gms | German Medical Science

Background: Despite acquiring massive amounts of content knowledge about the functioning of the human body, medical students struggle to transfer that knowledge to one of the core disciplinary practices – differential diagnosis. The lack of transfer may stem from current methods of university teaching which are focused primarily on imparting massive amounts of basic content knowledge without adequate attention to situate this knowledge in disciplinary practice. A possible solution to this problem is to expose and link the learning of medical students to the practice of differential diagnosis. To do so, we aim to explore the use of medical computer-based virtual environment (CVE) simulations with virtual patients. This approach is supported by theories of experiential learning [1].

Rationale: Recently, it has been shown that problem-solving preceding instruction, on average, results in better conceptual understanding and transfer outcomes than instruction-first learning approaches carried out in the domain of medicine [2]. Consequently, we will implement Bransford & Schwartz's [3] Preparation for Future Learning (PFL) paradigm which consists of two subsequent transfers.

Methods: By applying a quasi-experimental PFL design in a third-year medical students cohort, we aim to determine the sequence of two learning activities which leads to best acquisition and transfer outcomes. In the experimental condition we will set CVE problem-solving (including feedback) prior to direct instruction (CVE → I). The comparison condition will follow the typical sequence where CVEs are used as a learning tool after direct instruction (I → CVE). The covered topic will be neurology (migraine, subarachnoid hemorrhage). Direct instruction will be provided through a monologue video lecture where the diagnostic approach to headache will be explained.

As represented in figure 1 [Fig. 1], after having solved a pre-intervention multiple-choice quiz, the subjects of both groups will go through the two learning activities but in the reversed order. Once this intervention is completed, the groups will repeat the learning scenario in the test mode (no feedback) and answer the pre-intervention quiz again. Consequently, this will be an isomorphic assessment of clinical reasoning (CR) skills and clinical knowledge. This whole step will be repeated with a scenario and quiz based on a different related diagnosis. By doing so we can assess near transfer of clinical knowledge and CR skills.

Hypotheses: We hypothesize that problem-solving in CVE patient simulations prior to direct instruction leads to

1.

better isomorphic testing outcomes of clinical knowledge and CR skills in a new disease and

2.

better simulation to simulation near transfer of clinical knowledge and CR skills.

Conclusion: With the findings of this study we will demonstrate when CVE problem-solving is most effective to enhance clinical knowledge and CR skills acquisition and transfer when combined with direct instruction.