Virtual patients to explore and develop clinical case summary statement skills amongst Japanese resident physicians: a mixed methods study

BMC Medical Education

Research Article

Naoki Kishida¹  Sugihiro Hamaguchi²  Hiroyuki Kobayashi³  Gautam Deshpande⁴  Brian S. Heist⁵ 

[1] Department of General Internal Medicine and Infectious Diseases at Teine Keijinkai Hospital, Sapporo, Japan;Hokkaido General Internal Medicine Education Center, Ebetsu, Japan;Mito Medical Center, Tsukuba University Hospital, Mito, Japan;St. Luke’s International Hospital, Tokyo, Japan;Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA;University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;Adjunct Teaching Faculty, Teine Keijinkai Hospital, Sapporo, Japan;University of Pittsburgh School of Medicine, Division of General Internal Medicine, UPMC Shadyside Hospital - North Tower #306, 15232, Pittsburgh, PA, USA;

关键词: Clinical reasoning;    Summary statement;    Post-graduate;    Medical education;    Virtual patient;    Japan;   

DOI  :  10.1186/s12909-016-0571-y

 received in 2015-05-29, accepted in 2016-01-29,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundIn Western clinical training, formulation of a summary statement (SS) is a core exercise for articulation, evaluation, and improvement of clinical reasoning (CR). In Japanese clinical training, structured guidance in developing CR, including opportunity for SS practice, is uncommon, and the present status of case summarization skills is unclear. We used Virtual Patients (VPs) to explore Japanese junior residents’ SS styles and the effectiveness of VPs on improving SS quality.MethodsAll first-year junior resident physicians at 4 residency programs (n = 54) were assigned randomized sequences of 5 VP modules, rolled out at 6 day intervals. During each module, participants free-texted a case summary and then reviewed a model summary. Thematic analysis was used to identify SS styles and each SS was categorized accordingly. Frequency of SS styles, and SS CR quality determined by 1) an internally developed Key Feature rubric and 2) demonstration of semantic qualification, were compared across modules.ResultsFour SS styles were identified: numbered features matched to differential diagnoses, differential diagnoses with supportive comments, feature listing, and narrative summarization. From module #1 to #5, significant increases in the narrative summarization SS style (p = 0.016), SS CR quality score (p = 0.021) and percentage of semantically driven SS (p = 0.003) were observed.ConclusionsOur study of Japanese junior residents identified distinct clinical case summary statement styles, and observed adoption of the narrative summarization style and improvement in the CR quality of summary statements during a series of VP cases.

【 授权许可】

CC BY   
© Heist et al. 2016