Virtual patients improve history-taking competence and confidence in medical students

Abstract

Purpose

Klark is a novel online medical education tool (www.klark-cases.com) where students take histories from virtual patients with common presentations from multiple specialities. We investigated whether Klark could enhance student confidence and competence in history-taking, and whether students find Klark helpful.

Methods

A single cohort of first-year clinical medical students had access to Klark for three weeks. At both ends of the trial, participants were asked to complete feedback forms and participate in two mock Objective Structured Clinical Examination (OSCE) history stations. Outcome measures included self-reported confidence and competence in history-taking, performance in OSCE stations, and qualitative user experience data.

Results

Seventy participants successfully completed a case on Klark (mean 18.7), of which 63 (90% user retention) completed  ≥ 2 cases. Self-reported competence (p < 0.001) and confidence (p < 0.001) improved. Participants found Klark to be helpful, impactful, and would recommend it to other students. OSCE scores improved for medical (57% vs. 69%, p < 0.001) and surgical (58% vs. 70%, p < 0.001) histories.

Conclusions

Klark improved competence and confidence in history-taking. Students found it helpful and chose to continue using the platform. By developing confidence and competence at their own pace in the Klark simulated environment, students can then maximise benefit from in-person clinical opportunities.

Keywords:

• Teaching and Learning
• simulation
• learning outcomes
• communication skills
• instructional design
• phase of education
• undergraduate
• learning outcomes
• decision making

Acknowledgements

The authors thank the student volunteers who facilitated the mock OSCEs. ADH and NR thank the following senior clinicians for their feedback, and guidance in creating cases for Klark: Dr Tim Littlewood, Dr Richard Harrington, Dr Michala Pedersen, Dr Sanja Thompson, Dr Gina Hadley, Mr James Gilbert and Mr Giles Bond-Smith. Full credits on the Klark website.

Author contributions

Contributions are detailed below through the CRediT taxonomy (Brand et al. 2015):

NR: Conceptualisation, Methodology, Software, Data Curation, Formal analysis (Qualitative), Writing (Review & Editing), Funding acquisition.

ADH: Conceptualisation, Methodology, Formal analysis (Qualitative and Quantitative), Investigation, Writing (Original Draft), Writing (Review & Editing), Funding acquisition

KR: Methodology, Investigation, Writing (Review & Editing)

MJW: Methodology, Investigation, Writing (Review & Editing)

CS: Writing (Review & Editing), Resources, Project administration

KEAS: Conceptualisation, Methodology, Writing (Review & Editing), Supervision

Disclosure statement

This project represents independent, non-commissioned research. The views expressed in this article do not necessarily represent those of the NHS or the University of Oxford. ADH and NR are co-founders of Klark. KR, MJW, and CS declare no conflict of interest. KEAS is supported by the NIHR Oxford Health Biomedical Research Centre.

Additional information

Funding

NR and ADH were recipients of the Association for the Study of Medical Education (ASME) Education Innovation Award 2020. The prize was used to further develop the Klark platform prior to this study.

Notes on contributors

Nader Raafat

Nader Raafat, University of Oxford Medical School, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.

Alexander D. Harbourne

Alexander D. Harbourne, University of Oxford Medical School, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.

Kajal Radia

Kajal Radia, University of Oxford Medical School, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.

Myles J. Woodman

Myles J. Woodman, University of Oxford Medical School, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.

Catherine Swales

Catherine Swales, Director of Clinical Studies: University of Oxford Medical School, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.

Kate E. A. Saunders

Kate E. A. Saunders, Associate Professor: University of Oxford Medical School, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.

Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.