A Pilot Study On Strengthening Patient-centered Clinical Reasoning Ability Of General Practice Residents

Objective: To establish a virtual patient model suitable for the training of patient-centered clinical reasoning ability of general practice residents and evaluate its application effect,so as to provide new ideas for strengthening the training of patient-centered clinical reasoning and communication ability of general practice residents.Methods: 86 general practice residents from the First Hospital of China Medical University were selected as the subjects.Among them,there are 42 residents of 2017,24 residents of 2018 and 20 residents of 2019.First of all,we used literature research to systematically understand the current situation of standardized training of general practice residents at home and abroad and the assessment methods of clinical reasoning ability of general practice residents.Secondly,according to the contents and standards of standardized training for general practice residents in China,the Calgary-Cambridge Guideline is used for reference and Canadian general practice residents clinical ability evaluation standard.Under the guidance of general practice and related experts,based on Shanghai hengzan virtual patient in formation data platform,a general practice virtual patient model(4 assessment cases and 4 training cases)was established to strengthen resident’s patient-centered clinical reasoning ability.Next,according to the principle of randomized controlled trials,the subjects were divided into intervention group and control group according to the stratified randomized method.Then,from January 6,2020,the virtual patient model of general practice established in this study was applied in the interven tion group to strengthen the training of patient-centered clinical reasoning ability.Based on the Shanghai hengzan virtual patient information data platform,one training case was distributed every week for four weeks.Finally,the effect of training was evaluated by the Leicester assessment package,and the differences between the intervention group and the control group in the total score of clinical reasoning ability and the scores of each dimension were compared.Results: 1.There was no significant difference between the intervention group and the control group in terms of gender,age group,education background and training stage(P > 0.05).2.There was no significant difference in basic theoretical knowledge of general practice between the intervention group and the control group(P>0.05).3.The evaluation results of the Leicester assessment package scale showed that before the intervention,there was no significant difference in the total score and 7 dimensions(inquiry/medical history collection,physical examination,patient management,problem-solving,behavior/patient relationship,prevention and health care,record keeping)of clinical reasoning ability between the interventi on group and the control group(P > 0.05).4.After 4 weeks of intensive training of patient-centered clinical reasoning ability,the intervention group and the control group were examined again by the examination cases with the same type and difficulty of virtual cases.The evaluation results of the Leicester assessment packa ge showed that: the total score of clinical reasoning ability evaluation,six dimensions of consultation/medical history collection,patient management,problem-solving,behavior/patient relationship,prevention and health care,and record keeping in the intervention group were higher than those in the control group,and the differences were statistically significant(P<0.05);the intervention group’s 2017 grade resident was the best The total score of prognosis clinical reasoning ability evaluation,six dimensions of consultation / history collection,patient management,problem-solving,behavior/patient relationship,prevention and health care,and record keeping in the intervention group were higher than those in the control group,and the differences were statistically significant(P<0.05);the three dimensions of patient management,behavior/patient relationship and record keeping in the intervention group were higher than those in the control group,the difference between the two groups was statistically significant(P<0.05),and there was no significant difference between the other dimensions and the total score(P<0.05);the difference between the intervention group and the control group was statistically significant(P<0.05),and there was no significant difference between the other dimensions and the total score(P>0.05).Conclusion: Relying on the virtual patient information data platform,strengthening the training of patietn-centered clinical reasoning ability of general practice residents by using the virtual patient of general practice is helpful to improve the reception ability of general practice residents.It is suggested that in the third year of resident training,"virtual patient" should be used to strengthen the training of resident’s patient-centered clinical reasoning ability,and formative assessment should be carried out to help residents have the ability to practice independ ently at the grass-roots level when they graduate.