Clinical Decision-making Skills Research Articles

Clinical Decision-Making and Self-efficacy Skills in Anesthesiology Nursing Students: A Cross-Sectional Study

Background: Clinical decision-making and self-efficacy are essential parts of nurses' professional work, which includes information analysis, and proper implementation of decisions in the clinical field. Objectives: The present study investigated the perspectives of anesthesia nursing students on clinical decision-making and clinical self-efficacy skills. Methods: This cross-sectional study was done on 70 undergraduate anesthesia nursing students at Jundishapur University of Medical Sciences in Ahvaz, Iran, in 2021, who were recruited through the census method. The required data were collected using a questionnaire containing demographics, clinical decision-making, and self-efficacy in clinical performance. The collected data were analyzed in SPSS 16 using the chi-square test, Mann-Whitney U test, and Kruskal Wallis test at a statistical significance of 0.05. Results: Mean age of students was 21.70 ± 1.06 years. The median score of all students' perceptions of clinical decision-making was 66.5 ± 6. Moreover, 60% of the students had a weak perception of clinical decision-making (systematic analytical). The median clinical self-efficacy score of all students was 87.50 ± 22. Also, 51.4% of the students had a moderate level of clinical self-efficacy. Conclusions: There is insufficient perception of clinical decision-making and clinical self-efficacy among anesthesia nursing students at Jundishapur University of Medical Sciences in Ahvaz. Therefore, it is recommended to pay more attention to the curricula and educational programs in order to promote students' perceptions.

Effectiveness of the SBAR-Based training program in self-efficacy and clinical decision-making of undergraduate anesthesiology nursing students: a quasi-experimental study

BackgroundStructured Situation, Background, Assessment, and Recommendation (SBAR) training technique have been widely utilized in clinical and educational settings. Therefore, the current study investigated the effectiveness of an SBAR-based educational program in students’ self-efficacy and clinical decision-making skills.MethodsThis quasi-experimental study was conducted using a pretest and posttest design and a control group at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. A total of 70 three- and fourth-year students were recruited for the study using the census method. The students were randomly assigned to the intervention and control groups. The intervention group participated in an SBAR-based educational course consisting of eight sessions held in 4 weeks. Differences in the levels of self-efficacy and clinical decision-making skills before and after participation in the SBAR course were assessed and compared. Data were analyzed using descriptive tests, the Mann-Whiney U test, paired and independent t-tests, and the Wilcoxon test.ResultsThe intervention group demonstrated significantly higher levels of self-efficacy with a mean score of 140.66 ± 22.43 (P < 0.001) and clinical decision-making with a mean score of 75.31 ± 7.72 (P < 0.001); while in the control group, the mean score of self-efficacy and clinical decision-making skills was 85.34 ± 18.15 and 65.51 ± 4.49, respectively. Moreover, the Mann-Whitney U test showed that the levels of students’ clinical decision-making skills were promoted to the next level after the intervention (P < 0.001); it means the distribution of the level of intuitive-interpretive skill was upgraded from 0 to 22.9%.ConclusionThe SBAR-based training programs can promote the self-efficacy and clinical decision-making skills of anesthesiology nursing students. Considering the weakness of the anesthesiology nursing curriculum at the undergraduate level in Iran, it can be expected that the SBAR-based training course should be included as an educational intervention in the curriculum of anesthesiology nursing students.

Multilevel Modeling of Individual and Group Level Influences on Critical Thinking and Clinical Decision-Making Skills among Registered Nurses: A Study Protocol.

Critical thinking and clinical decision-making are two essential components of nursing services. The practice of nursing requires both components at every level of nurses' daily tasks. This paper describes the protocol for an ongoing project, which aims to examine the prevalence of critical thinking and clinical decision-making among registered nurses and determine the factors that influence the skills at individual and group levels using a multilevel modeling approach. Survey data will be collected from approximately nine states, with nine general hospitals, nine district hospitals, one private hospital, and one educational hospital in Malaysia included. We aim to recruit 800 registered nurses working shifts in hospital settings. We will use questionnaires to measure the perceived nurses' knowledge, critical thinking skills, and clinical decision-making skills. The study will have three levels as the nurses are nested within the unit and further nested within the hospitals. This study will give an insight into the nursing profession today where critical thinking and clinical decision-making skills can play a significant role in patient safety and the quality of care in nursing practice.

