Clinical reasoning in nursing, a think-aloud study using virtual patients - a base for an innovative assessment

Assessing progression of clinical reasoning through virtual patients: An exploratory study

To avoid test-driven learning, there have been discussions regarding the use of more formative assessments in health care education to promote students' deep learning. Feedback is important in formative assessment, but many students ignore it; therefore, interventions should be introduced which stimulate them to reflect on the new knowledge. The aim for this study was to explore if Virtual Patient (VP)-based formative assessments, in connection with self-evaluations, had an impact on postgraduate pediatric nursing students' development of clinical reasoning abilities. Students' self-evaluations served as the basis for measuring progress. Data was analysed using deductive content analysis. The findings showed a clear progression of the clinical reasoning ability of the students. After the first assessment, the students described feelings of uncertainty and that their knowledge gaps were exposed. At the mid-course assessment the awareness of improved clinical reasoning was obvious and the students were more certain of knowing how to solve the VP cases. In the final assessment, self-efficacy was expressed. VP-based assessments, in connection with self-evaluations, early in the education resulted in a gain of students' own identification of the concept of clinical reasoning, awareness of what to focus on during clinical practice and visualised expected clinical competence.

Virtual patients: development in cancer nursing education

BACKGROUND

The number of men diagnosed with prostate cancer is increasing and internationally there are high incidence rates. It is important that nurses and healthcare professionals are enabled to provide appropriate care to those men affected by prostate cancer and their families. Despite this need, there is recognition that many professionals feel ill prepared and lack knowledge in a number of areas. This paper presents the development of a Virtual Patient (VP) online resource to support practitioner learning.

AIM

To develop five online VP simulation scenarios to meet the learning needs of nurses and health-care professionals caring for men with prostate cancer.

METHOD

Topic areas for the VPs were taken from previous work exploring the needs of health care professionals working with men with prostate cancer. An initial scoping exercise involving nursing practitioners, students and a prostate cancer charity confirmed the focus of the case study scenarios. Service users and specialist practitioners reviewed an outline of each case study to ensure fidelity of the simulations scenarios. Cases were entered into UChoose, a web based interactive VP player and authoring tool. The final case studies were reviewed by a sample of both registered and non-registered nurses and nursing students.

RESULTS

The majority of respondents reported an increase in knowledge and suggested that they would recommend the resource to others. A number of positive aspects of the resource were highlighted. Respondents also commented about areas of weakness, a number of which have been addressed subsequently.

CONCLUSIONS

The VP case studies provided an opportunity to develop knowledge and confidence in caring for men with prostate cancer. The mode of delivery and the content was acceptable for less experienced and knowledgeable staff.

Using a virtual patient in an advanced assessment course

BACKGROUND

A virtual patient, Digital Clinical Experience (DCE), was incorporated into an advanced assessment course.

METHOD

Students conducted systems-based physical examinations on the DCE, documenting findings using a standard history format and physical examination skills checklists. Faculty reviewed transcripts generated from the students' history and physical examination to evaluate the logical order and progression of the examination.

RESULTS

The nine DCE modules were included as half of the 2-hour weekly laboratory requirement and counted as 17.5% of the course grade. Faculty customized specific components of individual modules, including instructions to students and model documentation, to align with course objectives and faculty preferences. DCE use permitted faculty to provide structured student practice and evaluate essential advanced assessment skills that have not been previously assessed for individual students due to excessive time and cost.

CONCLUSION

The potential impact of integrating a virtual patient on students' history taking and physical examination skills in their clinical courses should be explored.