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


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
a Department of Emergency Medicine , University of Alberta , Edmonton , Alberta , Canada.
Jake
J
Hayward
b Department of Family Medicine , University of Alberta , Edmonton , Alberta , Canada.
Amandy
A
Cheung
c Department of Emergency Medicine , University of Manitoba , Winnipeg , Manitoba , Canada.
Alkarim
A
Velji
d Faculty of Medicine and Dentistry , University of Alberta , Edmonton , Alberta , Canada.
Jenny
J
Altarejos
e Department of Pediatrics , The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada.
Peter
P
Gill
f Department of Oncology , University of Alberta , Edmonton , Alberta , Canada.
Andrew
A
Scarfe
g Department of Pediatrics , Stollery Children's Hospital, University of Alberta , Edmonton , Alberta , Canada.
Melanie
M
Lewis
D002983:Clinical Competence; D000066491:Clinical Decision-Making; D003198:Computer Simulation; D003194:Computer-Assisted Instruction / Q000379:methods*; D003951:Diagnostic Errors / Q000517:prevention & control; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D016013:Likelihood Functions; D018794:Problem-Based Learning / Q000379:methods; D014584:User-Computer Interface