Revealing a gap in the clinical competence of nursing staff in nursing homes: a cross-sectional study with the Ms. Olsen test

BackgroundNursing staff, caring for frail older people in long-term care, needs to have a certain level of clinical competence to identify diseases at an early stage and to assess and provide good nursing care. In Finland, nursing care is based on evidence-based and high-quality nursing care. However, earlier inspections by the National Supervisory Authority for Welfare and Health showed many discrepancies between the nursing staff’s clinical competence and adequate and continuous education.AimThis study aimed to explore nursing staff, i.e. the clinical competence and decision-making skills of registered and practical nurses in nursing homes for older people in Finland and to analyse the association between nurses’ clinical competence and fundamental background factors.MethodsWe conducted a cross-sectional study of 337 participants in 50 nursing homes in the western part of Finland, between December 2020 and January 2021. The instrument used was the validated Ms. Olsen test, an extraction of NOP-CET. Statistical analyses were conducted with descriptive statistics and correlations and a cut-off for clinical competence.ResultsThis study with the Ms. Olsen test revealed that only one-fourth of the RNs and a third of the PNs passed the clinical competence test. In the self-evaluation, almost all participants evaluated themselves with good clinical competence. The Finnish Current Care Guidelines were used on a daily basis by 7.4% and weekly by 30%. Significant correlation was found between Swedish as a working language and mother tongue and the score for clinical competence.ConclusionThe clinical competence test, the Ms. Olsen test, was used in Finland for the first time to evaluate the nursing staffs´ clinical competence in nursing homes. We found gaps in the clinical competence in Finnish nursing homes, both for PNs and RNs. The result differed remarkably from their self-assessments and the staff did not use the national nursing guidelines as required to develop their nursing skills and knowledge. Gaps in the clinical competence have been identified and can be used to develop targeted continuous education.

Development of a Novel Web-Based Tool to Enhance Clinical Skills in Medical Education.

A significant component of Canadian medical education is the development of clinical skills. The medical educational curriculum assesses these skills through an objective structured clinical examination (OSCE). This OSCE assesses skills imperative to good clinical practice, such as patient communication, clinical decision-making, and medical knowledge. Despite the widespread implementation of this examination across all academic settings, few preparatory resources exist that cater specifically to Canadian medical students. MonkeyJacket is a novel, open-access, web-based application, built with the goal of providing medical students with an accessible and representative tool for clinical skill development for the OSCE and clinical settings. This viewpoint paper presents the development of the MonkeyJacket application and its potential to assist medical students in preparation for clinical examinations and practical settings. Limited resources exist that are web-based; accessible in terms of cost; specific to the Medical Council of Canada (MCC); and, most importantly, scalable in nature. The goal of this research study was to thoroughly describe the potential utility of the application, particularly its capacity to provide practice and scalable formative feedback to medical students. MonkeyJacket was developed to provide Canadian medical students with the opportunity to practice their clinical examination skills and receive peer feedback by using a centralized platform. The OSCE cases included in the application were developed by using the MCC guidelines to ensure their applicability to a Canadian setting. There are currently 75 cases covering 5 specialties, including cardiology, respirology, gastroenterology, neurology, and psychiatry. The MonkeyJacket application is a web-based platform that allows medical students to practice clinical decision-making skills in real time with their peers through a synchronous platform. Through this application, students can practice patient interviewing, clinical reasoning, developing differential diagnoses, and formulating a management plan, and they can receive both qualitative feedback and quantitative feedback. Each clinical case is associated with an assessment checklist that is accessible to students after practice sessions are complete; the checklist promotes personal improvement through peer feedback. This tool provides students with relevant case stems, follow-up questions that probe for differential diagnoses and management plans, assessment checklists, and the ability to review the trend in their performance. The MonkeyJacket application provides medical students with a valuable tool that promotes clinical skill development for OSCEs and clinical settings. MonkeyJacket introduces a way for medical learners to receive feedback regarding patient interviewing and clinical reasoning skills that is both formative and scalable in nature, in addition to promoting interinstitutional learning. The widespread use of this application can increase the practice of and feedback on clinical skills among medical learners. This will not only benefit the learner; more importantly, it can provide downstream benefits for the most valuable stakeholder in medicine-the patient.

