Impact of the Virtual Patient Introduction on the Clinical Reasoning Process in Dental Education

Abstract

Background In the Virtual patient system Web-SP, the case authoring is entirely delegated to faculty. An analysis of the virtual patients (VPs) authored by faculty showed that the most common practice chosen by the case authors was to provide an introductory clinical vignette including rich anamnestic data. To evaluate the influence of the vignette, a controlled trial was conducted to determine if the absence of vignette would influence the students� therapeutic decisions and their clinical reasoning. Methods This double blind controlled trial randomized 57 fourth year dentistry students into two groups. Two virtual patient cases were created with the same content in both groups, but the VPs encountered by the intervention group lacked the introductory vignette. The therapy decisions and the history taking activity were scored and analysed by the course director. A stratified analysis was undertaken, stratifying by day. Results There were no statistically significant differences between the two groups with respect to their therapeutic decision scores (p=.16). Participants in both groups were equivalent with respect to the number of relevant medical history questions asked (p=.33) and the number of irrelevant questions asked (p=.20) Conclusions This study indicates that vignettes did not have an impact on students' clinical reasoning process. The use of detailed vignettes or case introductions might not be needed. A possible reason includes students� prior exposure for a full semester to other VPs for course work and clinical reasoning. Perhaps the intervention was too subtle to impact on learners at this stage of development. Clinical vignettes might have more impact at earlier stages of student learning such as early in the semester but not as preparation for final exam. The limited number of participants may have concealed differences between the groups. We also need to investigate if the one-hour limit given the students might influence the therapeutic decisions.