scholarly journals Scaffolding clinical reasoning of medical students with virtual patients: effects on diagnostic accuracy, efficiency, and errors

Diagnosis ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 137-149 ◽  
Author(s):  
Leah T. Braun ◽  
Katharina F. Borrmann ◽  
Christian Lottspeich ◽  
Daniel A. Heinrich ◽  
Jan Kiesewetter ◽  
...  
Keyword(s):  
Medical Students ◽  
Diagnostic Accuracy ◽  
Clinical Reasoning ◽  
Diagnostic Errors ◽  
Initial Assessment ◽  
Control Group ◽  
Diagnostic Efficiency ◽  
Virtual Patients ◽  
Or Efficiency ◽  
Electronic Learning Environment

Abstract Background Understanding clinical reasoning is a major challenge in medical education research. Little is known about the influence of scaffolding and feedback on the clinical reasoning of medical students. The aim of this study was to measure the effects of problem representation (cognitive representation of a clinical case) and structured scaffolding for reflection with or without feedback on the diagnostic efficiency and characterization of diagnostic errors of medical students. Methods One hundred and forty-eight advanced medical students were randomly assigned to one of five groups (2 × 2 design with a control group). They worked on 15 virtual clinical cases (five learning cases, five initial assessment cases, and five delayed assessment cases) in an electronic learning environment. After each case, they stated their presumed diagnosis and explained their diagnostic conclusion. Diagnostic accuracy, efficiency, and error distribution were analyzed. Results The diagnostic accuracy (number of correctly solved cases) and efficiency (solved cases/total time) did not differ significantly between any of the groups in the two different assessment phases [mean = 2.2–3.3 (standard deviation [SD] = 0.79–1.31), p = 0.08/0.27 and mean = 0.07–0.12 (SD = 0.04–0.08), p = 0.16/0.32, respectively]. The most important causes for diagnostic errors were a lack of diagnostic skills (20%), a lack of knowledge (18%), and premature closure (17%). Conclusions Neither structured reflections nor representation scaffolding improved diagnostic accuracy or efficiency of medical students compared to a control group when working with virtual patients.

scholarly journals The Effectiveness of Training on Auscultation of Heart with a Simulator of Cardiology in Medical Students

2021 ◽  
Vol 9 (E) ◽  
pp. 1055-1060
Author(s):  
Gulbakit Koshmaganbetova ◽  
Saulesh Kurmangalieva ◽  
Yerlan Bazargaliyev ◽  
Azhar Zhexenova ◽  
Baktybergen Urekeshov ◽  
...  
Keyword(s):  
Medical Students ◽  
Diagnostic Accuracy ◽  
Intervention Group ◽  
Control Group ◽  
Mitral Insufficiency ◽  
Training Module ◽  
Real Patient ◽  
Fourth Year Medical Students ◽  
Effectiveness Of Training ◽  
Clinical Conditions

Abstract The purpose of this study was to determine whether the training module with a simulator of cardiology improves auscultation skills in medical students. Methods. Medical students of the third year after completing the module of the cardiovascular system of the discipline “Propaedeutics of internal diseases, passed a two-hour or four-hour training module in clinical auscultation with retesting immediately after the intervention and in the fourth year. The control group consisted of fourth-year medical students who had no intervention. Results. The diagnostic accuracy in two-hour training was 45.9% vs 35.3% in four-hour training p <.001. The use of a cardio simulator significantly increased the accurate detection of mitral regurgitation immediately after training on a simulator (more than 73%) p <.001. The next academic year, regression was observed in the diagnostic accuracy of mitral insufficiency in the intervention group after six months of observation by 4%. The auscultation skills of students at the bedside of real patients did not increase after training on a simulator: the accuracy of diagnosis of the auscultatory picture of the defect was equally low in the intervention group and the control group (35.0% vs 30.8%, p = 0.651). Conclusions. Two-hour training was more effective than four-hour training. After training on cardiac auscultation using a patient’s cardiological simulator, the accuracy rate was low in a situation close to the clinical conditions and a clinic on a real patient.

