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Fostering critical thinking in undergraduate nursing students

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ABSTRACT

Results from previous studies indicated nursing students needed to further develop critical thinking (CT) especially with respect to employing it in their clinical reasoning. Thus, the study was conducted to

ABSTRACT

Results from previous studies indicated nursing students needed to further develop critical thinking (CT) especially with respect to employing it in their clinical reasoning. Thus, the study was conducted to support development of students’ CT in the areas of inference subskills that could be applied as they engaged in clinical reasoning during course simulations. Relevant studies from areas such as CT, clinical reasoning, nursing process, and inference subskills informed the study. Additionally, the power of simulation as an instructional technique along with reflection on those simulations contributed to the formulation of the study. Participants included junior nursing students in their second semester of nursing school. They completed a pre- and post-intervention Critical Thinking Survey, reflective journals during the course of the intervention, and interviews as the conclusion of the study. The intervention provided students with instruction on the use of three inference subskills (Facione, 2015). Moreover, they wrote reflective journal entries about their use of these skills. Quantitative results indicated no changes in various CT measures. By comparison, qualitative data analysis of individual interviews and reflective journals showed students: applied inference subskills in a limited way; demonstrated restricted clinical reasoning; displayed emerging reflection skills; and established a foundation on which to build additional CT in their professional roles. Limitations of the study included time—length of the intervention and limited power of the instruction—depth of the instruction with respect to teaching the inference subskills. Discussion focused on explaining the results. Implications for teaching included revision of the instruction in inference subskills to be more robust by extending it over time, perhaps across courses. Additionally, use of a ‘flipped’ instructional process was discussed in which students would learn the subskills by viewing video modules prior to class and then are ‘guided’ to apply their learning in classroom health care simulations. Implications for research included closer examination of the development of CT in clinical reasoning to devise a developmental trajectory that might be useful to understand this phenomenon and to develop teaching strategies to assist students in learning to use these skills as part of the clinical reasoning process.

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Date Created
  • 2017

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Virtual patient simulations for medical education: increasing clinical reasoning skills through deliberate practice

Description

Virtual Patient Simulations (VPS) are web-based exercises involving simulated patients in virtual environments. This study investigates the utility of VPS for increasing medical student clinical reasoning skills, collaboration, and engagement.

Virtual Patient Simulations (VPS) are web-based exercises involving simulated patients in virtual environments. This study investigates the utility of VPS for increasing medical student clinical reasoning skills, collaboration, and engagement. Many studies indicate that VPS provide medical students with essential practice in clinical decision making before they encounter real life patients. The utility of a recursive, inductive VPS for increasing clinical decision-making skills, collaboration, or engagement is unknown. Following a design-based methodology, VPS were implemented in two phases with two different cohorts of first year medical students: spring and fall of 2013. Participants were 108 medical students and six of their clinical faculty tutors. Students collaborated in teams of three to complete a series of virtual patient cases, submitting a ballpark diagnosis at the conclusion of each session. Student participants subsequently completed an electronic, 28-item Exit Survey. Finally, students participated in a randomized controlled trial comparing traditional (tutor-led) and VPS case instruction methods. This sequence of activities rendered quantitative and qualitative data that were triangulated during data analysis to increase the validity of findings. After practicing through four VPS cases, student triad teams selected accurate ballpark diagnosis 92 percent of the time. Pre-post test results revealed that PPT was significantly more effective than VPS after 20 minutes of instruction. PPT instruction resulted in significantly higher learning gains, but both modalities supported significant learning gains in clinical reasoning. Students collaborated well and held rich clinical discussions; the central phenomenon that emerged was "synthesizing evidence inductively to make clinical decisions." Using an inductive process, student teams collaborated to analyze patient data, and in nearly all instances successfully solved the case, while remaining cognitively engaged. This is the first design-based study regarding virtual patient simulation, reporting iterative phases of implementation and design improvement, culminating in local theories (petite generalizations) about VPS design. A thick, rich description of environment, process, and findings may benefit other researchers and institutions in designing and implementing effective VPS.

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Created

Date Created
  • 2014