1. Virtual patients to explore and develop clinical case summary statement skills amongst Japanese resident physicians: a mixed methods study
- Author
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Sugihiro Hamaguchi, Hiroyuki Kobayashi, Brian S. Heist, Gautam A. Deshpande, and Naoki Kishida
- Subjects
Medical education ,Virtual patient ,Program evaluation ,Models, Educational ,medicine.medical_specialty ,020205 medical informatics ,Statement (logic) ,media_common.quotation_subject ,education ,Alternative medicine ,Pilot Projects ,macromolecular substances ,02 engineering and technology ,Education ,Post-graduate ,03 medical and health sciences ,Mental Processes ,0302 clinical medicine ,Japan ,Medical Staff, Hospital ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Humans ,Quality (business) ,Prospective Studies ,030212 general & internal medicine ,Simulation Training ,Clinical reasoning ,media_common ,Medicine(all) ,Internship and Residency ,Summary statement ,General Medicine ,Automatic summarization ,Clinical Competence ,Clinical case ,Psychology ,Program Evaluation ,Research Article - Abstract
Background In 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. Methods All 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. Results Four 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. Conclusions Our 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. Electronic supplementary material The online version of this article (doi:10.1186/s12909-016-0571-y) contains supplementary material, which is available to authorized users.
- Published
- 2016
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