Clinical decision making: a pilot e-learning study

Background: As many medical schools focus on student-centred learning strategies, e-learning provides a useful approach to foster clinical decision-making skills in a case-based way. We developed an e-learning module based on real patient cases for final-year students as a self-directed studying tool. Methods: Ten patient cases were developed from patients treated in the emergency room. Original documents were integrated into the virtual patient system CASUS (R). In total, 522 students from three different terms of their final year were invited to use the e-learning module. Students filled out a self-assessment questionnaire regarding clinical decision-making skills before and after the module, and were also asked to fill out an evaluation form. Results: Only 30 per cent of the students invited participated in the e-learning module, and even fewer filled out the questionnaires. Nevertheless, the students participating liked the online cases and valued the relevance of the diseases. An increase in the self-assessment rating of clinical decision- making skills after the e-learning module was only seen for students in the first term of their final year. Additionally, those students showed significantly lower scores in their pre-module clinical decision- making skills compared with students in terms two and three of their final year. Discussion: Even though the overall participation was small, participating students were satisfied with the e-learning module and were motivated to work with the cases. A better integration into the clinical curriculum and a stronger association with an exam might provide an even better learning opportunity for medical students with respect to the acquisition of clinical decision-making skills.