Strides in Development of Medical Education

Document Type : Original Article


1 Research Development Center, Sina Hospital, Tehran University of Medical University, Tehran, Iran.

2 Laser Research Center of Dentistry, Dental Research Institute, Tehran University of Medical Sciences, Tehran, Iran

3 Medical Education Department, Tehran University of Medical University, Tehran, Iran

4 Anesthesiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran


Background: There is a paucity of literature regarding the medical students’ perspectives on web-based training of clinical reasoning.
Objectives: This study aimed to describe the implementation of a web-based training course of clinical reasoning for medical students and to evaluate their satisfaction with the program.
Methods: This cross-sectional study was conducted at the Tehran University of Medical Sciences in 2018. Fifty internal medicine interns were consecutively enrolled. The study consisted of two phases. The first phase focused on the development of a web-based training module of clinical reasoning. The second focused on evaluating the trainee’s satisfaction with the virtual course. The educational content of the program was prepared by an expert panel and incorporated in a web-based educational tool designed for virtual training purposes. The students’ satisfaction with the virtual course was assessed using a questionnaire. Each item of the questionnaire was scored from 0 (0) to 1.5 (100). The content validity of the questionnaire determined by an expert panel, and its reliability was measured.
Results: The mean score of each item of the questionnaire ranged from 77.3 to 85.3 which showed that the participants agreed with the items of the questionnaire. Also, Cronbach’s alpha coefficient was excellent in nine items of the questionnaire, good in four items, and acceptable in three items. The intraclass correlation coefficient was also estimated as 0.98.
Conclusions: The participants were satisfied with the web-based training tool for clinical reasoning, used in the present study. The developed questionnaire also showed good validity and reliability for the assessment of trainees’ satisfaction with the web-based training module of clinical reasoning.


