Abstract 3

Practicum Script, a clinical reasoning simulator:
Results of an international multicenter experience at the undergraduate level

Pleguezuelos EM (Practicum Institute of Applied Research in Health Sciences Education),
Hornos E (Practicum Institute of Applied Research in Health Sciences Education),
Collares CF (Maastricht University / European Board of Medical Assessors),
Sam A (Imperial College London),
Freeman A (University of Exeter / European Board of Medical Assesors),
Van der Vleuten C (Maastricht University / European Board of Medical Assessors)


The development of better approaches for training and assessing clinical reasoning, under conditions of uncertainty, remains a great challenge within medical education. This multicenter study, coordinated by the Practicum Institute and the European Board of Medical Assessors, aimed to investigate the utility of the simulation-based program Practicum Script (https://universities.practicumscript.education/) as a clinical reasoning training methodology in undergraduate teaching and assessment.


Medical schools implemented Practicum Script as a formative tool for final year students. The assessment material consisted of 20 internal medicine clinical cases, drawn from real patients. Cases were validated by 20 experienced internists from 16 faculties across Europe, USA and Latin America.  For each clinical case, students were asked to generate hypotheses in a ‘free-text’ format and justify them. Subsequently, they had to report, in 5 different scenarios, how new data might affect their prior hypotheses. Feedback was based on experts’ opinions, and clinical evidence.

1502/2457 (61%) volunteer students from 21 medical schools across Europe, USA and Latin America completed the 20 cases. 89,8% of responders to a satisfaction survey rated the experience as “excellent” or “good”. Cronbach's alpha coefficients were excellent for hypothesis generation (alpha = 0.909, 95% CI = 0.902-0.916) and hypothesis argumentation (alpha = 0.926, 95% CI = 0.920-0.931) and adequate for knowledge application (alpha = 0.786, 95% CI = 0.768-0.803). Goodness-of-fit indices RMSEA and SRMR, from confirmatory factor analysis, were also adequate: 0.025 and 0.059, respectively. Our findings support that Practicum Script is a useful resource to help students strengthen their reasoning skills.