scholarly journals Accuracy and usability of a diagnostic decision support system in the diagnosis of three representative rheumatic diseases: a randomized controlled trial among medical students

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Johannes Knitza ◽  
Koray Tascilar ◽  
Eva Gruber ◽  
Hannah Kaletta ◽  
Melanie Hagen ◽  
...  
Keyword(s):  
Decision Support ◽  
Medical Students ◽  
Diagnostic Accuracy ◽  
Rheumatic Diseases ◽  
Correct Diagnosis ◽  
Intervention Group ◽  
University Hospital ◽  
Control Group ◽  
First Case ◽  
Diagnostic Decision

Abstract Background An increasing number of diagnostic decision support systems (DDSS) exist to support patients and physicians in establishing the correct diagnosis as early as possible. However, little evidence exists that supports the effectiveness of these DDSS. The objectives were to compare the diagnostic accuracy of medical students, with and without the use of a DDSS, and the diagnostic accuracy of the DDSS system itself, regarding the typical rheumatic diseases and to analyze the user experience. Methods A total of 102 medical students were openly recruited from a university hospital and randomized (unblinded) to a control group (CG) and an intervention group (IG) that used a DDSS (Ada – Your Health Guide) to create an ordered diagnostic hypotheses list for three rheumatic case vignettes. Diagnostic accuracy, measured as the presence of the correct diagnosis first or at all on the hypothesis list, was the main outcome measure and evaluated for CG, IG, and DDSS. Results The correct diagnosis was ranked first (or was present at all) in CG, IG, and DDSS in 37% (40%), 47% (55%), and 29% (43%) for the first case; 87% (94%), 84% (100%), and 51% (98%) in the second case; and 35% (59%), 20% (51%), and 4% (51%) in the third case, respectively. No significant benefit of using the DDDS could be observed. In a substantial number of situations, the mean probabilities reported by the DDSS for incorrect diagnoses were actually higher than for correct diagnoses, and students accepted false DDSS diagnostic suggestions. DDSS symptom entry greatly varied and was often incomplete or false. No significant correlation between the number of symptoms extracted and diagnostic accuracy was seen. It took on average 7 min longer to solve a case using the DDSS. In IG, 61% of students compared to 90% in CG stated that they could imagine using the DDSS in their future clinical work life. Conclusions The diagnostic accuracy of medical students was superior to the DDSS, and its usage did not significantly improve students’ diagnostic accuracy. DDSS usage was time-consuming and may be misleading due to prompting wrong diagnoses and probabilities. Trial registration DRKS.de, DRKS00024433. Retrospectively registered on February 5, 2021.

scholarly journals Learning to diagnose accurately through virtual patients: do reflection phases have an added benefit?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maximilian C. Fink ◽  
Nicole Heitzmann ◽  
Matthias Siebeck ◽  
Frank Fischer ◽  
Martin R. Fischer
Keyword(s):  
Diagnostic Accuracy ◽  
Conceptual Knowledge ◽  
Diagnostic Process ◽  
Control Group ◽  
Strategic Knowledge ◽  
Virtual Patients ◽  
Visual Channel ◽  
Learning History ◽  
Simulation Based ◽  
Added Benefit