  1. Illing JC, Morrow GM, Rothwell nee Kergon CR, Burford BC, Baldauf BK, Davies CL, et al. Perceptions of UK medical graduates’ preparedness for practice: a multi-centre qualitative study reflecting the importance of learning on the job. BMC Med Educ. 2013; 13: 34.doi.:10.1186/1472-6920-13-34
  2. Goldacre MJ, Taylor K, Lambert TW. Views of junior doctors about whether their medical school prepared them well for work: questionnaire surveys. BMC Med Educ. 2010; 10: 78. doi: 10.1186/1472-6920-10-78
  3. Bordage G, Harris I. Making a difference in curriculum reform and decision-making processes. Med Educ. 2011; 45(1): 87-94. doi:10.1111/j.1365-2923.2010.03727.x
  4. Harden RM. Outcome-Based education: the future is today. Med Teach. 2007; 29(7): 625-9. doi:10.1080/01421590701729930
  5. Huang GC, Newman LR, Schwartzstein RM. Critical thinking in health professions education: summary and consensus statements of the Millennium Conference 2011. Teach Learn Med. 2014; 26(1): 95-102. doi:10.1080/10401334.2013.857335
  6. Nibbelink CW, Brewer BB. Decision-making in nursing practice: An integrative literature review. J Clin Nurs. 2018; 27(5-6): 917-28. doi:10.1111/jocn.14151
  7. Simpson E, Courtney M. Implementation and evaluation of critical thinking strategies to enhance critical thinking skills in Middle Eastern nurses. Int J Nurs Pract. 2008; 14(6): 449-54. doi:10.1111/j.1440-172X.2008.00719.x
  1. Peach BE, Mukherjee A, Hornyak M. Assessing critical thinking: A college’s journey and lessons learned. Journal of Education for Business. 2007; 82(6): 313-20. doi:10.3200/JOEB.82.6.313-320
  2. Norman G. Research in clinical reasoning: past history and current trends. Med Educ. 2005; 39(4): 418-27. doi:10.1111/j.1365-2929.2005.02127.x
  3. Graber M, Gordon R, Franklin N. Reducing diagnostic errors in medicine: what’s the goal?. Acad Med. 2002; 77(10): 981-92. doi:10.1097/00001888-200210000-00009
  4. Mirzazadeh A, Hejri SM, Jalili M, Asghari F, Labaf A, Siyahkal MS, et al. Defining a Competency Framework: The First Step toward CompetencyBased Medical Education. Acta Med Iran. 2014; 52(9): 710-6.
  5. Baumann-Birkbeck L, Florentina F, Karatas O, Sun J, Tang T, Thaung V, et al. Appraising the role of the virtual patient for therapeutics health education. Curr Pharm Teach Learn. 2017; 9(5): 934-44. doi:10.1016/j.cptl.2017.05.012
  6. Kassirer JP. Teaching clinical reasoning: case-based and coached. Acad Med. 2010; 85(7): 1118-24. doi:10.1097/ACM.0b013e3181d5dd0d
  7. Wood T. Assessment not only drives learning, it may also help learning. Med Educ. 2009; 43(1): 5-6. doi:10.1111/j.1365-2923.2008.03237.x
  8. Liaw SY1, Chan SW, Chen FG, Hooi SC, Siau C. Comparison of virtual patient simulation with mannequin-based simulation for improving clinical performances in assessing and managing clinical deterioration: randomized controlled trial. J Med Internet Res. 2014; 16(9): e214. doi:10.2196/jmir.3322
  1. Kleinert R, Heiermann N, Plum PS, Wahba R, Chang DH, Maus M, et al. Web-Based Immersive Virtual Patient Simulators: Positive Effect on Clinical Reasoning in Medical Education. J Med Internet Res. 2015; 17(11): e263. doi:10.2196/jmir.5035
  1. Weiner CK, Skålén M, Harju-Jeanty D, Heymann R, Rosén A, Fors U, et al. Implementation of a Web-Based Patient Simulation Program to Teach Dental Students in Oral Surgery. J Dent Educ. 2016; 80(2): 133-40. doi:10.1002/j.0022-0337.2016.80.2.tb06068.x
  2. Raupach T, Muenscher C, Anders S, Steinbach R, Pukrop T, Hege I, et al. Web-based collaborative training of clinical reasoning: a randomized trial. Med Teach. 2009; 31(9): e431-7. doi:10.1080/01421590903095502
  3. Hagedorn DK, Holm E. Effects of traditional physical training and visual computer feedback training in frail elderly patients. A randomized intervention study. Eur J Phys Rehabil Med. 2010; 46(2): 159-68.
  4. Jensen R. Clinical reasoning during simulation: Comparison of student and faculty ratings. Nurse Educ Pract. 2013; 13(1): 23-8. doi:10.1016/j.nepr.2012.07.001
  5. Johnson G, Flagler S. Web-based unfolding cases: a strategy to enhance and evaluate clinical reasoning skills. J Nurs Educ. 2013; 52(10): 589-92. doi:10.3928/01484834-20130919-02
  6. Wiesner SM, Walker JD, Creeger CR. Improving Critical Thinking Using a Web-Based Tutorial Environment. J Allied Health. 2017; 46(2): 111-6.
  7. Fingeret AL, Martinez RH, Hsieh C, Downey P, Nowygrod R. Watch what happens: using a web-based multimedia platform to enhance intraoperative learning and development of clinical reasoning. Am J Surg. 2016; 211(2): 384-9. doi:10.1016/j.amjsurg.2015.09.007
  1. Badiyepeymaie Jahromi Z, Mosalanejad L, Rezaee R. The effect of web quest and team-based learning on students’ self-regulation. J Adv Med Educ Prof. 2016; 4(2): 80-7.
  2. Samadbeik M, Yaaghobi D, Bastani P, Abhari S, Rezaee R, Garavand A. The Applications of Virtual Reality Technology in Medical Groups Teaching. J Adv Med Educ Prof. 2018; 6(3): 123-9.
  3. Lapkin S, Fernandez R, Levett-Jones T, Bellchambers H. The Effectiveness of Using Human Patient Simulation Manikins in the Teaching of Clinical Reasoning Skills to Undergraduate Nursing Students: A Systematic Review. JBI Libr Syst Rev. 2010; 8(16): 661-94. doi:10.11124/01938924-201008160-00001