Optimal learning in a virtual patient simulation of cranial nerve palsies: The interaction between social learning context and student aptitude

Abstract

Background Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. Aim To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. Methods Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the Neurological Exam Rehearsal Virtual Environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. Results An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). Conclusion The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students.

It's all in the mime: Actions speak louder than words when teaching the cranial nerves

“…Traditionally, CNs have been taught using two‐dimensional (2D) images in a didactic lecture, in combination with plastic models or cadaver material in a hands‐on laboratory class. As CN content is difficult, academics have used a range of strategies to engage students, including 3D virtual simulations (Yeung et al, ; Nowinski et al, , Johnson et al, ), gaming avatars (Richardson‐Hatcher et al, ), videos (Azer et al, ), models (Zhang and He, ), games (Jones et al, ), songs (Bromfield, ; Williams, ), and drawings (Bolek, ). However, evidence of these strategies' effectiveness in improving CN knowledge is limited.…”

Virtual patient simulations and optimal social learning context: A replication of an aptitude–treatment interaction effect

“…Moreover, a significant ATI effect identified that students in the team treatment attained a mean post-test score approximately 24% higher than students in the individual treatment at specific aptitudes. Johnson et al (2013) observed this same ATI effect with 57 second-year medical students; at pre-test scores ≤50%, students in the team treatment scored significantly higher (21%) on the knowledge post-test as compared to students in the individual treatment.…”

“…This control allows users to explore a variety of patient scenarios and to observe a wide range of abnormal physical findings in a self-directed manner. While our findings from this study and results from Johnson et al (2013) suggest that NERVE exercises may best be implemented in small collaborative team contexts, we recognize that the strain on medical education resources may challenge educators to successfully plan for such activities. Limited small-group learning spaces in institutional facilities and restrictions on contact hours allowed in the curriculum may necessitate a selection of self-directed, individualized learning opportunities.…”

“…Accordingly, understanding best practices associated with the use of novel simulation technologies is essential. Student outcomes following interactions with NERVE VPs were previously compared between individual and small-group learning contexts (Johnson et al 2013), as collaborative learning processes are suggested to promote critical thinking and enhance engagement in training (Gokhale 1995; Kraiger 2008). Examining pre- and post-test CN-specific knowledge scores among 57 second-year medical students by social learning context, researchers observed an aptitude–treatment interaction (ATI) effect related to learning.…”

Advancing Virtual Patient Simulations and Experiential Learning with InterPLAY: Examining How Theory Informs Design and Design Informs Theory.

“…Kleinsmith et al (2015), Rivera-Gutierrez et al (2014), Lyons, Johnson, Khalil, and Cendan (2014), and Johnson et al (2014Johnson et al ( , 2013 report findings from controlled experiments completed during the first four years of R&D that compared various aspects of VP simulations to inform the design of the system and advanced VP simulation research, such as individual versus small group use of the system, use of the system under competitive versus non-competitive conditions, the use of reflective questions embedded during versus after the simulation, instructor-led content delivery versus independent self-study of the content prior to use, and the use of an open-chat versus closed menu user interface.…”