Clinical Reasoning: Expanding the Opportunities for Virtual Patients

May 22, 2018 8:00 AM – 9:15 AM

David Price, East Carolina University, Brody School of Medicine

Virtual patients (VP) offer an opportunity to promote clinical reasoning across the medical education continuum. To exploit this opportunity we created and studied a VP platform where trainees make all decisions about the care of their VP with few restrictions. Our application is not restricted by linear or branched decisions and findings are not mapped to a diagnosis. As in the clinical arena, trainees using our application apply their knowledge and reasoning skills to provide care that is safe, effective, efficient, timely and patient-centered with little more that a short vignette and a search box. Trainees find actions for their VP. After selecting an action the findings, immediate feedback and an author narrative reflecting on the importance of their decision promote deep learning. Findings, feedback and author narratives are accumulated as the trainee moves through the case and are always available for review. Trainees learn to improve the timeliness of their decisions by revising the order of their decisions to create an ideal order. The trainee’s revised order and their original order of actions are compared to the author’s ideal order during a final review of the case. A differential diagnosis is developed and edited as trainees gather data. Diagnoses are ICD-10 based. In our pilot study third-year pediatric clerkship students eagerly search for and selected actions to help their virtual patient. In our application trainees make all decisions, receive feedback, assimilate data and have the opportunity to make errors and correct them. This is the essence of clinical reasoning.