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Learning clinical reasoning: how virtual patient case format and prior knowledge interact.

Jan Kiesewetter1, Michael Sailer2, Valentina M Jung3

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Summary
This summary is machine-generated.

Virtual patients improve clinical reasoning for medical students with high prior knowledge but not for those with low prior knowledge. Lower knowledge students experienced increased cognitive load, impacting learning outcomes.

Keywords:
Case formatsClinical reasoningInstructional materials/methodsVirtual patients

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Area of Science:

  • Medical Education
  • Cognitive Science

Background:

  • Clinical reasoning is crucial for medical professionals.
  • Virtual patients are increasingly used to train clinical reasoning skills.
  • The effectiveness of different virtual patient case formats for learners with varying prior knowledge is not well-established.

Purpose of the Study:

  • To investigate the impact of two virtual patient case formats (whole case vs. serial cue) on medical students' clinical reasoning outcomes.
  • To determine how students' prior knowledge level influences the effectiveness of these virtual patient formats.
  • To assess the effect of case format and prior knowledge on diagnostic accuracy and cognitive load.

Main Methods:

  • 142 medical students (3rd-6th year) were randomized into whole case or serial cue format groups.
  • Participants engaged with eight virtual patients in their assigned format.
  • Outcomes measured included diagnostic accuracy, knowledge gain (strategic and conceptual), and cognitive load.

Main Results:

  • Neither case format significantly affected overall knowledge gain or diagnostic accuracy.
  • Students with high baseline knowledge showed significant learning gains in strategic knowledge, unlike those with low prior knowledge.
  • Diagnostic accuracy was higher in students with high prior knowledge.
  • Students with low prior knowledge reported higher extraneous cognitive load compared to high prior knowledge students.

Conclusions:

  • Virtual patient case formats (whole vs. serial cue) did not independently impact knowledge gain or diagnostic accuracy.
  • Students with lower prior knowledge experienced greater cognitive load and less learning from virtual patients.
  • Cognitive load is a critical factor to consider when implementing virtual patients for clinical reasoning training, particularly for novice learners.