Online patient simulation training to improve clinical reasoning: a feasibility randomised controlled trial
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RESEARCH ARTICLE
Open Access
Online patient simulation training to improve clinical reasoning: a feasibility randomised controlled trial Ruth Plackett1* , Angelos P. Kassianos1, Maria Kambouri2, Natasha Kay1, Sophie Mylan3, Jenny Hopwood4, Patricia Schartau5, Shani Gray1, Jessica Timmis1, Sarah Bennett3, Chris Valerio3, Veena Rodrigues6, Emily Player6, Willie Hamilton7, Rosalind Raine1, Stephen Duffy8 and Jessica Sheringham1
Abstract Background: Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. However, little is known about how best to implement and evaluate OPS in medical curricula. The aim of this study was to assess the feasibility, acceptability and potential effects of eCREST — the electronic Clinical Reasoning Educational Simulation Tool. Methods: A feasibility randomised controlled trial was conducted with final year undergraduate students from three UK medical schools in academic year 2016/2017 (cohort one) and 2017/2018 (cohort two). Student volunteers were recruited in cohort one via email and on teaching days, and in cohort two eCREST was also integrated into a relevant module in the curriculum. The intervention group received three patient cases and the control group received teaching as usual; allocation ratio was 1:1. Researchers were blind to allocation. Clinical reasoning skills were measured using a survey after 1 week and a patient case after 1 month. Results: Across schools, 264 students participated (18.2% of all eligible). Cohort two had greater uptake (183/833, 22%) than cohort one (81/621, 13%). After 1 week, 99/137 (72%) of the intervention and 86/127 (68%) of the control group remained in the study. eCREST improved students’ ability to gather essential information from patients over controls (OR = 1.4; 95% CI 1.1–1.7, n = 148). Of the intervention group, most (80/98, 82%) agreed eCREST helped them to learn clinical reasoning skills. Conclusions: eCREST was highly acceptable and improved data gathering skills that could reduce diagnostic errors. Uptake was low but improved when integrated into course delivery. A summative trial is needed to estimate effectiveness. Keywords: Clinical reasoning, Simulation, Virtual patient, Online learning, Medical students, Medical education, Feasibility study
* Correspondence: [email protected] 1 Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative
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