The linguistic validation of the gut feelings questionnaire in Turkish

BACKGROUND

'Gut feelings' are frequently used by general practitioners in the clinical decision-making process, especially in situations of uncertainty. The Gut Feelings Questionnaire (GFQ) has been developed in the Netherlands and is now available in English, French, German, Polish, Spanish, and Catalan, enabling cross-border studies on the subject. However, a Turkish version of the GFQ is lacking.

OBJECTIVES

A Turkish version of the GFQ.

METHODS

A linguistic validation procedure was conducted, which took place in six phases: forward translation (step 1), backward translation (step 2), first consensus (step 3), cultural validation (step 4), second consensus (step 5), and final version (step 6).

RESULTS

The absence of literal equivalent of the term 'gut feelings' in Turkish was determined. The word 'intuition' was chosen as the Turkish literal equivalent of 'gut feelings'. There were also some challenges in finding the exact meanings of words and expressions in Turkish literature. However, we succeeded in finding adequate and responsible solutions. A Turkish version of the GFQ is available now.

CONCLUSION

With these validated GFQs, Turkish GPs can facilitate studies of the role of 'gut feelings' in clinical reasoning.

Script concordance testing in genetic counseling training: A pilot study

Clinical reasoning is a complex skill that represents a trainee's ability to use their professional knowledge and skills to assess and solve the problems that arise in clinical practice. As an integral tenet of the genetic counseling process, clinical reasoning skills underlie many of the Practice-Based Competencies (2019) across a variety of domains. Despite the long-lasting recognition of the importance of this complex skill in the training of genetic counselors, clinical reasoning has traditionally been difficult to assess in a standardized way in healthcare education. Script concordance testing is a standardized method of assessing clinical reasoning skills in ambiguous clinical situations. The tool has been used to successfully measure the clinical reasoning skills of trainees in various healthcare training programs and has never been used in a genetic counseling training program. We conducted a pilot study to assess the utility of script concordance testing in the field of genetic counseling as an objective measure of clinical reasoning in trainees. The script concordance test was constructed for the field of genetic counseling and administered to 22 second year genetic counseling students in the Joan H. Marks Graduate Program in Human Genetics at Sarah Lawrence College. Twelve genetic counselors served on a panel to provide expert clinical reasoning responses and a scoring grid was developed using the aggregate scores method. The utility of the tool was measured using Cronbach's alpha coefficient, and scores of students and the panel were compared using Hedge's g. Results revealed statistically significant differences between the scores of panelists and students and good reliability. This study shows that script concordance testing can be used to measure clinical reasoning skills in genetic counseling trainees in a way that is reliable, standardized, and easy to use, thereby allowing programs to better assess the clinical reasoning skills of trainees prior to graduation.

The iceberg of genomics: New perspectives in the use of genomics and epigenetics in oncology nursing clinical reasoning. A discursive paper

BACKGROUND

Although, there is a wealth of information in the medical literature on the usefulness of genomic testing in assessing risk and its application in medical oncology decision making, there are no theoretical reflections in the nursing field.

AIM

To understand the implications of molecular biology in nursing practice and highlight the role of Nursing Theory in guiding nurses' reasoning.

MATERIALS AND METHODS

Searching literature published between 2000 and 2022 in Medline and Google Scholar. Scientific evidence was analysed by the authors expert in different fields.

RESULTS

Based on the findings of the literature, concerns have been raised about the proper care of cancer patients who have a genomic risk profile determination. In particular, the absence of theoretical thinking and conceptual models that consider developments in molecular biology and their impact on nursing, in addition to the prevalence of heuristic thinking and the application of clinical patterns in nursing practice, could induce patient misjudgement with inadequate planning of preventive, curative, rehabilitative and educational nursing interventions. Nurses working in the field of oncology should be aware that the risk profile determined by genomics tests is merely the visible and stated portion of the cancer patient: the tip of iceberg.

DISCUSSION

This study demonstrates how genomic testing takes into account a fraction of genes discovered in tumour tissue to establish a risk profile. This subset differs, for example, from the social genome, which can determine the risk of dementia, cancer and cardiovascular disease, but in response to social adversity. Nursing theory, which views the environment as a metaparadigm, must consider a conceptual model that can integrate the findings of genomic testing with recommendations from studies on the social genome of humans to make it easier to build nursing treatments that can better reduce these risks.

