Simsurgeries: diagnostic reasoning and decision making in a simulated setting

Abstract Background: Simulated surgeries (SimSurgeries) allow medical students to practice diagnostic consultations in a safe environment. SimSurgeries at BSMS involve multiple stations, each with an actor portraying a standardised patient role. Students work in pairs, alternating the leading role, and at the end of each scenario, feedback is provided by clinical facilitators and the actors. Simulated practice has been linked to improvement in procedural skills, confidence, teamwork, and communication. However, very few studies have explored the link between simulation and diagnostic reasoning. Methodology: Our volunteers (4th year medical students) were filmed during their SimSurgeries. Afterwards, they watched their video and reflected upon their diagnostic reasoning and decision making. Thematic analysis was used to identify common themes. Results: Students viewed the SimSurgeries as valuable opportunities for both practice and vicarious learning. They were aware of the gaps in their biomedical knowledge, especially relating to management and this deficit was seen to restrict their diagnostic reasoning. We found that the format of the SimSurgeries closely resembles OSCEs and are viewed primarily as exam preparation and not as opportunities for flexible thinking. The perceived pressure to ‘tick boxes’ led to reductionist approach in history taking. Finally, students were competent at rapport building and empathising, but at times found it challenging to articulate their thoughts for the patients and to allow for moments of silence during the consultations to gather their thoughts. Discussion: In order to optimise the educational gains during simulated practice, it is important to investigate the simulations from the learner’s perspective. Our findings can help refine educational goals for 4th year medical students with regards to diagnostic reasoning. Our findings also suggest that there is room for improvement in the current design of the SimSurgeries. In order to facilitate flexible diagnostic thinking, the simulations will need to reduce the resemblance to OSCEs.