Clinical Reasoning Skills Research Articles

Challenges Experienced by Nurse Educators in Promoting Acquisition of Clinical Reasoning Skills by the Undergraduate Nursing Students: A Qualitative Exploratory Study

Challenges Experienced by Nurse Educators in Promoting Acquisition of Clinical Reasoning Skills by the Undergraduate Nursing Students: A Qualitative Exploratory Study

The Effectiveness of High-Fidelity Simulation on Clinical Competence Among Nursing Students

Introduction Clinical competence is a pre-requisite for every student nurse to showcase their proficiency in providing quality nursing care. Effective clinical experience during the study period plays a pivotal role in developing clinical competence among nursing students. Hence, the purpose of the study was to find the effectiveness of high fidelity simulation (HFS) on clinical competence among nursing students. Objectives The objectives of the study were to determine the impact of HFS on level of clinical competence among nursing students, to find the association between selected demographic characteristics of nursing students with their level of clinical competence and also, to find the association between academic performances of nursing students with their level of competence. Method The current study employed a quasi-experimental study design. Sixty-five nursing students from second year Bachelor of Science in Nursing (BSN) program were selected using consecutive sampling technique. The data was collected using demographic data form, objective structured clinical examination (OSCE) grade performa, and academic score sheet. SPSS version 24 was used to analyze data. Results The study revealed a significant impact of HFS on clinical competence of nursing students. Majority (52.3%) of the nursing students obtained high level clinical competence following the HFS. The findings showed a significant association between gender and medium of instruction with the level of clinical competence of nursing students. Further, there was a significant correlation between academic performance and level of clinical competence of the nursing students. Conclusion HFS served as a useful pedagogical approach in fulfilling the clinical learning outcomes. It further facilitated readiness of nursing students in second year BSN in terms of developing competence and confidence for clinical placement at the hospital for the third year of their study. However, further research is required to determine if HFS can be used in developing clinical reasoning skills in nursing students.

Clinical educators of the medical colleges of South Asia need to be trained for educating clinical reasoning skills to medical students

Clinical reasoning is the process of reasoning to decide for managing the patient using data and applying medical knowledge and experience. Clinical reasoning skills are essential skills for the novice learner of medical education to learn the process of clinical diagnosis, thereby providing safe and effectual health care. These skills learning help clinicians arrive at a diagnosis and prevent making diagnostic errors which are reported to occur in five to 15% of cases. Poor clinical reasoning leads to a diagnostic error which may jeopardize the patient’s safety. The clinical reasoning skills are not generally explicitly imparted to the learners especially during their undergraduate learning period even though these may be documented in the curriculum of medical undergraduate study. The key elements in the clinical reasoning process are the patients’ story, data acquisition, problem representation, hypothesis generation, search and selection of illness script, differential diagnosis, and a leading diagnosis. Clinical reasoning is a complex process, difficult to teach learners and assess their skills, consumes clinical medical educators’ time, and requires resources for teaching and learning. There must be educational strategies both at the undergraduate and postgraduate levels to promote diagnostic reasoning skills; for this, clinical medical educators must be acquainted/trained in how to convey the reasoning approaches to beginners. The clinical medical educator has to a play dual role; provide quality care to the patients, teach clinical reasoning skills to the learners, and assess their skills to make them independent decision-makers and problem solvers in clinical settings. Clinical reasoning skills are among the core competencies to be learned by medical learners to become competent clinicians. The clinical competence of the clinician cannot be superseded by the advancement of technology and evidence-based medicine. All these three need to be integrated to minimize the errors in diagnosis. Clinical educators must unequivocally nurture and enhance the capacity of learners to include and integrate both analytical and non-analytical clinical reasoning strategies into their approach to arrive at diagnosis. The clinical medical educator must identify the learners’ approach to clinical reasoning and enable them to follow the right approaches towards clinical reasoning. Clinical reasoning skills are better learned/imparted during clinical encounters and deliberate practice enriches learning of these skills. Enhancement of clinical reasoning skills learning can be achieved through deliberate practice. The clinical medical educator may organize and supervise the simulation-based deliberate practice sessions for the learners to boost their clinical reasoning skills. For the deliberate practice of clinical reasoning skills, The New England Journal of Medicine (NEJM) has developed an application NEJM Healer, a screen-based interactive patient encounter (Virtual Bedside Encounter) through which learners are involved in each element of clinical reasoning process. Virtual Reality (VR) is also gaining popularity in educating the medical students and has been demonstrated to be beneficial in enhancing students’ comprehension and memory as well as in the development of transferable skills like surgical methods. The medical schools in South Asian countries need to reiterate the development/enhancement of clinical reasoning skills of both medical undergraduate and postgraduate learners. To achieve this objective, medical colleges must regularly organize training for clinical medical educators to facilitate students’ learning in reasoning skills, and for assessing their skills, and provide feedback to the learners. The institutes should also invest in infrastructure to pursue the use of modern technologies like VR, skills labs, etc. to attain this objective.

