Community Research and Development Information Service - CORDIS


VirtualPatients Report Summary

Project ID: 654857
Funded under: H2020-EU.1.3.2.

Periodic Reporting for period 1 - VirtualPatients (Effective Clinical reasoning in Virtual Patients)

Reporting period: 2015-07-01 to 2016-12-31

Summary of the context and overall objectives of the project

The European Commission estimates in the report "Patient Safety and Quality of Care" (2014) that each year 8 - 12% of hospitalized patients suffer from adverse events, including errors in diagnosis. One reason for the occurrence of such errors is a lack of clinical reasoning skills, a core competency that healthcare students have to learn during their studies.
Clinical reasoning is often taught in face-to-face courses such as bedside-teaching, problem-based tutorials or during internships. Since the early nineties virtual patients (VPs) became more and more important in medical education to teach clinical reasoning skills.
The knowledge gap this project addresses was raised by Cook et al. (2009, 2010) but, until know, remains unaddressed. He concluded that there is no evidence how VP design variations influence clinical reasoning acquisition and that it is not fully understood how VPs teach clinical reasoning and how this process could be improved.
Therefore, in this project research will be undertaken to develop and assess an effective clinical reasoning tool to be embedded into VPs, and create guidelines on how to implement the tool based on the outcomes of an interdisciplinary grounded theory approach.

The project has the following four main objectives:
1. Provide an overview of VP types and VP systems, clinical reasoning features and integration with face-to-face teaching
2. Develop a research-based concept for a clinical reasoning tool
3. Assess the effectiveness of the tool in a large-scale, cross-institutional study
4. Disseminate the results and integrate the tool into the availables standards"

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

"Based on a broad interdisciplinary grounded theory analysis the topic of learning clinical reasoning and how it is implemented in virtual patients has been explored. The core category "multifactorial nature of learning clinical reasoning" is reflected in the following five main categories: Psychological Theories, Patient-centeredness, Context, Learner-centeredness, and Teaching/Assessment. Each category encompasses between four and six related concepts.
Based on the outcomes of grounded theory, the concept for a clinical reasoning tool and guidelines on how to embed it into VPs was developed.
This concept guided the development process which included a course concept, a technical specification, a prototype, the final software solution, and the integration into existing VP systems. Usability tests and a pilot study were implemented for quality assessment purposes. The developed clinical reasoning tool is based on a concept mapping approach and can be used as a stand-alone tool or in combination with virtual patients. Learners are asked to document relevant findings, differential diagnoses, necessary tests to rule out or confirm a diagnosis, and management options. All items can be connected with each other. Additionally, learners are pompted to compose a short summary statement about the patient. Feedback is provided based on the author's answer, peer answers and learning analytics.
Two courses have been developed consisting of VPs (44 in German, 27 in English) and four short videos explaining clinical reasoning as a process, cognitive errors, the purpose of a summary statement, and the handling of the software.
A "big data" study based on these two courses will start in January 2017."

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

The EC report from the commission to the council on patient safety (dated from 2012) identified the area of education and training as the least implemented among all areas envisaged to improve patient safety. The project addresses this issue by improving clinical reasoning training in medical students aiming to reduce medical errors in their future clinical practice. The projects results - including the clinical reasoning tool, the course material, and guidelines how to integrate it - will be made publicly available for adoption by educators in Europe. The implemented tool (code, database schema, interface API, and documentation) and all dissemination material is publicly available under a open source license. These resources can be used and adapted by educators and VP system developers and included into their VPs.
Overall, a Europe-wide provision of virtual patients - with effective clinical reasoning training for medical students - will improve students' diagnostic skills potentially leading to a reduction of diagnostic errors, avoiding unnecessary treatment and pain for patients and reducing healthcare costs.

The strategy for public engagement of the project focuses on online communication channels. The researcher set up a project-related research portfolio; updates about the project, such as results, new course or dissemination material are published in a journal integrated into the portfolio.
The results of workpackage 1 have been presented and discussed on international medical education conferences and on two local meetings of the project participants.

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