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 ?
B de
Bas L g1, Rene
d Leng R G t2, Jeroen
van Gent J D k 1, Frank
Donkers F k Hess
H 3 4, Jörn
3,4 H id4, JJean van Berlo
Jö Heid B l 1, Cees
C van der Vl t 1.
d Vleuten
1
Questions P
Procedure
d
All residents simultaneously worked out the same virtual patient,
patient based on a
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 real case where ‘premature
premature closure’
closure during clinical reasoning had occurred.
clinical reasoning? 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
How do residents perceive the value of a combination of small group together with the supervisor
supervisor. The logged actions of the residents and their
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? notes were startingg points
p for the discussion.
How does
H d the
th clinical
li i l supervisor
i perceive
i the
th value
l off a virtual
it l M t i l
Materials
patient a feedback tool and small group discussions for teaching
patient, Virtual
Vi t l patient
ti t
clinical
li i l reasoning?
i ? Based
Based on a real case where
‘
‘premature
t closure’
l ’ had
h d
How does the clinical supervisor judge the feasibility of this teaching occurred
occurred.
approach for the pediatric specialist training at the workplace? Built in CAMPUS
CAMPUS, a cross
platform and web
web-based
based
program developed at
Instruments Heidelberg University, Germany.
1 Two questionnaires developed within the e
1. e-ViP
ViP project Feedback
F db k ttooll
((www.virtualpatients.eu)
p ) The logged actions of the individual residents were compiled and fed
a) Students
Students’ questionnaire to evaluate their experiences with virtual 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
patients.
p i IIt contains
i twelve l 5-point
p i Lik
Likert S
Scalel statements on the
h Netherlands
Netherlands.
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
Results 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 ini the
th workup k p off th
the
same casecase. This stimulated their
thi ki g p
thinking prior
i tto th the di
discussion i off ththe
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
Issues that jeopardize the authenticity of VPs are: The small group discussions made the session th moderator
the d t iin organizing i i the th
the impossibility to phrase your own questions lively, stimulated argumentation about clinical discussions but the slow performance
discussions,
duringg the historyy taking
g reasoning and gave residents an impression of
reasoning, impeded the flow of actionsactions.””
the absence of a real observation of a sick clinical reasoning of their peers. “Developing
Developing 40 VPs and applying them
patient to g
p get an impression
p off the seriousness During the group discussions the residents felt biweekly combined with small group
of the situation
situation, and secure enough to openly discuss their discussions in 45 minutes sessions,
that
th t cases are contrived
t i d for
f educational
d ti l shortcomings
shortcomings. would be a feasible teaching approach
purposes making users feel that there has to be
purposes, for the pediatric specialist training.
training.”
a catch.
t h
Conclusion
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.