Visualizing Multi-Step Decision-Making at a Glance: Pairing Choose Your Own Adventure Style Simulated Cases with a...

Area of Science:

• Medical Education
• Clinical Reasoning Assessment
• Health Professions Education

Background:

• Assessing clinical reasoning in dynamic, real-world scenarios is challenging.
• Traditional methods like multiple-choice questions inadequately simulate complex decision-making.
• Choose Your Own Adventure (CYOA) case studies offer a promising alternative for simulating non-linear decision processes.

Purpose of the Study:

• To evaluate the effectiveness of pairing CYOA-style clinical cases with dynamic mapping tools for assessing clinical reasoning.
• To visualize user decision-making patterns in simulated high-dose methotrexate treatment for pediatric leukemia.
• To compare decision-making behaviors across different user cohorts and interventions.

Main Methods:

• Development of CYOA branched narrative case studies simulating clinical decision-making.
• Utilization of R-based DiagrammeR software to map user decision pathways post-case completion.
• Analysis of visualized decision maps to identify user pathways and behaviors.

Main Results:

• Decision maps effectively visualized user pathways and decision-making behaviors at each stage.
• 25.9% of users demonstrated expert-level decision-making; 51.9% made decisions leading to adverse outcomes.
• Rapid generation (under 10 seconds) of visualizations and data tables for immediate performance insights.

Conclusions:

• Combining CYOA case studies with dynamic mapping tools offers a nuanced and interactive method for assessing clinical reasoning.
• This approach provides valuable insights into user performance and decision-making patterns.
• The methodology has potential for improving medical education and clinical skills assessment.