In the middle of the year, Practicum Script will launch a new version of the platform, with a greater focus on thinking skills and more qualitative feedback, as well as a leap in navigation speed and design. But if one thing stands out, it is the new functionality to make thinking visible through an audio message. Soon, any student will be able to make their reasoning process explicit, which will allow students to make their reasoning processes explicit and learn from their own reflections.

Madrid, 13 February 2023. Mental processes for decision-making are like a "black box", full of automatisms and phenomena that are unconscious to the person performing the action and difficult for educators to understand and evaluate from an observable result or behaviour. By thinking or expressing themselves aloud, students externalise the ideas or concepts they have in mind, their way of interpreting and analysing information and their reasons and considerations for deciding on a certain approach. In this way, by making their thinking visible, students develop their own judgement and gain awareness of their cognitive abilities and knowledge.

In the new version of the simulator, students will have the option of spontaneously expressing the reasoning processes that have led them to formulate their hypotheses of approach in each of the cases that make up the Practicum Script clinical reasoning training programme. Specifically, they will have two minutes to express themselves orally and will be able to erase and start again, although the timer will continue to run. The aim is for them to gauge their level of understanding and critical judgement in the analysis of the situation presented and what cognitive resources they have brought into play in the heuristic reasoning stage. 

This recording will also be available during the step of comparing their hypotheses and arguments with those of the experts, as well as in the final review of the case, focusing on inductive thinking, and within the portfolio, to foster metacognitive learning. For the CEO of Practicum Script, Dr Eduardo Hornos, "the assimilation of content increases when students think through and with the information and concepts they are studying.” Moreover, "by making clinical reasoning visible, we are providing more opportunities from which to build reflective and self-regulated learning, accompanied, as always, by expert feedback.”

The idea of making thinking visible, coined with Harvard's Project Zero in the late 1960s, is concerned with the analytical, logical, conscious and explicit system of cognition, which follows the rapid thinking phase that is activated by the presentation of the clinical vignette. Practicum Script invites the participant to stop and think about how they have thought under the premise that learning is meaningful when it is the result of deep thinking and understanding associated with previous concepts and experiences and leads to the cognitive integration and accommodation of what is newly learned.

With the intention of providing a more effective feedback the teaching team will be able to access these audios in order to draw conclusions about possible knowledge gaps, inattention to key elements of the patient, or other factors that may lead students to cognitive failures. Ultimately," explains Dr Hornos, "this new functionality provides valuable input on the strengths and weaknesses of a given cohort of students or even a particular student and encourages adaptive learning, as well as opening the door to making the most of the debriefing and error deconstruction sessions conducted by tutors through Practicum Mentoring.”

Hints for novices

Many of these failures are due to the fact that novices lack the prior experience to integrate information. Comparative studies between experts and novices have highlighted that experts rely on their background to recognise patterns and tacitly integrate disciplinary knowledge, clinical data and even patient preferences. In contrast, novices do not have the same conceptual networks. To remedy this situation, Practicum Script has incorporated two triads of symptoms, signs or conditions to put the first- or second-year clinical trainee on the track of diagnostic, treatment or further study options. In addition, their use will not be sanctioned.

These clues, which will be presented in the form of three key facts leading (together) to a certain hypothesis, are a way of introducing a new stimulus station for the learner to think for themselves and are particularly relevant in the contexts of uncertainty that characterise the Practicum Script simulation model. For example, if we are faced with an infant who refuses to feed, touches his ear and cries a lot, it would be logical to think of otitis. However, if after using these two triads, the student is still unable to think of a hypothesis, he/she will have to complete a short questionnaire on why he/she has not come up with hypotheses in order to provide the teaching team with valuable information to approach the casuistry.

Assessment of emotional aspects

The assessment of emotional aspects in the levels of attention, concentration and performance in the case presented will also gain weight. To this end, before answering each case, the student will have to answer three questions about their state of mind and the hours and quality of their sleep. The intention is to analyse in a simulated environment the impact that emotional phenomena and a marked lack of sleep have in real medical practice on the quality of decision making in front of the patient. Dr Hornos also points out that "this brings to the table the problem of burnout and its impact on medical error and the perception of signals; for example, it may be the case that certain signs are not appreciated due to sleep and/or a possible depressed state.”

In addition to the above innovations, the student will receive more personalised feedback, through messages in the portfolio that will indicate which clinical evidence to review, which clinical scenarios to review and which weaknesses are detected in their performance in different subject areas or types of clinical decisions. Likewise, considering the frequently observed asymmetry between the formulation of correct hypotheses and their weak defence with patient data, the new interface will give greater visibility to the results obtained in the argumentation of hypotheses, in each case and longitudinally accumulated.

In any case, the feedback that students will receive will be more personalised, with special attention to which clinical evidence they have not read, which clinical scenarios they should review, and which are the thematic areas in which they perform worst or the weakest types of decisions. Moreover, Practicum Script will give greater visibility to argumentation, which is added to the accumulated longitudinal results.

In terms of design, Practicum Script incorporates performance dashboards in the style of car speedometers and updates its signage and iconography within the platform to make it more recognisable and intuitive. Colours and graphics are updated, and visual components and prompts are added at the start of each case to alert the learner to the patient's care setting (emergency, inpatient or outpatient) and the time available to analyse the patient's situation and formulate hypotheses. Finally, users will notice a substantial change in their navigation thanks to the implementation of a new programming language that improves usability.