Script-theory virtual case: A novel tool for education and research

Abstract

Context/Setting: The script theory of diagnostic reasoning proposes that clinicians evaluate cases in the context of an “illness script,” iteratively testing internal hypotheses against new information eventually reaching a diagnosis. We present a novel tool for teaching diagnostic reasoning to undergraduate medical students based on an adaptation of script theory.

Intervention: We developed a virtual patient case that used clinically authentic audio and video, interactive three-dimensional (3D) body images, and a simulated electronic medical record. Next, we used interactive slide bars to record respondents’ likelihood estimates of diagnostic possibilities at various stages of the case. Responses were dynamically compared to data from expert clinicians and peers. Comparative frequency distributions were presented to the learner and final diagnostic likelihood estimates were analyzed. Detailed student feedback was collected.

Observations: Over two academic years, 322 students participated. Student diagnostic likelihood estimates were similar year to year, but were consistently different from expert clinician estimates. Student feedback was overwhelmingly positive: students found the case was novel, innovative, clinically authentic, and a valuable learning experience.

Discussion: We demonstrate the successful implementation of a novel approach to teaching diagnostic reasoning. Future study may delineate reasoning processes associated with differences between novice and expert responses.

Glossary

Virtual patient: The representation of a patient in an interactive computer simulation of a real-life scenario.

Harden, R.M., and Laidlaw, J.M. (2012) Essential Skills for a Medical Teacher. Edinburgh: Churchill Livingstone.

Script theory: Script theory is a psychological theory which posits that human behaviour largely falls into patterns called “scripts” because they function analogously to the way a written script does, by providing a program for action.

Acknowledgements

Authors thank the University of Alberta Medicine Classes of 2015 and 2016 for partaking in the study, and also Drs. Maury Pinsk, Karen Forbes, Janet Ellsworth, Jennifer Walton, Samina Ali for their participation and expertise. They also thank Dr. Mara Tietzen for her research assistance.

They also extend thanks to the University of Alberta Faculty of Medicine and Dentistry for their Summer Studentship funding which helped make this project possible.

(Special thanks to Dr. Robert Hayward and Qwogo Inc. for their assistance in developing the online case and accruing data).

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Notes on contributors

Jake Hayward, BSc, MD, is a second year emergency medicine resident at the University of Alberta.

Amandy Cheung, BSc, MD, is a second year family medicine resident at the University of Alberta.

Alkarim Velji, BSc, BEd, MD, is a first year emergency medicine resident at the University of Manitoba.

Jenny Altarejos, is the Chief Technology Officer at Qwogo Inc.

Peter Gill, BMSc, MSc, DPhil, MD, is a paediatric resident at the University of Toronto.

Andrew Scarfe, MD, FRCP, is an Associate Professor of medical oncology at the University of Alberta.

Melanie Lewis, BN, MD, MMedED, FRCP, is the Associate Dean of Learner Advocacy and Wellness at the University of Alberta.