Validity Evidence for Using Virtual, Interactive Patient Encounters to Teach and Assess Clinical Reasoning for First-Year Medical Students.

IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES
Academic Medicine Pub Date : 2025-04-01 Epub Date: 2024-12-13 DOI:10.1097/ACM.0000000000005952
John K Roberts, Nancy Weigle, James W Fox, Sreeja Natesan, David Gordon, Saumil M Chudgar
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引用次数: 0

Abstract

Purpose: Despite universal agreement on the importance of clinical reasoning skills, inadequate curricular attention to these skills remains a problem. To facilitate integration of clinical reasoning instruction and assessment into the preclerkship phase, the authors created a clinical reasoning curriculum using technology-enhanced patient simulations.

Method: In 2023, first-year medical students at Duke University School of Medicine were enrolled in a biomedical science course using diagnostic reasoning sessions and 16 virtual, interactive patient (VIP) encounters to teach and assess clinical reasoning. The encounters were enhanced with interactive pop-in windows that assessed multiple clinical reasoning domains. Student responses were independently evaluated by faculty. Cumulative VIP clinical reasoning composite (CRC) scores were calculated, and growth mixture modeling was used to define students by growth trajectory. Clinical reasoning was assessed in a summative objective structured clinical examination (OSCE).

Results: Of the 118 students who participated in the curriculum, 1 was excluded from analysis for inadequate participation in the VIP encounters, leaving 117 students. The aggregate VIP encounter response rate was 95% (1,783 of 1,872 assessments completed). Clinical reasoning was assessed through cumulative performance across multiple domains. The mean (SD) scores were 58 (13) for information gathering, 46 (13) for illness script identification, 64 (14) for hypothesis generation, 59 (12) for differential diagnosis, and 77 (21) for management and plan. To identify latent classes of growth in cumulative VIP-CRC scores, growth mixture modeling was performed for 1-, 2-, and 3-class models. The 2-class model showed the best fit due to having the lowest bayesian information criterion (11,765.17) and Akaike information criteria (11,737.55).

Conclusions: Integrated clinical reasoning instruction and deliberate, formative practice through authentic simulations were effective at teaching and assessing clinical reasoning in the preclerkship phase. VIP and OSCE can be used to identify students at risk of low performance in the clerkship year.

使用虚拟的、互动的病人接触来教授和评估一年级医学生临床推理的有效性证据。
目的:尽管普遍同意临床推理技能的重要性,但课程对这些技能的关注不足仍然是一个问题。为了促进临床推理教学和评估整合到实习前阶段,作者使用技术增强的患者模拟创建了临床推理课程。方法:2023年,杜克大学医学院的一年级医学生参加了一门生物医学科学课程,使用诊断推理课程和16次虚拟互动患者(VIP)会面来教授和评估临床推理。通过评估多个临床推理领域的交互式弹出式窗口,这些相遇得到了加强。学生的回答由教师独立评估。计算VIP临床推理综合评分(CRC),采用生长混合模型以生长轨迹定义学生。临床推理在总结性客观结构化临床检查(OSCE)中进行评估。结果:在118名参与课程的学生中,有1名学生因未充分参与VIP会面而被排除在分析之外,剩下117名学生。VIP的总应答率为95%(完成了1872次评估中的1783次)。临床推理通过多个领域的累积表现进行评估。信息收集的平均(SD)得分为58分(13分),疾病脚本识别的平均(SD)得分为46分(13分),假设生成的平均(SD)得分为64分(14分),鉴别诊断的平均(SD)得分为59分(12分),管理和计划的平均(SD)得分为77分(21分)。为了确定累积VIP-CRC评分的潜在增长类别,对1级、2级和3级模型进行了增长混合建模。由于贝叶斯信息准则(11,765.17)和赤池信息准则(11,737.55)最低,2类模型的拟合效果最好。结论:综合临床推理指导和通过真实模拟的刻意形成性实践对实习前阶段临床推理教学和评估是有效的。VIP和欧安组织可以用来识别学生在办书员年度表现不佳的风险。
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来源期刊
Academic Medicine
Academic Medicine 医学-卫生保健
CiteScore
7.80
自引率
9.50%
发文量
982
审稿时长
3-6 weeks
期刊介绍: Academic Medicine, the official peer-reviewed journal of the Association of American Medical Colleges, acts as an international forum for exchanging ideas, information, and strategies to address the significant challenges in academic medicine. The journal covers areas such as research, education, clinical care, community collaboration, and leadership, with a commitment to serving the public interest.
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