Documentation of students' clinical reasoning using a computer simulation
W. Schwartz
University of Pennsylvania School of Medicine, Philadelphia.
Computer simulations can provide both a clinical experience for teaching
problem solving and a method of documenting a student's clinical reasoning
style. The CAMPS simulation consists of approximately 500 items describing
a patient's history, physical examination and laboratory results, and
treatments. The student has full option to select any item in any order,
producing a wide variation of performances. Since all of the students
interact with the same clinical problems, the faculty member can make
comparisons of that individual student with the class. From the record of
the simulation encounter, the person responsible for student evaluations
can prepare a narrative that lists the overall performance, the specific
omissions and commissions, and comparisons with the class. Experience with
a group of 111 students in a basic pediatric course showed that this method
of documenting clinical inquiry detected a variety of levels of
performances. Comparisons of the results of these tests with the faculty
observations showed that 16% of these students who were judged to be very
good or excellent in problem solving by the faculty performed at least 1 SD
below the class average on the simulations. This project highlights the
power of computer simulations to provide documentation of student
performance with the additional benefit of a cost of less than $1 per
student.
