Diagnosis, 2023/05, 10(2):A3-A4. doi: 10.1515/dx-2023-0006, type of study: ,css,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://www.degruyter.com/document/doi/10.1515/dx-2023-0006/html)

Keywords:

clinical reasoning [85]
congress [77]
cross sectional study [894]
diagnosis [412]
medical students [694]
osteopathic medicine [2109]

Abstract:

Background: - NEJM Healer is a computer-based simulator using illness script theory to enhance the teaching and assessment of clinical reasoning. - During a virtual patient encounter, learners must select data, write problem representations, build a differential diagnosis, and propose a management plan - After the encounter, learners perform informed self-assessments of their problem representations, management plan, and level of confidence in their lead diagnosis. - They are given formative assessment on their lead diagnostic accuracy, differential diagnostic accuracy (DDxA), and illness script concordance. - Educators can view all the feedback data in the NEJM Healer Educator Portal, including informed self-assessment of problem representations, management plan, and level of confidence. Objectives: - To augment deliberate practice for over 1100 medical students at Lake Erie College of Osteopathic Medicine (LECOM) dispersed across several campuses. - To compare performance in NEJM Healer with learner clinical experience in a cross-sectional analysis. Results: - Normalized data was used to support early identification of learners who could use additional support for developing clinical reasoning skills using a defined framework. - Comparative cross-sectional analysis of all encounters showed that pre-clerkship students spent significantly more time per encounter and had significantly lower diagnostic accuracy than post-clerkship students. - In one encounter of medium-difficulty, DDxA was significantly lower after history-taking than after physical exam and review of diagnostic interventions (Fig. 1). DDxA of pre-clerkship students was significantly lower than post-clerkship students at every stage of the encounter. - Post-clerkship students were significantly more confident of their diagnosis than pre-clerkship students. - Diagnostic accuracy in NEJM Healer significantly but weakly correlated with NBOME COMLEX-USA Level 2 CE test scores. Conclusion: - Performance in NEJM Healer identified students who could use additional support for developing clinical reasoning skills. - Clinical reasoning performance in NEJM Healer correlated with clinical-student experience level. - While differential diagnostic accuracy was significantly correlated with COMLEX Level-2 CE scores in this large sample size, very little of the variation between students was predicted by their knowledge test scores, indicating that clinical reasoning requires a distinct set of skills in addition to clinical knowledge.