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document
Virtual patients design and its effect on clinical reasoning and student experience : a protocol for a randomised factorial multi-centre study . BACKGROUND Virtual Patients ( VPs ) are web-based representations of realistic clinical cases . They are proposed as being an optimal method for teaching clinical reasoning skills . International standards exist which define precisely what constitutes a VP . There are multiple design possibilities for VPs , however there is little formal evidence to support individual design features . The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience . These are the branching case pathways ( present or absent ) and structured clinical reasoning feedback ( present or absent ) . METHODS/DESIGN This is a multi-centre randomised 2 x 2 factorial design study evaluating two independent variables of VP design , branching ( present or absent ) , and structured clinical reasoning feedback ( present or absent ) .The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom , Warwick , Keele and Birmingham . There are four core musculoskeletal topics . Each case can be designed in four different ways , equating to 16 VPs required for the research . Students will be randomised to four groups , completing the four VP topics in the same order , but with each group exposed to a different VP design sequentially . All students will be exposed to the four designs . Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment , integrated into each VP , which is identical for each topic . Additionally a 15-item self-reported evaluation is completed for each VP , based on a widely used EViP tool . Student patterns of use of the VPs will be recorded.In one centre , formative clinical and examination performance will be recorded , along with a self reported pre and post-intervention reasoning score , the DTI . Our power calculations indicate a sample size of 112 is required for both primary outcomes . DISCUSSION This trial will provide robust evidence to support the effectiveness of different designs of virtual patients , based on student performance and evaluation . The cases and all learning materials will be open access and available on a Creative Commons Attribution-Share-Alike license .
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Intervention_Physical
Virtual patients design
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Intervention_Physical
Virtual Patients ( VPs )
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Intervention_Physical
VP
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Intervention_Physical
VP design , branching ( present or absent )
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Intervention_Physical
structured clinical reasoning feedback ( present or absent )
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Intervention_Physical
VP
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Intervention_Pharmacological
VP
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Intervention_Pharmacological
VP
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Outcome_Mental
clinical reasoning
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Outcome_Other
student experience :
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Outcome_Mental
clinical reasoning skills
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Outcome_Other
student experience
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Outcome_Mental
.
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Outcome_Mental
performance for each case design in a standardized fifteen item clinical reasoning assessment
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Outcome_Other
15-item self-reported evaluation
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Outcome_Mental
student performance
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Outcome_Other
evaluation
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Participant_Sample-size
112