This week I’ve been supporting two types of projects. The first is a thick narrative simulation that uses video, branching, and rich description to immerse learners in a clinical story about a patient whose cancer is progressing. The second is a new project for CME credit that will create short, thin narrative simulations focusing on one learning objective each.

What is the difference between thick and thin narrative simulations? According to Bizzocchi and Schell (2009) a thick narrative uses rich media to portray the “complex reality of patient presentation and interaction,” and provides a more holistic portrayal of the patient. Thin narrative simulations are short cases that allow learners to quickly focus on “the mastery of critical clinical information” and build a repertoire of illness scripts. Since thin narratives focus primarily on symptoms, diagnosis and treatment, they can depersonalize the patient.

Bizzocchi and Schell recommend creating a blend of both thick and thin narrative simulations in educational programs. For novice learners, the curriculum should primarily use thick cases to reinforce a holistic perspective of the problem—along with a sprinkling of thin cases. As expertise develops, the emphasis should slowly switch to more thin cases with a few thick cases here and there. This will help learners build up that memory bank of patterns that experts use to diagnose problems.

How does this relate to DecisionSim? First, think about your learners and their level of expertise. If they are novice learners, you may want to create a rich, immersive simulation with a thick narrative. If your learners are more experienced, then you may want to create a series of short, thin narrative simulations to cover specific clinical reasoning skills. So, in addition to thinking about each simulation, consider your library of simulations and what percentage should be thin and thick narratives. Secondly, consider the type of skill you are teaching. For example, in the first project I mentioned above, the goal is to help primary care physicians develop their communication skills to hold difficult conversations with patients who are receiving bad news about their illness. For this type of skill, it’s critical to create a thick narrative with video to portray issues of communication and to provide more insight into the patient’s feelings, goals and challenges.

To learn more, read: Rich-narrative case study for online PBL in medical education