Vinten Claire E K, Cobb Kate A, Mossop Liz H
Veterinary Education, Royal Veterinary College, The LIVE Centre.
Teaching Learning and Assessment, University of Nottingham School of Veterinary Medicine and Science.
J Vet Med Educ. 2020 Feb;47(1):56-68. doi: 10.3138/jvme.0917-132r1. Epub 2019 Mar 28.
Clinical reasoning is an important skill for veterinary students to develop before graduation. Simulation has been studied in medical education as a method for developing clinical reasoning in students, but evidence supporting it is limited. This study involved the creation of a contextualized, standardized client simulation session that aimed to improve the clinical reasoning ability and confidence of final-year veterinary students. Sixty-eight participants completed three simulated primary-care consultations, with the client played by an actor and the pet by a healthy animal. Survey data showed that all participants felt that the session improved their clinical decision-making ability. Quantitative clinical reasoning self-assessment, performed using a validated rubric, triangulated this finding, showing an improvement in students' perception of several components of their clinical reasoning skill level from before the simulation to after it. Blinded researcher analysis of the consultation video recordings found that students showed a significant increase in ability on the history-taking and making-sense-of-data (including formation of a differential diagnosis) components of the assessment rubric. Thirty students took part in focus groups investigating their experience with the simulation. Two themes arose from thematic analysis of these data: variety of reasoning methods and "It's a different way of thinking." The latter highlights differences between the decision making students practice during their time in education and the decision making they will use once they are in practice. Our findings suggest that simulation can be used to develop clinical reasoning in veterinary students, and they demonstrate the need for further research in this area.
临床推理是兽医专业学生毕业前需要培养的一项重要技能。在医学教育中，模拟已作为一种培养学生临床推理能力的方法进行了研究，但支持这一方法的证据有限。本研究创建了一个情境化、标准化的客户模拟环节，旨在提高兽医专业最后一年学生的临床推理能力和信心。68名参与者完成了三次模拟初级保健咨询，客户由一名演员扮演，宠物由一只健康动物扮演。调查数据显示，所有参与者都认为该环节提高了他们的临床决策能力。使用经过验证的评分标准进行的定量临床推理自我评估对这一发现进行了验证，结果显示，从模拟前到模拟后，学生对其临床推理技能水平的几个组成部分的认知有所提高。研究人员对咨询视频记录进行的盲法分析发现，学生在评估评分标准的病史采集和数据理解（包括形成鉴别诊断）部分的能力有显著提高。30名学生参加了焦点小组，调查他们在模拟中的体验。对这些数据进行主题分析后出现了两个主题：推理方法的多样性和“这是一种不同的思维方式”。后者突出了学生在学习期间练习的决策方式与他们在实际工作中将会使用的决策方式之间的差异。我们的研究结果表明，模拟可用于培养兽医专业学生的临床推理能力，并且证明了在这一领域进行进一步研究的必要性。
