A randomized comparison of alternative formats for clinical simulations,” Med

Computer-based clinical simulations for medical education vary widely in structure and for-mat, yet few studies have examined which formats are optimal for particular educational settings. This study is a randomized comparison of the same simulated case in three formats: a "pedagogic " format offering explicit educational support, a "high-fidelity " format attempting to model clinical reasoning in the real world, and a "problem-solving " format that requires students to express specific diagnostic hypotheses Data were collected from rising third-year medical students using a posttest, attitudinal questionnaire, students ’ writeups of the case, and log files of students ’ progress through the simulation. Student performances on all measures differed significantly by format. In general, students using the pedagogic format were more proficient but less efficient. They acquired more information but were able to do proportionately less with it. The results suggest that the format of computer-based simulations is an important educational variable. Key words. medical education, undergraduate; clinical reasoning; computer-assisted instruction. (Med Decis Making 1991;11:265-272) Interest in educational use of computer-based clin-ical simulations took root in the early 1970s. The most visible products of this early work included the CASE system, developed at the University of Illinois, ’ and a series of simulations developed at the Massachusett