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

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. 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. Seventy participants successfully completed a case on Klark (mean 18.7), of which 63 (90% user retention) completed  ≥ 2 cases. Self-reported competence (<i>p</i> &lt; 0.001) and confidence (<i>p</i> &lt; 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%, <i>p</i> &lt; 0.001) and surgical (58% vs. 70%, <i>p</i> &lt; 0.001) histories. 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.

Klark是一款创新性在线医学教育工具（网址：www.klark-cases.com），供医学生与覆盖多专科的常见临床表现虚拟患者开展病史采集练习。本研究旨在探究Klark能否提升医学生在病史采集方面的自信心与临床胜任力，以及学生是否认可Klark的使用价值。本研究纳入单队列一年级临床医学生，使其可使用Klark平台三周。在试验的起始与结束阶段，参与者均需填写反馈问卷，并参与两场模拟客观结构化临床考试（Objective Structured Clinical Examination，OSCE）的病史采集考站。本研究的结局指标包括：自我报告的病史采集自信心与临床胜任力评分、OSCE考站表现得分，以及质性用户体验数据。共有70名参与者成功完成了Klark平台上的病例练习（人均完成18.7例），其中63人（用户留存率90%）完成了至少2例病例练习。自我报告的临床胜任力（p<0.001）与自信心（p<0.001）均得到显著提升。参与者普遍认为Klark具有实用性与影响力，并愿意向其他同学推荐该平台。内科（57% vs. 69%，p<0.001）与外科（58% vs. 70%，p<0.001）方向的病史采集OSCE得分均有所提升。研究结果表明，Klark可有效提升医学生在病史采集方面的自信心与临床胜任力，学生认可其使用价值并愿意持续使用该平台。通过在Klark的模拟环境中按自身节奏提升病史采集的自信心与临床胜任力，学生可在后续的线下临床实践中最大化获益。