132 Assessment Tools to Measure Clinical Reasoning While Attending Simulation-Based Courses

Clinical reasoning is interconnected with decision-making which is a critical element to ensure patient safety [1]. To avoid practice mistakes, healthcare professionals should be competent with effective clinical reasoning skills. To develop effective clinical reasoning skills, healthcare professionals should get the chance to practise and be exposed to various experiences and levels of patient complexities. Simulation can immerse learners in scenarios that mimic clinical situations, simultaneously mitigating safety risks and increasing standardization in healthcare education [2]. Through simulation, learners can get the chance to practise clinical reasoning with focussed learning opportunities [3]. Several assessment tools have been used to measure clinical reasoning while attending simulation-based activities. However, we would like to explore the most valid and reliable tools to assess clinical reasoning while attending simulation, in addition to finding out whether these tools have considered the seniority and competency levels of their users.A scoping review was undertaken to answer the questions: What are the best available valid and reliable tools to evaluate clinical reasoning while attending simulation-based activities? Do we have valid and reliable clinical reasoning assessment tools for simulation that measure clinical reasoning considering different seniority and competency levels? We searched Medline, Scopus, Education Research Complete, and Google Scholar to identify relevant recent primary research conducted on this topic from 2000 onwards. The search included MeSH topics of: ‘Clinical reasoning’, ‘Simulation-based courses’ and ‘Clinical Reasoning tools’. The inclusion criteria were primary studies that described the use of tools measuring clinical reasoning while attending simulation-based courses. Two independent researchers agreed on the inclusion of the identified papers for full-text review. This review followed the review guidelines of Joanne Briggs institute.There are valid and reliable tools to evaluate clinical reasoning while attending simulation which is Clinical Reasoning Evaluation Simulation Tool CREST [1]; Lasater Clinical Judgment Rubric LCJR [4]; Creighton Competency Evaluation Instrument Creighton C-SEI- Tool [5]. However, the validity and reliability of these tools were tested on undergraduate student nurses, and there was no consideration for different seniority and competence levels, and applicability to other healthcare professions.There is an adequate number of tools to measure clinical reasoning while attending simulation. However, there is a significant basis to test the reliability and validity of these tools against different competence and seniority levels, and applicability to other healthcare professions.

The Effectiveness of Using Virtual Patient Educational Tools to Improve Medical Students’ Clinical Reasoning Skills: A Systematic

Background Use of virtual patient educational tools could fill the current gap in the teaching of clinical reasoning skills. However, there is a limited understanding of their effectiveness. The aim of this study was to synthesise the evidence to understand the effectiveness of virtual patient tools aimed at improving undergraduate medical students’ clinical reasoning skills. Methods We searched MEDLINE, EMBASE, CINAHL, ERIC, Scopus, Web of Science and PsycINFO from 1990 to October 2020, to identify all experimental articles testing the effectiveness of virtual patient educational tools on medical students’ clinical reasoning skills. Quality of the articles was assessed using an adapted form of the MERSQI and the Newcastle-Ottawa Scale. A narrative synthesis summarised intervention features, how virtual patient tools were evaluated and reported effectiveness. Results The search revealed 7,290 articles, with 20 articles meeting the inclusion criteria. Average study quality was moderate (M=7.1, SD=2.5), with around a third not reporting any measurement of validity or reliability for their clinical reasoning outcome measure (7/20, 35%). Eleven articles found a positive effect of virtual patient tools on reasoning (11/20, 55%). Seven (7/20, 35%) reported no significant effect or mixed effects and two found a significantly negative effect (2/20, 10%). Several domains of clinical reasoning were evaluated. Data gathering, ideas about diagnosis and patient management were more often found to improve after virtual patient use (27/46 analyses, 59%) than knowledge, flexibility in thinking, problem-solving, and critical thinking (4/10 analyses, 40%). Conclusions Using virtual patient tools could effectively complement current teaching especially if opportunities for face-to-face teaching or other methods are limited, as there was some evidence that virtual patient educational tools can improve undergraduate medical students’ clinical reasoning skills. Evaluations that measured more case specific clinical reasoning domains, such as data gathering, showed more consistent improvement than general measures like problem-solving. Case specific measures might be more sensitive to change given the context dependent nature of clinical reasoning. Consistent use of validated clinical reasoning measures is needed to enable a meta-analysis to estimate effectiveness.

