Assessing clinical reasoning skills following a virtual patient dizziness curriculum

被引：2

作者：

Kotwal, Susrutha ^{[1
]}

Singh, Amteshwar ^{[1
]}

Tackett, Sean ^{[2
]}

Bery, Anand K. ^{[3
]}

Omron, Rodney ^{[4
]}

Gold, Daniel ^{[5
]}

Newman-Toker, David E. ^{[5
]}

Wright, Scott M. ^{[2
]}

机构：

[1] Johns Hopkins Univ, Div Hosp Med, Johns Hopkins Bayview Med Ctr, Dept Med,Sch Med, 5200 Eastern Ave,MFL Bldg East Tower,2nd Floor CIM, Baltimore, MD 21224 USA

[2] Johns Hopkins Univ, Johns Hopkins Bayview Med Ctr, Dept Med, Div ofGeneral Internal Med,Sch Med, Baltimore, MD USA

[3] Ottawa Hosp, Dept Med, Div Neurol, Ottawa, ON, Canada

[4] Johns Hopkins Univ, Sch Med, Dept Emergency Med, Baltimore, MD USA

[5] Johns Hopkins Univ, Sch Med, Johns Hopkins Hosp, Div Neurovisual & Vestibular Disorders,Dept Neurol, Baltimore, MD 21205 USA

来源：

DIAGNOSIS | 2024年 / 11卷 / 01期

关键词：

clinical reasoning; OSCE; physical examination; simulation; virtual patients; diagnostic errors; CONTEXTUAL FACTORS; ACUTE VERTIGO; MEDICINE; PHYSICIANS; EDUCATION; CARE; SPECIFICITY; PERFORMANCE; EXPERTS; IMPACT;

D O I：

10.1515/dx-2023-0099

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives: 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).Methods: 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 6 weeks later. The OSCEs were recorded and assessed using a rubric that was systematically developed and validated.Results: 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).Conclusions: The VP-based dizziness curriculum resulted in improved diagnostic accuracy among IM interns with enhanced physical exam skills retained at 6 weeks post-intervention.

引用

页码：73 / 81

页数：9