Abstract
ObjectivesMedical error is a significant cause of patient harms in clinical practice, but education and training are recognised as having a key role in minimising their incidence. The use of virtual patient (VP) activities targeting training in medical error allows learners to practice patient management in a safe environment. The inclusion of branched decision-making elements in the activities has the potential to drive additional generative cognitive processing and improved learning outcomes, but the increased cognitive load on learning risks negatively affecting learner motivation. The aim of this study is to better understand the impact that the inclusion of decision-making and inducing errors within the VP activities has on learner motivation.MethodsUsing a repeated study design, over a period of six weeks we provided undergraduate medical students at six institutions in three countries with a series of six VPs written around errors in paediatric practice. Participants were divided into two groups and received either linearly structured VPs or ones that incorporated branched decision-making elements. Having completed all the VPs, each participant was asked to complete a survey designed to assess their motivation and learning strategies.ResultsOur analysis showed that in general, there was no significant difference in learner motivation between those receiving the linear VPs and those who received branched decision-making VPs. The same results were generally reflected across all six institutions.ConclusionsThe findings demonstrated that the inclusion of decision-making elements did not make a significant difference to undergraduate medical students’ motivation, perceived self-efficacy or adopted learning strategies. The length of the intervention was sufficient for learners to overcome any increased cognitive load associated with branched decision-making elements being included in VPs. Further work is required to establish any immediate impact within periods shorter than the length of our study or upon achieved learning outcomes.
Highlights
Medical error and educationMedical error has been widely identified as a key cause of preventable adverse events in clinical practice, with recent estimates indicating that it is the third leading cause of death in the US health system [1]
Our analysis showed that in general, there was no significant difference in learner motivation between those receiving the linear virtual patient (VP) and those who received branched decision-making VPs
Virtual patients designed for training against medical error project reference is 561583-EPP-1-2015-1-KZEPPKA2-CBHE-JP
Summary
Medical error and educationMedical error has been widely identified as a key cause of preventable adverse events in clinical practice, with recent estimates indicating that it is the third leading cause of death in the US health system [1]. The findings of this report built upon previous studies and estimated that up to 98,000 people die each year in US hospitals as a result of medical errors by practitioners This had a significant impact on the medical community both in the US and globally, and its recommendations helped to launch a significant drive to improve quality [3]. When errors during such simulation exercises are approached in an educational environment that permits reflection upon negative emotions associated with error, learner awareness of the possibility of errors is raised, and allows learners to take responsibility for adapting their practice to avoid making the same or similar mistakes in future [6] While such educational approaches allow learners to make mistakes in a safe place, some educational experts contend that education should look further than that and seek to induce error in learners as a formative learning experience [7]. Eva acknowledges that this approach can be a challenging one for learners who are seeking positive affirmation of their knowledge through learning exercises, while considering the powerful positive implications of learning from one’s mistakes, stating that “educators should be working to induce error in learners, leading them to short term pain for long term gain”
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