Abstract Background Simulation-based learning with virtual patients is a highly effective method that could potentially be further enhanced by including reflection phases. The effectiveness of reflection phases for learning to diagnose has mainly been demonstrated for problem-centered instruction with text-based cases, not for simulation-based learning. To close this research gap, we conducted a study on learning history-taking using virtual patients. In this study, we examined the added benefit of including reflection phases on learning to diagnose accurately, the associations between knowledge and learning, and the diagnostic process. Methods A sample of N = 121 medical students completed a three-group experiment with a control group and pre- and posttests. The pretest consisted of a conceptual and strategic knowledge test and virtual patients to be diagnosed. In the learning phase, two intervention groups worked with virtual patients and completed different types of reflection phases, while the control group learned with virtual patients but without reflection phases. The posttest again involved virtual patients. For all virtual patients, diagnostic accuracy was assessed as the primary outcome. Current hypotheses were tracked during reflection phases and in simulation-based learning to measure diagnostic process. Results Regarding the added benefit of reflection phases, an ANCOVA controlling for pretest performance found no difference in diagnostic accuracy at posttest between the three conditions, F(2, 114) = 0.93, p = .398. Concerning knowledge and learning, both pretest conceptual knowledge and strategic knowledge were not associated with learning to diagnose accurately through reflection phases. Learners’ diagnostic process improved during simulation-based learning and the reflection phases. Conclusions Reflection phases did not have an added benefit for learning to diagnose accurately in virtual patients. This finding indicates that reflection phases may not be as effective in simulation-based learning as in problem-centered instruction with text-based cases and can be explained with two contextual differences. First, information processing in simulation-based learning uses the verbal channel and the visual channel, while text-based learning only draws on the verbal channel. Second, in simulation-based learning, serial cue cases are used to gather information step-wise, whereas, in text-based learning, whole cases are used that present all data at once.

Diagnostic accuracy in Family Medicine residents using a clinical decision support system (DXplain): a randomized-controlled trial

Diagnosis ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. 71-76 ◽  
Author(s):  
Adrian Israel Martinez-Franco ◽  
Melchor Sanchez-Mendiola ◽  
Juan Jose Mazon-Ramirez ◽  
Isaias Hernandez-Torres ◽  
Carlos Rivero-Lopez ◽  
...  
Keyword(s):  
Decision Support ◽  
Family Medicine ◽  
Diagnostic Accuracy ◽  
Clinical Decision Support ◽  
Medical Practice ◽  
Intervention Group ◽  
Diagnostic Errors ◽  
Clinical Decision ◽  
Control Group ◽  
Family Medicine Residents

Abstract Background: Clinical reasoning is an essential skill in physicians, required to address the challenges of accurate patient diagnoses. The goal of the study was to compare the diagnostic accuracy in Family Medicine residents, with and without the use of a clinical decision support tool (DXplain http://www.mghlcs.org/projects/dxplain). Methods: A total of 87 first-year Family Medicine residents, training at the National Autonomous University of Mexico (UNAM) Postgraduate Studies Division in Mexico City, participated voluntarily in the study. They were randomized to a control group and an intervention group that used DXplain. Both groups solved 30 clinical diagnosis cases (internal medicine, pediatrics, gynecology and emergency medicine) in a multiple-choice question test that had validity evidence. Results: The percent-correct score in the Diagnosis Test in the control group (44 residents) was 74.1±9.4 (mean±standard deviation) whereas the DXplain intervention group (43 residents) had a score of 82.4±8.5 (p<0.001). There were significant differences in the four knowledge content areas of the test. Conclusions: Family Medicine residents have appropriate diagnostic accuracy that can improve with the use of DXplain. This could help decrease diagnostic errors, improve patient safety and the quality of medical practice. The use of clinical decision support systems could be useful in educational interventions and medical practice.

scholarly journals Using peer role-playing to improve students’ clinical skills for musculoskeletal physical examinations

2020 ◽  
Author(s):  
Kazuyo Yamauchi ◽  
Yoko Hagiwara ◽  
Nahoko Iwakura ◽  
Saori Kubo ◽  
Azusa Sato ◽  
...  
Keyword(s):  
Medical Students ◽  
Physical Examination ◽  
Clinical Reasoning ◽  
Clinical Skills ◽  
Role Play ◽  
Role Playing ◽  
Simulation Program ◽  
Control Group ◽  
Clinical Competency ◽  
Simulation Group