The effect of crossword puzzle activity used in distance education on nursing students’ problem-solving and clinical decision-making skills: A comparative study

AimThe study was planned to determine the effect of crossword puzzle activity in distance education on nursing students’ problem-solving and clinical decision-making skills. BackgroundIn online education, increasing nursing students’ learning skills, motivations and participation is important. DesignThe study is a randomized-controlled trial. MethodThe study sample consisted of 132 nursing students registered to the Pediatric Nursing distance course in the 2020–2021 academic year. 20 students who were assigned to the control group did not agree to participate in the study and did not fill in the data form. Accordingly, the study was completed with the participation of 112 students, with 66 students in the experimental group and 46 students in the control group. In the 14-week distance education, 20-question crossword puzzle activity per unit was applied to the students in the experimental group. The standards for reporting consort guidelines for reporting parallel group randomized trials were used to report this research. The students in the control group were taught in the form of presentation. At the beginning and end of the study, CDMNS and PSI were applied to the students. Ethics committee approval (Number: 2021/79) was obtained from the relevant university to conduct the research. ResultsA statistically significant difference was found between pretest and posttest scores of the experimental group in PSI and CDMNS scales (p < 0.001). ConclusionCrossword puzzle activity used in distance education developed the students’ problem-solving and clinical decision-making skills.

Is high-fidelity simulation-based training in emergency nursing effective in enhancing clinical decision-making skills? A mixed methods study

AimTo evaluate the effects of a high-fidelity simulation-based training in emergency nursing and the relationships between study outcomes. The objectives were to: (1) evaluate the effects of high-fidelity simulation-based training in emergency nursing on final-year nursing students’ generic capabilities, self-confidence and anxiety during clinical decision-making; (2) examine the relationships between the outcomes of generic capabilities and clinical decision-making skills; (3) examine participants’ satisfaction with the simulation experience; and (4) explore their experiences and opinions of the training module. BackgroundFollowing the emergence of coronavirus disease 2019, safety and other considerations have limited the clinical training opportunities available to nursing students. This has resulted in the increased use of high-fidelity simulations to provide clinical training for nursing students. However, evidence of the effects of such training modalities on generic capabilities, clinical decision-making skills and learning satisfaction remains lacking. In particular, the effectiveness of high-fidelity simulations of emergency clinical situations in training has not been closely evaluated. DesignA mixed methods study incorporating quasi-experimental and qualitative components. MethodsWe recruited a convenience sample of 255 final-year pre-registration nursing students (183 bachelor and 72 master students) from a government-funded local university in Hong Kong. Four case scenarios of emergency nursing were developed and simulated in the simulation wards of the study institution in May and June 2021. We assessed the pre- and post-intervention outcomes of generic capabilities and clinical decision-making skills. We also explored the participants’ post-intervention satisfaction, experiences and opinions. ResultsPost-intervention, the participants reported significant improvements in generic capabilities, self-confidence and anxiety during clinical decision-making. They expressed a high level of satisfaction with the simulation experience. Additionally, we detected significant relationships between generic capabilities and clinical decision-making skills. Qualitative data analysis yielded four themes that either confirmed or complemented the quantitative findings. ConclusionsThis study provides evidence of the effectiveness of high-fidelity simulation-based training in emergency nursing in enhancing students’ learning outcomes. Further studies should include a control group, evaluate students’ knowledge and skills, and retention of knowledge to confirm the true impact of such training.

