Virtual patients to explore and develop clinical case summary statement skills amongst Japanese resident physicians: a mixed methods study.

Brian S Heist,Sugihiro Hamaguchi,Naoki Kishida,Gautam Deshpande,Hiroyuki Kobayashi

doi:10.1186/s12909-016-0571-y

Abstract

BackgroundIn Western clinical training, formulation of a summary statement (SS) is a core exercise for articulation, evaluation, and improvement of clinical reasoning (CR). In Japanese clinical training, structured guidance in developing CR, including opportunity for SS practice, is uncommon, and the present status of case summarization skills is unclear. We used Virtual Patients (VPs) to explore Japanese junior residents’ SS styles and the effectiveness of VPs on improving SS quality.MethodsAll first-year junior resident physicians at 4 residency programs (n = 54) were assigned randomized sequences of 5 VP modules, rolled out at 6 day intervals. During each module, participants free-texted a case summary and then reviewed a model summary. Thematic analysis was used to identify SS styles and each SS was categorized accordingly. Frequency of SS styles, and SS CR quality determined by 1) an internally developed Key Feature rubric and 2) demonstration of semantic qualification, were compared across modules.ResultsFour SS styles were identified: numbered features matched to differential diagnoses, differential diagnoses with supportive comments, feature listing, and narrative summarization. From module #1 to #5, significant increases in the narrative summarization SS style (p = 0.016), SS CR quality score (p = 0.021) and percentage of semantically driven SS (p = 0.003) were observed.ConclusionsOur study of Japanese junior residents identified distinct clinical case summary statement styles, and observed adoption of the narrative summarization style and improvement in the CR quality of summary statements during a series of VP cases.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0571-y) contains supplementary material, which is available to authorized users.

Highlights

In Western clinical training, formulation of a summary statement (SS) is a core exercise for articulation, evaluation, and improvement of clinical reasoning (CR)
Change in summary statement style Four SS styles were identified: numbered features matched to differential diagnoses (NMD), differential diagnoses with supportive comments (DD), feature listing (FL), and narrative summarization (NS) (Table 1)
From module #1 to #5, the demonstration of NMD, DD, and FL each decreased (2.6 – 0 %, 21.1 – 9.1 %, and 44.7 % – 13.6 %, respectively), while the demonstration of NS increased from 31.6 % to 77.3 %

Summary

Introduction

In Western clinical training, formulation of a summary statement (SS) is a core exercise for articulation, evaluation, and improvement of clinical reasoning (CR). In Japanese clinical training, structured guidance in developing CR, including opportunity for SS practice, is uncommon, and the present status of case summarization skills is unclear. Financial and cultural barriers continue to delay reform [1,2,3,4]. One result of this history has been limited teaching of fundamental skills including clinical reasoning [2, 3, 5]. In Western medical training, education in clinical reasoning has traditionally involved case-based discussions and case presentations [8,9,10,11]. While not yet widespread in Japan, enthusiasm toward VPs as an educational modality has been

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