Why include Case-based Learning in the medical curriculum? – A review

Introduction: Clinical teaching is an irreplaceable component of medical education. It takes place through many teaching–learning methodologies in various settings such as the bedside, classrooms, and the community. Case-based Learning is a method which had been devised to fill the gaps seen in bedside teaching where learning is mostly opportunistic. CBL evolves around pre-selected typical cases from an existing collection through small-group discussions.Method: The objective of the study was to identify the positive features of CBL in clinical education. A narrative review was done to search articles on PubMed and Google Scholar between 2018 and 2023. The search terms were ‘case-based learning’ ‘clinical education’ and ‘medical curriculum’.Results: The narrative review identified articles (n=14) relevant to our study. Case-based learning and discussion were seen as an effective and acceptable learning tool by medical students. It helped them to gain clinical reasoning skills which are critical in clinical decision-making and management. Exposure to case-based learning scenarios, allowed them to relate basic sciences to clinical sciences. Students were able to recollect the concepts that they had learnt by correlating them with case scenarios in a stress-free environment enhancing their critical thinking abilities. It promoted collaborative learning skills among students.Conclusion: CBL was perceived as a good learning tool by students. It is possible to combine CBL with other traditional clinical teaching methods such as bedside teaching. The case-based learning approach promotes recapitulating the basic concepts learned, relating them to a clinical scenario that results in the consolidation of the concepts.

Teaching Strategies for Developing Clinical Reasoning Skills in Nursing Students: A Systematic Review of Randomised Controlled Trials.

Clinical reasoning (CR) is a holistic and recursive cognitive process. It allows nursing students to accurately perceive patients' situations and choose the best course of action among the available alternatives. This study aimed to identify the randomised controlled trials studies in the literature that concern clinical reasoning in the context of nursing students. A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) was performed to identify relevant studies published up to October 2023. The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary study aim; (b) articles published for the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) Randomised Clinical Trials. The Critical Appraisal Skills Programme tool was utilised to appraise all included studies. Fifteen papers were analysed. Based on the teaching strategies used in the articles, two groups have been identified: simulation methods and learning programs. The studies focus on comparing different teaching methodologies. This systematic review has detected different approaches to help nursing students improve their reasoning and decision-making skills. The use of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students' reasoning skills. Nursing schools should evaluate their current methods and consider integrating or modifying new technologies and methodologies that can help enhance students' learning and improve their clinical reasoning and cognitive skills.

Experiences of students and educators with simulated placements in allied health profession and nursing education: a qualitative systematic review

Reduced clinical placement capacity, the COVID-19 pandemic and growing training place numbers have resulted in the development of innovative placement design in healthcare education. Simulation is widely used in healthcare education; however, its use as a placement model is in its infancy. The experiences and perceptions of students and educators are important to shape simulated placements moving forward. A systematic search of the literature was conducted on eight databases to identify qualitative and mixed-methods studies exploring the experiences of students or educators in the nursing and allied health professions. Eight studies met the inclusion criteria and were assessed for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research. A meta-aggregative approach, in accordance with JBI guidelines for reviews of qualitative evidence, was used to synthesize the results. From the eight studies, a total of 69 findings were extracted. These were grouped into nine categories to form three synthesized findings of overall low quality. These findings were related to (1) reality of the simulated placement, (2) emotions evoked during the simulated placement, and (3) opportunities and challenges associated with implementing simulated placements. Simulated placements were considered a useful tool for the enhancement of communication skills, clinical reasoning skills, new knowledge generation, enhancing reflection and for preparation for clinical practice by students as well as educators.

