyu Astuti

Keyword(s):

Critical Care ◽

Patient Safety ◽

Exposure Assessment ◽

Clinical Reasoning ◽

Nursing Care ◽

Positive Impact ◽

Exam Score ◽

Reasoning Process ◽

Airway Assessment ◽

Primary Assessment

The results showed that most respondents had good critical nursing competency scores including primary assessment: airway assessment (53.8%); breathing assessment (56.4%); Circulation assessment (61.5%); Disability assessment (56.4%); and Exposure assessment (59%), professionalism (56.4%), critical nursing care competencies (79.5%), Clinical reasoning process (71.8%), Patient safety (61.5%) and critical care exam score (46.2%). The result of statistical test with Pearson test obtained that the primary assessment: airway assessment (ρ = 0.038); circulation assessment (ρ = 0.029); Exposure assessment (ρ = 0.023), competence of critical nursing care (ρ = 0.049), clinical reasoning process (ρ = 0.028) and patient safety (ρ = 0.001) have a significant relationship to the critical care exam score. The implementation of learning methods for journal sharing of critical care has a positive impact on competencies and results in good student competencies.

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Debriefing of virtual patient encounters: Systematic collection of nursing students clinical reasoning activities

10.7287/peerj.preprints.1172v1 ◽

2015 ◽

Author(s):

Carina Georg ◽

Elisabet Welin Henriksson ◽

Maria Jirwe ◽

Johanna Ulfvarson ◽

Nabil Zary

Keyword(s):

Nursing Education ◽

Nursing Students ◽

Clinical Reasoning ◽

Clinical Judgment ◽

Virtual Patient ◽

Learning Activity ◽

Virtual Patients ◽

Feed Forward ◽

Undergraduate Nursing ◽

Starting Point

Background. Studies have shown that nursing students have challenges in translating and applying their theoretical knowledge in a clinical context. Virtual patients (VPs) have been proposed as an adequate learning and assessment activity to improve clinical reasoning. Although feedback and debriefing are essential aspects to foster learning in medical simulation, few studies have explored systematic and theory anchored ways of supporting feed forward and debriefing based on student activity collected in a systematic manner. Objective. The aim of this study was to develop a systematic approach for collecting the nursing students’ clinical reasoning artifacts as they encounter virtual patients. Method. The Outcome-Present-State-Test (OPT) model for clinical reasoning was used as the starting point since it is an internationally common model used by faculty to plan for and design learning activities in nursing education (Pesut & Herman, 1999). Two virtual patients were developed using the virtual patient nursing design model vpNDM (Georg &Zary, 2014). Nighty-five participants from undergraduate nursing education encountered the VPs and the intervention was composed of the exploration of methods for tracking and collecting the participants’ clinical reasoning artifacts. Results. An instrument to collect the students’ clinical reasoning was developed. Artifacts are collected during the whole virtual patient encounter. The aspects collected are related to clinical judgment, nursing action, outcome and present states, cue logic and the client in context. The empirical demonstrated that the instrument was able to collect and expose quantitative and qualitative aspects of the students’ clinical reasoning. Conclusions. A method to systematically collect aspects of clinical reasoning during a virtual patient driven learning activity would allow purposeful feed forward and provide the necessary information for constructive debriefing sessions.

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Debriefing of virtual patient encounters: Systematic collection of nursing students clinical reasoning activities

10.7287/peerj.preprints.1172 ◽

2015 ◽

Author(s):

Carina Georg ◽

Elisabet Welin Henriksson ◽

Maria Jirwe ◽

Johanna Ulfvarson ◽

Nabil Zary

Keyword(s):

Nursing Education ◽

Nursing Students ◽

Clinical Reasoning ◽

Clinical Judgment ◽

Virtual Patient ◽

Learning Activity ◽

Virtual Patients ◽

Feed Forward ◽

Undergraduate Nursing ◽

Starting Point

Background. Studies have shown that nursing students have challenges in translating and applying their theoretical knowledge in a clinical context. Virtual patients (VPs) have been proposed as an adequate learning and assessment activity to improve clinical reasoning. Although feedback and debriefing are essential aspects to foster learning in medical simulation, few studies have explored systematic and theory anchored ways of supporting feed forward and debriefing based on student activity collected in a systematic manner. Objective. The aim of this study was to develop a systematic approach for collecting the nursing students’ clinical reasoning artifacts as they encounter virtual patients. Method. The Outcome-Present-State-Test (OPT) model for clinical reasoning was used as the starting point since it is an internationally common model used by faculty to plan for and design learning activities in nursing education (Pesut & Herman, 1999). Two virtual patients were developed using the virtual patient nursing design model vpNDM (Georg &Zary, 2014). Nighty-five participants from undergraduate nursing education encountered the VPs and the intervention was composed of the exploration of methods for tracking and collecting the participants’ clinical reasoning artifacts. Results. An instrument to collect the students’ clinical reasoning was developed. Artifacts are collected during the whole virtual patient encounter. The aspects collected are related to clinical judgment, nursing action, outcome and present states, cue logic and the client in context. The empirical demonstrated that the instrument was able to collect and expose quantitative and qualitative aspects of the students’ clinical reasoning. Conclusions. A method to systematically collect aspects of clinical reasoning during a virtual patient driven learning activity would allow purposeful feed forward and provide the necessary information for constructive debriefing sessions.

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