Evaluation of virtual assessment

BackgroundThe study emerged from the necessity to reschedule an in-person long case examination to an online platform for Physician Associate students’ final clinical examination. The group had already experienced a delay in taking this clinical examination due to missing clinical hours, during Covid-19 restrictions. The aim of this study was to evaluate the experiences of students and examiners for a high stakes’ clinical examination online. Research suggests that the long case is the only clinical examination that promotes holistic assessment. However, a disconnect between the patient’s presence and the student in the virtual environment was a key finding in this study. Methods This was an evaluation research study, using the Context, Input, Process, Product (CIPP) model, which provided a framework to establish the effectiveness and/or success of an online format for a high stakes’ clinical examination. All students and examiners were invited to take part in virtual interviews. ResultsResults suggest that both students (n=5) and examiners (n=7) agree that, while the stress of a face-to-face examination was lessened for the student, this was balanced by a new stressor of potential internet problems. All agreed that a virtual setting for a high stakes assessment is not transferable, with both groups citing the lack of opportunities to ‘read the patient’ and ‘showcase their physical exam skills’ as challenging. Conclusions Our study suggests that, in the context of balancing the risks of the pandemic with graduating healthcare professionals, the online format was a success. The benefits cited included the preparation of students for real life situations in a clinical setting, with a healthcare system now more reliant on virtual consultations, and the capacity to offer increased opportunities for formative assessment of consultation and clinical reasoning skills. However, recommendations suggest that the long case could be planned so that student and patient are in the same setting to perform a ten-minute physical exam, confirming the finding that questions on ‘how to’ examine a patient are no substitute for ‘doing’.

Using Technology as a Novel Method to Develop Students’ Clinical Reasoning Skills Through Virtual Collaborative Learning in Scriptwriting

One of the most important skills students need to learn in applying pharmacotherapeutics is clinical reasoning. This study aimed to evaluate the impact of virtual collaboration in scriptwriting as a teaching approach to develop clinical reasoning skills. Data was from student feedback (n=102). Discussing conceptual questions in a collaborative learning environment with peers proved to support the development of clinical reasoning skills as the activity increased interactivity, improved understanding and retention. Findings show that the development of clinical reasoning skills were enhanced with the use of scriptwriting as a virtual collaborative activity.

Standardised Holographic Patients: An Evaluation of Their Role in Developing Clinical Reasoning Skills

In 2019, two standardised holographic patients viewed through a mixed-reality (MR) HoloLens headset were used in a structured learning activity to develop clinical reasoning skills among second-year nursing students (N=99, 94%). Quantitative results indicated that all students felt that being able to closely view holographic patients enhanced their learning experience. Qualitative results showed that the best feature of the MR technology was being able to clinically assess the patient in a safe facilitated environment. Further analysis revealed that students were at the ‘beginning’ or ‘developing’ skill level of the vpLCJR. These findings confirm that using standardized holographic patients offers a dynamic and effective experience for students and helps students to develop clinical reasoning and judgement skills. The technology also allows educators to determine a student’s development of clinical judgement skills and tailor learning experiences to further develop these skills.

Video-based e-learning tools for geriatric nursing education

Background: Future clinical challenges in nursing care of geriatric patients require educational courses that provide a high level of clinical reasoning skills. Serious Soap (www.serioussoap.nl/eng) is a video-based educational tool that combines entertainment with learning and reflection; it can serve as an attractive e-learning tool for nurses, nursing students, and tutors in geriatric care.Objective: This article describes Serious Soap’s development process, the lessons learned, and the most beneficial factors for student-centredness and teacher-centredness.Conclusions: The lessons learned from the development process highlight that it is important to use the experiences from previous gamification projects, co-create with target users, conduct elaborate testing and research before launching the final version, and ensure sustainability. The most valuable features for student-centeredness were the use of humor, authentic critical situations, popular actors, and interactivity. The most favorable aspects for teacher-centeredness were free accessibility of the tool, evidence-based content, and the possibility of using different features of the tool in various manners.

The Use of a Modified Script Concordance Test in Clinical Rounds to Foster and Assess Clinical Reasoning Skills

The development of clinical reasoning skills is a high priority during clinical service, but an unpredictable case load and limited time for formal instruction makes it challenging for faculty to foster and assess students’ individual clinical reasoning skills. We developed an assessment for learning activity that helps students build their clinical reasoning skills based on a modified version of the script concordance test (SCT). To modify the standard SCT, we simplified it by limiting students to a 3-point Likert scale instead of a 5-point scale and added a free-text box for students to provide justification for their answer. Students completed the modified SCT during clinical rounds to prompt a group discussion with the instructor. Student feedback was positive, and the instructor gained valuable insight into the students’ thought process. A modified SCT can be adopted as part of a multimodal approach to teaching on the clinic floor. The purpose of this article is to describe our modifications to the standard SCT and findings from implementation in a clinical rounds setting as a method of formative assessment for learning and developing clinical reasoning skills.

