How to tell a patient’s story? Influence of the case narrative design on the clinical reasoning process in virtual patients

Figures & data

Table 1. Overview of the six virtual patients created for the study.

Order	VP	Final diagnosis	Disruptive version (Schmidt 2016)	Level of difficulty
1	Michael Bauer	Acute glomerulonephritis	a patient who has low expectations of his doctor’s support	0.87 (easy)
2	Nina Sanders	Graves' disease	a patient who presents herself as helpless	0.56 (difficult)
3	Frank Reiter	Sick sinus syndrome	an aggressive patient	0.69 (easy)
4	Miray Günal	Community acquired pneumonia	a ‘frequent demander’	0.84 (easy)
5	Tim Wagemann	Colon carcinoma	a patient who questions the doctor’s competence	0.82 (easy)
6	Benedikt Vogt	Renal stenosis	a patient who ignores his doctor’s advice	0.56 (difficult)

The level of difficulty is calculated as mean of correct final diagnosis on first try over all three groups.

Figure 1. Screenshot of the virtual patient Miray Günal with the concept mapping tool on the right side.

Figure 2. Overview of the study design.

Table 2. Participant characteristics and exemplary answers to questionnaire 2 for the three groups.

Variable	FRIENDLY (n = 15)	DISRUPTIVE (n = 15)	NOSTORY (n = 16)
Mean age	26.20 years	27.13 years	26.06 years
Sex	Male: 20% (n = 3)	Male: 33.3% (n = 5)	Male: 31.2% (n = 5)
	Female: 80% (n = 12)	Female: 66.6% (n = 10)	Female: 68.8% (n = 11)
Mean state examination grade	M = 1.80	M = 2.03	M = 2.13
	SD = 0.68	SD = 0.90	SD = 0.72
How satisfied are you with your performance?	M = 2.33*	M = 2.73	M = 2.81*
	SD = 0.62	SD = 0.70	SD = 0.66
Level of VP difficulty was appropriate	M = 4.53	M = 4.67	M = 4.69
	SD = 0.52	SD = 0.62	SD = 0.48
I found the clinical reasoning tool unnecessarily complex.	M = 2.67*	M = 1.80*	M = 2.25
	SD = 1.11	SD = 0.94	SD = 1.29
Learning with the VPs was a worthwhile learning experience	M = 4.13	M = 4.53	M = 4.38
	SD = 1.06	SD = 0.64	SD = 0.72
Extrinsic motivation	M = 3.40*	M = 2.93	M = 2.56*
	SD = 1.12	SD = 1.33	SD = 0.89

*significant (p < 0.05).

Figure 3. Mean number of tries to submit the correct final diagnosis for the two levels of difficulty and the three groups. * significant difference to group FRIENDLY (p < .05).

Table 3. Mean number of the different nodes and connections for the three groups and VP difficulty.

Difficulty	Node category	FRIENDLY	DISRUPTVE	NOSTORY	Expert
Easy	Problems	5.25	6.37^F	5.97	7.12
	Differential diagnoses	4.27	6.43^F	5.03^D	8.67
	Tests	3.72	5.53^F	4.69^F	6.56
	Treatment options	1.57	2.02^F	1.34^D	1.67
	Connections	3.13	2.93	2.98	5.77
Difficult	Problems	4.20	5.70^F	5.84^F	5.84
	Differential diagnoses	5.37	6.40	5.69	10.00
	Tests	4.27	6.10^F	5.16	6.50
	Treatment options	1.93	1.67	1.38	1.84
	Connections	3.82	2.03	2.31	9.28

^Fsignificantly different to group FRIENDLY, ^Dsignificantly different to group DISRUPTIVE (p < 0.05).