Can virtual patients

p be used to promote
p reflective practice
p as part
p of pediatric
p
t i
trainees’
trainees ’ diagnostic
di ti reasoning
i strategies?
t t i ?
B de
Bas L g1, Rene
d Leng R G t2, Jeroen
van Gent J D k 1, Frank
Donkers F k Hess
H 3 4, Jörn
3,4 H id4, JJean van Berlo
Jö Heid B l 1, Cees
C van der Vl t 1.
d Vleuten
1

Questions P
Procedure
d
 All residents simultaneously worked out the same virtual patient,
patient based on a
How do
H d residents
id t perceive
p i the
th value
l off a virtual
i t l patient
p ti t for
f learning
l i g real case where ‘premature
premature closure’
closure during clinical reasoning had occurred.
clinical reasoning?  Three times during the work
work-out
out of the virtual patient a ‘time
time out’
out was
scheduled
sc edu ed in which
c the
t e residents
es de ts discussed
d scussed ttheir
e d diagnostic
ag ost c reasoning
easo g
How do residents perceive the value of a combination of small group together with the supervisor
supervisor. The logged actions of the residents and their
di
discussions
i with
ith virtual
i t l patients
ti t for
f learning
l i g clinical
li i l reasoning?
i g? notes were startingg points
p for the discussion.

How does
H d the
th clinical
li i l supervisor
i perceive
i the
th value
l off a virtual
it l M t i l
Materials
patient a feedback tool and small group discussions for teaching
patient, Virtual
Vi t l patient
ti t
clinical
li i l reasoning?
i ? Based
Based on a real case where
‘
‘premature
t closure’
l ’ had
h d
How does the clinical supervisor judge the feasibility of this teaching occurred
occurred.
approach for the pediatric specialist training at the workplace? Built in CAMPUS
CAMPUS, a cross
platform and web
web-based
based
program developed at
Instruments Heidelberg University, Germany.
1 Two questionnaires developed within the e
1. e-ViP
ViP project Feedback
F db k ttooll
((www.virtualpatients.eu)
p )  The logged actions of the individual residents were compiled and fed
a) Students
Students’ questionnaire to evaluate their experiences with virtual b kb
back by
y a web-based
bb dp program
g d
developed
l p d att M
Maastricht
t i ht U
University,
i ity the
th
patients.
p i IIt contains
i twelve l 5-point
p i Lik
Likert S
Scalel statements on the
h Netherlands
Netherlands.
issues:
 Authenticity
A th ti ity
 Professional approach
 Coaching
C hi g
 Learning effect
 Overall
O ll judgment
j dg t
b) Students
Students’ questionnaire to evaluate their experiences their
experiences
i with
ith the
th integration
i t ti off virtual
i t l patients.
ti t It contains
t i
twenty 5-point
5 point Likert Scale statements on the issues:
 Teaching
T hi presence
 Cognitive presence
 Social
S i l presence
 Learning effect
 Overall judgment

2 A structured interview with the clinical supervisor

2.

Results Supervisor
p perceptions
p p
 “VPs
VPs gave the possibility to design a
case that p pinpointed
p to a specific
p
learning goal: in a ‘clear
clear-cut
cut’ case,
case
f
findings
g slightly
g y deviating g from
f a usual
presentation must trigger the resident to
t k a more comprehensive
take p h i approach.”
pp h”
 “VPs
VPs obliged all participants to be
i di id lly active
individually ti ini the
th workup k p off th
the
same casecase. This stimulated their
thi ki g p
thinking prior
i tto th the di
discussion i off ththe
case and made them eager to tell what
th y had
they h d done.”
d ”
 “The
The feedback tool gave a good
overview
i off the
th development
d l t off
diagnostic idea’s
idea s over time
time, supported
Issues that jeopardize the authenticity of VPs are:  The small group discussions made the session th moderator
the d t iin organizing i i the th
 the impossibility to phrase your own questions lively, stimulated argumentation about clinical discussions but the slow performance
discussions,
duringg the historyy taking
g reasoning and gave residents an impression of
reasoning, impeded the flow of actionsactions.””
 the absence of a real observation of a sick clinical reasoning of their peers.  “Developing
Developing 40 VPs and applying them
patient to g
p get an impression
p off the seriousness  During the group discussions the residents felt biweekly combined with small group
of the situation
situation, and secure enough to openly discuss their discussions in 45 minutes sessions,
 that
th t cases are contrived
t i d for
f educational
d ti l shortcomings
shortcomings. would be a feasible teaching approach
purposes making users feel that there has to be
purposes, for the pediatric specialist training.
training.”
a catch.
t h

Conclusion
 Both residents and clinical supervisor of a medical specialist training perceived a session combining individual virtual patient workup with ‘time time out’
out
moments t off smallll group di
discussions
i as a valuable
l bl learning
l i activity
ti it ffor clinical
li i l reasoning.i
 If we can speed up the procedure and/or the performance of the feedback tool tool, this instrument has great potential to facilitate the discussions on clinical
reasoning.
reasoning
 The clinical supervisor found the presented teaching approach feasible for the medical specialist training at the workplace.

1 Department of Educational Development and Research, Maastricht University, The Netherlands.

2 Máxima Medical Centre,, Department
p of Pediatrics,, Veldhoven,, The Netherlands.
3 Center for Virtual Patients,, Medical Faculty
y of Heidelberg g University,
y, Germany.
y
4 Heilbronn University, Germany.