P3.281: Virtual Simulated Encounters as a Remediation Assessment Tool

Purpose/Objectives: Academic remediation for medical reasoning deficits presents a diagnostic challenge for faculty and residency leadership. Individual observations vary across assessors, real-time feedback can be overwhelming for learners, and there may not be time in clinical environments to explore deficits. For some, observation itself evokes distress. Supervisors performing direct observation may have preconceived ideas of resident weaknesses from other clinical encounters that could lead to hyperfocus on minor items in high-stakes observation. We describe a pilot using online meetings to simulate health encounters and reproduce observed structured clinical examinations. We aimed to increase observers and observations while reducing learner stress to better identify errors in clinical decision making and medical reasoning.

Design/Methods: We created pre-written outpatient, emergency department, and inpatient role-playing cases to target remediation objectives. After a pre-brief, with participants’ consent, sessions were recorded through the meeting platform. The resident and three faculty joined online while in different physical rooms. The staff played “patient/caregiver”, “preceptor”, and “exercise observer” roles. Microphones and cameras were off when not directly engaged. The resident alternatively met with the “patient/caregiver” to elicit history, obtain exam and lab findings, or to relay the plan of care; or with the “preceptor” to discuss findings, their intended next step, and their reasoning behind their plans. The “exercise observer” oversaw the full encounter. Simulated patient findings were presented when requested. All participants immediately met in-person to debrief once the encounter was complete. The observer facilitated discussion based on initial goals and incorporated feedback from "patient" and "preceptor" role-players.

Results: Through virtual role-playing encounters, we successfully enabled multiple faculty to observe resident decisions in real-time. As errors unfolded, especially if resident recall was inaccurate or confusing, we inspected underlying reasoning during debrief. The learner reported greatly reduced stress in this low-stakes approach and found the feedback organized and actionable. Session recordings provided data to the clinical competency committee. Ultimately, our remediation team used observations gathered in the virtual encounters to help establish the resident's competency when direct observations were negatively influenced by non-cognitive and environmental factors, and we determined the resident successfully met the terms of remediation.

Conclusion/Discussion: This use of an online meeting is a successful proof of concept for an adjunct to direct clinical observation. With this, we assessed medical reasoning with fidelity and facilitated an objective, tailored remediation. It is especially attractive if access to standardized patients is limited. Cases can be designed to target remediation objectives. The online environment allows multiple observers, reduces resident stress, and improves incorporation of feedback. We believe this tool can be adapted for other remediation plans and can be generalized to other programs.