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Evaluation of virtual patient cases for teaching diagnostic and management skills in internal medicine: a mixed methods study.

ABSTRACT: OBJECTIVE:The virtual patient (VP) is a computer program that simulates real-life clinical scenarios and allows learners to make diagnostic and therapeutic decisions in a safe environment. Although many VP cases are available, few focus on junior trainees as their target audience. In addition, there is wide variability in trainees' clinical rotation experiences, based on local practice and referral patterns, duty hour restrictions, and competing educational requirements. In order to standardize clinical exposure and improve trainees' knowledge and perceived preparedness to manage core internal medicine cases, we developed a pool of VP cases to simulate common internal medicine presentations. We used quantitative and qualitative analyses to evaluate the effectiveness of one of our VP cases among medical trainees at University of Toronto. We also evaluated the role of VP cases in integrated teaching of non-medical expert competencies. RESULTS:Despite modest effects on knowledge acquisition, a majority of participants enjoyed using VP cases as a resource to help them prepare for and reinforce clinical experiences. Cognitive interactivity and repetitive practice were particularly appreciated by study participants. Trainees perceived VP cases as a useful resource as their learning can be customized to their actions within the case, resulting in unique learning trajectories.

SUBMITTER: Jeimy S

PROVIDER: S-EPMC5989465 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Evaluation of virtual patient cases for teaching diagnostic and management skills in internal medicine: a mixed methods study.

Jeimy Samira S Wang Jenny Yujing JY Richardson Lisa L

BMC research notes 20180605 1

<h4>Objective</h4>The virtual patient (VP) is a computer program that simulates real-life clinical scenarios and allows learners to make diagnostic and therapeutic decisions in a safe environment. Although many VP cases are available, few focus on junior trainees as their target audience. In addition, there is wide variability in trainees' clinical rotation experiences, based on local practice and referral patterns, duty hour restrictions, and competing educational requirements. In order to stan ...[more]

PMID: 29871699

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Project description:ObjectivesTo evaluate the impact and transferability of a novel teaching method on virtual communication skills for final year medical students.DesignMixed-methods, interventional before-and-after study.SettingNHS Lanarkshire, Scotland.Participants21 final year medical students on their obstetrics and gynaecology (O&G) placement from September to December 2020.InterventionsA two-part teaching session on virtual communication skills.Main outcome measuresSelf-reported confidence in conducting consultations preteaching and post-teaching, exposure to virtual consultations, usefulness of teaching and transferability to primary care. Data were collected using preteaching and post-teaching evaluation tools and an online survey.ResultsOf 21 participants, 1 student did not attend the second session so was excluded from post-teaching evaluation results and the online survey. Preteaching results were collected from 21 participants and post-teaching results from 20. Mean confidence scores increased across all domains post-teaching. Mean confidence in opening the consultation increased from 2.67 (95% CI 2.21 to 3.13) to 4.70 (95% CI 4.50 to 4.90); history-taking from 3.38 (95% CI 3.07 to 3.69) to 4.45 (95% CI 4.19 to 4.71); decision-making and forming a management plan from 2.62 (95% CI 2.28 to 2.96) to 3.90 (95% CI 3.66 to 4.14) and closing the consultation from 2.81 (95% CI 2.45 to 3.17) to 4.60 (95% CI 4.38 to 4.81). There was no change in exposure to virtual consultations during O&G placement. 16 (80%) participants responded to the online survey; 14 (87.5%) rated the sessions 'very useful' and all 16 considered them worthwhile continuing. 12 (75%) had the opportunity to practise virtual consultations on general practitioner, mostly via telephone.ConclusionsWe found that teaching students virtual consultation skills improved short term confidence and were transferable to primary care placements. Future research is suggested to assess this teaching model following adaptation and incorporation into medical education and training across specialties and grades. It would be useful to evaluate the impact on competence post intervention through observed skills.

Project description:BackgroundFor academic physicians, teaching represents an essential skill. The proliferation of educator training programs aimed at residents and medical students signals the increasing commitment of training programs to develop teaching skills in their trainees as early as possible. However, clinical fellowships represent an important opportunity to advance training as educators. In addition to enriching the pipeline of future teachers, developing fellows as teachers augments the training experience for more junior trainees and may impact patient care. Fellows' needs for programs to improve teaching skills have been largely unexplored.MethodsWe conducted a multi-institutional needs assessment of internal medicine (IM) subspecialty fellows to gauge interest in teaching and improvement of teaching skills. We surveyed IM subspecialty fellows at three academic medical centers about their access to fellow-as-teacher programs and other mechanisms to improve their teaching skills during fellowship. We also elicited their attitudes towards teaching and interest in training related to teaching skills.ResultsOne hundred eighty-three fellows representing 20 programs and nine different subspecialties responded to the survey (48% response rate). The majority of participants (67%) reported having no specific training focused on teaching skills and only 12% reported receiving regular feedback about their teaching during their fellowship. Seventy-nine percent of fellows anticipated teaching to be part of their careers, and 22% planned to participate in medical education scholarship. Fellows reported a strong interest in teaching and programs aimed at improving their teaching skills.ConclusionsThe majority of fellows reported a lack of mechanisms to advance their teaching skills as fellows, despite anticipating teaching to be an important aspect of their future careers and having strong interest in such programs. Our findings at three academic medical centers confirm a lost opportunity among subspecialty fellowships to accelerate teaching skills development for future educators.

