Respective value of the traditional clinical rotation and high fidelity simulation on the acquisition of clinical reasoning skills in medical students – A Randomized Controlled Trial.

Sarahn Lovett,Naomi Tomlinson,Ian Symonds,Joerg Mattes,Robert Gagnon,Jan Roche,Bernard Charlin,Sharyn Hunter

doi:10.15694/mep.2016.000037

Abstract

This article was migrated. The article was marked as recommended. OBJECTIVE To assess the respective value of Traditional clinical rotation and High Fidelity Simulation (HFS) on the acquisition of clinical reasoning (CR) skills in Medical Students.METHODSA randomized controlled trial was conducted. Forty medical students were exposed to a full day of HFS, either during their Paediatric Term (PT) (Experimental group = PT+, HFS+) or, after completion of their PT (Control group = PT+, HFS-). CR skills were assessed by a Script Concordance Test (SCT) prior to group allocation and at the completion of PT.RESULTS39 out of 40 students completed both SCT. Scores before (mean/SD 57.4/6.7) and after (mean/SD 61.1/7.0) the PT were significantly improved (mean increase [95% confidence interval (CI)]: 3.6 [2.0-5.2]; p<0.0001; n=39). There was no added improvement from involvement in a full day of HFS in SCT scores between the experimental and the control groups (mean increase [95% CI]: 3.2 [0.5-5.9], n=18 versus 4.0 [1.9-6.1], n=21, respectively; p=0.61).CONCLUSIONExposure to PT significantly improves the medical students' CR acquisition with no further enhancement by exposure to HFS. Thus potential improvements in students' knowledge and skills due to exposure to HFS may not affect CR skills, and thus may not be assessable by SCT.

Highlights

In clinical settings, the challenge for educators today, is to develop educational interventions that improve the knowledge, professional development and technical skill of our medical graduates, but that improve the core clinical competency of clinical reasoning (CR) skill acquisition
We have shown that High Fidelity Simulation (HFS) implemented into the Paediatric Term (PT) in a way which was thought to be deliverable and sustainable within the Joint Medical Program (JMP) medical curriculum in the future, had no significant effect on CR skills assessed by Script Concordance Test (SCT)
We were able to show that during exposure to the traditional paediatric curriculum found in the JMP, there is a significant improvement in CR acquisition skills in our population and this was detected by the SCT

Summary

Introduction

The challenge for educators today, is to develop educational interventions that improve the knowledge, professional development and technical skill of our medical graduates, but that improve the core clinical competency of clinical reasoning (CR) skill acquisition. The organization of knowledge used in that endeavor is termed a "Script" (Charlin, Roy, Brailowsky, Goulet, & Vleuten, 2000). Activation of the illness scripts, when dealing with a patient, helps the clinician to efficiently rule in or out hypotheses, and helps decide on management strategies for them (Charlin, Roy, Brailowsky, Goulet, & Vleuten, 2000; Charlin, Boshuizen, Custers, & Feltovich, 2007; Feltovich & Barrows, 1984)

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