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School of Health Professions Education Prof. dr. Albert Scherpbier. The combination of virtual patients and small group discussions to promote reflective practice. Bas de Leng, PhD ICVP London, 26 April 2010. Risks of life…. Medical errors. Diagnostic errors: 5-15% of medical diagnosis

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School of health professions education prof dr albert scherpbier
School of Health Professions Education Prof. dr. Albert Scherpbier

The combination of virtual patients and small group discussions to promote reflective practice

Bas de Leng, PhD

ICVP London, 26 April 2010



Medical errors
Medical errors

  • Diagnostic errors: 5-15% of medical diagnosis

  • Taxonomy of diagnostic error (Graber,2005):

    • No-fault errors

    • System-related errors

    • Cognitive errors

  • Cognitive errors contributeto 75% of all diagnostic errrors

  • ‘Premature closure’ mostcommon cognitive error


Education to prevent cognitive errors
Education to prevent cognitive errors

Relationships between reliability and effort of diagnostic decision making (Graber, 2009)

ideas for educational approaches

More

Deductive reasoning

Monitoring, reflection

Pre-expert reasoning: heuristics

Effort

Expert thinking

Expert thinking

Less

Low

High

Accuracy


Increase expertise
Increase expertise

  • Deliberate practice with coaching and feedback by more accomplished professionals (Ericsson, 2003)

  • Access to a large numbers of patients with similar symptoms for which the correct diagnosis is validated

  • Virtual patients can supplement real patient encounters


Learn to apply reflective thinking
Learn to apply reflective thinking

Learning to:

  • Recognize and understand the most likely diagnostic pitfalls (Croskerry, 2003)

  • Use a checklist for the diagnostic process including ‘reflection’.


Clinical reasoning sessions
Clinical reasoning sessions

Ingredients:

Virtual patients based on real cases in which ‘premature closure’ had occurred

Procedure to induce reflective diagnostic reasoning (Mamede, 2008)


Clinical reasoning sessions1
Clinical reasoning sessions

  • Procedure:

  • All residents simultaneously worked out the same virtual patient

  • And the end of the work-up they had a moderated discussion on their clinical reasoning

  • The logged actions and their notes were starting points for the discussion


Evaluation of perceptions
Evaluation of perceptions

Two student questionnaires:

Experiences with the use virtual patients. With 12 statements on:

Authenticity

Professional approach

Coaching

Learning effect

Overall judgment

Experiences with the integration of virtual patients. With 20 statements on:

Teaching presence

Cognitive presence

Social presence

Learning effect

Overall judgment


Conclusion
Conclusion

Residents perceived a session combining individual virtual patient workup with small group discussions as a valuable learning activity for clinical reasoning.

The clinical supervisor found the presented teaching approach feasible for the medical specialist training at the workplace.


Future research
Future research

Evaluation of clinical reasoning sessions with VPs on 3rd and 4th level of Kirkpatrick:

Do they learn clinical reasoning and reflective practice from this activity?

Do the learning outcomes transfer to clinics and wards?


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