CONCLUSION

A nursing theoretical discourse on genomics is a paramount requirement for developing effective nursing care.

Effects of matched vs. unmatched physical therapy interventions on pain or disability in patients with neck pain - a systematic review and meta-analysis

BACKGROUND

The interventions performed in most randomized controlled trials (RCTs) on neck pain patients are standardized, irrespective of the high heterogeneity of patients. However, clinicians tend to choose an intervention based on the patients' clinical characteristics, and thus match the treatment to the patient.

OBJECTIVES

To investigate the effectiveness of interventions matched to the clinical characteristics of patients with neck pain versus the same, but unmatched treatment for improving pain or disability.

DESIGN

A systematic review and meta-analysis conducted following Cochrane guidelines.

METHODS

Databases searches were performed from inception to September 2023. RCTs were included if the patients in the experimental group received a treatment matched to clinical presentation or to clinicians' assessment, if the patients in the control group received a similar but unmatched treatment, and if pain or disability were reported as outcome measures.

RESULTS

The literature search produced 9516 records of which 27 met the inclusion criteria. Matched exercise therapy was superior to unmatched exercise for pain (SMD -0.57; 95% CI -0.95, -0.18) and for disability (SMD -0.69; 95% CI -1.14, -0.23) at short term, but not at intermediate-term follow-up. Matched manual treatment was not superior to unmatched manual therapy for pain or for disability at short or intermediate-term follow-up.

CONCLUSIONS

Results suggest that matching exercise to movement limitation, trapezius myalgia, or forward head position may lead to better outcomes in the short term, but not in the intermediate-term. Matched manual therapy was not superior to unmatched treatment either short or intermediate-term. Further research is warranted to verify if those criteria are potentially useful matching criteria.

What factors do physical therapists consider when determining patient prognosis: A mixed methods study

INTRODUCTION

A prognosis provides valuable information to expected progress and anticipated outcome over the course of care. Although it is known that physical therapists can accurately prognose, it is unknown what factors are utilised in clinical practice.

OBJECTIVE

The purpose of this study was to determine the prognostic domains and factors that influenced a PT's clinical reasoning processes.

DESIGN

Mixed Methods Design, affirming the prognostic ability of the physical therapists and the qualitative exploration of the prognostic factors considered by physical therapists.

METHODS

Twenty-nine physical therapists participated in this study. Participants underwent semi-structured qualitative interviews that were coded to populate a prognostic framework. In addition, de-identified patient data was used to determine the ability of the PT to form a prognosis. Linear regression was used to determine if an initial prognostic score was related to function at discharge.

RESULTS

There were significant relationships (p = <0.05) between the prognosis score and Focus on Therapeutic Outcomes (B = 2.25), Numeric Pain Rating Scale (B = 0.257), and GROC (B = 0.289) upon patient discharge. Qualitative factors were categorised into prognostic domains (prevalence): Mood, Motivation, Pain Behaviours (100%), Disease Severity (93.1%), Health Status (86.2%), Social, Occupation, Environmental (67.0%), and Genetics, Biology, Biomarkers (44.8%). Factors that did not fit established domains were reported and categorised as Other (86.2%).

CONCLUSION

Our findings support the relationship between PT prognosis of patients with musculoskeletal pain and patient outcomes. In addition, the domains and factors PTs use to formulate prognosis during evaluation present a complex biopsychosocial framework, suggesting that PTs consider factors from multiple domains when forming a prognosis.

Neurocognitive Correlates of Clinical Decision Making: A Pilot Study Using Electroencephalography

The development of sound clinical reasoning, while essential for optimal patient care, can be quite an elusive process. Researchers typically rely on a self-report or observational measures to study decision making, but clinicians' reasoning processes may not be apparent to themselves or outside observers. This study explored electroencephalography (EEG) to examine neurocognitive correlates of clinical decision making during a simulated American Board of Anesthesiology-style standardized oral exam. Eight novice anesthesiology residents and eight fellows who had recently passed their board exams were included in the study. Measures included EEG recordings from each participant, demographic information, self-reported cognitive load, and observed performance. To examine neurocognitive correlates of clinical decision making, power spectral density (PSD) and functional connectivity between pairs of EEG channels were analyzed. Although both groups reported similar cognitive load (p = 0.840), fellows outperformed novices based on performance scores (p < 0.001). PSD showed no significant differences between the groups. Several coherence features showed significant differences between fellows and residents, mostly related to the channels within the frontal, between the frontal and parietal, and between the frontal and temporal areas. The functional connectivity patterns found in this study could provide some clues for future hypothesis-driven studies in examining the underlying cognitive processes that lead to better clinical reasoning.

