Transcript Document

The combination of virtual patients and small
group discussions to promote reflective practice
School of Health Professions Education
Bas de Leng, PhD Prof. dr. Albert Scherpbier
ICVP London, 26 April 2010
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Risks of life…
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Medical errors
Diagnostic errors: 5-15% of medical diagnosis
Taxonomy of diagnostic error (Graber,2005):
– No-fault errors
– System-related errors
– Cognitive errors
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 Cognitive errors contribute
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46
to 75% of all diagnostic errrors
 ‘Premature closure’ most
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common cognitive error
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Factors
No fault
Only system
Only cognitive
Both system and
cognitve
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
Less
Low
High
Accuracy
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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
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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’.
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Clinical reasoning sessions
Ingredients:
 Virtual patients based on real cases in which ‘premature
closure’ had occurred
 Procedure to induce reflective diagnostic reasoning
(Mamede, 2008)
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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
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Evaluation of perceptions
Two student questionnaires:
1.
Experiences with the use virtual patients. With 12 statements on:
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2.
Authenticity
Professional approach
Coaching
Learning effect
Overall judgment
Experiences with the integration of virtual patients. With 20
statements on:
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Teaching presence
Cognitive presence
Social presence
Learning effect
Overall judgment
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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.
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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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