There is a growing demand for better assessment of medical students’ clinical reasoning skills and their ability to manage dilemmatic situations in clinical practice. Practicum Script  is an online simulation-based program that is designed to enhance clinical reasoning and problem solving skills, as well as introducing the concept of uncertainty in clinical decision-making. The project known as Practicum Universities is a multicentre pilot study, coordinated by the European Board of Medical Assessors (EBMA) and the Practicum Foundation (Madrid, Spain), aimed to investigate the effectiveness of Practicum Script as an education resource in undergraduate teaching and assessment. 

Imperial College London, Oxford and Charité – Universitätsmedizin, amont other faculties, are in

The participation is anticipated to include at least 15 European medical faculties, such as Imperial College London (ICL), Oxford, Sapienza of Rome, Charité – Universitätsmedizin Berlin or Complutense University of Madrid. Top medical schools in other countries, including Harvard in USA and the University of Sao Paulo in Brazil, will also join the project. The assessment material will consist of 20 clinical cases targeting key topics in Internal Medicine. With the editorial stage already completed by an editorial board at ICL led by Dr. Amir H. Sam, the cases are currently under revision by a panel of referees comprised by internists, and the next step will be the compilation of their answers as part of the feedback for the participants.

Practicum Script presents challenges in dilemmatic contexts. For each clinical scenario, final year medical students will be asked to generate hypotheses and justify them by identifying pertinent positive and negative findings in the case. Subsequently, they will be required to report, in five different clinical scenarios, how new data may affect their original hypotheses. The students will be able to observe the agreement between their responses and those of the experts, along with the literature-based clinical evidence. This tool will allow the students to self-assess their clinical reasoning abilities in real-life situations, boosting their confidence in decision making. 

The project is ongoing and the plan is to obtain psychometric results by the end of 2020. The level of agreement between experts will be analysed, as well as the validity based on the internal structure using a hierarchical polytomous item response theory model. Also, cognitive diagnostic modelling will be used to explore the possibility of determining profiles of specific clinical reasoning skills needed to solve each item. For sure, student satisfaction and perceptions will be evaluated.

Usefulness of this pedagogic model

There is a strong need for effective approaches tailored to the development of problem-solving skills and Practicum Script could contribute meaningfully to this goal. In fact, Practicum Script has been used as a CPD/CME tool and in residency training for more than 10 years. Also, a recent research published in Medical Education concluded that “even when their positions remain unchanged, by knowing about controversies, the examinees may calibrate their certainty and apply more diverse thinking going forward”.

The investigation, conducted by a group of researchers from the Practicum Foundation, the University of Illinois at Chicago, and the University of Kansas, revealed multifactorial reasons behind the divergence that naturally occurs among experts during decision making in complex situations, as well as the usefulness of this pedagogic model in medical education. According to the study, “controversial cases may be valuable stimuli in an assessment for learning that better reflects the complexity of medical decision making.” Both, the international project for medical students and the investigation about the experts’ response process validity will be presented at the AMEE conference 2019 by the Practicum Foundation – Institute of Applied Research in Health Sciences Education. 


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