Comparison of Learning Outcomes Between Active Participants and Observer Roles in Simulation-Based Learning

BackgroundThe educational impact of observation compared to active participation in simulation-based learning remains uncertain. This study aimed to compare knowledge, clinical reasoning skills, and learning flow between active participants and observers in a nursing simulation experience. MethodsThis study was a parallel randomized trial of two groups. Nursing students were randomly assigned to active participant (n = 37) and observer (n = 32) groups. Knowledge, clinical reasoning skills, and learning flow were measured before and after the simulation. ResultsBoth groups showed improved knowledge, clinical reasoning skills, and learning flow after simulation-based learning, with no pre-test−post-test differences in the three outcomes between the groups. ConclusionsObservers showed similar improvements in learning outcomes compared to active participants in a simulated learning experience. Further studies are needed to identify the effects of reflective observation on performance acquisition and retention.

Expanding the scope of problem-based-learning at Hackensack Meridian School of Medicine; integrating domain-general skills with domain-specific content

The Master Adaptive Learner is a model used to develop students to become self-regulated and adaptable lifelong learners to practice medicine in a complex and ever-changing environment. The Hackensack Meridian School of Medicine (HMSOM) proposes a new course, Patient Presentation Problem-Based Learning Curriculum (PPPC), a dynamic and integrated course that goes beyond the scope of traditional Problem-Based-Learning (PBL). PPPC allows students to build domain-general skills in tandem with domain-specific content learned during a pre-clerkship curriculum. An integrated case provides weekly scaffolding, such that the course takes place throughout the week and is not isolated from the rest of the curriculum. Students receive iterative feedback and structured assignments which allows development of self-directed learning skills along with integration and consolidation of weekly curricular content. A layered analysis approach was used to outline the philosophies, principles and techniques that link to our course objectives. Techniques used could easily be translated to other pre-clerkship curriculum to promote development of self-directed learning and clinical reasoning skills, as well as promote more meaningful learning of basic, clinical, and health system science content.

Outcome measures in clinical education research

. The Journal of Clinical Education in Physical Therapy (JCEPT) is an open-access journal that disseminates peer-reviewed quantitative and qualitative scholarship to increase the quality evidence available related to clinical education in physical therapy. Since 2021, the number of article downloads has increased by more than 10-fold, with annual increases exceeding 200%. Open-access allows JCEPT readers free access to both read online and download full-text articles. Last year, one article was viewed over 900 times while another was downloaded nearly 1,200 times. The Directory of Open Access Journals (DOAJ) began indexing JCEPT last year and now accounts for 14% of our referral sources. Next year, we expect to obtain indexing in PubMed Central (PMC), which will further increase the discoverability of JCEPT articles. The nature of clinical education raises various challenges to research, with one being how to assess outcomes. Articles published this year in JCEPT reflect the thoughtful application of different approaches to outcome measures. Some questions were assessed with quantitative measures while others used qualitative research methods. Self-efficacy was measured in two different articles exploring the domains of cross-cultural psychological capital and clinical competence. Clinical reasoning was assessed using the physical therapy Clinical Performance Instrument in one article and script concordance tests in another. A more recently established outcome such as inter-professional socialization was assessed with a quantitative scale while emotional and educational adaptability themes were explored with qualitative methods. In past volumes, a SNAPPS model (summarize, narrow, analyse, probe, plan, select) of clinical mentoring was used to help students process initial evaluation findings and longitudinal narrative analyses were used to assess the development of resident clinical reasoning skills. Outcome measures assessing the effectiveness of clinical education are essential.1 Efforts may start with the thoughtful choice of psychometrically supported quantitative measures as well as rigorous description of qualitative measures.2 However, recent JCEPT articles suggest many factors can influence the quality of a clinician,1 including their educational curriculum, pre- clinical training, the clinical environment of their patient exposures, the individual characteristics and stresses of students and their clinical instructors, as well as environmental forces such as the COVID pandemic. Translating the effectiveness of clinical education to improved clinical care and patient outcomes remains a challenge for future researchers. JCEPT publishes scholarly work affecting any aspect of clinical education in physical therapy addressing academic or clinical faculty, entry-level students or residents, curricula or teaching and learning methods. In addition to original research, systematic reviews, and innovative teaching methods, this year JCEPT published our first ‘clinical education case report’ describing remediation methods during clinical training and related outcomes. We look forward to publishing more papers and developing the evidence underpinning physical therapy clinical education.