Abstract Background: The traditional curriculum for medical students in Japan does not include sufficient opportunity for the students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. So, the effective program requires to help medical students and residents improve these clinical skills about MSK. Our purpose was to assess using mini-CEX that these clinical skills of medical students have experienced peer role-playing simulation program.Methods: Participants were 90 women medical students who were completing their first orthopaedic clinical clerkship, were allocated into two groups. The simulation group encountered with role-play for MSK cases as low fidelity simulation, and a structured debriefing with the course supervisor including self- reflection at Day 1 (n = 64). The control group did not participate in the role-play due to clerkship schedule randomized (n = 26). We observed and assessed all participants’ performance at outpatient encounter using the mini clinical evaluation exercise (mini-CEX) when all participant encountered the first visit MSK outpatient at Day 2, and compared mini-CEX score between the simulation group and the control group. A statistical method was used Wilcoxon rank-sum test.Results: The Physical examination, the Clinical reasoning and Diagnosis, and the Overall clinical competency of the mini-CEX scores were significant differences in the simulation group higher than in the control group (p < .05, Physical examination: p = .014, Clinical Reasoning: p = .042, Overall: p = .016). These finding suggests the possibility that our medical students who have experienced peer role-playing simulation program improved the clinical skills of physical examination, the clinical reasoning and diagnosis, and the Overall clinical competency on the real-life MSK outpatient encounters.Conclusions: We successfully capture to assess using mini-CEX that these clinical skills improving of medical students who have experienced peer role-playing simulation program. A peer role-playing as a low-fidelity simulation will enable to polish the competency of medical students a musculoskeletal physical examination, and a clinical reasoning and diagnosis in a clinical setting, as a practical educational opportunity.

scholarly journals Online patient simulation training to improve clinical reasoning: A feasibility randomised controlled trial

2020 ◽  
Author(s):  
Ruth Plackett ◽  
Angelos P Kassianos ◽  
Maria Kambouri ◽  
Natasha Kay ◽  
Sophie Mylan ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Clinical Reasoning ◽  
Controlled Trial ◽  
Intervention Group ◽  
Diagnostic Errors ◽  
Control Group ◽  
Feasibility Randomised Controlled Trial ◽  
Reasoning Skills ◽  
Randomised Controlled ◽  
Clinical Reasoning Skills

Abstract Background: Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. However, little is known about how best to implement and evaluate OPS in medical curricula. The aim of this study was to assess the feasibility, acceptability and potential effects of eCREST — the electronic Clinical Reasoning Educational Simulation Tool.Methods: A feasibility randomised controlled trial was conducted with final year undergraduate students from three UK medical schools in academic year 2016/2017 (cohort one) and 2017/2018 (cohort two). Student volunteers were recruited in cohort one via email and on teaching days, and in cohort two eCREST was also integrated into a relevant module in the curriculum. The intervention group received three patient cases and the control group received teaching as usual; allocation ratio was 1:1. Researchers were blind to allocation. Clinical reasoning skills were measured using a survey after one week and a patient case after one month.Results: Across schools, 264 students participated (18.2% of all eligible). Cohort two had greater uptake (183/833, 22%) than cohort one (81/621, 13%). After one week, 99/137 (72%) of the intervention and 86/127 (68%) of the control group remained in the study. eCREST improved students’ ability to gather essential information from patients over controls (OR =1.4; 95% CI 1.1-1.7, n =148). Of the intervention group, most (84/98, 82%) agreed eCREST helped them to learn clinical reasoning skills.Conclusions: eCREST was highly acceptable and improved data gathering skills that could reduce diagnostic errors. Uptake was low but improved when integrated into course delivery. A summative trial is needed to estimate effectiveness.

scholarly journals Using peer role-playing to improve students’ clinical skills for musculoskeletal physical examinations

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kazuyo Yamauchi ◽  
Yoko Hagiwara ◽  
Nahoko Iwakura ◽  
Saori Kubo ◽  
Azusa Sato ◽  
...  
Keyword(s):  
Medical Students ◽  
Physical Examination ◽  
Clinical Reasoning ◽  
Clinical Skills ◽  
Role Play ◽  
Role Playing ◽  
Control Group ◽  
Simulation Group ◽  
Physical Examinations ◽  
Simulation Programme