A Scaffolded Simulation Curriculum: Translating Simulation with Standardized Patient Encounters into Clinical Practice for Nurse Practitioner Students

BackgroundMore high-quality research is needed to connect learning in simulation to clinical practice experiences of advanced practice registered nurse (APRN) students. The purpose of this study was to evaluate students’ perceptions of simulation and explore qualitative reflections about the role of simulation in preparing them for clinical practicum experiences. MethodsIn this longitudinal, mixed methods study, a series of six, scaffolded simulation experiences were implemented in an APRN curriculum. Focus groups were conducted with a convenience sample of 23 nurse practitioner students. ResultsThree key, interconnected themes emerged from the focus groups: authenticity, confidence, and harmonization. Quantitative data demonstrated that simulation was effective in promoting clinical decision-making skills. ConclusionsThe findings of this study support the use of scaffolded simulation experiences in nurse practitioner education. The participants valued the knowledge, skills, and confidence gained through the simulation experiences that included a standardized patient, multi-modal feedback, and a debriefing process. Students’ knowledge and behaviors learned through simulation experiences were transferred into their clinical practice.

Role of Nursing Managers in Enhancing the Clinical Decision-Making Skills of Critical Care Nurses in Yaoundé-Cameroon: A Qualitative Study

Purpose: This study aims at exploring the role of nurse managers in decision-making in 4 referral hospitals in Yaoundé-Cameroon.&#x0D; Methodology: The study used a qualitative exploratory design using semi-structured interview guides as data collection instruments. The study population was made up of 15 nurse managers (frontline, middle-level, and top-level managers) from four referral hospitals in Yaoundé-Cameroon. Data were collected using a semi-structured interview guide from a purposeful sample of nurse managers. The saturation level determined the sample size for the study. Data were analyzed using inductive content analysis.&#x0D; Findings: There was a diversity in the role of nurse managers in developing the clinical decision-making skills of critical care nurses. Professional recognition, advocacy, and teamwork were the categories generated from the managers' views on nurses’ participation in institutional meetings. Nine managers viewed effective recognition and reward system as the main motivation system for empowering nurses in clinical decision-making. Administrative meetings and rounds, basic materials and skills, interdisciplinary collaboration and standardization of care were the main strategies used by nurse managers to support decision-making in critical care. Subordination of nurses, lack of qualified staff, and infrequent organization of seminars, and meetings involving nurses were the major challenges they faced.&#x0D; Unique contributions to theory, practice, and policy: Findings from the study proposed that hospital nurse managers should employ various strategies to motivate nurses in decision-making by installing an effective recognition and reward system, involving them in institutional meetings, and creating a collaborative environment that favors nurse’s autonomy in decision-making.

Turkish nurses' leadership orientations and clinical decision-making skills

PurposeThe purpose of this study was to determine the relationship between the leadership orientations of nurses and their clinical decision-making skills.Design/methodology/approachThis descriptive study was conducted between June and December 2018 on nurses working at three hospitals in Turkey. This study was completed with 1,100 nurses. The Personal Information Form, Leadership Orientation Scale and Clinical Decision-Making Scale in Nursing were used for data collection.FindingsA significant correlation was found between the leadership orientations of nurses and age, sex, institution where they were employed, time spent in the profession, being in a management position and satisfaction with the current unit of employment (p < 0.05), and a significant correlation was found between clinical decision-making skills of nurses and age, sex and occupational status (p < 0.05). Furthermore, a significant correlation was found between the mean scores of the Leadership Orientation Scale and Clinical Decision-Making in Nursing Scale (p < 0.05).Originality/valueThe development of leadership orientations of nurses positively affects their clinical decision-making skills. In this respect, it is important to instill effective leadership orientations in nurses and to incorporate novel training methods in nursing education to develop accurate and timely clinical decision-making skills.

The Relationship Between Lifelong Learning Perceptions of Pediatric Nurses and Self-Confidence and Anxiety in Clinical Decision-Making Processes

