In the article “Effects of live and video simulation on clinical reasoning performance and reflection”, published in 2020 in the journal Advances in Simulation, Timothy Cleary and his team present the results of a study on the effects of live and video simulations on physicians’ clinical reasoning performance and reflection. The study addresses a significant gap in the literature by analysing how different simulation approaches affect physicians’ cognitive and regulatory skills during clinical reasoning activities.
The study involved 38 military physicians from different specialties and levels of experience, who were randomly assigned either to take part in live scenarios or to watch video cases. Both groups went through two stages: an encounter with a simulated patient and a video-based reflection activity. After the encounter (live or video), the physicians completed a Post-Encounter Form, answered microanalysis questions and rated the mental effort involved. They were also asked to rewatch the video of their own interaction with the patient (live group) or the case video (video group), sharing their thoughts on how they arrived at the diagnosis and treatment plan.
The results revealed significant differences between the groups in clinical reasoning performance, with physicians in the live scenarios performing better. In addition, the live simulation group showed a distinct profile of reflective judgements and cognitive processing compared with the video simulation group. Participants in the live scenario paid more attention to aspects of the clinical reasoning process and showed higher-level cognitive processing.
The authors suggest that live simulation may provide a more engaging environment in which physicians focus more directly on the clinical reasoning process and on integrating data. However, they also note the efficiency and accessibility of video simulations, which allow detailed review of interactions and more careful reflection.
These conclusions do not rule out the relevance of video simulations, but they show that videographic language needs to be rethought and better planned, adopting specific strategies that can make up for the effects of the absence of face-to-face contact.
A valuable contribution of the study is its multifaceted approach to assessing clinical reasoning. Beyond traditional performance assessments, the researchers explored physicians’ perceptions of the challenges they faced and the adaptive inferences they made during post-activity reflection. This offers insights into how health professionals evaluate their own actions and thought processes during simulations.
The research offers an in-depth understanding of the different effects of live and video simulation on the development of physicians’ clinical reasoning and reflection. It points to the importance of considering both cognitive and regulatory aspects when designing and implementing simulation environments for training and professional development in medicine.
Full article:
Cleary, T.J., Battista, A., Konopasky, A. et al. Effects of live and video simulation on clinical reasoning performance and reflection. Adv Simul 5, 17 (2020). https://doi.org/10.1186/s41077-020-00133-1
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