"Learning a Way of Thinking"-World Café on Clinical Reasoning in Nursing and Midwifery Education and Practice across Five European Union Countries

Clinical reasoning is a key attribute of nursing and midwifery professionals. As a part of the Erasmus plus project, we designed a study with the aim of exploring the understanding of clinical reasoning as a concept, experiences of teaching clinical reasoning and practices related to using clinical reasoning in nursing and midwifery. A qualitative study was carried out using the World Café method, involving 44 participants from five European countries. The participants represented diverse professional backgrounds, including nurses, midwives and lecturers. Our analytical approach was based on a thematic analysis. We categorized the data into three main categories, namely, "Spiral of thinking", "The learning and teaching of a way of thinking" and "Clinical reasoning in real life", all under an overarching theme, "Learning a way of thinking". This study highlighted areas of learning and teaching which can be improved in current nursing and midwifery education. Furthermore, it identified barriers, facilitators and practices from five European countries which can be used in the further development of nursing and midwifery curricula and courses with the aim of enhancing clinical reasoning competence and ultimately improving patient care.

Case-Based Serious Gaming for Complication Management in Colorectal and Pancreatic Surgery: Prospective Observational Study

BACKGROUND

The potential risk and subsequent impact of serious complications after pancreatic and colorectal surgery can be significantly reduced through early recognition, correct assessment, and timely initiation of appropriate therapy. Serious gaming (SG) is an innovative teaching method that combines play with knowledge acquisition, increased concentration, and quick decision-making and could therefore be used for clinically oriented education.

OBJECTIVE

This study aims to develop a case-based SG platform for complication management in pancreatic and colorectal surgery, validate the application by comparing game courses of various professional groups in the health care sector, and test the acceptance of the developed platform in the context of clinical education by measuring levels of usability and applicability within the framework of a validity and usefulness analysis.

METHODS

In this observational trial, a novel SG for management of postoperative complications was developed and prospectively validated in a cohort of 131 human caregivers with varying experience in abdominal surgery. A total of 6 realistic patient cases were implemented, representing common complications after pancreatic and colorectal surgery. Cases were developed and illustrated using anonymized images, data, and histories of postoperative patients. In the prospective section of this study, following a brief case presentation, participants were asked to triage the virtual patient, make an initial suspected diagnosis, and design a 3-step management plan, throughout which the results of selected diagnostic and therapeutic actions were presented. Participants' proposed case management was compared to ideal case management according to clinical guidelines. Usability, applicability, validity, and acceptance of the application were assessed using the Trier Teaching Evaluation Inventory as part of a noncomparative analysis. In addition, a comparative analysis of conventional teaching and learning formats was carried out.

RESULTS

A total of 131 cases were answered. Physicians selected more appropriate therapeutic measures than nonphysicians. In the Trier Teaching Evaluation Inventory, design, structure, relevance, timeliness, and interest promotion were predominantly rated positively. Most participants perceived the application to be superior to conventional lecture-based formats (training courses, lectures, and seminars) in terms of problem-solving skills (102/131, 77.9%), self-reflection (102/131, 77.9%), and usability and applicability (104/131, 79.4%).

CONCLUSIONS

Case-based SG has educational potential for complication management in surgery and could thereby contribute to improvements in postoperative patient care.

The first diagnostic excellence conference in Japan

In February 2023, the first national conference on Diagnostic Excellence was held in Japan. As the conference covered a wide range of academic areas, we placed particular emphasis on topics related to excellence in physicians' clinical reasoning. This focus reflected the culture of Japanese medical professionals, especially of physicians, who have shown passion for clinical diagnosis for decades, having held non-profit voluntary multi-institutional conferences during off-duty hours. Of the over 1,400 participants who attended the two-day conference, 80% were generalist physicians and residents, 10% were medical students, and the remainder were healthcare professionals and participants from other academic areas. Given the background of Japanese physicians' passion for clinical diagnosis, the conference organizers believed that focusing on the diagnostic thinking of physicians as part of the Diagnostic Excellence concept would have strong appeal to participants. Simultaneously, the organizers believed that it was important to target participants in their 20s-40s, and made efforts to utilize social networking services and advertising strategies, including creating individual posters with the help of professional designers. On reflection after the conference, consideration of the local characteristics of the population, particularly their interest in the target population, and the expansion of the conference's focus to include younger participants may have served as drivers of the success of the conference. This outcome of the conference in Asia is an intriguing step in the world deployment strategy of Diagnostic Excellence, and is expected to promote cooperation among Asia and the United States, Europe, and Oceania.

