Modelo de escenarios de simulación para el entrenamiento de razonamiento clínico en estudiantes de medicina

Abstract

Introduction: Clinical reasoning is a complex task that physicians use when treating patients, and it can be carried out through intuitive and analytical processes. Clinical simulation is a tool to train reasoning, however, its evaluation remains challenging. In the present study, we evaluated the scenario design template for clinical reasoning associated with using an observation scale applied to medical students in two sequential simulation scenarios. Materials and methods: Two simulation scenarios with 4 levels of complexity were designed to manage sepsis in adult patients, where 12 groups of 8 students participated. These simulations were recorded and later analyzed by qualified observers through a guideline built on the conceptual proposals of Croskerry, Braun, and Pennaforte. Results: The scenarios were carried out in an average of 12 minutes. Most students established the diagnosis and initial management through the partial collection of information, showing control of intuitive reasoning in 98 % of the cases, whereas only 10,4 % achieved the analytical processes. Conclusion: The design of simulation scenarios composed of different levels of complexity could promote the development of clinical reasoning. Using an observation guideline allowed the analysis of the clinical reasoning process in realistic environments and without interruptions and could be used to guide debriefings.