Can virtual patients be used to promote reflective practice as part of pediatric
p p p p p
trainees’ di
trainees’ diagnostic reasoning strategies?
t i ti i t t i ?
B de Leng1, Rene van Gent2, Jeroen D k 1, Frank Hess3 4, Jörn Heid4, J
Bas d L g R G t J Donkers F k H 3,4 Jö H id Jean van Berlo1, Cees van der Vleuten1.
B l C d Vl t
1
Questions Procedure
P d
 All residents simultaneously worked out the same virtual patient, based on a
patient
How do residents perceive the value of a virtual patient for learning
H d id t p i th l f i t l p ti t f l i g real case where ‘premature closure’ during clinical reasoning had occurred.
premature closure
clinical reasoning?  Three times during the work out of the virtual patient a ‘time out’ was
work-out time out
sc edu ed
scheduled in which the residents discussed t e d ag ost c reasoning
c t e es de ts d scussed their diagnostic easo g
How do residents perceive the value of a combination of small group together with the supervisor The logged actions of the residents and their
supervisor.
discussions with virtual patients for learning clinical reasoning?
di i ith i t l ti t f l i g li i l i g? notes were starting points for the discussion.
gp
How does the clinical supervisor perceive the value of a virtual
H d th li i l i i th l f it l Materials
M t i l
patient,
patient a feedback tool and small group discussions for teaching Virtual ti t
Vi t l patient
clinical reasoning?
li i l i ? Based on a real case where
Based
‘premature closure’ had
‘ t l ’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 a cross
CAMPUS,
platform and web based
web-based
program developed at
Instruments Heidelberg University, Germany.
1.
1 Two questionnaires developed within the e ViP project
e-ViP Feedback tool
F db k t l
(
(www.virtualpatients.eu)
p )  The logged actions of the individual residents were compiled and fed
a) Students’ questionnaire to evaluate their experiences with virtual
Students back by
b k by a web-based p g
bb d program d developed at M
l p d t Maastricht U i
t i ht University, the
ity th
p i
patients. I contains twelve 5-point Lik S l statements on the
It i l p i Likert Scale h Netherlands.
Netherlands
issues:
 A th ti ity
Authenticity
 Professional approach
CCoaching
hi g
 Learning effect
OOverall judgment
ll j dg t
b) Students’ questionnaire to evaluate their experiences their
Students
experiences with the integration of virtual patients. It contains
i ith th i t ti f i t l ti t t i
twenty 5-point Likert Scale statements on the issues:
5 point
TTeaching presence
hi
 Cognitive presence
 S i l presence
Social
 Learning effect
 Overall judgment
2.
2 A structured interview with the clinical supervisor
Results Supervisor perceptions
p p p
 “VPs gave the possibility to design a
VPs
case that p p
pinpointed to a specific
p
learning goal: in a ‘clear cut’ case,
clear-cut case
findings slightly deviating from a usual
f g g y gf
presentation must trigger the resident to
take
t k a more comprehensive approach.”
p h i pp h”
 “VPs obliged all participants to be
VPs
individually ti i th
i di id lly active in the workup of th
k p f the
same case This stimulated their
case.
thinking prior to the discussion of th
thi ki g p i t th di i f the
case and made them eager to tell what
they h d d
th y had done.” ”
 “The feedback tool gave a good
The
overview of the development of
i f th d l t f
diagnostic idea’s over time supported
idea s time,
Issues that jeopardize the authenticity of VPs are:  The small group discussions made the session the
th moderator i organizing the
d t in i i th
 the impossibility to phrase your own questions lively, stimulated argumentation about clinical discussions,
discussions but the slow performance
during the history taking
g y g reasoning,
reasoning and gave residents an impression of impeded the flow of actions ”
actions.”
 the absence of a real observation of a sick clinical reasoning of their peers.  “Developing 40 VPs and applying them
Developing
p
patient to g an impression of the seriousness
get p f  During the group discussions the residents felt biweekly combined with small group
of the situation and
situation, secure enough to openly discuss their discussions in 45 minutes sessions,
 th t cases are contrived for educational
that ti df d ti l shortcomings.
shortcomings would be a feasible teaching approach
purposes,
purposes making users feel that there has to be 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 out’
time out
moments of small group di
t f ll discussions as a valuable learning activity f clinical reasoning.
i l bl l i ti it for li i l i
 If we can speed up the procedure and/or the performance of the feedback tool this instrument has great potential to facilitate the discussions on clinical
tool,
reasoning.
reasoning
 The clinical supervisor found the presented teaching approach feasible for the medical specialist training at the workplace.
1 Department of Educational Development and Research, Maastricht University, The Netherlands.
2 Máxima Medical Centre, Department of Pediatrics, Veldhoven, The Netherlands.
, p , ,
3 Center for Virtual Patients, Medical Faculty of Heidelberg University, Germany.
, y g y, y
4 Heilbronn University, Germany.