Simulation Game Versus Multiple Choice Questionnaire to Assess the Clinical Competence of Medical Students: Prospective Sequential Trial

Games to support teaching clinical reasoning in health professions education: a scoping review

INTRODUCTION

Given the complexity of teaching clinical reasoning to (future) healthcare professionals, the utilization of serious games has become popular for supporting clinical reasoning education. This scoping review outlines games designed to support teaching clinical reasoning in health professions education, with a specific emphasis on their alignment with the 8-step clinical reasoning cycle and the reflective practice framework, fundamental for effective learning.

METHODS

A scoping review using systematic searches across seven databases (PubMed, CINAHL, ERIC, PsycINFO, Scopus, Web of Science, and Embase) was conducted. Game characteristics, technical requirements, and incorporation of clinical reasoning cycle steps were analyzed. Additional game information was obtained from the authors.

RESULTS

Nineteen unique games emerged, primarily simulation and escape room genres. Most games incorporated the following clinical reasoning steps: patient consideration (step 1), cue collection (step 2), intervention (step 6), and outcome evaluation (step 7). Processing information (step 3) and understanding the patient's problem (step 4) were less prevalent, while goal setting (step 5) and reflection (step 8) were least integrated.

CONCLUSION

All serious games reviewed show potential for improving clinical reasoning skills, but thoughtful alignment with learning objectives and contextual factors is vital. While this study aids health professions educators in understanding how games may support teaching of clinical reasoning, further research is needed to optimize their effective use in education. Notably, most games lack explicit incorporation of all clinical reasoning cycle steps, especially reflection, limiting its role in reflective practice. Hence, we recommend prioritizing a systematic clinical reasoning model with explicit reflective steps when using serious games for teaching clinical reasoning.

Clinical Decision Support Requirements for Ventricular Tachycardia Diagnosis Within the Frameworks of Knowledge and Practice: Survey Study

BACKGROUND

Ventricular tachycardia (VT) diagnosis is challenging due to the similarity between VT and some forms of supraventricular tachycardia, complexity of clinical manifestations, heterogeneity of underlying diseases, and potential for life-threatening hemodynamic instability. Clinical decision support systems (CDSSs) have emerged as promising tools to augment the diagnostic capabilities of cardiologists. However, a requirements analysis is acknowledged to be vital for the success of a CDSS, especially for complex clinical tasks such as VT diagnosis.

OBJECTIVE

The aims of this study were to analyze the requirements for a VT diagnosis CDSS within the frameworks of knowledge and practice and to determine the clinical decision support (CDS) needs.

METHODS

Our multidisciplinary team first conducted semistructured interviews with seven cardiologists related to the clinical challenges of VT and expected decision support. A questionnaire was designed by the multidisciplinary team based on the results of interviews. The questionnaire was divided into four sections: demographic information, knowledge assessment, practice assessment, and CDS needs. The practice section consisted of two simulated cases for a total score of 10 marks. Online questionnaires were disseminated to registered cardiologists across China from December 2022 to February 2023. The scores for the practice section were summarized as continuous variables, using the mean, median, and range. The knowledge and CDS needs sections were assessed using a 4-point Likert scale without a neutral option. Kruskal-Wallis tests were performed to investigate the relationship between scores and practice years or specialty.

RESULTS

Of the 687 cardiologists who completed the questionnaire, 567 responses were eligible for further analysis. The results of the knowledge assessment showed that 383 cardiologists (68%) lacked knowledge in diagnostic evaluation. The overall average score of the practice assessment was 6.11 (SD 0.55); the etiological diagnosis section had the highest overall scores (mean 6.74, SD 1.75), whereas the diagnostic evaluation section had the lowest scores (mean 5.78, SD 1.19). A majority of cardiologists (344/567, 60.7%) reported the need for a CDSS. There was a significant difference in practice competency scores between general cardiologists and arrhythmia specialists (P=.02).

CONCLUSIONS

There was a notable deficiency in the knowledge and practice of VT among Chinese cardiologists. Specific knowledge and practice support requirements were identified, which provide a foundation for further development and optimization of a CDSS. Moreover, it is important to consider clinicians' specialization levels and years of practice for effective and personalized support.