Project description:BackgroundAlthough urine microscopy is an important step in the initial evaluation of a patient with kidney disease, internal medicine residents have minimal exposure to this technique during their training. The goal of this study was to understand knowledge of and attitudes toward urine microscopy among internal medicine residents and to implement virtual urine microscopy teaching sessions.MethodsA voluntary, anonymous, online survey was sent to all of the categorical internal medicine residents (n=131) training at the Icahn School of Medicine at Mount Sinai (ISMMS). The survey included 13 questions to assess attitudes toward, experience with, and clinical interpretation of urine microscopy specimens. In response to the survey results, we implemented virtual urine microscopy teaching sessions using video conferencing software that incorporated real-time urine sediment analysis with nephrology fellows and attending nephrologists.ResultsThe survey response rate was 45% (59 of 131). Forty-seven percent (28 of 59) of respondents reported performing urine microscopy at least once during their training, and 75% (44 of 59) of respondents did not feel comfortable performing urine microscopy. The majority of residents (92%; 54 of 59) reported they felt urine microscopy was very helpful or somewhat helpful in the evaluation of patients with AKI. Overall, 41% of responses to clinical interpretation questions were considered correct. Following survey completion, virtual urine microscopy sessions were held monthly and well received by the participants.ConclusionsOur study found that internal medicine residents perceive urine microscopy as a helpful diagnostic tool, although lack the skills to perform and interpret urine microscopy sediments. Virtual educational sessions using video conferencing software are a technically feasible approach to teaching urine microscopy to internal medicine residents. Future studies include a study of the effect of these sessions on learning of urine microscopy.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/K360/2021_01_28_KID0006282020.mp3.

Project description:BackgroundImproving clinical reasoning skills-the thought processes used by clinicians to formulate appropriate questions and diagnoses-is essential for reducing missed diagnostic opportunities. The electronic Clinical Reasoning Educational Simulation Tool (eCREST) was developed to improve the clinical reasoning of future physicians. A feasibility trial demonstrated acceptability and potential impacts; however, the processes by which students gathered data were unknown.ObjectiveThis study aims to identify the data gathering patterns of final year medical students while using eCREST and how eCREST influences the patterns.MethodsA mixed methods design was used. A trial of eCREST across 3 UK medical schools (N=148) measured the potential effects of eCREST on data gathering. A qualitative think-aloud and semistructured interview study with 16 medical students from one medical school identified 3 data gathering strategies: Thorough, Focused, and Succinct. Some had no strategy. Reanalysis of the trial data identified the prevalence of data gathering patterns and compared patterns between the intervention and control groups. Patterns were identified based on 2 variables that were measured in a patient case 1 month after the intervention: the proportion of Essential information students identified and the proportion of irrelevant information gathered (Relevant). Those who scored in the top 3 quartiles for Essential but in the lowest quartile for Relevant displayed a Thorough pattern. Those who scored in the top 3 quartiles for Relevant but in the lowest quartile for Essential displayed a Succinct pattern. Those who scored in the top 3 quartiles on both variables displayed a Focused pattern. Those whose scores were in the lowest quartile on both variables displayed a Nonspecific pattern.ResultsThe trial results indicated that students in the intervention group were more thorough than those in the control groups when gathering data. The qualitative data identified data gathering strategies and the mechanisms by which eCREST influenced data gathering. Students reported that eCREST promoted thoroughness by prompting them to continuously reflect and allowing them to practice managing uncertainty. However, some found eCREST to be less useful, and they randomly gathered information. Reanalysis of the trial data revealed that the intervention group was significantly more likely to display a Thorough data gathering pattern than controls (21/78, 27% vs 6/70, 9%) and less likely to display a Succinct pattern (13/78, 17% vs 20/70, 29%; χ23=9.9; P=.02). Other patterns were similar across groups.ConclusionsQualitative data suggested that students applied a range of data gathering strategies while using eCREST and that eCREST encouraged thoroughness by continuously prompting the students to reflect and manage their uncertainty. Trial data suggested that eCREST led students to demonstrate more Thorough data gathering patterns. Virtual patients that encourage thoroughness could help future physicians avoid missed diagnostic opportunities and enhance the delivery of clinical reasoning teaching.

Dataset Information

Evaluation of virtual patient cases for teaching diagnostic and management skills in internal medicine: a mixed methods study.

Publications

Evaluation of virtual patient cases for teaching diagnostic and management skills in internal medicine: a mixed methods study.

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