Virtual patients for assessment of clinical reasoning

Sammanfattning: In healthcare education it is essential for the students to develop and achieve clinical reasoning skills. Clinical reasoning is complex to teach and learn, and effective assessment methods are also lacking. Virtual Patients (VPs) are interactive computer simulations of real-life clinical scenarios for the purpose of healthcare training, education and assessment. Many VP systems are focused on clinical reasoning and have the possibility to track every interaction from the user and therefore have been suggested to be used for assessment. The overall aim of the thesis was to explore the potential of using VPs for assessment of clinical reasoning in postgraduate paediatric nursing education. Study I evaluated the applicability of VPs for the postgraduate paediatric nursing field and students’ acceptance for using VPs for assessment. Study II aimed to identify how clinically experienced paediatric nurses through clinical reasoning solve complex paediatric VP cases. The study was also aimed to give information about how clinical reasoning might be assessed in VP-based exams for postgraduate paediatric nurse students. Study III evaluated a novel scoring and grading model for VP-based exams. Study IV explored whether formative VP-based assessments in connection with self- evaluations had an impact on postgraduate paediatric nursing students’ development of clinical reasoning abilities and the learners’ discovery of their progression. The findings showed that it was possible to develop and implement VP cases that reflected specific tasks for paediatric nursing. Students and experienced paediatric nurses found the cases realistic and engaging. Both groups also thought using VPs was an innovative and interactive way to be assessed and that VP cases can be used to assess clinical reasoning. The novel scoring and grading model developed for summative VP-based exams could be used to assess the clinical reasoning process and the clinical decision-making. The model has opportunities to give negative points if not protecting patient safety or doing unnecessary things, which was good. In study III, one group of students performed a VP-based exam in three consecutive courses and a clear progress was detected: 53% of the students passed the first exam, 63% at the second and in the last, 84% of the students passed the exam. The most common reason for deduction of points was due to students asking too many interview questions or ordering too many laboratory tests. In study IV, when VPs were used for formative assessments; the findings showed that students’ understanding of the concept of clinical reasoning, awareness of what to focus on in clinical practice and grasp of the level of clinical competence they would require in future professional practice was improved. The students reported a perceived progression of clinical reasoning ability during the courses (from uncertainty about the competence to self-efficacy). In conclusion, the results of the Thesis indicate that VPs seem to have excellent opportunities to assess clinical reasoning skills. Even though the four studies have been performed within the area of postgraduate paediatric nursing care, most of the results are most certainly applicable and transferable to many other areas within healthcare education.