Problem-solving in virtual environment simulations prior to direct instruction for differential diagnosis in medical education: An experimental study

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Background: Despite acquiring vast content knowledge about the functioning of the human body through university teaching, medical students struggle to transfer that knowledge to one of the core disciplinary practices – differential diagnosis (DD). The authors aimed to overcome this problem by implementing computer-based virtual environment (CVE) simulations in medical education courses. Methods: In an experimental study, the authors compared problem-solving in medical CVEs prior to instruction with an instruction-first approach. They compared the effects on isomorphic testing and transfer performance of clinical knowledge (CK) and clinical reasoning skills (CRS) as well as evoked learning mechanisms. The study took place in spring 2021 with undergraduate medical students in the scope of a medical trajectory course. Due to COVID-19 issues participants completed all study activities remotely from home. Results: The authors did not find any learning activity sequence to be superior to the other. However, when looking at the two learning activities individually, they found that problem-solving in CVEs as well as direct instruction are equally effective at imparting content knowledge, whereas problem-solving in CVE with formative feedback imparts clinical reasoning skills better than mere instruction. Conclusions: The findings indicate that only the problem-solving learning activity in CVEs imparts CRS and that such skills cannot be taught by theoretical instruction only. The present study has a high level of ecological validity because it took place in a realistic setting where students had to perform all learning and testing tasks autonomously.