school of health professions education prof. dr. albert scherpbier
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School of Health Professions Education Prof. dr. Albert Scherpbier. The combination of virtual patients and small group discussions to promote reflective practice. Bas de Leng, PhD ICVP London, 26 April 2010. Risks of life…. Medical errors. Diagnostic errors: 5-15% of medical diagnosis - PowerPoint PPT PresentationTRANSCRIPT
Faculty of Health, Medicine and Life Sciences
School of Health Professions Education Prof. dr. Albert Scherpbier
The combination of virtual patients and small group discussions to promote reflective practice
Bas de Leng, PhD
ICVP London, 26 April 2010
Faculty of Health, Medicine and Life Sciences
Risks of life…
Faculty of Health, Medicine and Life Sciences
719
28
46
FactorsNo fault
Only system
Only cognitive
Both system and cognitve
Medical errors Diagnostic errors: 5-15% of medical diagnosis Taxonomy of diagnostic error (Graber,2005):
– No-fault errors– System-related errors– Cognitive errors
Cognitive errors contributeto 75% of all diagnostic errrors
‘Premature closure’ mostcommon cognitive error
Faculty of Health, Medicine and Life Sciences
Education to prevent cognitive errorsRelationships between reliability and effort of diagnostic decision making (Graber, 2009)
Effort
AccuracyLow High
Less
More
Deductive reasoning
Expert thinking
Monitoring, reflection
Expert thinking
Pre-expert reasoning: heuristics
ideas for educational approaches
Faculty of Health, Medicine and Life Sciences
Increase expertise Deliberate practice with coaching and feedback by
more accomplished professionals (Ericsson, 2003) Access to a large numbers of patients with similar
symptoms for which the correct diagnosis is validated
Virtual patients can supplement real patient encounters
Faculty of Health, Medicine and Life Sciences
Learn to apply reflective thinkingLearning to: Recognize and understand the most likely
diagnostic pitfalls (Croskerry, 2003) Use a checklist for the diagnostic process including
‘reflection’.
Faculty of Health, Medicine and Life Sciences
Clinical reasoning sessionsIngredients:Virtual patients based on real cases in which ‘premature closure’ had occurredProcedure to induce reflective diagnostic reasoning (Mamede, 2008)
Faculty of Health, Medicine and Life Sciences
Clinical reasoning sessionsProcedure:All residents simultaneously worked out the same virtual patientAnd the end of the work-up they had a moderated discussion on their clinical reasoningThe logged actions and their notes were starting points for the discussion
Faculty of Health, Medicine and Life Sciences
Evaluation of perceptions
Two student questionnaires:1. Experiences with the use virtual patients. With 12 statements on:
Authenticity Professional approach Coaching Learning effect Overall judgment
2. Experiences with the integration of virtual patients. With 20 statements on: Teaching presence Cognitive presence Social presence Learning effect Overall judgment
Faculty of Health, Medicine and Life Sciences
Conclusion Residents perceived a session combining individual
virtual patient workup with small group discussions as a valuable learning activity for clinical reasoning.
The clinical supervisor found the presented teaching approach feasible for the medical specialist training at the workplace.
Faculty of Health, Medicine and Life Sciences
Future research
Evaluation of clinical reasoning sessions with VPs on 3rd and 4th level of Kirkpatrick:Do they learn clinical reasoning and reflective practice from this activity?Do the learning outcomes transfer to clinics and wards?