Background: Final year medical students at the University Duisburg-Essen, Germany, are unsatisfied with their clinical judgement skills in common elective and emergency clinical situations. A competency based medical curriculum determines that clinical judgement is an essential tool in effective patient care, patient safety and limiting clinical error. Approaches to clinical judgement include either analytical, intuitive or a combination of both approaches. Novices show specific factors, which are typical in inexperienced clinicians. Simulation provides opportunities in a competency-based medical education curriculum. There is limited evidence showing that simulation can provide an effective environment for teaching and learning clinical decision-making skills. This project explores how final year medical students at the University of Duisburg-Essen approach the clinical decision-making process as well as how simulation influences this process.

Methods: Ethics approval was obtained from the local ethics committee. After completing a 10-week simulation course,thirty-five students completed a clinical decision-making instrument to categorise their clinical decision-making approaches. The Novice Decision Making Model and the Cognitive Continuum Model were combined with learning theories in Simulation (Social Cognitive Theory) and used to explore and interpret data collected through questionnaires, interviews and observation.

Results: The majority (60%) of students employed a predominantly analytic approach, some students showed intuitive tendencies in clinical situations. During interviews students displayed typical novice approaches to decision-making and expressed positive comments relating to simulation.

Conclusions: Simulation presents an opportunity for teaching and learning clinical decision-making. Results show the need for further inquiry into learning clinical decision-making through simulation. This research provides initial evidence that simulation can be incorporated into curricular teaching of clinical decision-making.