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How to come to deliberate practice with

virtual patients for clinical reasoning?


School of Health Professions Education
Bas de Leng, Jeroen Donkers, Soeren Huwendiek, Andrzej
Kononowicz Prof. dr. Albert Scherpbier
Krakow, June 5th, 2009

Faculty of Health, Medicine and Life Sciences


VPs for clinical reasoning
 The virtual patients are
based on a real cases where
‘premature closure’ had
occurred.
 Video of physical
examination together with
sounds of results.
 No feedback on performance
during work-up of case.
 Built in CAMPUS, a cross
platform and web-based
program developed at
Heidelberg University
 Feature to rank diagnoses in
the DD.
Faculty of Health, Medicine and Life Sciences
Educational scenario: integration
 All residents
simultaneously worked
out the same virtual
patient.
 Three times during the
work-out a ‘time out’
was scheduled in which
the residents discussed
their diagnostic
reasoning.
 The logged actions of
the residents and their
notes were point of
departure.
Faculty of Health, Medicine and Life Sciences
Feedback tool
 Feedback tool developed at Maastricht University compiled
and fed back the logged actions of the individual residents.

Faculty of Health, Medicine and Life Sciences


Questionnaire on VPs
Students’ questionnaire to evaluate their experiences with virtual
patients. It contains twelve 5-point Likert Scale statements on
the issues:
1. Authenticity
2. Professional approach
3. Coaching
4. Learning effect
5. Overall judgment

Faculty of Health, Medicine and Life Sciences


Recidents perceptions of VP
Issues that jeopardize the authenticity of VPs:
 the impossibility to
phrase your own
questions during the
history taking
 the absence of a real
observation of a sick
patient to get an
impression of the
seriousness of the
situation, and
 that cases are
contrived for
educational
purposes, making
users feel that there
has to be a catch.

Faculty of Health, Medicine and Life Sciences


Questionnaire on Educational Scenarios
Students’ questionnaire to evaluate their experiences with the
integration of virtual patients. It contains twenty 5-point Likert
Scale statements on the issues
1. Teaching presence
2. Cognitive presence
3. Social presence
4. Learning effect
5. Overall judgment

Faculty of Health, Medicine and Life Sciences


Recidents perceptions of scenario
 The small group
discussions stimulated
argumentation about
clinical reasoning, and
gave residents an
impression of clinical
reasoning of their
peers.
 During the group
discussions the
residents felt secure
enough to openly
discuss their
shortcomings.

Faculty of Health, Medicine and Life Sciences


Conclusions
 Both residents and clinical supervisor of a medical specialist
training perceived a session combining individual virtual
patient workup with ‘time out’ moments of small group
discussions as a valuable learning activity for clinical
reasoning.
 The clinical supervisor found the presented teaching
approach feasible for the medical specialist training at the
workplace.

Faculty of Health, Medicine and Life Sciences

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