The challenge of clinical reasoning in chronic multimorbidity: time and interactions in the Health Issues Network model

The increasing prevalence of multimorbidity requires new theoretical models and educational approaches to develop physicians' ability to manage multimorbidity patients. The Health Issues Network (HIN) is an educational approach based on a graphical depiction of the evolutions over time of the concurrent health issues of a patient and of their interactions. From a theoretical point of view, the HIN approach is rooted in Prigogine's vision of the "becoming" of the events and in the concept of knowledge organization, intended as the process of storing and structuring of information in a learner's mind. The HIN approach allows to design clinical exercises to foster learners' ability to detect evolutionary paths and interactions among health issues. Recent findings of neuroscience support the expectation that interpreting, completing, and creating diagrams depicting complex clinical cases improves the "sense of time", as a fundamental competence in the management of multimorbidity. The application of the HIN approach is expected to decrease the risk of errors in the management of multimorbidity patients. The approach is still under validation, both for undergraduate students and for the continuous professional development of physicians.

A comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions

INTRODUCTION

Clinical reasoning is a core competence in health professions that impacts the ability to solve patients' health problems. Due to its relevance, it is necessary to identify difficulties arising from different sources that affect clinical reasoning development in students. The aim of this study was to explore a comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions.

METHODS

Mixed methods were used in four stages: (1) students and clinical teachers focus groups to identify challenges to clinical reasoning development; (2) literature review to explore potential solutions for these challenges; (3) Delphi technique for teacher consensus on pertinence and feasibility of solutions (1-5 scale); and (4) teachers' self-perception of their ability to implement the solutions.

RESULTS

Three categories and seven subcategories of challenges were identified: (I) educational context factors influencing the clinical reasoning process; (II) teacher's role in clinical reasoning development; and (III) student factors influencing the clinical reasoning process. From 134 publications identified, 53 were selected for review, resulting in 10 potential solutions. Through two Delphi rounds, teachers rated the potential solutions very highly in terms of relevance (4.50-4.85) and feasibility (3.50-4.29). Finally, a prioritisation ranking of these solutions was generated using their scores for relevance, feasibility, and teachers' self-perception of their ability to implement them.

CONCLUSIONS

The present comprehensive approach identified challenges for clinical reasoning development in dental students and their potential solutions, perceived as relevant and feasible by teachers, requiring further research and follow-up actions to address them.

Academic Leadership Academy Summer Program: Clerkship Transition Preparation for Underrepresented in Medicine Medical Students

PROBLEM

Enhancing workforce diversity by increasing the recruitment of students who have been historically excluded/underrepresented in medicine (UIM) is critical to addressing healthcare inequities. However, these efforts are inadequate when undertaken without also supporting students' success. The transition to clerkships is an important and often difficult to navigate inflection point in medical training where attention to the specific needs of UIM students is critical.

INTERVENTION

We describe the design, delivery, and three-year evaluation outcomes of a strengths-based program for UIM second year medical students. The program emphasizes three content areas: clinical presentations/clinical reasoning, community building, and surfacing the hidden curriculum. Students are taught and mentored by faculty, residents, and senior students from UIM backgrounds, creating a supportive space for learning.

CONTEXT

The program is offered to all UIM medical students; the centerpiece of the program is an intensive four-day curriculum just before the start of students' second year. Program evaluation with participant focus groups utilized an anti-deficit approach by looking to students as experts in their own learning. During focus groups mid-way through clerkships, students reflected on the program and identified which elements were most helpful to their clerkship transition as well as areas for programmatic improvement.

IMPACT

Students valued key clinical skills learning prior to clerkships, anticipatory guidance on the professional landscape, solidarity and learning with other UIM students and faculty, and the creation of a community of peers. Students noted increased confidence, self-efficacy and comfort when starting clerkships.