The Role of Simulated Patient in Physiotherapy Education: A Review Article

Introduction: Using Simulated Patients (SPs) in clinical skills education is a common method of training students to improve their skills for future client encounters. This systematic review aims to provide an overview of the SP strategy in Physical Therapy (PT) education. Materials and Methods: PubMed, Scopus, and Web of Science databases were searched from January 1980 up to November 2019. Different keywords related to the topic were selected using MeSH. Any types of quantitative study design which had used simulation-based learning in physical therapy were eligible for inclusion. Two reviewers read studies and appraised them critically. Results: A total of 1049 abstracts were retrieved and after reviewing the full-text paper, 11 full- text articles met the inclusion criteria. These studies had used simulated patients for various objectives, including replicate different aspects of knowledge, self-perceived skills, real clinical practice, attitudes, and feasibility. Based on the result of studies, SP as an educational technique can improve student’s clinical reasoning skills, communication, and motivation in a safe environment. Conclusion: SP is a useful learning strategy to deliver learning activities in medical education and physical therapy curricula, facilitating feedback on students’ performance with opportunities to interact with real patients and environments.

Problem Representation in Occupational Therapy

<p>Clinical reasoning is a fundamental component of occupational therapy practice. Educators, researchers and clinicians are faced with the challenge of understanding and fostering the acquisition of clinical reasoning skills. The aim of this study was to examine the internal problem representations held by students and clinicians in respect of clients they had been treating for a period of time. Such representations form the basis on which treatment is formulated so are highly influential in the clinical reasoning process. The ultimate purpose of the study was to identify educational strategies that could be used to assist students to develop clinical reasoning skills. Understandings gained from the literature and from observation, indicated that there would be differences between novices and experts and that the work setting would affect problem representation. Thus the influence of experience and location was the primary focus of the study. To place the study within the context of the occupational therapy literature, the beliefs underlying problem representation were also explored to determine whether or not these were consistent with the philosophical assumptions identified in the literature. The method of investigation was an interview with pre-determined questions. The interview was consistent with the theory base of the study (ie. information processing), but the analysis also included the investigation of qualitative aspects. To ensure a developmental perspective was gained, respondents included students on two different levels of an occupational therapy course and clinicians who were currently practicing. The total number of respondents was 67 ie. 14 stage II students, 31 stage III students (ie. in their final year) and 22 clinicians. The study illustrated that the environmental context affects problem representation in respect of both the amount of data to be considered and the nature of that data. Differences between students' and clinicians' representation of the problem were related to qualitative aspects rather than identification of the elements relevant to treatment planning. In particular, clinicians were more able to elaborate on the data, justify their responses and provide a humanistic perspective beyond the more technical aspects of knowing the clients concerns. The beliefs governing thinking about treatment, demonstrated consistency with the occupational therapy literature (apart from one assumption). A major finding of this study is that the development of schemata related to practice areas is the basis of sound reasoning and justification of treatment planning decisions. Both domain specific knowledge and an understanding of the environmental context are important to the forming of these schemata. The implication for teaching is that the wealth of experiential knowledge that is gained by students while on clinical practice should be tapped to enable them to make links with academic knowledge and thus develop a comprehensive problem representation.</p>

Problem Representation in Occupational Therapy

<p>Clinical reasoning is a fundamental component of occupational therapy practice. Educators, researchers and clinicians are faced with the challenge of understanding and fostering the acquisition of clinical reasoning skills. The aim of this study was to examine the internal problem representations held by students and clinicians in respect of clients they had been treating for a period of time. Such representations form the basis on which treatment is formulated so are highly influential in the clinical reasoning process. The ultimate purpose of the study was to identify educational strategies that could be used to assist students to develop clinical reasoning skills. Understandings gained from the literature and from observation, indicated that there would be differences between novices and experts and that the work setting would affect problem representation. Thus the influence of experience and location was the primary focus of the study. To place the study within the context of the occupational therapy literature, the beliefs underlying problem representation were also explored to determine whether or not these were consistent with the philosophical assumptions identified in the literature. The method of investigation was an interview with pre-determined questions. The interview was consistent with the theory base of the study (ie. information processing), but the analysis also included the investigation of qualitative aspects. To ensure a developmental perspective was gained, respondents included students on two different levels of an occupational therapy course and clinicians who were currently practicing. The total number of respondents was 67 ie. 14 stage II students, 31 stage III students (ie. in their final year) and 22 clinicians. The study illustrated that the environmental context affects problem representation in respect of both the amount of data to be considered and the nature of that data. Differences between students' and clinicians' representation of the problem were related to qualitative aspects rather than identification of the elements relevant to treatment planning. In particular, clinicians were more able to elaborate on the data, justify their responses and provide a humanistic perspective beyond the more technical aspects of knowing the clients concerns. The beliefs governing thinking about treatment, demonstrated consistency with the occupational therapy literature (apart from one assumption). A major finding of this study is that the development of schemata related to practice areas is the basis of sound reasoning and justification of treatment planning decisions. Both domain specific knowledge and an understanding of the environmental context are important to the forming of these schemata. The implication for teaching is that the wealth of experiential knowledge that is gained by students while on clinical practice should be tapped to enable them to make links with academic knowledge and thus develop a comprehensive problem representation.</p>