By Supriya Krishnan
During the 2nd International Conference on Virtual Patients and MedBiquitous Annual Meeting, Dr Bas de Leng from Maastricht University, The Netherlands, outlined his approach of combining virtual patients with ‘diagnostic time out’ to promote reflective practice in clinical reasoning.
The rate of diagnostic error in medicine is likely to be in the range of 5-15%. These errors can be classified in different categories:
Cognitive errors contribute to about three-quarter of all diagnositic errors and premature closure is the most common type. Of the cognitive errors “premature closure is the most common type,” said Dr de Leng. Therefore, Dr de Leng and team developed a training programme in clinical reasoning for pediatricians. This programme used virtual patients that were created based on actual cases where ‘premature closure’ had occurred.
The trainees took time out to reflect on their clinical decision-making skills in a controlled educational setting. “During this procedure all residents simultaneously worked on the same VP,” he explained. “At the end, they had a moderated discussion on their clinical reasoning. The logged actions and their notes were the starting points for the discussions.”
During the evaluation stage, residents completed two questionnaires, and their experiences using the VPs were noted. The feedback was positive. “The residents thought that this method is a valuable learning activity for clinical reasoning,” Dr de Leng said.
“But do they learn clinical reasoning and reflective practice from this activity? Do the learning outcomes transfer to the wards?” he asked, concluding that further research needs to be carried out to answer these questions.