Abstract Background The traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. Therefore, an effective programme is required to help medical students and residents improve their clinical skills in MSK. This paper aims to assess the clinical skills of medical students who have participated in a peer role-playing simulation programme using a mini clinical evaluation exercise (mini-CEX). Methods Participants were 90 female medical students who were completing their first orthopaedic clinical clerkship. They were divided into two groups. The simulation group participated in a role-play focussed on MSK cases as low-fidelity simulation, a structured debriefing with the course supervisor, and a self-reflection on Day 1 (n = 64). The control group did not participate in the role-play due to randomised clerkship schedules (n = 26). On Day 2 of the intervention, we observed and assessed all participants’ performances during MSK outpatient encounters using the mini-CEX. We compared the mini-CEX score between the simulation group and the control group; the Wilcoxon rank-sum test was used for statistical analysis. Results The mini-CEX scores for physical examination, clinical reasoning and diagnosis, and overall clinical competency were significantly higher in the simulation group than in the control group (p < .05, physical examination: p = .014, clinical reasoning: p = .042, overall: p = .016). These findings suggest that medical students who partake in a peer role-playing simulation programme could experience improved clinical skills for physical examination, clinical reasoning and diagnosis, and overall clinical competency in real-life MSK outpatient encounters. Conclusions Through a mini-CEX assessment, our findings indicate that medical students who participated in our peer role-playing simulation programme have improved clinical skills. Peer role-playing as a low-fidelity simulation and practical educational opportunity will enable educators to polish the competency of medical students in musculoskeletal physical examinations and clinical reasoning and diagnosis in a clinical setting.

scholarly journals Teaching clinical reasoning to undergraduate medical students by illness script method: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mana Moghadami ◽  
Mitra Amini ◽  
Mohsen Moghadami ◽  
Bhavin Dalal ◽  
Bernard Charlin
Keyword(s):  
Medical Students ◽  
Clinical Reasoning ◽  
Controlled Trial ◽  
Intervention Group ◽  
Signs And Symptoms ◽  
Control Group ◽  
Illness Script ◽  
Fourth Year Medical Students ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills

Abstract Background The illness script method employs a theoretical outline (e.g., epidemiology, pathophysiology, signs and symptoms, diagnostic tests, interventions) to clarify how clinicians organized medical knowledge for clinical reasoning in the diagnosis domain. We hypothesized that an educational intervention based on the illness script method would improve medical students’ clinical reasoning skills in the diagnosis domain. Methods This study is a randomized controlled trial involving 100 fourth-year medical students in Shiraz Medical School, Iran. Fifty students were randomized to the intervention group, who were taught clinical reasoning skills based on the illness script method for three diseases during one clinical scenario. Another 50 students were randomized to the control group, who were taught the clinical presentation based on signs and symptoms of the same three diseases as the intervention group. The outcomes of interest were learner satisfaction with the intervention and posttest scores on both an internally developed knowledge test and a Script Concordance Test (SCT). Results Of the hundred participating fourth-year medical students, 47 (47%) were male, and 53 (53%) were female. On the knowledge test, there was no difference in pretest scores between the intervention and control group, which suggested a similar baseline knowledge in both groups; however, posttest scores in the intervention group were (15.74 ± 2.47 out of 20) statistically significantly higher than the control group (14.38 ± 2.59 out of 20, P = 0.009). On the SCT, the mean score for the intervention group (6.12 ± 1.95 out of 10) was significantly higher than the control group (4.54 ± 1.56 out of 10; P = 0.0001). Learner satisfaction data indicated that the intervention was well-received by students. Conclusion Teaching with the illness script method was an effective way to improve students’ clinical reasoning skills in the diagnosis domain suggested by posttest and SCT scores for specific clinical scenarios. Whether this approach translates to improved generalized clinical reasoning skills in real clinical settings merits further study.

scholarly journals Uncovering the relation between clinical reasoning and diagnostic accuracy – An analysis of learner's clinical reasoning processes in virtual patients

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0204900 ◽  
Author(s):  
Inga Hege ◽  
Andrzej A. Kononowicz ◽  
Jan Kiesewetter ◽  
Lynn Foster-Johnson
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Reasoning ◽  
Virtual Patients
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