ABSTRACT This study was conducted to evaluate the relationship between lifelong learning perceptions of pediatric nurses and self-confidence and anxiety in clinical decision-making processes. One of the most important ways to adapt to change in the developing and changing health care environment worldwide and in evidence based nursing care is lifelong learning. The most essential characteristics of a lifelong learner are reflection, questioning, enjoying learning, understanding the dynamic nature of knowledge and engaging in learning by actively seeking learning opportunities so that evidence-based nursing care can be achieved. Pediatric nurses were included in this descriptive, correlational and cross‐sectional study. The study was based on pediatric nursing in the pediatric clinics of a hospital in the capital of Turkiye between April and July 2021. It was determined that the mean scores of lifelong learning differed according to gender, education level, length of service in the profession and the unit in which each individual worked, and these differences were statistically significant. Pediatric nurses’ lifelong learning level explained the three subdimensions of self‐confidence in clinical decision-making. The results of the regression analysis indicate that lifelong learning levels of the pediatric nurses did not significantly predict their scores on the subdimensions of anxiety with clinical decision‐making scale. Positive effects on clinical decision-making in the nursing process can be achieved if the tendencies of pediatric nurses toward lifelong learning are sufficient. Assessing nurses’ lifelong learning perceptions is an essential step toward implementing evidence-based care for pediatric patients. Clinical decision-making skills can be supported by increasing nurses’ lifelong learning awareness.

Factors Affecting the Level of Reflective Thinking and Clinical Decision-Making Skills in Medical Faculty Students.

The aim of this study is to evaluate the reflection skills of students at the Faculty of Medicine and the factors influencing these skills, as well as to measure the impact of students' reflection skills on their clinical decision-making. This study is an educational research project conducted on fifth-year Ear Nose Throat (ENT) interns at Vakif University's Faculty of Medicine. The "Reflective Thinking Level Determination Scale" and the "Clinical Decision-Making Scale," which are valid and reliable, were used to assess the reflection skills and clinical decision-making abilities of the 125 students participating in the study. In our study, the mean score of the sub-dimensions of the Groningen Reflection Skills Scale was 77.04±5.14 for the fifth-year student population surveyed. Scores from the "Self-Reflection" and "Reflective Communication" sub-dimensions of the Groningen Reflection Skills Scale were compared based on gender, participation in summer internships, receipt of scholarships, membership in social sciences clubs, place of residence, school attended, diary-keeping habits, study styles, and cities of residence. Although there were some differences between the groups, these differences were not statistically significant. The total scores of the students on the Clinical Decision-Making Scale sub-dimensions ranged from 98 to 169, with a mean score of 146.18±10.97. A statistically positive and moderate correlation was found between the total scores of the participants on the Groningen Reflection Skills Scale and the total scores they obtained on the Clinical Decision-Making Scale (r=0.403; p=0.001). Consequently, an increase in the reflection skills of participants is associated with higher clinical decision-making scores. Reflection is the primary means of transitioning students from novices to experts, enhancing both comprehensive learning and learning experiences. Therefore, every medical school should develop a training program for student reflection, along with a feedback and assessment system integrated into the curriculum.

Transforming Teaching of Foundational Nursing Skills to Enhance Clinical Reasoning Development: A Proposed Simulation Based Learning Activity

Over the past decade nurse educators have been called to transform nursing academia in order to better prepare our future nurses for the tremendous changes in the healthcare environment. The advancing medical technology, aging population, nursing shortages and recent COVID pandemic have provided unique challenges that require complex decision-making abilities. The National Council of State Boards of Nursing (NCSBN) has made significant changes in their licensure examination to accommodate the need to assess vital clinical judgment and decision-making skills in entry level graduate nurses. A model to measure clinical judgment was developed by NCSBN in 2019 to assist faculty in evaluating students beyond textbook nursing knowledge to actively perform and evaluate safe, effective clinical decisions. In order for students to fully grasp the clinical judgment process, faculty need to create active learning opportunities that provide patient context so students can cultivate clinical decision-making skills parallel to clinical knowledge. In nursing curricula, students learn fundamental skills in the first year of their education that provide them with a strong foundation to assess and care for thousands of patients. Transforming how these vital nursing skills are taught from solely performing the psychomotor learning domain to incorporating patient specific scenarios can foster development of clinical reasoning and sound clinical judgment in practice. This article outlines the transformation and redesign of teaching clinical skills to first semester nursing students to enhance clinical reasoning development and a proposed future study of assessing student outcomes using a simulation-based approach.

The Relationship Between Personality Traits and Clinical Decision-Making, Anxiety and Stress Among Intern Nursing Students During COVID-19: A Cross-Sectional Study.

