Utilizing case-based reasoning and multimedia to enhance clinical decision making of novice practitioners: product implementation and evaluation

This paper describes the outcomes of a self-paced multimedia learning environment designed to enhance critical thinking skills in clinical decision making of graduate nurses entering the workforce. The multimedia-learning environment represents a contrived situation that simulates the complexities of life in a typical hospital ward, which places the users in the role of problem-solvers. Problem solving in the simulation is based on a rich repository of cases and stories that have been extracted from the experiences of expert practitioners. This case-based reasoning architecture reflects a model of learning where users are coached in the development of decisionmaking skills within the context of a contrived but an authentic presenting problem. Users engage in critical thinking and decision making after accessing the experiences and expert stories of practitioners, which are presented in the form of audio/video clips on the CD-ROM. The formative evaluation of the learning environment, with embedded activities involved structured and open ended question types with individual and small groups of practicing nurses and subject matter experts. A semi-structured questionnaire was employed to ascertain user perceptions and this enabled us to evaluate the utility and the efficacy of the product from the perspective of graduates. The results show a very high user acceptance of this learning environment and the approach to learning.