LESSONS LEARNED

There is power in learning in a community connected by shared identities and grounded in the strengths of UIM learners, particularly when discussing aspects of the hidden curriculum in clerkships and sharing specific challenges and strategies for success relevant to UIM learners. We learned that while students found unique benefits to preparing for clerkships in a community of UIM students, near peers, and faculty, future programs could be enhanced by pairing this formal intensive curriculum with more longitudinal opportunities for community building, mentoring, and career guidance.

Tailoring of exercise and dietary interventions to adverse effects and existing comorbidities in patients with ovarian cancer receiving chemotherapy: a clinical vignettes study among expert physical therapists and dietitians

PURPOSE

This study aims to capture the complex clinical reasoning process during tailoring of exercise and dietary interventions to adverse effects and comorbidities of patients with ovarian cancer receiving chemotherapy.

METHODS

Clinical vignettes were presented to expert physical therapists (n = 4) and dietitians (n = 3). Using the think aloud method, these experts were asked to verbalize their clinical reasoning on how they would tailor the intervention to adverse effects of ovarian cancer and its treatment and comorbidities. Clinical reasoning steps were categorized in questions raised to obtain additional information; anticipated answers; and actions to be taken. Questions and actions were labeled according to the evidence-based practice model.

RESULTS

Questions to obtain additional information were frequently related to the patients' capacities, safety or the etiology of health issues. Various hypothetical answers were proposed which led to different actions. Suggested actions by the experts included extensive monitoring of symptoms and parameters, specific adaptations to the exercise protocol and dietary-related patient education.

CONCLUSIONS

Our study obtained insight into the complex process of clinical reasoning, in which a variety of patient-related variables are used to tailor interventions. This insight can be useful for description and fidelity assessment of interventions and training of healthcare professionals.

What information sources do Dutch medical specialists use in medical decision-making: a qualitative interview study

OBJECTIVE

To explore what information sources medical specialists currently use to inform their medical decision-making.

DESIGN

Qualitative, semistructured interviews.

SETTING AND PARTICIPANTS

A total of 20 semistructured interviews were conducted with 10 surgeons and 10 internal medicine specialists who work in academic and/or regional hospitals in the Netherlands.

RESULTS

Medical specialists reported that they primarily rely on their general knowledge and experience, rather than actively using information sources. The sources they use to update their knowledge can be categorised into 'scientific publications', 'guidelines or protocols', and 'presentations and meetings'. When medical specialists feel their general knowledge and experience are insufficient, they use three different approaches to find answers in response to clinical questions: consulting a colleague, actively searching the literature and asking someone else to search the literature.

CONCLUSION

Medical specialists use information sources to update their general knowledge and to find answers to specific clinical questions when they feel their general knowledge and experience are insufficient. An important finding is that medical specialists prefer accessible information sources (eg, consulting colleagues) over existing evidence-based medicine tools.

Drawing a "Perfect Circle": How Clinicians Can Become Better Communicators

SYNOPSIS: Despite the importance of communication in person-focused care, biomedical knowledge and technical skill development are often prioritized in physical therapy education. As clinicians and educators, we contend that mindfulness and reflection nurture effective communication approaches and support physical therapists in navigating the complexity and uncertainty that comprise most clinical interactions. We suggest that clinicians be mindful of the self, the patient, and the context when interacting with patients. Although being mindful cultivates awareness and curiosity, being reflective is an active practice that can be used while deliberating about the right thing to do or say in a particular situation. In this Viewpoint, we offer clinicians and educators suggestions for engaging in mindful and reflective practices. Through the contemplative practices of mindfulness and reflection, clinicians can better cultivate their communication expertise and good practice. J Orthop Sports Phys Ther 2023;53(10):579-584. Epub: 8 September 2023. doi:10.2519/jospt.2023.11917.

[The ISP, officer and caregiver: two visions for optimal care]

When participating in activities related to emergency medical assistance, especially without medical presence, the firefighter nurse develops many skills. As a firefighter officer, he has a global and strategic vision of the response, which goes beyond the field of nursing skills to take on a civil security dimension. When he takes care of the victim, the clinical reasoning of the nurse, who intervenes alone, is crucial.

