The online simulation platform will be tested in at least five British universities (Imperial College London, Oxford, Exeter, Plymouth, and Newcastle) and more than a dozen schools in other countries, including Harvard.


Current tools assessing applied knowledge in undergraduate medical education are limited in their scope for testing clinical reasoning and the ability to manage uncertainty in clinical practice. Practicum Script ( is an online simulation-based program aimed at enhancing clinical reasoning and problem-solving skills, as well as introducing the concept of uncertainty in decision making. This multicenter pilot study, coordinated by the European Board of Medical Assessors (EBMA) and the Practicum Foundation (Madrid, Spain), aims to investigate the effectiveness of Practicum Script as a clinical reasoning training tool in undergraduate teaching and assessment.

The participation is anticipated to include at least five medical schools in the UK (Imperial College London, Oxford, Exeter, Plymouth, and Newcastle) and more than a dozen schools in other countries, including Harvard in the US and the University of Sao Paulo in Brazil. The assessment material will consist of 20 clinical cases targeting key topics in Internal Medicine. With the editorial stage already completed by an editorial board at ICL led by Dr. Amir H. Sam, the cases are currently under revision by a panel of referees comprised by internists, and the next step will be the compilation of their answers as part of the feedback for the participants.

Practicum Script presents challenges in dilemmatic contexts. For each clinical scenario, final year medical students will be asked to generate hypotheses and justify them by identifying pertinent positive and negative findings in the case. Subsequently, they will be required to report, in five different clinical scenarios, how new data may affect their original hypotheses. The students will be able to observe the agreement between their responses and those of the experts, along with the literature-based clinical evidence. This tool will allow the students to self-assess their clinical reasoning abilities in real-life situations, boosting their confidence in decision making.

The project is ongoing and the plan is to obtain psychometric results by the end of 2020. There is a strong need for effective approaches tailored to the development of clinical reasoning skills, and Practicum Script could contribute meaningfully to this goal. In fact, Practicum Script has been used as a CPD/CME tool and in residency training for more than 10 years. Also, a recent research published in Medical Education concluded that “even when their positions remain unchanged, by knowing about controversies, the examinees may calibrate their certainty and apply more diverse thinking going forward”.

The investigation, conducted by a group of researchers from the Practicum Foundation, the University of Illinois at Chicago, and the University of Kansas, revealed multifactorial reasons behind the divergence that naturally occurs among experts during decision making in complex situations, as well as the usefulness of this pedagogic model in medical education. According to the study, “controversial cases may be a valuable stimuli in an assessment for learning that better reflects the complexity of medical decision making.”

Both, the international project for medical students and the investigation about the experts’ response process validity were presented at the AMEE conference 2019 by the Practicum Foundation - Institute of Applied Research in Health Sciences Education. In general, this nonprofit organization is focused on mental processes activated before and during clinical decision making in contexts of uncertainty. The Practicum Foundation is an institutional member of AMEE, EBMA, and ASME.

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