Virtual Patient Simulation in Junior-Level Japanese Resident Physicians: Attitudinal Questionnaire and Clinical Reasoning Enhancement

• Published in: Igaku Kyoiku / Medical Education (Japan) Vol. 45; no. 6; pp. 401 - 413
• Main Authors: Deshpande, Gautam, Heist, Brian Sanjay
• Format: Journal Article
• Language: English; Japanese
• Published: Japan Society for Medical Education 25.12.2014
• Subjects: Clinical Reasoning; Junior Residency Education; Virtual Patient Simulation
• ISSN: 0386-9644; 2185-0453
• DOI: 10.11307/mededjapan.45.6_401

Background: Virtual Patient Simulation （VPS） is commonplace in Western medical education and, globally, increasingly popular as a means to teaching clinical reasoning. VPS is not popular in Japan. This pilot study evaluates the receptiveness of Japanese junior resident physicians to VPS and the effectiveness of VPS on their clinical reasoning. Methods: Each first-year junior resident physician at 4 residency programs （n＝54） was assigned a randomized sequence to complete 5 VPS modules. In accordance, online access was provided to each subsequent module at 6 day intervals. We evaluated participants’ change in performance on pre-post administration of a validated instrument of diagnostic reasoning. We developed a scoring rubric and evaluated change in efficiency of selecting items in the history and physical examination portions of the modules. Upon completing the module series, participants received a validated questionnaire on the effectiveness of VPS. Results: Pre-posttest improvement in diagnostic reasoning scores was not statistically significant （p＝0.07）. Improvement in efficiency from 1st to 5th modules was significant for history taking （p＜0.01）, but not physical examination （p＝0.697）. Mean perceived effectiveness of VPS was superior to traditional methods （mean 3.58-3.71 on 1-5 Likert scale） for understanding methods of diagnosis, medical management, generation of differential diagnosis, and knowledge about clinical cases. Conclusions: First-year resident physicians demonstrated enthusiasm for VPS. Improvement on the validated measure of diagnostic reasoning was not confirmed and thus, it is premature to draw conclusions on the effectiveness of VPS amongst Japanese junior resident physicians. Larger scale follow-up investigation is warranted.