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Impact of the virtual patient introduction on the clinical reasoning process in dental education

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Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
In the Virtual patient (VP) system Web-SP, the case authoring is entirely delegated to faculty. An analysis of the virtual patients (VPs)VPs authored by faculty showed that the most common practice chosen by the case authors was to provide an introductory clinical vignette including rich anamnestic data. To evaluate the influence of the vignette, a controlled trial was conducted to determine if the absence of vignette would influence the students’ therapeutic decisions and their clinical reasoning. This double blind controlled trial randomized 57 fourth year dentistry students into two groups. Two virtual patient cases were created with the same content in both groups, but the VPs encountered by the intervention group lacked the introductory vignette. The therapy decisions and the history taking activity were scored and analysed by the course director. A stratified analysis was undertaken, stratifying by day. There were no statistically significant differences between the two groups with respect to their therapeutic decision scores (p=.16). Participants in both groups were equivalent with respect to the number of relevant medical history questions asked (p=.33) and the number of irrelevant questions asked (p=.20). This study indicates that vignettes did not have an impact on students' problem solvingclinical reasoning process. The use of detailed vignettes or case introductions might not be needed. A possible reason includes students’ prior exposure for a full semester to other VPs for course work and problem solvingclinical reasoning. Perhaps the intervention was too subtle to impact on learners at this stage of development. Clinical vignettes might have more impact at earlier stages of student learning such as early in the semester but not as preparation for final exam. The limited number of participants may have concealed differences between the groups. We also need to investigate if the one-hour limit given the students might influence the therapeutic decisions.
Rocznik
Strony
173--184
Opis fizyczny
Bibliogr. 21 poz., rys., tab., wykr.
Twórcy
autor
  • Dept of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
autor
  • Department of Dental Medicine, Karolinska Institutet, 141 04 Huddinge, Sweden
  • Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
Bibliografia
  • 1. Zary N, Johnson G, Boberg J, Fors UG: Development, implementation and pilot evaluation of a Web-based Virtual Patient Case Simulation environment--Web-SP. BMC Med Educ 2006, 6:10.
  • 2. Janda MS, Mattheos N, Nattestad A, Wagner A, Nebel D, Farbom C, Le DH, Attstrom R: Simulation of patient encounters using a virtual patient in periodontology instruction of dental students: design, usability, and learning effect in history-taking skills. Eur J Dent Educ 2004, 8(3):111-119.
  • 3. Schultze-Mosgau S, Thorwarth WM, Grabenbauer GG, Amann K, Zielinski T, Lochner J, Zenk J: The concept of a clinical round as a virtual, interactive web-based, e-learning model for interdisciplinary teaching. Int J Comput Dent 2004, 7(3):253-262.
  • 4. Walmsley D: CAL programs in orthodontics elicit positive responses from students. Evid Based Dent 2006, 7(3):77.
  • 5. Abbey LM: Interactive multimedia patient simulations in dental and continuing dental education. Dent Clin North Am 2002, 46(3):575-587, vii-viii.
  • 6. Welk A, Splieth C, Wierinck E, Gilpatrick RO, Meyer G: Computer-assisted learning and simulation systems in dentistry--a challenge to society. Int J Comput Dent 2006, 9(3):253-265.
  • 7. Kleinert HL, Sanders C, Mink J, Nash D, Johnson J, Boyd S, Challman S: Improving student dentist competencies and perception of difficulty in delivering care to children with developmental disabilities using a virtual patient module. J Dent Educ 2007, 71(2):279-286.
  • 8. Schittek Janda M, Mattheos N, Nattestad A, Wagner A, Nebel D, Farbom C, Le DH, Attstrom R: Simulation of patient encounters using a virtual patient in periodontology instruction of dental students: design, usability, and learning effect in history-taking skills. Eur J Dent Educ 2004, 8(3):111-119.
  • 9. Schuwirth LW, van der Vleuten CP: The use of clinical simulations in assessment. Med Educ 2003, 37 Suppl 1:65-71.
  • 10. Friedman CP: Anatomy of the clinical simulation. Acad Med 1995, 70(3):205-209.
  • 11. Huwendiek S, De leng BA, Zary N, Fischer MR, Ruiz JG, Ellaway R: Towards a typology of virtual patients. Med Teach 2009, 31(8):743-748.
  • 12. Ruderich F, Bauch M, Haag M, Heid J, Leven FJ, Singer R, Geiss HK, Junger J, Tonshoff B: CAMPUS--a flexible, interactive system for web-based, problem-based learning in health care. Medinfo 2004, 11(Pt 2):921-925.
  • 13. Bearman M, Cesnik B, Liddell M: Random comparison of 'virtual patient' models in the context of teaching clinical communication skills. Med Educ 2001, 35(9):824-832.
  • 14. Zary N, Johnson G, Fors U: Web-based virtual patients in dentistry: factors influencing the use of cases in the Web-SP system. Eur J Dent Educ 2009, 13(1):2-9.
  • 15. Bearman M, Cesnik B: Comparing student attitudes to different models of the same virtual patient. Medinfo 2001, 10(Pt 2):1004-1008.
  • 16. Triola M, Feldman H, Kalet A, Zabar S, Kachur E, Gillespie C, Anderson M, Griesser C, Lipkin M: A Randomized Trial of Teaching Clinical Skills Using Virtual and Live Standardized Patients. Journal of General Internal Medicine 2006, 21(5):424-429.
  • 17. Cook DA: The research we still are not doing: an agenda for the study of computer-based learning. Acad Med 2005, 80(6):541-548.
  • 18. Schittek Janda M, Tani Botticelli A, Mattheos N, Nebel D, Wagner A, Nattestad A, Attstrom R: Computer-mediated instructional video: a randomised controlled trial comparing a sequential and a segmented instructional video in surgical hand wash. Eur J Dent Educ 2005, 9(2):53-58.
  • 19. Cook DA, Erwin PJ, Triola MM: Computerized virtual patients in health professions education: a systematic review and meta-analysis. Acad Med 2010, 85(10):1589-1602.
  • 20. Cook DA, Triola MM: Virtual patients: a critical literature review and proposed next steps. Med Educ 2009, 43(4):303-311.
  • 21. StatXact software 7.0 [http://www.cytel.com/Products/StatXact]
Typ dokumentu
Bibliografia
Identyfikator YADDA
bwmeta1.element.baztech-2bd26015-58a3-49dd-bae9-9ba6950cc562
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