| Emergency medicine has been customarily learned by practicing on live patients, but in order to protect patients, safer methods have to be found of acquiring clinical skills and knowledge. There have been few studies to support the claim that computer-based simulation technologies can promote clinical reasoning. The goal of this qualitative study was to evaluate whether Virtual Patients (VPs) promoted clinical reasoning in emergency medicine tutorials. Qualitative data consisted of field notes from direct observations of tutorials and transcriptions of the videotaped tutorials and semistructured interviews. Field notes and interviews were subjected to interpretive analysis. Transcriptions of tutorials were subjected to interaction analyses for evidence of learning-oriented interactions. The results of this study were evaluated according to context of use, group interactions, and outcomes of using VPs. Study participants comprised the program head and 12 medical doctors enrolled in an emergency medicine graduate program at a Caribbean university. In this study, learning-oriented interactions accounted for over 90% of the verbal interactions, with cumulative reasoning, handling conflicts about knowledge, and exploratory questioning accounting for about 63%, 16%, and 11% of the interactions, respectively. The study results indicated that participants felt positive about VPs. VPs were cost-effective, authentic, and relevant. Participants felt that VPs should be used for both independent study and collaborative learning. The study results further indicated that VPs reduced cognitive load, focused attention, encouraged interaction, motivated participants, stimulated reflection, and supported analytical reasoning. The tutor played a significant role in promoting reflection-on-action and resolving cognitive conflict. Recommendations for practical applications included the following: (a) integrate VPs into graduate medical curricula; (b) design branching VPs so that users do not have to retrace their path; (c) train staff and students to design VPs; and (d) train tutors to provide affective and pedagogic support. Effective tutors coach, scaffold, model reflection-on-action, provide feedback and prevent premature closure and faulty synthesis of information. Further research should focus on different populations, disciplines, VP designs, and integration strategies. Other outcomes besides clinical reasoning should be investigated. |