Performance effects of simulation training for medical students - a systematic review

OBJECTIVE

Simulation based medical education (SBME) is fast becoming embedded into undergraduate medical curricula with many publications now describing its various modes and student self-reported impacts. This systematic review synthesizes the available literature for evidence of performance effects of SBME as an adjunct within traditional teaching programmes.

METHODS

A narrative systematic review was conducted according to PRISMA guidelines using Ovid MEDLINE, EMBASE, and PubMed databases for studies, published in English, reporting on general medical and surgical undergraduate SBME between 2010 to 2020. Two reviewers independently assessed potential studies for inclusion. Methods and topics of simulation with their assessments were evaluated. Descriptive statistics were used to describe pooled student cohorts.

RESULTS

3074 articles were initially identified using the search criteria with 92 full-text articles then screened for eligibility. Nineteen articles, including nine randomised trials, concerning 2459 students (median 79/study), were selected for review. Cardiac scenarios were commonest (n=6) with three studies including surgical topics. Nine studies used mannequin simulators (median time/session 17.5minutes) versus standardised patients in seven (median time/session=82 minutes). Educational impact was measured by written (n=10), checklist (n=5) and OSCEs (n=3) assessment either alone or in combination (n=1, OSCE/written assessment). All articles reported a positive effect of SBME on knowledge including improved retention in three.

CONCLUSION

SBME, as an adjunct to existing curricula, improves knowledge-based performance of medical students at least in the short-term. Future studies should broaden its topics, assess longer term impacts and cost-effectiveness while also considering whether and what areas of traditional undergraduate learning it can replace.

Application of trauma-informed care principles in academic nursing settings during the COVID-19 pandemic

The persistence of the COVID-19 pandemic has led to a multitude of changes in the ways nursing education, research, and practice are carried out. In addition to the demands of shifting to remote education as well as finding alternatives to direct patient care learning, nursing faculty and students are directly confronting morbidity and mortality among classmates, colleagues, friends, and family members. These experiences unquestionably meet criteria for traumatic experience, and this must be accounted for in nursing education as they can have detrimental effects on learning, teaching, and well-being. The current generation of nursing students and faculty will necessarily carry the traumatic experiences of this chaotic time into workplace, classroom, and community settings. Understanding how to manage this trauma appropriately not only supports individuals through this experience but provides increased opportunity and capacity for the provision of trauma-informed care (TIC) to patients and colleagues going forward. This paper describes some of the ways COVID-19-related trauma may affect nursing faculty and students; and proposes application of TIC principles to research, education, and practice environments to enhance well-being and overall functioning in the profession.

Implementation strategies for high-performance health care simulation centres: A multicentre exploratory case study in China

INTRODUCTION

The number of health care simulation centres (HSCs) in mainland China has increased exponentially recently. However, the performance of these centres varies significantly between hospitals. The aim of this study is to address two research questions: (i) what are the critical factors for implementing high-performance HSCs and (ii) how are these critical factors used in the development of implementation strategies to achieve satisfactory performance?

METHODS

Following a literature review on information technology (IT) implementation, we identified a framework comprising four key dimensions for HSCs implementation: technology, organisation, environment and individuals. This TOEI (technology-organisation-environment-individual) framework was then used as a basis for a multicentre case study through which data collection and analysis proceeded. We collected 12 one-to-one in-depth interviews alongside secondary data from six high-performance HSCs in mainland China.

RESULTS

Our study identifies critical TOEI factors that collectively influence HSC implementation performance and major activities at the six high-performance HSCs. Three strategies for implementing high-performance HSCs are also identified: facility management platform, education and training centre and innovation centre.

CONCLUSIONS

HSC implementation is an holistic approach. The critical TOEI factors collectively build a foundation for centre activities. An HSC's implementation strategy highly relies on organisational strategic goals. Additionally, HSCs in mainland China face some common challenges such as faculty retention and future opportunities such as expanding the research scope. Our study also provides insights for hospital leadership, medical associations and policymakers.