Assessing clinical reasoning skills following a virtual patient dizziness curriculum.

Dizziness is a common medical symptom that is frequently misdiagnosed. While virtual patient (VP) education has been shown to improve diagnostic accuracy for dizziness as assessed by VPs, trainee performance has not been assessed on human subjects. The study aimed to assess whether internal medicine (IM) interns after training on a VP-based dizziness curriculum using a deliberate practice framework would demonstrate improved clinical reasoning when assessed in an objective structured clinical examination (OSCE). All available interns volunteered and were randomized 2:1 to intervention (VP education) vs. control (standard clinical teaching) groups. This quasi-experimental study was conducted at one academic medical center from January to May 2021. Both groups completed pre-posttest VP case assessments (scored as correct diagnosis across six VP cases) and participated in an OSCE done 6weeks later. The OSCEs were recorded and assessed using a rubric that was systematically developed and validated. Out of 21 available interns, 20 participated. Between intervention (n=13) and control (n=7), mean pretest VP diagnostic accuracy scores did not differ; the posttest VP scores improved for the intervention group (3.5 [SD 1.3] vs. 1.6 [SD 0.8], p=0.007). On the OSCE, the means scores were higher in the intervention (n=11) compared to control group (n=4) for physical exam (8.4 [SD 4.6] vs. 3.9 [SD 4.0], p=0.003) and total rubric score (43.4 [SD 12.2] vs. 32.6 [SD 11.3], p=0.04). The VP-based dizziness curriculum resulted in improved diagnostic accuracy among IM interns with enhanced physical exam skills retained at 6weeks post-intervention.

BEDSIDE LEARNING: VITAL FOR NURSING EDUCATION - CREATING COMPETENT, EMPATHETIC HEALTHCARE PROFESSIONAL

This comprehensive review explores the vital role of bedside learning in nursing education, focusing on its impact on clinical skill development and empathy among students. By bridging theoretical knowledge with practical application, bedside teaching allows nursing students to apply classroom concepts directly to patient care, enhancing understanding and retention. The review highlights evidence-based practice (EBP) teaching strategies and emphasizes the need for improved interactive and clinically integrated approaches.. It cultivates empathy and compassion as students interact with patients personally, witnessing their struggles and hopes. Furthermore, bedside learning enhances communication skills, enabling students to establish meaningful connections with patients and healthcare teams. Finally, this method promotes critical thinking by challenging students to analyze patient cases and make informed decisions. Conclusion:In conclusion, research highlights the pivotal role of bedside teaching in clinical education, especially in nursing. Hands-on experiences and patient interactions are essential for developing clinical reasoning skills, fostering patient-centered care, and nurturing professional growth. Conflict of Interest: There is no conflict of interest.

Using Simulation to Develop Clinical Reasoning Skills for Registered Practical Nurses New to Acute Care

BackgroundTo address the nursing workforce shortage, registered practical nurses (RPNs) were introduced to acute care areas at The Ottawa Hospital. MethodsThe Kirkpatrick levels were used to evaluate the RPN simulation-based education session. A paired T-test was used to assess statistical significance of patient safety data. ResultsGreater than 81% of RPNs found the simulations to be extremely effective at preparing them for their new role. Patient safety data showed a statistically significant decrease in rapid-response team calls (p = .0431) and a decrease in patient falls that was not quite statistically significant (p = .0506). ConclusionThrough the simulation sessions, the RPNs mastered the fundamentals of being able to assess, construct, implement, and evaluate a plan of patient care, setting the framework for clinical reasoning.

Co-teaching in medicine and nursing in training nurse anesthetists: a before-and-after controlled study

BackgroundClarifying the effectiveness of co-teaching in medicine and nursing (CMN) is important as it is crucial in clinical practice to improve the quality of patient care and prognosis. In this study, we aimed to determine the efficacy of CMN in nurse anesthetist training.MethodThe study comprised a 6-month training session and a before-and-after controlled study. In total, 59 nurses were recruited. The first 30 nurses were enrolled in the conventional single-teaching in nursing (SN) group and only took nursing-related courses. The next 29 students were enrolled in the CMN group and received both general medical and nursing-specific curricula. Before and after training, medical and nursing collaboration competency scores and knowledge scores were compared between the two groups. At the end of the study, qualitative comments on teaching satisfaction and clinical reasoning skills improvement were queried, and content analysis was performed.ResultsParticipants in the CMN group outperformed those in the SN group in tests of medical and nursing collaboration abilities as well as knowledge. The CMN group outperformed the SN group in terms of teaching satisfaction evaluation, particularly in terms of fostering learning in the anesthetist specialty, improving clinical practice, fostering motivation, and influencing how people think about challenges at work. Furthermore, participants in the CMN group felt that their clinical reasoning abilities had improved.ConclusionIn comparison to the SN group, the CMN group had enhanced outcomes of patient care, medical and nursing collaboration, and clinical reasoning skills.