The aim of this study was to investigate whether the personality traits of intern nursing students could serve as valid predictors of their psychological status and clinical decision making. Additionally, we aimed to understand the psychological state of intern nursing students during the regular epidemic prevention and control stage of COVID-19. This study was designed as a cross-sectional survey. A total of 181 intern nursing students involved in clinical placements participated in this study. Participants provided relevant data by completing the Big Five Inventory-44, the Self-Rating Anxiety Scale, the Perceived Stress Scale 14, and the Clinical Decision-Making in Nursing Scale. The results showed that neuroticism (β = -0.282, p < 0.01) and openness (β = 0.302, p < 0.001) played significant roles in predicting clinical decision-making skills among intern nursing students. Regression analysis also showed extraversion (β = -0.249, p < 0.01), openness (β = 0.2, p < 0.01), and neuroticism (β = 0.391, p < 0.001) could significantly predict stress in intern nursing students. The agreeableness (β = -0.354, p < 0.001) and neuroticism (β = 0.237, p < 0.01) could also predict the anxiety of intern nursing students. Additionally, some intern nursing students still suffered from anxiety and stress in the context of the ongoing pandemic. Personality traits are good predictors of clinical decision-making, anxiety and stress among intern nursing students. In conclusion, the openness in personality traits of intern nursing students should be valued and cultivated in clinical work, which will benefit the development of nursing talents.

Effectiveness of case-based learning among medical interns using microbiology laboratory report as a tool

Background: Due to lack of consensus of teaching learning methods during undergraduate period, intern doctors face many challenges in clinical settings. Knowledge gaps related to clinical application of laboratory medicine leads to poor case management. Active learner centered training with real clinical cases is a need to help the interns to link their basic science knowledge into a practical context. Aims and Objectives: The present study was done to evaluate the effect of case based learning (CBL) on the interns’ knowledge and clinical decision-making skill of interpretation of laboratory investigation reports and to assess perception of participants about CBL. Materials and Methods: CBL method was used to train the interns in clinical application microbiology reports. This is a pre- and post-test type study, carried out for 2 months with 43 Medical interns, willing to participate. The process included evaluation of CBL by pre-validated questionnaires by multiple choice questions, clinical case scenarios before, immediately after and 10 days after the intervention and perception toward CBL was assessed. Statistical analysis was done using Student’s t-test and SPSS 17 software. The value of P &lt; 0.05 was considered as significant. Results: A significant improvement in the interns’ knowledge and problem solving following CBL sessions had been observed in present study. The post-test scores of all the CBL sessions were significantly higher than pre-test scores (P &lt; 0.05). The perception of interns toward CBL was assessed and it was responded positively. It helped in strengthening the critical skills of interns such as problem solving, critical thinking, and teamwork. Conclusion: The present study proved that interns during internship require to be trained in laboratory medicine. CBL is an effective teaching method to train interns in enhancing their problem solving skill with correct use of laboratory test results and strengthening critical thinking, teamwork, and time management skills.

Physical therapy students’ perception of their ability of clinical and clinical decision-making skills enhanced after simulation-based learning courses in the United States: a repeated measures design

It aimed to investigate physical therapy students’ perception of their ability of clinical and clinical decision-making skills after a simulation-based learning course in the United States. Survey questionnaires were administered to voluntary participants, including 44 second and third-year physical therapy students of the University of St. Augustine for Health Sciences during 2021–2022. Thirty-six questionnaire items consisted of 4 demographic items, 1 general evaluation, 21 test items for clinical decision-making skills, and 4 clinical skill items. Descriptive and inferential statistics evaluated differences in students’ perception of their ability in clinical decision-making and clinical skills, pre- and post-simulation, and post-first clinical experience during 2021–2022. Friedman test revealed a significant increase from pre- to post-simulation in perception of the ability of clinical and clinical decision-making skills total tool score (P<0.001), clinical decision-making 21-item score (P<0.001), and clinical skills score (P<0.001). No significant differences were found between post-simulation and post-first clinical experience. Post-hoc tests indicated a significant difference between pre-simulation and post-simulation (P<0.001) and between pre-simulation and post-first clinical experience (P<0.001). Forty-three students (97.6%) either strongly agreed (59.1%) or agreed (38.5%) that simulation was a valuable learning experience. The above findings suggest that simulation-based learning helped students begin their first clinical experience with enhanced clinical and clinical decision-making skills.

