title: Use of a computer-based simulated consultation tool to assess whether doctors explore sociocultural factors during patient evaluation.
abstract: OBJECTIVE
  The delivery of patient-centred care to diverse populations requires that doctors identify sociocultural factors that may affect care. We adapted a computer-based simulated consultation tool and tested its utility for assessing whether doctors explore sociocultural factors during a patient evaluation, and whether they include such information in their case conclusions and follow-up recommendations.
  
  
  METHODS
  We developed two detailed patient 'stories' that involved sociocultural issues that doctors needed to identify and consider for adequate clinical management. They were incorporated into an existing 'Virtual Internet Patient Simulation' (VIPS) program designed to test clinical reasoning skills. Doctors and medical students (n = 618) were invited to access the program via Internet. For each consultation, participants were assigned a sociocultural score, corresponding to the number of sociocultural domains explored. Scores were then compared with subjective ratings of participants' performance by expert doctors.
  
  
  RESULTS
  118 respondents completed at least one virtual consultation (19%), 92 conducted both. The mean number of sociocultural dimensions explored by doctors (i.e. sociocultural score) was 3.9 (standard deviation 2.6) for case 1, and 5.2 (standard deviation 2.3) for case 2. The two sociocultural scores were moderately correlated (Spearman r = 0.65, P < 0.001). Sociocultural scores correlated positively with experts' subjective ratings of participants' performance (Spearman r = 0.84 for case 1 and 0.78 for case 2, both P < 0.001).
  
  
  CONCLUSIONS
  The adapted computer-based simulated consultation tool provided a feasible means to assess doctors' exploration of sociocultural issues during a clinical evaluation. Further validation of this method should be conducted by comparing VIPS results with other skills assessment methods such as objective structured clinical examination or direct observation of clinical performance.
authors.affiliation: Academic Primary Care Physicians, Geneva University Hospitals, Genève, Switzerland. noelle.junod@hcuge.ch
authors.forename: Noëlle Junod
authors.initials: NJ
authors.lastname: Perron
authors.forename: Thomas
authors.initials: T
authors.lastname: Perneger
authors.forename: Véronique
authors.initials: V
authors.lastname: Kolly
authors.forename: Melissa Dominicé
authors.initials: MD
authors.lastname: Dao
authors.forename: Johanna
authors.initials: J
authors.lastname: Sommer
authors.forename: Patricia
authors.initials: P
authors.lastname: Hudelson
mesh_terms: D000704:Analysis of Variance; D002983:Clinical Competence / Q000592:standards*; D003194:Computer-Assisted Instruction / Q000379:methods*; D003466:Cultural Characteristics; D006801:Humans; D016015:Logistic Models; D016544:Patient Simulation; D018802:Patient-Centered Care; D010820:Physicians / Q000592:standards*; D012017:Referral and Consultation; D012959:Socioeconomic Factors; D014584:User-Computer Interface