Assessing Cognitive Apprenticeship Impact on Clinical Reasoning in Third-Year Student Pharmacists

ObjectiveThe objective of this study was to evaluate the impact of implementing a cognitive apprenticeship theory (CAT) model into a Doctor of Pharmacy course in improving clinical reasoning skills of third-year student pharmacists over time and preparing them for Advanced Pharmacy Practice Experiences (APPEs). MethodsThis was a single center, nonrandomized, observational before-and-after study from January 2022 through May 2022. Third-year student pharmacists enrolled in the Critical Care Integrated Drugs and Disease pharmacotherapy course at the University of Kentucky College of Pharmacy were administered a well-established and nationally recognized clinical patient case assessment on weeks 1 and 15 of the course. Students were asked to prioritize patient problems and provide recommendations for therapy, goals, and monitoring. Responses were then scored using a predefined case key. In addition, student pharmacists were asked to self-evaluate their confidence in APPE readiness on a 5-point Likert scale. ResultsOf the 136 student pharmacists enrolled in the course, 92 (68%) student pharmacists completed both week 1 and week 15 clinical cases and self-assessment surveys, provided informed consent, and were included. Cumulative clinical case scores were significantly increased from week 1 to week 15 (34.8 vs 39.7). In addition, significant improvement was seen in overall problem prioritization, overall recommendations, and self-perceived preparedness for APPE rotations. ConclusionThe use of a CAT model into a 15-week pharmacotherapy course improved comprehensive scores of clinical reasoning assessment in third-year student pharmacists and was associated with increased self-perceived confidence and readiness for APPEs.

Reflective learning conversations model for simulation debriefing: a co-design process and development innovation

BackgroundHealth practitioners must be equipped with effective clinical reasoning skills to make appropriate, safe clinical decisions and avoid practice errors. Under-developed clinical reasoning skills have the potential to threaten patient safety and delay care or treatment, particularly in critical and acute care settings. Simulation-based education which incorporates post-simulation reflective learning conversations as a debriefing method is used to develop clinical reasoning skills while patient safety is maintained. However, due to the multidimensional nature of clinical reasoning, the potential risk of cognitive overload, and the varying use of analytic (hypothetical-deductive) and non-analytic (intuitive) clinical reasoning processes amongst senior and junior simulation participants, it is important to consider experience, competence, flow and amount of information, and case complexity related factors to optimize clinical reasoning while attending group- based post-simulation reflective learning conversations as a debriefing method. We aim to describe the development of a post-simulation reflective learning conversations model in which a number of contributing factors to achieve clinical reasoning optimization were addressed.MethodsA Co-design working group (N = 18) of doctors, nurses, researchers, educators, and patients’ representatives collaboratively worked through consecutive workshops to co-design a post-simulation reflective learning conversations model to be used for simulation debriefing. The co-design working group established the model through a theoretical and conceptual-driven process and multiphasic expert reviews. Concurrent integration of appreciative inquiry, plus/delta, and Bloom’s Taxonomy methods were considered to optimize simulation participants’ clinical reasoning while attending simulation activities. The face and content validity of the model were established using the Content Validity Index CVI and Content Validity Ratio CVR methods.ResultsA Post-simulation reflective learning conversations model was developed and piloted. The model was supported with worked examples and scripted guidance. The face and content validity of the model were evaluated and confirmed.ConclusionsThe newly co-designed model was established in consideration to different simulation participants’ seniority and competence, flow and amount of information, and simulation case complexity. These factors were considered to optimize clinical reasoning while attending group-based simulation activities.