Diagnosing Extrapulmonary Sarcoidosis and the Implications of Diagnosis on Military Service

Sarcoidosis is a systemic inflammatory disease that can cause granulomatous infiltration of almost all organs and tissues which allows for a wide variety of presentations that may overlap with other disease processes. Renal sarcoidosis is a much rarer site of extrapulmonary involvement and may present as hypercalcemia, tubular or glomerular dysfunction, and/or granulomatous interstitial nephritis. Prompt diagnosis of sarcoidosis is crucial for initiating appropriate treatment and avoiding organ dysfunction. Herein, we describe a case of an armed forces service member who developed extrapulmonary sarcoidosis and renal sarcoidosis with acute complications refractory to glucocorticoids requiring adalimumab. The case highlights and emphasizes a rare manifestation of extrapulmonary sarcoidosis, the importance of avoiding premature closure of the differential diagnosis to avoid diagnostic delay and treatment imitation, and the unique clinical reasoning that occurs in active-duty personnel where diagnoses and subsequent treatments can have career implications and affect the ability of the service member to maintain the ability to deploy worldwide.

The association between quality of connections and diagnostic accuracy in student-generated concept maps for clinical reasoning education with virtual patients

Objectives

Concept maps are a learning tool that fosters clinical reasoning skills in healthcare education. They can be developed by students in combination with virtual patients to create a visual representation of the clinical reasoning process while solving a case. However, in order to optimize feedback, there is a need to better understand the role of connections between concepts in student-generated maps. Therefore, in this study we investigated whether the quality of these connections is indicative of diagnostic accuracy.

Methods

We analyzed 40 concept maps created by fifth-year medical students in the context of four virtual patients with commonly encountered diagnoses. Half of the maps were created by students who made a correct diagnosis on the first attempt; the other half were created by students who made an error in their first diagnosis. The connections in the maps were rated by two reviewers using a relational scoring system. Analysis of covariance was employed to examine the difference in mean connection scores among groups while controlling for the number of connections.

Results

There were no differences between the groups in the number of concepts or connections in the maps; however, maps made by students who made a correct first diagnosis had higher scores for the quality of connections than those created by students who made an incorrect first diagnosis (12.13 vs 9.09; p=0.03). We also observed students' general reluctance to use connections in their concept maps.

Conclusion

Our results suggest that the quality, not the quantity, of connections in concept maps is indicative of their diagnostic accuracy.

Corrigendum: Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation

No abstract available.

How patients in general practice voice and value their gut feelings about health: a qualitative interview study

BACKGROUND

GPs consider their gut feelings a valuable tool in clinical reasoning. Research suggests patients' gut feelings may be a useful contribution to that process. Describing these feelings more precisely could improve primary care professionals' (PCPs) recognition of patients' gut feelings and insight into the underlying reasons. These descriptions would also enable a thorough examination of the validity of patients' gut feelings and their contribution to professionals' clinical reasoning.

AIM

To gather the words and phrases that patients or their relatives use to share their gut feelings with primary care professionals and what they convey and imply.

DESIGN AND SETTING

Qualitative study of Dutch and Belgian patients visiting an out-of-hours GP service or a GP's office.

METHOD

Face-to-face semi-structured interviews were carried out with 47 patients. Interviews were coded using a descriptive content analysis in an iterative process until data sufficiency.

RESULTS

Patients or their relatives expressed their gut feelings by using words relating to trusting or not trusting the situation, or to changes in normal patterns. Their gut feelings are most often felt as a sense of alarm. In general, patients experiencing a sense of alarm, particularly mothers of sick children, were convinced that something was wrong and had often learned to trust their gut feeling. A gut feeling was the main reason to contact a PCP. Patients generally felt that their gut feelings were taken seriously.

CONCLUSION

The findings of this study provide an insight into how patients and relatives may express their gut feelings about their own or their relative's health and how they share these feelings with healthcare professionals. This may help clinicians improve their recognition of patients' gut feelings, being particularly alert to a patient or relative using phrases that relate to feelings of not trusting a situation, things seeming wrong or different from normal, and experiencing a sense of alarm. Further research should be carried out into the validity of patients' gut feelings.

