Patricia G. McBurney, MD, MD, Medical University of South Carolina, Charleston, SC, David M. Mills, MD, Medical University of South Carolina, Charleston, SC, Joseph V. Dobson, MD, Medical University of South Carolina, Charleston, SC
Introduction: Virtual patients and high-fidelity simulation-based medical education (SBME) are both attractive means of meeting pediatric clerkship goals. Our project seeks to determine the benefits of integrating virtual patients (Computer-assisted Learning in Pediatrics Program, CLIPP) with SBME.
Methods: SBME is a subcourse of our pediatric clerkship at the Medical University of South Carolina. It consists of stations of skills training and scenarios (basic airway, intravenous access, and lumbar puncture); the full content is delivered by three pediatricians over two half-days. CLIPP cases 19, 23, and 25 are the online cases most closely matched with our stations. Students from odd-numbered rotations (about 20 students/rotation) were instructed to complete these cases before their SBME sessions while the remaining students completed them afterwards. Knowledge was measured with a multiple-choice exam immediately following SBME completion. Clinical reasoning was evaluated by testing the student’s ability to form differential diagnosis lists (measured by number of items listed and items matching the expert list). Comfort with forming/discussing differential diagnoses was measured with surveys. We administered the survey and test before the first SBME session and again after the second SBME session. Data were analyzed with Student’s t-test and Wilcoxon-Mann-Whitney tests. We hypothesized that students exposed to the virtual patients before SBME would have higher knowledge, clinical reasoning, and comfort.
Results: Fifty-eight students completed CLIPP before entering the SBME. Fifty-two students were in the comparison group. There was no difference in multiple-choice exam scores (Pre-test CLIPP group mean 56.6%, non-CLIPP 56.2; p=0.8) (Post-test CLIPP group mean 80, non-CLIPP 80.1; p=0.91). There was no statistically significant difference between the groups’ abilities to form differential diagnoses. We did not detect any statistically significant difference in students’ comfort.
Conclusions: Addition of CLIPP cases to the simulation sub-course at our institution did not improve student performance pre-simulation course or in post-simulation course measures. While the students required to complete CLIPP were documented having done so, we could not assess their degree of effort in reviewing the CLIPP material. Future efforts will need to account for student effort in the evaluation of integration potential.