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Abstract：
Introduction The coronavirus 2019 pandemic highlighted virtual learning (VL) as a promising tool for medical education, yet its effectiveness in teaching clinical reasoning (CR) remains underexplored. Past studies have suggested VL can effectively prepare students for clinical settings. Informed by the Milestones of Observable Behaviours for CR (MOBCR) and whole-case theoretical frameworks, the Mock Wards (MW) program was created using a novel blended in-person learning (IPL) and VL platform. MW consisted of case-based small-group formats for medical students interested in learning approaches and differentials to commonly encountered presenting symptoms and diagnoses in internal medicine. This study sought to use MW\'s blended design to qualitatively analyze CR development and compare its utility between VL and IPL. Methods Qualitative analysis was conducted using in-depth semi-structured interviews with first-year pre-clerkship medical students (n = 8) who completed the MW program and participated in the study. The interview guide was informed by the MOBCR framework. Interview transcripts were analyzed using a directed qualitative content analysis approach. Translational coding and HyperRESEARCHTM (Researchware, Inc., Randolph, MA) software-generated mind maps guided the theme development. Results Three overarching themes were constructed: (1) tailoring pedagogical frameworks to learning modalities, (2) learning through interactivity, and (3) balancing accessibility with learner engagement. Participants emphasized that teaching CR skills is modality-specific and not fully interchangeable, with IPL being superior in facilitating social cohesion, non-verbal communication, and feedback. In contrast, VL required structured approaches and relied more on verbal communication and pre-made digital materials. IPL also enhanced interactivity, peer relationships, and spontaneous communication, whereas VL faced challenges such as social awkwardness and technological constraints hindering effective collaboration. VL provided superior accessibility to facilitate distributed learning and management of concurrent academic obligations. Conclusion The MW-blended platform highlights the importance of focusing on modality-tailored pedagogies, emphasizing group interactability, and balancing VL accessibility against decreased engagement within the IPL environment when teaching CR skills. Blended education models may benefit from a scaffolding approach, using IPL as a prerequisite to VL to improve CR development and alignment within a learner\'s zone of proximal development.
摘要：
2019年冠状病毒大流行强调虚拟学习（VL）是医学教育的一种有前途的工具，然而，其在临床推理（CR）教学中的有效性仍未得到充分开发。过去的研究表明，VL可以有效地为学生做好临床准备。由CR的可观察行为里程碑(MOBCR)和全案理论框架通知，MockWards（MW）程序是使用新颖的混合式当面学习（IPL）和VL平台创建的。MW由基于病例的小组格式组成，适用于对学习方法感兴趣的医学生，并与内科中常见的症状和诊断区分。这项研究试图使用MW的混合设计来定性分析CR的发展，并比较VL和IPL之间的效用。方法对完成MW计划并参与研究的一年级实习前医学生（n=8）进行深入的半结构化访谈，进行定性分析。采访指南由MOBCR框架提供信息。使用定向定性内容分析方法对访谈笔录进行了分析。翻译编码和HyperRESEARCHTM(Researchware，Inc.,伦道夫,MA)软件生成的思维导图指导了主题开发。结果构建了三个总体主题：(1)根据学习方式量身定制教学框架，（2）通过互动学习，(3)平衡可访问性与学习者参与度。与会者强调，教授CR技能是特定于模态的，不能完全互换，IPL在促进社会凝聚力方面是优越的，非语言交流，和反馈。相比之下,VL需要结构化的方法，并且更多地依赖于口头交流和预制的数字材料。IPL还增强了交互性，同伴关系，和自发的交流，而VL面临着社会尴尬和技术限制等挑战，阻碍了有效的合作。VL提供了优越的可访问性，以促进分布式学习和并发学术义务的管理。结论MW混合平台强调了专注于模态定制教学法的重要性，强调群体的互动性，在教授CR技能时，平衡VL可及性与IPL环境中参与度的降低。混合教育模式可能会受益于脚手架方法，使用IPL作为VL的先决条件，以改善CR发展和在学习者的近端发展区域内的对齐。