A Team-based Learning Approach During Pediatric Clerkship to Promote Clinical Reasoning

BACKGROUND

Clinical reasoning skills are essential to medical practice. The problem lies in assuming junior medical students with limited experience develop clinical reasoning and decision-making skills passively and solely through clinical exposure. To prepare learners for independent practice and care for future patients, explicit teaching and assessment of clinical reasoning in low-stakes, collaborative learning environments are needed.

METHODS

The key-feature question (KFQs) format is an assessment approach that focuses on the reasoning and decision-making aspects of medical problems rather than knowledge recall. This report describes the development, implementation, and evaluation of a team-based learning (TBL) approach using KFQs to foster clinical reasoning in the third-year pediatric clerkship at our institution.

RESULTS

Over the first 2 years of implementation (2017-18, 2018-19), 278 students participated in TBL sessions. Mean individual student scores significantly improved in the group setting for both academic years (P < .001). Individual scores were moderately positively correlated with their total summative Objective Structured Clinical Examination score (r[275] = 0.51; P < .001). The correlation between individual score and their multiple-choice question examination was weaker at 0.29 (P < .001) but remained positive.

CONCLUSIONS

A TBL session using KFQs to both teach and assess clinical reasoning in clerkship students may help educators identify students with gaps in knowledge and/or reasoning. The next steps include developing and implementing individualized coaching opportunities, and expanding this approach within the undergraduate medical curriculum. Outcome measures to assess clinical reasoning in authentic patient encounters require further research and development.

Keeping it all in balance: a qualitative analysis of the role of balance outcome measurement in physical therapist decision-making and patient outcomes

PURPOSE

The use of outcome measures (OMs) is a hallmark of contemporary physical therapy in the USA. The effect of OM utilization on patient care decisions and the results of PT services remain poorly understood. The purpose of this study is to explore PTs perceptions about the relationship between balance OMs and decision-making and how that interaction impacts patient outcomes, particularly for patients with acquired brain injury.

MATERIALS AND METHODS

This qualitative study used semi-structured phone interviews with an interview guide. Maximum variation sampling was used. Thematic analysis was situated in a priori determined theory-based categories.

RESULTS

Twenty-three physical therapists (PTs) from diverse geographic areas and practice settings participated. Therapists expressed diverse views on the impact of OM use on patient outcomes, but the majority perceived that using OMs improved rehabilitation outcomes. The use of OMs was related to the selection of optimal intervention type and intensity and justified continued high-frequency rehabilitation services. OMs were important to therapists' decision-making.

CONCLUSIONS

In the present study, PTs reported that they believe the use of validated, clinically useful OMs may improve patient outcomes.Implications For RehabilitationBalance outcome measures are considered an important tool to the optimal management of the profound impact of balance impairments after brain injury.Most physical therapists in this study believe that using balance outcome measures results in better outcomes for patients with brain injury.In this study, physical therapists reported using outcome measures in wide-ranging ways to guide clinical decisions about balance in those with brain injury.

The development of clinical reasoning throughout the training and career of psychiatrists in Singapore

Objectives

The current study sought to explain how different professional experiences led Singaporean psychiatrists to alter their clinical reasoning processes as their careers evolved from psychiatry residents to senior consultant psychiatrists.

Methods

The current qualitative study interviewed 26 clinicians at various stages of their psychiatric career, spanning residents to senior psychiatrists.  The authors used a constructivist grounded theory approach to structure the collection and analysis of data. Analyses produced a dense theoretical explanation rooted in the experiences of participants.

Results

Several differences emerged between the way psychiatry residents and senior psychiatrists explained their reasoning process and the experiences on which they based their preference. Residents preferred using deductive logic-driven frameworks that were diagnosis-centric, because of the pressures they experienced during their training and assessments. Senior psychiatrists emphasized a more holistic and problem-centric approach. Participants attributed the changes that occurred over time to practical experiences, such as their greater clinical responsibility and independence, and individual experiences, such as growing sensitivity to the clinical reasoning process or their growing propensity for professional reflectiveness. These changes manifest as an increase in repertoire and flexibility in deployment of different clinical reasoning strategies.

Conclusions

It is important for trainees to be aware of the deductive and inductive modes of clinical reasoning during supervision and to be comfortable with shifting clinical focus from diagnoses to specific individual problems. Training programs should provide and plan adequate longitudinal clinical exposure to develop clinical reasoning abilities in a way that allows consequences of decisions to be explored. Continued faculty development to ease the diversification of clinical reasoning skills should be encouraged, as should reflectivity in the learners during clinical supervision.