간호학 실습교과목의 간호역량, 실습교육방법, 교수법 관련 문헌고찰

Objectives Nursing practicum has used various teaching methods to enable nursing students to build their nursing competencies. This review summarized the definition of nursing competencies, teaching modes of delivery, and teaching methods that were commonly used in clinical practicum in South Korea.
 Methods The initial search resulted in 17 articles in RISS, nine in DBpia, and 54 in KISS. Following the removal of duplicates, 14 articles were excluded. Next, the title and abstract of 66 studies were reviewed against our in-clusion and exclusion criteria, and 39 studies remained for the full-text review. Following these steps, 37 studies were included in this literature review.
 Results Nursing competencies were measured using 17 concepts in clinical practicum. Of these 17 concepts, the most common concept used to evaluate nursing competency in clinical training was communication skills in nurs-ing practice, followed by clinical performance skills, problem-solving skills, self-discipline in learning, critical thinking skills, self-efficacy, and clinical reasoning skills. In terms of teaching modes of delivery in clinical practi-cum, the following modes were commonly used: simulation training, online learning, hybrid learning, and face-to-face training. Regarding teaching methods, high-fidelity simulation, flipped learning, team-based learn-ing, problem-based learning, and role-playing were commonly used in nursing practicum.
 Conclusions This literature review identified the commonly used concept of nursing competency in clinical practi-cum, teaching modes of delivery, and teaching methods in the existing literature published before the 4th cycle of the Korean Nursing Education Accreditation evaluation. Given that a new model of the Korean Nursing Education Accreditation was recently launched and new criteria for nursing competency were announced, the current clinical practicum needs to adopt new concepts of nursing competency and revise teaching methods accordingly. Future studies warrant more detailed investigations on evaluating the appropriateness of the sub-categories of clinical training.

A84Medical Escape Rooms as a novel approach to simulation

Medical escape rooms have risen in popularity for their ability to teach various skills to medical students in a gamified context [1]. We designed two simulation-based medical escape rooms in which students could enhance their clinical and non-clinical skills, and learn about human factors. The escape room mimicked the complexity of a real patient with multiple pathologies, unlike traditional simulation, which usually focuses on one. This created a fun, realistic approach to experiential learning whilst enhancing psychological safety, collaboration, teamwork and communication. Learning outcomes for the escape room incorporated clinical reasoning, prescribing, data interpretation, synthesis of management plans, practicing effective communication, teamworking, leadership and situational awareness skills. These were mapped to the General Medical Council’s outcomes for graduates. The aim of creating the escape room was to create a realistic complex scenario, incorporate teamworking and clinical and non-clinical aspects of patient care, whilst maximizing engagement and easing the stress of traditional simulation. The escape room simulations were themed for Christmas and Valentine’s day with an underlying non-medical mission. The simulation was designed to ensure students practiced their A-E assessments. When students made the correct assessments and requested the correct investigations and management, clues would reveal answers to complete a puzzle or unlock a box that would slowly allow them to solve their non-medical mission. Feedback was collected from all 40 students who participated in the two escape rooms, using Likert scales and open answer text. 97% of students agreed or strongly agreed that the Escape Room enhanced their clinical reasoning skills. 98% agreed or strongly agreed that the session addressed nonclinical skills e.g. leadership, communication and teamworking and that the session will benefit patient care in future clinical practice. 95% agreed or strongly agreed that the debrief enhanced their clinical knowledge. Students enjoyed treating realistic multiple pathologies and completing several tasks, allowing for prolonged, in depth simulated practice. Students appreciated the teamworking opportunities, quizzes, puzzles and lateral thinking opportunities. They found the Escape Room simulation more fun and relaxing than traditional simulation, yet just as relevant. The positive feedback validates the potential of medical escape rooms as a unique teaching modality, and the scope to promote teamworking within a complex simulation scenario beyond that of traditional simulation. There is the potential to diversify and use escape rooms to promote interprofessional learning. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A11An evaluation of student views on the use of virtual simulation in undergraduate pharmacy education

