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

<b>Context/Setting:</b> 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. <b>Intervention:</b> 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. <b>Observations:</b> 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. <b>Discussion:</b> 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.

<b>研究背景：</b> 诊断推理脚本理论（script theory of diagnostic reasoning）提出，临床医师会基于「疾病脚本」的框架对病例进行评估，通过结合新信息反复验证内部假设，最终得出诊断结论。本研究基于该理论的改良版本，开发了一款面向医学本科生的诊断推理教学工具。<b>干预方案：</b> 我们开发了一款虚拟病例，该病例采用符合临床真实场景的音视频素材、交互式三维（3D）人体图像以及模拟电子病历（electronic medical record）系统。随后，我们通过交互式滑块来记录受试者在病例不同阶段对各诊断可能性的概率评估值。系统会将受试者的评估结果与临床专家及同龄学习者的评估数据进行动态比对，并向学习者展示比对后的频数分布情况，同时对最终的诊断概率评估结果进行分析。此外，本研究还收集了受试者的详细反馈信息。<b>研究结果：</b> 在两个学年的教学周期内，共有322名学生参与了本研究。不同学年中学生的诊断概率评估结果较为一致，但始终与临床专家的评估结果存在显著差异。学生的反馈整体呈积极倾向：他们均认为该虚拟病例新颖独特、兼具创新性与临床真实性，是一次极具价值的学习体验。<b>讨论：</b> 本研究证实了这款基于创新方法开发的诊断推理教学工具的成功应用。后续研究可进一步厘清新手与专家在诊断推理过程中的差异机制。