Domains of Students' Concerns in Oral Diagnosis and Surgery Clinic

Background

Oral diagnosis and surgery education is the main educational subject in dental schools. Due to its importance and the demand to achieve a proper level of training, dental students might have some concerns related to this subject. The study aims to investigate domains related to students' concerns in oral surgery clinics.

Materials and Method

An online questionnaire of five domains was circulated to 211 fourth, and fifth-year students. The domains include; the benefit of oral surgery lectures in oral surgery clinic; the importance of oral surgery clinic, what they fear the most during their oral surgery training; difficulty domain, and importance domain. It was distributed to a sample of 211 fourth-, and fifth-year students at the Ibn Sina College of Dentistry, Baghdad, Iraq in January, and February 2022.

Results

In the domain of "benefit of oral surgery lectures in the oral surgery clinic" Half of the respondents think theory lectures are useful. About one-third of the students believe it is essential. The most important item in the domain of "most factors students' fear" was the item of nerve injury (42.1%). Incomplete tooth removal was reported in (32.7%), whereas post-extraction bleeding was reported by (19.2%). In the domain "the most difficult" 71% of students stated that it is dealing with uncooperative patients was the most important item. Similarly, in the domain "the most important" the majority of students reported that correct surgical diagnosis (70.1%) is the most important item, followed by master extraction technique (26.2%), and master anesthesia technique (3.7%).

Conclusion

This study evaluated the "fear", "difficulty", and "importance" domains of students' concerns during oral surgery training. There is a noticeable shift in students' attention toward clinical reasoning compared to the technical aspects of surgical training. This positive shift reflects the perceived importance of diagnosis for proper clinical practice. This needs to be encouraged by the teaching staff.

Student and Faculty Perspectives on the Usefulness and Usability of a Digital Health Educational Tool to Teach Standardized Assessment of Persons After Stroke: Mixed Methods Study

BACKGROUND

The VSTEP Examination Suite is a collection of evidence-based standardized assessments for persons after stroke. It was developed by an interdisciplinary team in collaboration with clinician users. It consists of 5 standardized assessments: 2 performance-based tests using the Kinect camera (Microsoft Corp) to collect kinematics (5-Time Sit-to-Stand and 4-Square Test); 2 additional performance-based tests (10-Meter Walk Test and 6-Minute Walk Test); and 1 patient-reported outcome measure, the Activities-Specific Balance Confidence Scale.

OBJECTIVE

This study aimed to describe the development of the VSTEP Examination Suite and its evaluation as an educational tool by physical therapy students and faculty to determine its usefulness and usability.

METHODS

A total of 6 students from a Doctor of Physical Therapy program in the United States and 6 faculty members who teach standardized assessments in different physical therapy programs from the United States and Israel were recruited by convenience sampling to participate in the study. They interacted with the system using a talk-aloud procedure either in pairs or individually. The transcripts of the sessions were coded deductively (by 3 investigators) with a priori categories of usability and usefulness, and comments were labeled as negative or positive. The frequencies of the deductive themes of usefulness and usability were tested for differences between faculty and students using a Wilcoxon rank sum test. A second round of inductive coding was performed by 3 investigators guided by theories of technology adoption, clinical reasoning, and education.

RESULTS

The faculty members' and students' positive useful comments ranged from 83% (10/12) to 100%. There were no significant differences in usefulness comments between students and faculty. Regarding usability, faculty and students had the lowest frequency of positive comments for the 10-Meter Walk Test (5/10, 50%). Students also reported a high frequency of negative comments on the 4-Square Test (9/21, 43%). Students had a statistically significantly higher number of negative usability comments compared with faculty (W=5.7; P=.02), specifically for the 5-Time Sit-to-Stand (W=5.3; P=.02). Themes emerged related to variable knowledge about the standardized tests, value as a teaching and learning tool, technology being consistent with clinical reasoning in addition to ensuring reliability, expert-to-novice clinical reasoning (students), and usability.

CONCLUSIONS

The VSTEP Examination Suite was found to be useful by both faculty and students. Reasons for perceived usefulness had some overlap, but there were also differences based on role and experience. Usability testing revealed opportunities for technology refinement. The development of the technology by interdisciplinary teams and testing with multiple types of users may increase adoption.