Learning clinical reasoning: how virtual patient case format and prior knowledge interact
Abstract Introduction Clinical reasoning has been fostered with varying case formats including the use of virtual patients. Existing literature points to different conclusions regarding which format is most beneficial for learners with diverse levels of prior knowledge. We designed our study to bett...
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | BMC Medical Education |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12909-020-1987-y |
| _version_ | 1818997219997515776 |
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| author | Jan Kiesewetter Michael Sailer Valentina M. Jung Regina Schönberger Elisabeth Bauer Jan M. Zottmann Inga Hege Hanna Zimmermann Frank Fischer Martin R. Fischer |
| author_facet | Jan Kiesewetter Michael Sailer Valentina M. Jung Regina Schönberger Elisabeth Bauer Jan M. Zottmann Inga Hege Hanna Zimmermann Frank Fischer Martin R. Fischer |
| author_sort | Jan Kiesewetter |
| collection | DOAJ |
| description | Abstract Introduction Clinical reasoning has been fostered with varying case formats including the use of virtual patients. Existing literature points to different conclusions regarding which format is most beneficial for learners with diverse levels of prior knowledge. We designed our study to better understand which case format affects clinical reasoning outcomes and cognitive load, dependent on medical students’ prior knowledge. Methods Overall, 142 medical students (3 rd to 6 th year) were randomly assigned to either a whole case or serial cue case format. Participants worked on eight virtual patients in their respective case format. Outcomes included diagnostic accuracy, knowledge, and cognitive load. Results We found no effect of case format on strategic knowledge scores pre- vs post-test (whole case learning gain = 3, 95% CI. -.01 to .01, serial cue learning gain = 3, 95% CI. -.06 to .00 p = .50). In both case formats, students with high baseline knowledge (determined by median split on the pre-test in conceptual knowledge) benefitted from learning with virtual patients (learning gain in strategic knowledge = 5, 95% CI .03 to .09, p = .01) while students with low prior knowledge did not (learning gain = 0, 95%CI −.02 to .02). We found no difference in diagnostic accuracy between experimental conditions (difference = .44, 95% CI −.96 to .08, p = .22), but diagnostic accuracy was higher for students with high prior knowledge compared to those with low prior knowledge (difference = .8, 95% CI 0.31 to 1.35, p < .01). Students with low prior knowledge experienced higher extraneous cognitive load than students with high prior knowledge (multiple measurements, p < .01). Conclusions The whole case and serial cue case formats alone did not affect students’ knowledge gain or diagnostic accuracy. Students with lower knowledge experienced increased cognitive load and appear to have learned less from their interaction with virtual patients. Cognitive load should be taken into account when attempting to help students learn clinical reasoning with virtual patients, especially for students with lower knowledge. |
| first_indexed | 2024-12-20T21:42:10Z |
| format | Article |
| id | doaj.art-506dd8ff1d7b4f00a6e0ba10e6f29598 |
| institution | Directory Open Access Journal |
| issn | 1472-6920 |
| language | English |
| last_indexed | 2024-12-20T21:42:10Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj.art-506dd8ff1d7b4f00a6e0ba10e6f295982022-12-21T19:25:45ZengBMCBMC Medical Education1472-69202020-03-0120111010.1186/s12909-020-1987-yLearning clinical reasoning: how virtual patient case format and prior knowledge interactJan Kiesewetter0Michael Sailer1Valentina M. Jung2Regina Schönberger3Elisabeth Bauer4Jan M. Zottmann5Inga Hege6Hanna Zimmermann7Frank Fischer8Martin R. Fischer9Institute for Medical Education, University Hospital, LMU MunichEducation and Educational Psychology, LMU MunichInstitute for Medical Education, University Hospital, LMU MunichInstitute for Medical Education, University Hospital, LMU MunichEducation and Educational Psychology, LMU MunichInstitute for Medical Education, University Hospital, LMU MunichMedical School, University AugsburgDepartment of Radiology, University Hospital, LMU MunichEducation and Educational Psychology, LMU MunichInstitute for Medical Education, University Hospital, LMU MunichAbstract Introduction Clinical reasoning has been fostered with varying case formats including the use of virtual patients. Existing literature points to different conclusions regarding which format is most beneficial for learners with diverse levels of prior knowledge. We designed our study to better understand which case format affects clinical reasoning outcomes and cognitive load, dependent on medical students’ prior knowledge. Methods Overall, 142 medical students (3 rd to 6 th year) were randomly assigned to either a whole case or serial cue case format. Participants worked on eight virtual patients in their respective case format. Outcomes included diagnostic accuracy, knowledge, and cognitive load. Results We found no effect of case format on strategic knowledge scores pre- vs post-test (whole case learning gain = 3, 95% CI. -.01 to .01, serial cue learning gain = 3, 95% CI. -.06 to .00 p = .50). In both case formats, students with high baseline knowledge (determined by median split on the pre-test in conceptual knowledge) benefitted from learning with virtual patients (learning gain in strategic knowledge = 5, 95% CI .03 to .09, p = .01) while students with low prior knowledge did not (learning gain = 0, 95%CI −.02 to .02). We found no difference in diagnostic accuracy between experimental conditions (difference = .44, 95% CI −.96 to .08, p = .22), but diagnostic accuracy was higher for students with high prior knowledge compared to those with low prior knowledge (difference = .8, 95% CI 0.31 to 1.35, p < .01). Students with low prior knowledge experienced higher extraneous cognitive load than students with high prior knowledge (multiple measurements, p < .01). Conclusions The whole case and serial cue case formats alone did not affect students’ knowledge gain or diagnostic accuracy. Students with lower knowledge experienced increased cognitive load and appear to have learned less from their interaction with virtual patients. Cognitive load should be taken into account when attempting to help students learn clinical reasoning with virtual patients, especially for students with lower knowledge.http://link.springer.com/article/10.1186/s12909-020-1987-yInstructional materials/methodsClinical reasoningVirtual patientsCase formats |
| spellingShingle | Jan Kiesewetter Michael Sailer Valentina M. Jung Regina Schönberger Elisabeth Bauer Jan M. Zottmann Inga Hege Hanna Zimmermann Frank Fischer Martin R. Fischer Learning clinical reasoning: how virtual patient case format and prior knowledge interact BMC Medical Education Instructional materials/methods Clinical reasoning Virtual patients Case formats |
| title | Learning clinical reasoning: how virtual patient case format and prior knowledge interact |
| title_full | Learning clinical reasoning: how virtual patient case format and prior knowledge interact |
| title_fullStr | Learning clinical reasoning: how virtual patient case format and prior knowledge interact |
| title_full_unstemmed | Learning clinical reasoning: how virtual patient case format and prior knowledge interact |
| title_short | Learning clinical reasoning: how virtual patient case format and prior knowledge interact |
| title_sort | learning clinical reasoning how virtual patient case format and prior knowledge interact |
| topic | Instructional materials/methods Clinical reasoning Virtual patients Case formats |
| url | http://link.springer.com/article/10.1186/s12909-020-1987-y |
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