Virtual patient simulation in pharmacy education: A systematic review

Background: This review summarises the impact of virtual patient simulation (VPS) on pharmacy students’ knowledge, skills, and perceptions. Methods: The PubMed, Cochrane Library, and Web of Science databases were searched using relevant keywords. Full-text articles in English, published between 2010 and August 2021, were retrieved if they evaluate the impact of web-based interactive VPS in pharmacy education. Results: This review included 19 studies, 9 of which were comparative. VPS was used to develop or assess different pharmacy-related skills. In general, post-VPS exposure test scores were better than the pre-VPS test scores in 12 studies. VPS significantly improved higher-level learning, counselling, and decision-making skills more than paper-based cases. The favourable impact of VPS on learners’ confidence, student engagement, and satisfaction was noted. Conclusion: VPS enhances knowledge and clinical decision-making skills. It can also address the needs of pharmacy students with active learning preferences.

Investigating the clinical decision-making of nursing students using high-fidelity simulation, observation and think aloud: A mixed methods research study.

The aim of this study was to investigate nursing students' clinical decision-making by using high-fidelity simulation of a deteriorated patient scenario. A convergent parallel mixed methods research design was used consisting of quantitative and qualitative data collection. Twenty-three students completed the Health Science Reasoning Test before and after the simulation between October 2015 and June 2016. They were presented with a simulated scenario and asked to 'think aloud' during and after the simulation. The students were audio-video recorded and observations were collected by the researcher. There was a significant moderate increase in the 'deduction' and 'analysis' sub-scale scores and overall test score, suggestive of improved analytical decision-making processes through the simulation experience. Think-aloud and observation data identified that students predominantly applied 'forward' reasoning during the simulated 'patient's' deterioration, focusing mainly on cue acquisition. 'Backward' reasoning with a focus on cue interpretation was most prominent in the debriefing data, in line with the survey outcomes. Accurate cue interpretation of critical, key cues appeared more useful than the total number of cues in solving the main clinical case problem. Students learn different clinical decision-making skills during the simulation compared to what they learn from debriefing. Using observation and think-aloud methods have significant benefits for researchers seeking to optimize the evaluation of the clinical decision-making process.

Can web-based implementation interventions improve physician early diagnosis of cerebral palsy? Protocol for a 3-arm parallel superiority randomised controlled trial and cost–consequence analysis comparing adaptive and non-adaptive virtual patient instructional designs with control to evaluate effectiveness on physician behaviour, diagnostic skills and patient outcomes

IntroductionCerebral palsy (CP) is the most common childhood physical disability. Accurate diagnosis before 6 months is possible using predictive tools and decision-making skills. Yet diagnosis is typically made at 12–24...

The Episodic Tool: An innovative approach to teach clinical decision making in advanced health assessment.

Advanced health assessment (AHA) serves as the foundational course in advanced practice nurse education in which students apply clinical decision-making skills to gather appropriate subjective and objective data and to begin to formulate diagnostic hypotheses. Summative objective structured clinical exams (OSCEs) have been used in AHA courses to evaluate students' clinical competence. After implementing summative OSCEs in AHA, we found that students struggled with evaluations requiring critical thinking skills and subsequently designed a teaching tool to address this gap. An Episodic Tool was created for the six main body systems with a chief complaint and three age and gender combinations. In small groups, students used the tool to identify pertinent history and physical exam components for a specific age and gender. A faculty-facilitated group discussion followed. A pre/post design was used in this quality improvement project to compare OSCE and oral clinical exam (OCE) scores. OCEs were used in 2020 due to COVID-19 limitations. There was a statistically significant increase of 7% in the mean OCE/OSCE scores after implementation of the tool (p<.001). Qualitative feedback from students and faculty suggested the tool effectively enhanced students' critical thinking and clinical decision-making skills and promoted consistency across course sections.