A Randomized, Crossover Pilot Study of a Novel Web-Based/Mobile Platform for Collaborative Small Group Practice in Therapeutic Reasoning

Abstract

Background and Purpose: Therapeutic reasoning—the mental process of making judgments and decisions about treatment—is developed through acquisition of knowledge and application in actual or simulated experiences. Health professions education frequently uses collaborative small group work to practice therapeutic reasoning. This pilot study compared the impact of a web-based/mobile tool for collaborative case work and discussion to usual practice on student perceptions and performance on questions designed to test therapeutic knowledge and reasoning. Methods: In a therapeutics course that includes case-based workshops, student teams of 3 to 4 were randomly assigned to usual workshop preparation (group SOAP sheet) or preparation using the Practice Improvement using Virtual Online Training (PIVOT) platform. PIVOT was also used in the workshop to review the case and student responses. The next week, groups crossed over to the other condition. Students rated favorability with the preparatory and in-workshop experiences and provided comments about the PIVOT platform via a survey. Student performance on examination items related to the 2 workshop topics was compared. Results: One hundred and eleven students (94%) completed post-workshop surveys after both workshops. The majority of students (57%) preferred using the PIVOT platform for workshop collaboration. Favorability ratings for the in-workshop experience did not change significantly from first to second study week, regardless of sequence of exposure. There was no relationship between examination item scores and the workshop platform the students were exposed to for that content ( P = .29). Student responses highlighted the efficiency of working independently before collaborating as a group and the ability to see other students’ thought processes as valuable aspects of PIVOT. Students expressed frustration with the PIVOT user interface and the lack of anonymity when discussing their answers in the workshop. Conclusion: A web-based/mobile platform for student team collaboration on therapeutic reasoning cases discussed in small group settings yielded favorable ratings, examination performance comparable to standard approaches, and was preferred by a majority of students. During the rapid shift to substantial online learning for the COVID-19 pandemic, virtual collaboration tools like PIVOT may help health professions teachers to better support groups working virtually on scaffolded therapeutic reasoning tasks.

Learning technology in health professions education: Realising an (un)imagined future

“…Technologies used included social media, 51 virtual reality, 85 game-based learning [86][87][88][89] and mobile or web-based activities. 46,48,63,90,91 These augmentation-related articles tended to focus more on including additional learning activities, formative feedback or self-assessment for learning. 56,88,[92][93][94] Thirty-five articles modified teaching methods with technology, often using technology to support changes to curriculum or teaching methods.…”

In-Person or Online? The Effect of Delivery Mode on Team-Based Learning of Clinical Reasoning in a Family Medicine Clerkship

“…While online learning appears to support collaboration and communication, it can be challenging, posing difficulties in rapport building and limiting the depth of discussion [ 20 ]. Furthermore, existing literature remains sparse and inconclusive about the effect of delivery mode (in-person vs. online) on student learning in small-group methods of instruction, including in TBL [ 21 , 22 , 23 , 24 , 25 ].…”

“…Palsolé and Awalt reported no significant differences in grades following online TBL in undergraduate science students compared to in-person TBL; however, students reported greater satisfaction with teamwork in online TBL compared to in-person [ 22 ]. Gruenberg and colleagues also reported no significant differences in pharmacy students’ therapeutic reasoning exam performance between in-person and online small-group learning; however, the majority of students were in favor of the online format [ 24 ]. Holmes observed no significant differences in IRAT scores between in-person and online TBL in a cohort of 75 graduate physician assistant students; however, significant differences were present in GRAT scores, with a higher mean score in the in-person TBL format [ 25 ].…”

“…Silva and colleagues observed no significant differences in undergraduate students’ preferences regarding the TBL sessions being in-person vs. online [ 3 ]. Interestingly, prior to the pandemic, learners tended to favor the in-person over the online format [ 21 , 23 ], whereas studies published shortly after the start of the pandemic report learners favoring the online format equally or even more so than the in-person format [ 3 , 24 ].…”

Design, Implementation, and Evaluation of a Distance Learning Framework to Adapt to the Changing Landscape of Anatomy Instruction in Medical Education During COVID-19 Pandemic: A Proof-of-Concept Study

“…In response to the pandemic, medical education faculty around the globe have rapidly and successfully transitioned the entire pre-clerkship curriculum to distance-learning (DL) formats that comprise content in the basic sciences, health systems sciences, and even in behavioral sciences (13)(14)(15). Small-group designs assemble online in virtual team settings (16), and clinical skills sessions may occur online employing the precepts of telemedicine (17) or, in some cases, may be deferred (18). Examinations have also migrated to online settings through the use of specific online proctoring modules (19).…”