Measuring Problem Representation Among Preclinical Medical Students Following Mannequin Simulations

This thesis project was a study gathering validity evidence of an instrument’s scores used to detect clinical reasoning in preclinical medical students in the simulation laboratory. Student participants were assigned to one of three conditions, Group 1 received problem representation training and a structured questionnaire, Group 2 received no problem representation training and a structured questionnaire, and Group 3 received neither problem representation training nor a structured questionnaire. The student participants wrote case summaries after participating in a simulated clinical patient encounter using a high-fidelity robot-mannequin. An adaptation of a prior instrument was used to rate the case summaries in regards to formulating a problem representation and a relevant differential diagnosis, justifying a working diagnosis, and selecting an accurate working diagnosis. The two main goals of the study were to determine 1) if the instrument could detect the use of problem representation amongst the trained students (Group 1) as compared to Group 2 and 2) if a prompting effect was present using a structured questionnaire for the written case summaries. The instrument did detect that the trained students were able to formulate a problem representation, but the mean scores between and trained and untrained groups were not significantly different in formulating a relevant differential diagnosis, justifying a working diagnosis, and selecting an accurate working diagnosis. Due to lack of standardization amongst instructors, it was unclear from this study if a prompting effect was present due to the structured questionnaire.