Electronic Clinical Reasoning Education Simulation Tool (eCREST): scaling up and adaptation of an online resource to support clinical reasoning

eCREST (the Electronic Clinical Reasoning Educational Simulation Tool) is an online training aid for a range of clinical professionals. We developed this novel educational resource to support diagnostic skills in current and future health care professionals.

eCREST was informed by our research to understand GPs’ diagnostic decision making. To date, it has been used with medical students, physician associate students, pharmacy students and qualified pharmacists. As primary care teams broaden, eCREST may have a role with a range of both future and current clinical professionals.

On eCREST, students accessed hypothetical (simulated) patient cases via a virtual ‘waiting room’. They watched videos of patients describing their symptoms and reviewed their medical history, medications, and lifestyle notes. The information that students obtained was determined by the options they selected (e.g. through question menus, virtual ‘examinations’, or bedside tests).

At the start of each case, students were asked to select initial diagnoses for the patient. Importantly, they were then prompted to review their initial diagnoses and were given the option to make changes at intervals during the case.

Once students were satisfied that they had enough information, they were asked to give their final selection of diagnoses, choose an initial management plan for the patient, and decide on a follow-up plan.

eCREST has been used with over 800 students from four different professional groups across four countries (UK, Cyprus, Turkey and Spain). In 2024, eCREST was piloted with three pharmacy groups: practising pharmacists in North Central London (n=36), and 2 pharmacy MPHARM education courses (Newcastle and Kings College).

Educators observed that eCREST addressed a need not met by current education particularly around recognition and management of uncertainty. Qualified pharmacists were enthusiastic about using eCREST further “Really love the platform. Coming from community to primary care, wish I had a blueprint”, and 65% of students agreed it enhanced their learning. Following these pilots, eCREST has been implemented on a rolling basis in both courses. There is interest in developing further cases across educators and practitioners.

Having successfully developed Electronic Clinical Reasoning Education Simulation Tool (eCREST) initially for medical students to address gaps in training on clinical reasoning, we have now adapted eCREST for use with pharmacists, pharmacy students and physician associate students in educational and service settings.

Educators and students report that eCREST has added value in their teaching by encouraging questioning and introducing management of uncertainty into their teaching in a safe space. We have also explored the clinical reasoning learning styles of different student groups through their use of eCREST. eCREST therefore has the potential to impact on workforce development by upskilling future and current clinicians.

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