Have you wondered how to create a dynamic simulation that evolves as your learners progress through the case? Or have you wondered how to create time pressure for your learners?

Just this week, I met with a DecisionSim author who is doing just that. His goal is to analyze the clinical diagnosis process utilized by both novice and expert clinicians. The simulation begins in the Emergency Department with a patient who needs immediate care. Learners have a variety of information that they can explore—maybe even too much!  Using counters to keep track of time, the patient’s vitals can deteriorate quickly if learners spend too much time reviewing information. This is achieved by rules that send learners to different screens based upon the values on counters. So, if the time counter is high, learners will notice that the vitals have deteriorated when they revisit the vitals screen. In this approach, learners can access the same type of information (such as the patient’s vitals) multiple times because the information changes based upon the learner’s actions.

The goal for the simulation is to compare and contrast differences in how novices and experts diagnose patients. This reminds me of the literature which states that experts use illness scripts and pattern recognition while diagnosing patients. Whereas, novices use reasoning via conceptual science since they have not yet built up a repertoire of diagnostic cases. With DecisionSim’s data reporting capabilities, this simulation has the potential to add insightful findings to the literature on clinical decision-making.

While this simulation is being created predominantly for assessment, this approach can be used for training as well. For example, while interviewing the patient, you could instruct learners to identify the most important questions. If learners ask too many questions, you can interrupt the learner and automatically direct them to a new screen that shows the patient deteriorating. We have recently published a branching tool that showcases this approach (Interrupter Branching Tool).

To read more about clinical reasoning, go to: Research in Clinical Reasoning