A Closed-Loop Clinical Reasoning Training and Multi-Dimensional Evaluation System Based on Deliberate Practice and Kolb's Experiential Learning Theory for Medical Interns
DOI:
https://doi.org/10.17161/sjm.v3i2.25485Keywords:
Clinical reasoning, Deliberate practice, Kolb cycle, Virtual patientAbstract
Purpose: To evaluate a virtual patient-based closed-loop training system combining deliberate practice with Kolb's experiential learning cycle and assess its impact on clinical reasoning in medical interns.
Methods: In this quasi-experimental study, 235 fifth-year interns (control: n=120; intervention: n=115) received the same conventional clinical teaching. Additionally, the intervention group completed a four-phase closed-loop training program—orientation, hands-on training, structured debriefing, and targeted reinforcement—using the ZhiQu virtual patient platform, grounded in deliberate practice and Kolb's experiential learning cycle. The control group used the same platform for unsupervised self-practice. Outcomes included longitudinal clinical reasoning scores, Objective Structured Clinical Examination (OSCE) performance, graduation examination results, and teaching satisfaction.
Results: Compared with the control group, the intervention group showed greater improvement in systematicity, accuracy, and logic (each p<0.05), with higher final scores in these dimensions. No significant differences were observed for agility or cost-effectiveness. The intervention group also performed better on OSCE stations for history taking, medical record writing, and case analysis (p<0.05), as well as on the graduation clinical skills examination (p<0.05). Theory examination scores did not differ significantly. Teaching satisfaction was significantly higher in the intervention group (p<0.01).
Conclusions: A closed-loop training system driven by deliberate practice and Kolb's experiential learning cycle effectively improves specific dimensions of clinical reasoning and cognitive-intensive clinical skills in medical interns. Virtual patient platforms should be embedded within structured, faculty-led debriefing to act as "cognitive amplifiers" rather than standalone electronic question banks.
Downloads
Published
Data Availability Statement
The datasets generated and/or analyzed during the current study are not publicly available due to privacy or ethical restrictions (the study involved medical interns and their performance data). However, they are available from the corresponding author upon reasonable request.
Issue
Section
License
Copyright (c) 2026 Zhen Zhang, Lili Yang, Chujie Chen, Dan Liu, Peng Yun (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
