Jacklin, Simon (2019) The use of virtual patients for developing the evidence informed, shared decision making of clinicians. Doctoral thesis, Keele University.

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Abstract

Background
Shared decision-making (SDM) involves a patient and a health professional sharing information to arrive at a decision that aligns with both the best available evidence and the patient’s preferences. Research shows that SDM is not occurring in practice to the extent that it ought to. SDM is proposed as a skill of communication which means that it can be learnt and developed.
Virtual Patients (VPs) are computer programs that simulate real-life clinical scenarios; learners take on the role of a health professional to interact with a patient and make decisions. VPs may provide a way for students and professionals to practice SDM. Very few VPs published in the literature focus on SDM or related concepts.
Aim
To design and evaluate a VP for developing the shared decision-making skills of undergraduate medical and pharmacy students, and General Practice Registrars (GPRs).
Method
A multi-step design process incorporating patient involvement was followed to create the VP.
Mixed-method evaluations of the VP utilising pre- and post-questionnaires and semi-structured interviews were conducted at a series of workshops. The qualitative questionnaire data was analysed using content analysis. Descriptive statistics were used for the majority of the quantitative data; one question was analysed using a Wilcoxon rank test. The interview data was analysed by data-driven thematic analysis.
Results
The VP was found by workshop participants to be both enjoyable and easy to use. The multiple-choice system of interaction provided useful prompts to the participants as to which words and phrases they could use. In future, an extended feedback activity may be required but the optimal composition of this is unclear.
For the pharmacy and medical student evaluations, there was a statistically significant change in the rank position of “Respecting patient choices” when comparing pre- and post-VP (p=0.026 and p=0.038 respectively); in both cases, the median rank changed from 2nd to 1st. The modal suggestion for each evaluation was that it was “Likely” there would be changes in the participants’ practice as a result of the VP; the suggested changes were broadly in line with the aims of the VP.
Conclusions
The VP was well accepted by the majority of the participants in all of the evaluations. The multiple-choice system had some particular advantages for less experienced consulters but its place with those more experienced is unclear. The VP resulted in positive changes in both the participants reported priorities within a consultation and suggested changes in their practice.

Item Type: Thesis (Doctoral)
Subjects: R Medicine > RS Pharmacy and materia medica
Divisions: Faculty of Medicine and Health Sciences > School of Pharmacy
Depositing User: Lisa Bailey
Date Deposited: 06 Nov 2019 12:49
Last Modified: 06 Nov 2019 12:49
URI: http://eprints.keele.ac.uk/id/eprint/7148

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