Academic journal

Does having in-person, virtual or non-existent collaboration affect a… : The Hearing Journal

Clinical reasoning is defined as the thinking processes used during clinical practice, and a few recent studies have appealed to the need to improve clinical reasoning through instruction design; the results of one were published in November 2017 in the General Internal Journal Medicine, and the results of another was published in June 2019 in Diagnostic. Additionally, the results of a study from a January 2017 issue of Academic medicine identified three causes of misdiagnosis among healthcare professionals: cognitive biases, knowledge deficits, and dual-process thinking. The effects of these three factors during diagnosis can be mitigated or entirely eliminated when virtual patients are involved. Virtual patients can also reduce time constraints and lack of knowledge in teaching clinical reasoning.

Another study set out to explore the topics of clinical reasoning, audiology teaching and virtual learning, the results of which were published as “Examining Audiology Students’ Clinical Collaboration Skills When Using Virtual Audiology Cases Aided With No Collaboration, Live Collaboration, and Virtual Collaboration”. in the March 2022 issue of American Journal of Audiology, written by Ramy Shaaban and Cynthia M. Richburg. The findings seem particularly relevant in today’s era of increasingly virtual work and frequent debates about the effectiveness of collaboration when none of the collaborators are physically in the same room.


The study included 38 participants, all students of audiology courses at a public university in Pennsylvania and another in Kansas; 36 were female and two were male, reflecting the gender imbalance traditionally seen in communication science and audiology curricula. It consisted of three groups: a treatment group where participants collaborated virtually, and two control groups where participants had no collaboration and where participants collaborated in person (participants were randomly sorted into these groups ). It aimed to examine students’ collaboration skills in what is called a scaffolded environment. Scaffolding is a way to help students learn until they reach specific goals, and the two main types are hard scaffolding (predefined tools) and soft scaffolding (adaptive and dynamic tools provided at the student throughout the learning process). The nature of this study ensured the use of multiple scaffolding methods.

Two computerized simulations of audiology cases were created to put participants’ clinical reasoning skills into action. The simulation program was created using Adobe Animate to design the interactions, Google Forms as the problem-based scaffolding and activity tool, and WordPress as the host for the simulation session. The program consisted of an interactive simulation of the clinical tools used to diagnose the two cases, an interactive problem-solving activity using branching questions with situations that changed based on student choices, and a scoring system that recorded student grades. in an Excel file. sheet.

Each virtual case had the same steps and activities, but different situations and case designs. Students have different levels of knowledge about computers and the Internet, so the first case involved what was called an easy diagnosis while the second involved a more difficult one. Easy diagnosis in this case meant that the necessary clues were provided, aiming to arrive at an accurate diagnosis with simple reasoning. The second case provided more indirect clues that required further thought.


Participants in the in-person and virtual collaboration groups performed significantly better than participants in the non-collaborative group. The in-person group, consisting of 12 participants, had a total score of 97.9%, while the total score for the virtual group (also 12 participants) was 95.1% and the score for the non-collaborative group (14 participants ) was 78.6. %.

The results suggest a significant difference in clinical reasoning skills between the three groups, although the scores of the in-person and virtual groups are close. The results also imply that lower scores were related to students receiving more instructor-designed content and higher scores to students receiving less. Participants who received more scaffolds with the collaborations may have shown better decision-making outside of this exercise than participants who did not, but it is important to note that lower scores do not correspond not necessarily lower skills, just different paths to full expertise.

Excerpts from “Examining Clinical Collaboration Skills of Audiology Students When Using Assisted Virtual Audiology Cases Without Collaboration, Live Collaboration, and Virtual Collaboration” have been included in this column. The audience log would like to point out that the original study was published in its entirety on January 19, 2022, on (DOI: 10.1044/2021_AJA-21-00052).