Abstract
Clinical reasoning is an important skill for veterinary students to develop before graduation. Simulation has been studied in medical education as a method for developing clinical reasoning in students, but evidence supporting it is limited. This study involved the creation of a contextualized, standardized client simulation session that aimed to improve the clinical reasoning ability and confidence of final-year veterinary students. Sixty-eight participants completed three simulated primary-care consultations, with the client played by an actor and the pet by a healthy animal. Survey data showed that all participants felt that the session improved their clinical decision-making ability. Quantitative clinical reasoning self-assessment, performed using a validated rubric, triangulated this finding, showing an improvement in students' perception of several components of their clinical reasoning skill level from before the simulation to after it. Blinded researcher analysis of the consultation video recordings found that students showed a significant increase in ability on the history-taking and making-sense-of-data (including formation of a differential diagnosis) components of the assessment rubric. Thirty students took part in focus groups investigating their experience with the simulation. Two themes arose from thematic analysis of these data: variety of reasoning methods and "It's a different way of thinking." The latter highlights differences between the decision making students practice during their time in education and the decision making they will use once they are in practice. Our findings suggest that simulation can be used to develop clinical reasoning in veterinary students, and they demonstrate the need for further research in this area.
Highlights
The use of simulation in veterinary education has grown in the last 10 years
If extrapolated to veterinary medicine, this theory could explain the improvement in history taking, despite it not being a focus of the simulation; i.e. by reviewing the formation of differential diagnoses during the debriefing, the ability to structure data gathering improved
This study has shown that standardised client simulation can be used to increase student confidence in clinical reasoning ability
Summary
The use of simulation in veterinary education has grown in the last 10 years This has been mainly driven by the increasing importance placed on communication training [1] and clinical skills teaching, coupled with the overwhelming acceptance of the pedagogical value of simulation within the fields of human medicine and nursing. It may be due, in part, by the increasing numbers of veterinary students at universities makes time practicing clinical skills competitive and limited [2,3]. Actors recreate the experience of conversing with a client so that students may practice the techniques of history taking, dealing with conflict and breaking bad news
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