gms | German Medical Science

Background: Final year medical students at the University Duisburg-Essen, are unsatisfied with their clinical judgement skills in common elective and emergency clinical situations. Approaches to clinical judgement include either analytical, intuitive or a combination of both approaches. Novices display tendencies, which are typical of inexperienced clinicians. A competency based medical curriculum determines that clinical judgement is an essential skill in effective patient care. Simulation presents particular educational opportunities in a competency-based medical education curriculum and possibly in clinical decision-making. The social cognitive learning theory supports that in the capacity as observer and/or participant, learners are presented with opportunities for learning and self-reflection, which can be effectively applied in a simulation scenario. There is limited evidence showing that simulation ptovides effective opportunities learning clinical decision-making. project explores the clinical decision-making approaches as well as the influence of the simulation course on these decision-making approaches.

Method: Ethics approval was obtained from the local ethics committee. 35 students, completed a validated clinical decision-making instrument devised to categorise their clinical decision-making approaches. The two theories of clinical decision-making (Novice Decision Making Model and the Cognitive Continuum Model) combined with learning theories in simulation (Social Cognitive Theory) were used to explore and interpret data collected through questionnaires, interviews and observation. Eight students further participated in focus group interviews exploring how they made decisions and what personal and environmental factors affected their decision-making and how the simulation had subsequently influenced their approach to clinical decision-making.

Results: The majority of students employed an analytic approach, some students showed intuitive and quasi-rational tendencies to clinical decision-making making in clinical situations. Students elaborated on typical factors established in novice approaches as well as expressed positive comments relating to simulation, clinical decision making and application of the social cognitive learning theory. Five general themes of personal issues, social factors, approaches to decision-making, learning strategies and simulation issues were generated.

Discussion: Students exhibited a predominantly analytic approach to clinical decision-making. Decision-making is influenced by anxiety, lack of confidence and fear of negative consequences. These factors are all in keeping with features described in the Novice Clinical Reasoning Model. Simulation offers a cost-effective alternative to actual clinical ward experience, which can facilitate learning decision-making.

Conclusion: Simulation offers an alternative to clinical experience and can be used to learn decision-making which improves patient care.