Table 1 Inclusion and exclusion criteria
| Key Concepts | Criteria |
|---|---|
| Population |
Undergraduate medical students Excluded: health professionals, postgraduate students, other health students |
| Intervention |
Interventions that describe an educational method that explicitly teaches clinical reasoning skills and is an interactive computer simulation of real-life clinical scenarios between ‘physicians’ and ‘patients’. The student should emulate the role of a clinician by undertaking various reasoning activities such as gathering data from the patient, interpreting information, or making diagnostic decisions [9]. Patient information could be presented in text or videos on the computer Excluded: high fidelity simulators, manikins, standardised patients, and decision support tools |
| Comparator |
Teaching as usual e.g., no explicit clinical reasoning teaching or a comparison to an alternative method of delivering explicit clinical reasoning teaching e.g., tutorials, problem-based learning discussion groups often involving paper-based instruction Excluded: alternative formats e.g., comparing different types of virtual patient cases |
| Outcome | Clinical reasoning skills are the thought processes required to identify likely diagnoses, formulate appropriate questions and reach clinical decisions [2]. Interventions that provided sufficient detail to establish whether it improved clinical reasoning skills in a written, oral, or practical test. Commonly used synonyms for clinical reasoning were accepted e.g., clinical decision-making, clinical reasoning, problem-solving, critical thinking, and clinical judgement skills |
| Study type(s) |
RCTs, crossover trials, quasi-experimental studies, and observational studies Excluded: qualitative designs |
| Publication type(s) |
Peer reviewed articles including theses Excluded: conference papers, editorials letters, notes, comments, and meeting abstracts. Articles not in English |
| Time | Articles from the year 1990, as this was when online learning was beginning to be described [14] |