¹Charité – Universitätsmedizin Berlin, Dieter Scheffner Center for Medical Education, Berlin, Germany

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Background and aim: Management reasoning is a crucial skill in physicians’ daily practice. While virtual patient (VP) cases have proven effective for training diagnostic reasoning, their potential for teaching management reasoning remains underexplored. Building on prior work by Richters et al. [1] on intervention skills and Cook et al. [2] on management reasoning, we identified the need for a structured framework to guide VP case development. Script theory [3] served as the guiding theoretical foundation. Through a co-design process involving students and academic staff, we developed and piloted a structured framework for VP-based management reasoning training.

Methods: We, a team at Charité Medical School consisting of four clinicians and five students, conducted a literature review, engaging in collaborative reading and discussion of 15 selected articles. Key themes were extracted, clustered, and synthesized into core domains for VP case development, which were agreed upon through consensus. We piloted the framework by mapping existing VP cases against these domains and comparing them with newly created cases developed using the framework. Evaluation involved analyzing the coverage of management reasoning elements before and after framework implementation.

Results: The management reasoning framework comprises five interdependent scripts: intervention (planning and executing therapy), social (communicating with patients and teams), ethical (applying moral principles), process (navigating team and system workflows), and self-care (ensuring clinician well-being). Analysis of 7 VP cases created without the framework revealed that all 36 case segments focused exclusively on intervention. In contrast, 10 cases developed using the framework demonstrated a broader distribution across 55 case segments: 62% intervention, 16% communication, 15% ethical considerations, 16% process-related reasoning, and 4% self-care, with 7 case segments spanning multiple scripts.

Discussion: Our co-creation process successfully integrated perspectives from learners, educators, and current literature into a content framework that demonstrated utility in prototype testing. The framework effectively captures the complexity of management reasoning and serves as both a mapping tool and a shared mental model for VP case development. While our pilot study provides proof of principle, future steps should include broader involvement of clinical educators, adaptation for bedside teaching, and investigation of long-term effects on students’ reasoning precision.

Take home messages:

• Management reasoning encompasses multiple domains beyond intervention decisions.
• A structured framework can guide the development of comprehensive VP cases.

Literatur

[1] Richters C, Schmidmaier R, Popov V, Schredelseker J, Fischer F, Fischer MR. Intervention skills – a neglected field of research in medical education and beyond. GMS J Med Educ. 2024;41(4):Doc48. DOI: 10.3205/zma001703
[2] Cook DA, Durning SJ, Stephenson CR, Gruppen LD, Lineberry M. Assessment of management reasoning: Design considerations drawn from analysis of simulated outpatient encounters. Med Teach. 2025;47(2):218-232. DOI: 10.1080/0142159X.2024.2337251
[3] Parsons AS, Wijesekera TP, Rencic JJ. The Management Script: A Practical Tool for Teaching Management Reasoning. Acad Med. 2020;95(8):1179-1185. DOI: 10.1097/ACM.0000000000003465