In part due motivated by a lack of in-person placement opportunities for undergraduate pharmacy students during the COVID-19 pandemic, a UK university teaching team developed a programme of virtual simulated placement-style events to support undergraduate pharmacy students in developing skills and experience to support them in engaging with their foundation training. These experiences were developed at a time of significant change for undergraduate pharmacy training, as all new pharmacists being annotated as independent prescribers at the point of registration from 2026 onwards [1]. It has been reported that in medical students, the use of virtual patient simulation could improve clinical reasoning skills [2] but evidence of student views on the acceptability and implementation of virtual simulation in the target audience is limited and frequently not reflective of the style of self-directed simulation being utilized. This work aimed to evaluate final-year undergraduate pharmacy student views of the impact of the introduction of a programme of student-led virtual simulation on their education. In academic years 2020–2021 and 2021–2022, an electronic questionnaire was distributed to final-year students who had recently been introduced to and given access to a range of student-led virtual placement experiences in academic years. Prior to administering questionnaires to students, the study was approved by the relevant school research ethics committee. Questionnaires were formed of a mixture of qualitative and quantitative questions, and asked students about their experiences of engagement with virtual simulation and views on the potential applications of virtual simulation in the curriculum. Quantitative data were analysed by simple descriptive statistics, and a critical review of free-text responses was performed through grounded theory to identify emergent key themes. A total of 43 student questionnaires were collected, with 18 responses (41.9%) being received in the academic year 2020–2021 and 25 responses (58.1%) received in the academic year 2022. 88.4% of respondents agreed that the introduction of virtual simulation would enhance their educational experience. Four key themes emerged from qualitative data analysis: individuality and autonomy, convenience, immediacy, and control. Students most commonly believed that the second year of the 4-year Master of Pharmacy programme is the optimal time for the introduction of placement-style virtually simulated experiences. Final-year undergraduate pharmacy students believed that the introduction of a programme of student-led virtual simulation would enhance their educational experience. Students were found to value the convenience, control and autonomy of the introduction of student-led virtual simulation. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A19Identification of clinical reasoning models commonly used in simulation-based education

Simulation can immerse learners in scenarios that mimic clinical situations, simultaneously mitigating safety risks and increasing standardization in healthcare education [1]. Through simulation, learners can get the chance to develop clinical reasoning with focused learning opportunities [2]. Clinical reasoning is multidimensional in nature, and underdeveloped clinical reasoning skills and the risk of cognitive overload can potentially threaten patient safety and delay care, so it is important to systematize, optimize and structure clinical reasoning for simulation-based education [3]. That can be achieved through using valid clinical reasoning models but with careful consideration to the contributing and influencing factors of case complexity, staff seniority, competence, scope of practice, specialty and subspecialty. A scoping review was undertaken to answer the questions: what are the best available valid and reliable clinical reasoning models for simulation-based education? We searched Medline, Scopus, Education Research Complete and Google Scholar to identify relevant recent primary research conducted on this topic from 2000 onwards. The search included MeSH topics of ‘Clinical reasoning’, ‘Simulation-based education’ and ‘Clinical Reasoning models’. The inclusion criteria were primary studies describing the clinical reasoning models developed for simulation-based courses. Two independent researchers agreed on the inclusion of the identified articles for full-text review. This review followed the review guidelines of Joanne Briggs Institute. Five valid and reliable models to structure the clinical reasoning process while attending simulation-based training were identified and are reported in Identified clinical reasoning models based on the scoping review There is an adequate number of clinical reasoning models to be used while taking part in simulation-based training; however, there is a significant basis to test the reliability and validity of these models against different competence and seniority levels, and applicability to other healthcare professions. The authors are presently working on the development of a new model using an innovative and rigorous approach. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Performance of ChatGPT on Registered Nurse License Exam in Taiwan: A Descriptive Study.

(1) Background: AI (artificial intelligence) chatbots have been widely applied. ChatGPT could enhance individual learning capabilities and clinical reasoning skills and facilitate students' understanding of complex concepts in healthcare education. There is currently less emphasis on its application in nursing education. The application of ChatGPT in nursing education needs to be verified. (2) Methods: A descriptive study was used to analyze the scores of ChatGPT on the registered nurse license exam (RNLE) in 2022~2023, and to explore the response and explanations of ChatGPT. The process of data measurement encompassed input sourcing, encoding methods, and statistical analysis. (3) Results: ChatGPT promptly responded within seconds. The average score of four exams was around 51.6 to 63.75 by ChatGPT, and it passed the RNLE in 2022 1st and 2023 2nd. However, ChatGPT may generate misleading or inaccurate explanations, or it could lead to hallucination; confusion or misunderstanding about complicated scenarios; and languages bias. (4) Conclusions: ChatGPT may have the potential to assist with nursing education because of its advantages. It is recommended to integrate ChatGPT into different nursing courses, to assess its limitations and effectiveness through a variety of tools and methods.