Plackett Ruth, Kassianos Angelos P, Kambouri Maria, Kay Natasha, Mylan Sophie, Hopwood Jenny, Schartau Patricia, Gray Shani, Timmis Jessica, Bennett Sarah, Valerio Chris, Rodrigues Veena, Player Emily, Hamilton Willie, Raine Rosalind, Duffy Stephen, Sheringham Jessica
Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
Institute of Education, UCL, London, UK.
BMC Med Educ. 2020 Jul 31;20(1):245. doi: 10.1186/s12909-020-02168-4.
Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. However, little is known about how best to implement and evaluate OPS in medical curricula. The aim of this study was to assess the feasibility, acceptability and potential effects of eCREST - the electronic Clinical Reasoning Educational Simulation Tool.
A feasibility randomised controlled trial was conducted with final year undergraduate students from three UK medical schools in academic year 2016/2017 (cohort one) and 2017/2018 (cohort two). Student volunteers were recruited in cohort one via email and on teaching days, and in cohort two eCREST was also integrated into a relevant module in the curriculum. The intervention group received three patient cases and the control group received teaching as usual; allocation ratio was 1:1. Researchers were blind to allocation. Clinical reasoning skills were measured using a survey after 1 week and a patient case after 1 month.
Across schools, 264 students participated (18.2% of all eligible). Cohort two had greater uptake (183/833, 22%) than cohort one (81/621, 13%). After 1 week, 99/137 (72%) of the intervention and 86/127 (68%) of the control group remained in the study. eCREST improved students' ability to gather essential information from patients over controls (OR = 1.4; 95% CI 1.1-1.7, n = 148). Of the intervention group, most (80/98, 82%) agreed eCREST helped them to learn clinical reasoning skills.
eCREST was highly acceptable and improved data gathering skills that could reduce diagnostic errors. Uptake was low but improved when integrated into course delivery. A summative trial is needed to estimate effectiveness.
在线患者模拟（OPS）是一种向学生传授临床推理技能的新方法，有助于减少诊断错误。然而，对于如何在医学课程中最佳地实施和评估OPS知之甚少。本研究的目的是评估电子临床推理教育模拟工具（eCREST）的可行性、可接受性和潜在效果。
在2016/2017学年（队列一）和2017/2018学年（队列二），对来自三所英国医学院的本科最后一年学生进行了一项可行性随机对照试验。在队列一中，通过电子邮件和教学日招募学生志愿者，在队列二中，eCREST也被纳入课程中的一个相关模块。干预组接受三个患者病例，对照组接受常规教学；分配比例为1:1。研究人员对分配情况不知情。在1周后使用一项调查以及在1个月后使用一个患者病例来测量临床推理技能。
三所学校共有264名学生参与（占所有符合条件学生的18.2%）。队列二的参与率（183/833，22%）高于队列一（81/621，13%）。1周后，干预组的137名学生中有99名（72%）、对照组的127名学生中有86名（68%）仍参与研究。与对照组相比，eCREST提高了学生从患者那里收集基本信息的能力（比值比=1.4；95%置信区间1.1 - 1.7，n = 148）。在干预组中，大多数学生（80/98，82%）认为eCREST帮助他们学习了临床推理技能。
eCREST具有高度可接受性，提高了可能减少诊断错误的数据收集技能。参与率较低，但当整合到课程教学中时有所提高。需要进行一项总结性试验来评估其有效性。
