Practicum Script is on the agenda for McMaster’s Rethink Clinical Reasoning Conference

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The results of the multicentre application of Practicum Script in undergraduate medical education will be exposed at a virtual event organised by Canadian McMaster University in February. Developed during 2019 and 2020, this study aimed to investigate the utility of the simulation-based programme Practicum Script as a clinical reasoning training methodology for final year students. More than 2,500 trainees from 21 European and American universities tried out the system, and 89.9% of them rated their overall perception as very satisfactory. The findings showed that Practicum Script is a useful resource to strengthen clinical reasoning skills, with a solid psychometric backup.

The analysis of the students’ results has proved good psychometric properties of Practicum Script  in terms of validity, reliability and discrimination of students’ clinical reasoning skills.

The clinical reasoning training programme for medical students Practicum Script makes part of the Rethink Clinical Reasoning Conference, organised by McMaster University, based in Hamilton (Canada). According to the coordinating committee, “this will be a mostly Zoom virtual event to examine some new ideas from innovative thinkers and explore the complexities behind clinical reasoning”. McMaster Faculty of Health Sciences suggests there’s a growing concern over rising rates of clinical error, and the merger  between education and technology may represent a good starting point to mitigate the problem.

Practicum Script is an online clinical case-based learning resource aimed at enhancing clinical reasoning and problem-solving skills. In 2019 and 2020, 21 medical schools implemented Practicum Script as a formative methodology for future doctors. The material consisted of 20 internal medicine clinical cases, created by an editorial team from Imperial College London and validated by 20 experienced internists from Europe and America.  For each case, students were asked to generate hypotheses in a ‘free-text’ format and justify them. Subsequently, they had to report, in 5 different scenarios, how new data might affect their prior hypotheses. Feedback was based on experts’ opinions, and clinical evidence. 

Known as Practicum Universities and jointly developed by the Practicum Foundation and the European Board of Medical Assessors, this unique project on clinical reasoning reached more than 2,500 students. The point was to introduce the concept of uncertainty in decision making, challenging students to face real patients and scenarios, so that they could improve their critical judgement and maximise the acquisition of experiential knowledge in their transition to professional practice. Why? Because, by addressing cognitive failures, educators can redefine the future of clinical practice. 

As for the outcomes, 1,502  students from medical schools across Europe, USA and Latin America completed the 20 cases and 89.8% of responders to a satisfaction survey rated the experience as “excellent” or “good”. Cronbach’s alpha coefficients were excellent for hypothesis generation (alpha = 0.909, 95% CI = 0.902-0.916) and hypothesis argumentation (alpha = 0.926, 95% CI = 0.920-0.931) and adequate for knowledge application (alpha = 0.786, 95% CI = 0.768-0.803). Goodness-of-fit indices RMSEA and SRMR, from confirmatory factor analysis, were also adequate: 0.025 and 0.059, respectively. The reliability estimates and the evidence of validity based on its internal structure are superb, which is a consequence of good work in item writing and reviewing processes.

The analysis of the students’ results has proved good psychometric properties of Practicum Script  in terms of validity, reliability and discrimination of students’ clinical reasoning skills. Conclusions not only support that Practicum Script as a useful resource to increase the quality of clinical reasoning, but also the potential use of cognitive diagnostic modelling to provide a more qualitative feedback to medical students regarding specific cognitive tasks involved in clinical reasoning, such as interpretation, comparison, prediction, inference, and application of knowledge. What’s more, the items measuring knowledge application may be further subdivided into smaller competencies domains.This approach is intended to be better aligned with a competency-based curriculum. 

On February 16th, the Practicum Script team will take the opportunity to share ideas with an international multidisciplinary group of scientists, clinicians, and educators. Practicum Universities was aimed to validate the utility of Practicum Script as a clinical reasoning training tool in undergraduate teaching and assessment. At this ocasion, Dr Eduardo Pleguezuelos, academic secretary at the Practicum Foundation, will present the level of satisfaction perceived both by medical students and educators; and, regarding measurement properties, the value of Practicum Script to identify knowledge gaps and poor judgement and to provide inputs to improve curricular development. 

The ReThink conference will include studies about patient safety,  quality of healthcare and process improvement, among other topics. Dr Ellen Amster, who teaches for the Michael DeGroote School of Medicine, the Master of Public Health Programme, and the Bachelor of Health Sciences Programme at McMaster’s, will be the keynote speaker.

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