Abstract
BackgroundOnline patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. However, little is known about how best to implement and evaluate OPS in medical curricula. The aim of this study was to assess the feasibility, acceptability and potential effects of eCREST — the electronic Clinical Reasoning Educational Simulation Tool.MethodsA feasibility randomised controlled trial was conducted with final year undergraduate students from three UK medical schools in academic year 2016/2017 (cohort one) and 2017/2018 (cohort two). Student volunteers were recruited in cohort one via email and on teaching days, and in cohort two eCREST was also integrated into a relevant module in the curriculum. The intervention group received three patient cases and the control group received teaching as usual; allocation ratio was 1:1. Researchers were blind to allocation. Clinical reasoning skills were measured using a survey after 1 week and a patient case after 1 month.ResultsAcross schools, 264 students participated (18.2% of all eligible). Cohort two had greater uptake (183/833, 22%) than cohort one (81/621, 13%). After 1 week, 99/137 (72%) of the intervention and 86/127 (68%) of the control group remained in the study. eCREST improved students’ ability to gather essential information from patients over controls (OR = 1.4; 95% CI 1.1–1.7, n = 148). Of the intervention group, most (80/98, 82%) agreed eCREST helped them to learn clinical reasoning skills.ConclusionseCREST was highly acceptable and improved data gathering skills that could reduce diagnostic errors. Uptake was low but improved when integrated into course delivery. A summative trial is needed to estimate effectiveness.
Highlights
Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors
In undergraduate medical education, there is a lack of explicit teaching on clinical reasoning and the development and delivery of additional high quality and consistent clinical reasoning teaching potentially increases burden on faculty’s already stretched time and resources [2, 7, 8]
The intervention group changed their diagnoses more often than controls, but the difference was not statistically significant. This feasibility trial of Electronic Clinical Reasoning Educational Simulation Tool (eCREST) demonstrated that optimal recruitment and retention was achieved when the tool was integrated into curricula, as seen in the greater uptake for cohort two than cohort one. eCREST was highly acceptable to students, suggesting it would be feasible to conduct a summative trial to estimate effectiveness of OPS in medical schools, if there was course integration
Summary
Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. In undergraduate medical education, there is a lack of explicit teaching on clinical reasoning and the development and delivery of additional high quality and consistent clinical reasoning teaching potentially increases burden on faculty’s already stretched time and resources [2, 7, 8]. Online patient simulations (OPS) are a specific type of computer-based program that simulates real-life clinical scenarios and could support teaching reasoning skills [7, 9]. Using technology-enhanced learning (TEL) may have its own limitations, such as the potential for lack of engagement from users and faculty, lack of fidelity with real patient consultations and limited TEL skills of faculty [15, 16]
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