Exercise In Clinical Reasoning Research Articles

Virtual patients versus standardized patients for improving clinical reasoning skills in ophthalmology residents. A randomized controlled trial

BackgroundHistory taking and clinical reasoning are important skills that require knowledge, cognition and meta-cognition. It is important that a trainee must experience multiple encounters with different patients to practice these skills. However, patient safety is also important, and trainees are not allowed to handle critically ill patients. To address this issue, a randomized controlled trial was conducted to determine the effectiveness of using Virtual Patients (VP) versus Standardized Patients (SP) in acquiring clinical reasoning skills in ophthalmology postgraduate residents.MethodsPostgraduate residents from two hospitals in Lahore, Pakistan, were randomized to either the VP group or the SP group and were exposed to clinical reasoning exercise via the VP or SP for 30 min after the pretest. This was followed by a posttest. One month after this activity, a follow-up posttest was conducted. The data were collected and analysed using IBM-SPSS version 25. Repeated measures ANOVA was used to track the effect of learning skills over time.ResultsThe mean age of the residents was 28.5 ± 3 years. The male to female ratio was 1:1.1. For the SP group, the mean scores were 12.6 ± 3.08, 16.39 ± 3.01 and 15.39 ± 2.95, and for the VP group, the mean scores were 12.7 ± 3.84, 16.30 ± 3.19 and 15.65 ± 3.18 for the pretest, posttest and follow-up posttest, respectively (p value < 0.00). However, the difference between the VP and SP groups was not statistically significant (p = 0.896). Moreover, there was no statistically significant difference between the VP and SP groups regarding the retention of clinical reasoning ability. In terms of learning gain, compared with the VP group, the SP group had a score of 51.46% immediately after clinical reasoning exercise as compared to VP group, in which it was 49.1%. After one month, it was 38.01 in SP and 40.12% in VP group.ConclusionVPs can be used for learning clinical reasoning skills in postgraduate ophthalmology residents in a safe environment. These devices can be used repeatedly without any risk to the real patient. Although similarly useful, SP is limited by its nonavailability for repeated exercises.

A Break in the Case: an Exercise in Clinical Reasoning.

A Break in the Case: an Exercise in Clinical Reasoning.

Exercises in Clinical Reasoning: Beyond the Surface.

Exercises in Clinical Reasoning: Beyond the Surface.

Coagulation Conundrum: an Exercise in Clinical Reasoning.

Coagulation Conundrum: an Exercise in Clinical Reasoning.

Mirror Mirror: An Exercise in Clinical Reasoning.

Mirror Mirror: An Exercise in Clinical Reasoning.

Exercise in Clinical Reasoning: Trust but Verify.

Exercise in Clinical Reasoning: Trust but Verify.

Diagnostic Momentum in Acute Liver Injury: an Exercise in Clinical Reasoning.

Diagnostic Momentum in Acute Liver Injury: an Exercise in Clinical Reasoning.

Unpacking the Cognitive Baggage: an Exercise in Clinical Reasoning.

Unpacking the Cognitive Baggage: an Exercise in Clinical Reasoning.

Over the Threshold: an Exercise in Clinical Reasoning.

Over the Threshold: an Exercise in Clinical Reasoning.

Confusion andRepresentative Restraint: An Exercise in Clinical Reasoning.

Confusion andRepresentative Restraint: An Exercise in Clinical Reasoning.

Tissue, Teamwork, and Timing: an Exercise in Clinical Reasoning.

Tissue, Teamwork, and Timing: an Exercise in Clinical Reasoning.

Hearts and Minds: an Exercise in Clinical Reasoning.

Hearts and Minds: an Exercise in Clinical Reasoning.

Exercises in Clinical Reasoning: Digesting a Bloated Differential Diagnosis.

Exercises in Clinical Reasoning: Digesting a Bloated Differential Diagnosis.

Overcoming Inertia: an Exercise in Clinical Reasoning.

Overcoming Inertia: an Exercise in Clinical Reasoning.

The Writing on the Wall: An Exercise in Clinical Reasoning.

The Writing on the Wall: An Exercise in Clinical Reasoning.

When the Past Informs the Present: An Exercise in Clinical Reasoning.

When the Past Informs the Present: An Exercise in Clinical Reasoning.

Accuracy of self-monitoring: does experience, ability or case difficulty matter?

The ability to self-monitor one's performance in clinical settings is a critical determinant of safe and effective practice. Various studies have shown this form of self-regulation to be more trustworthy than aggregate judgements (i.e. self-assessments) of one's capacity in a given domain. However, little is known regarding what cues inform learners' self-monitoring, which limits an informed exploration of interventions that might facilitate improvements in self-monitoring capacity. The purpose of this study is to understand the influence of characteristics of the individual (e.g. ability) and characteristics of the problem (e.g. case difficulty) on the accuracy of self-monitoring by medical students. In a cross-sectional study, 283 medical students from 5years of study completed a computer-based clinical reasoning exercise. Confidence ratings were collected after completing each of six cases and the accuracy of self-monitoring was considered to be a function of confidence when the eventual answer was correct relative to when the eventual answer was incorrect. The magnitude of that difference was then explored as a function of year of seniority, gender, case difficulty and overall aptitude. Students demonstrated accurate self-monitoring by virtue of giving higher confidence ratings (57.3%) and taking a shorter time to work through cases (25.6seconds) when their answers were correct relative to when they were wrong (41.8% and 52.0seconds, respectively; p<0.001 and d>0.5 in both instances). Self-monitoring indices were related to student seniority and case difficulty, but not to overall ability or student gender. This study suggests that the accuracy of self-monitoring is context specific, being heavily influenced by the struggles students experience with a particular case rather than reflecting a generic ability to know when one is right or wrong. That said, the apparent capacity to self-monitor increases developmentally because increasing experience provides a greater likelihood of success with presented problems.

A Curriculum for Diagnostic Reasoning: JGIM's Exercises in Clinical Reasoning.

A Curriculum for Diagnostic Reasoning: JGIM's Exercises in Clinical Reasoning.

Putting Schemas to the Test: An Exercise in Clinical Reasoning

Putting Schemas to the Test: An Exercise in Clinical Reasoning

Look No Further: An Exercise in Clinical Reasoning.

Look No Further: An Exercise in Clinical Reasoning.