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Knight H, Peterson J, Reilly M, Furze J, Jensen G. Implementation of a clinical reasoning blueprint: Knowledge translation resources. CLINICAL TEACHER 2024; 21:e13763. [PMID: 38497166 DOI: 10.1111/tct.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/06/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Heather Knight
- Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA
| | - Julie Peterson
- Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA
| | - Michelle Reilly
- Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA
| | - Jennifer Furze
- Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA
| | - Gail Jensen
- Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA
- Center for Health Professions Education, School of Medicine, Uniform Services University of Health Sciences, Bethesda, Maryland, USA
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Baker MJ, Maggio LA, Dorris CS, Uijtdehaage S, Soh M. Clinical supervision in medical education: A citation analysis. MEDICAL TEACHER 2024; 46:505-511. [PMID: 37949084 DOI: 10.1080/0142159x.2023.2257375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
PURPOSE Medical education relies on clinical supervision for critical functions, including trainee assessment and ensuring patient safety. Yet, there is substantial variance in supervision, which has led to calls for a shared definition of the concept and guidelines to inform practice. AMEE Guide No. 27 provided these desired elements and is highly cited, suggesting that translation and utilization of the Guide's knowledge is suboptimal. This study investigates utilization by systematically characterizing citations to the Guide and by describing translation of its recommendations in relation to supervision. MATERIALS AND METHODS Citations were identified using Web of Science, Scopus, and Google Scholar. The authors coded all citations and conducted a subanalysis of studies specific to supervision. RESULTS 583 studies were identified; 268 met inclusion criteria for general analysis of which 167 studies were further analyzed. Most studies reiterated the Guide's characterization of effective supervision, but few demonstrate how these recommendations inform innovations in supervisory practice. CONCLUSION Translation of the Guide's recommendations regarding clinical supervision appears limited. Future research should consider the extent of knowledge translation occurring in clinical supervision literature as well as AMEE Guides. Increased attention to knowledge translation in medical education may benefit the distribution of similar knowledge products.
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Affiliation(s)
- M J Baker
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
- Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - L A Maggio
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
| | - C S Dorris
- Dahlgren Memorial Library, Georgetown University Medical Center, Washington, DC, USA
| | - S Uijtdehaage
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
| | - M Soh
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
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Boyle SM, Martindale J, Parsons AS, Sozio SM, Hilburg R, Bahrainwala J, Chan L, Stern LD, Warburton KM. Development and Validation of a Formative Assessment Tool for Nephrology Fellows' Clinical Reasoning. Clin J Am Soc Nephrol 2024; 19:26-34. [PMID: 37851423 PMCID: PMC10843222 DOI: 10.2215/cjn.0000000000000315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Diagnostic errors are commonly driven by failures in clinical reasoning. Deficits in clinical reasoning are common among graduate medical learners, including nephrology fellows. We created and validated an instrument to assess clinical reasoning in a national cohort of nephrology fellows and established performance thresholds for remedial coaching. METHODS Experts in nephrology education and clinical reasoning remediation designed an instrument to measure clinical reasoning through a written patient encounter note from a web-based, simulated AKI consult. The instrument measured clinical reasoning in three domains: problem representation, differential diagnosis with justification, and diagnostic plan with justification. Inter-rater reliability was established in a pilot cohort ( n =7 raters) of first-year nephrology fellows using a two-way random effects agreement intraclass correlation coefficient model. The instrument was then administered to a larger cohort of first-year fellows to establish performance standards for coaching using the Hofstee method ( n =6 raters). RESULTS In the pilot cohort, there were 15 fellows from four training program, and in the study cohort, there were 61 fellows from 20 training programs. The intraclass correlation coefficients for problem representation, differential diagnosis, and diagnostic plan were 0.90, 0.70, and 0.50, respectively. Passing thresholds (% total points) in problem representation, differential diagnosis, and diagnostic plan were 59%, 57%, and 62%, respectively. Fifty-nine percent ( n =36) met the threshold for remedial coaching in at least one domain. CONCLUSIONS We provide validity evidence for a simulated AKI consult for formative assessment of clinical reasoning in nephrology fellows. Most fellows met criteria for coaching in at least one of three reasoning domains, demonstrating a need for learner assessment and instruction in clinical reasoning.
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Affiliation(s)
- Suzanne M. Boyle
- Section of Nephrology, Hypertension, and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - James Martindale
- Office of Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Andrew S. Parsons
- Division of General, Geriatric, Palliative, and Hospital Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Hilburg
- Renal, Electrolyte, and Hypertension Division, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jehan Bahrainwala
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Lili Chan
- Barbara T. Murphy Division of Nephrology, Mt. Sinai School of Medicine, New York, New York
| | - Lauren D. Stern
- Renal Section, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Karen M. Warburton
- Division of Nephrology, University of Virginia School of Medicine, Charlottsville, Virginia
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Wurth S, Maisonneuve H, Moussa MA, Campion B, Caire Fon N, Peltier C, Audétat MC. Development of complex pedagogical competencies and reflexivity in clinical teachers via distance learning: a mixed methods study. MEDICAL EDUCATION ONLINE 2023; 28:2265163. [PMID: 37818594 PMCID: PMC10569352 DOI: 10.1080/10872981.2023.2265163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/26/2023] [Indexed: 10/12/2023]
Abstract
Clinical reasoning is the cornerstone to healthcare practice and teaching it appropriately is of utmost importance. Yet there is little formal training for clinical supervisors in supervising this reasoning process. Distance education provides interesting opportunities for continuous professional development of healthcare professionals. This mixed methods study aimed at gaining in-depth understanding about whether and how clinical teachers can develop complex pedagogical competencies through participation in a Massive Open Online Course on the supervision of clinical reasoning (MOOC SCR). Participants self-assed their clinical supervision skills before and after partaking in the MOOC SCR through the Maastricht Clinical Teachers Questionnaire. Item scores and the distribution of response proportions before and after participation were compared using paired t-tests and McNemar's tests respectively. In parallel, the evolution of a subset of MOOC participants' pedagogical practice and posture was explored via semi-structured interviews throughout and beyond their MOOC participation using simulated and personal situational recalls. The verbatim were analysed with standard thematic analysis. Quantitative and qualitative findings converged and their integration demonstrated that partaking in the MOOC SCR promoted the development of complex pedagogical competencies and reflexivity with the participants. This was quantitatively evidenced by significantly higher self-assessed supervision skills and corresponding attitudes after completing the MOOC. The qualitative data provided rich descriptions of how this progression in pedagogical practice and posture occurred in the field and how it was shaped by participants' interaction with the MOOC's content and their motivations to progress. Our findings provide evidence for the development of pedagogical skills and corresponding attitudes for the supervision of clinical reasoning through participation in the MOOC SCR and contribute to the literature body on the opportunities that distance learning provides for the development of pedagogical competencies. The extent to which the pedagogical underpinnings of the MOOC contributed to these developments remains to be determined.
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Affiliation(s)
- Sophie Wurth
- Unit for Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Hubert Maisonneuve
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mohamed Amir Moussa
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Baptiste Campion
- Institute of Higher Studies in Social Communications, Brussels School of Journalism and Communication, Brussels, Belgium
| | - Nathalie Caire Fon
- Family Medicine and Emergency Medicine Department, Medicine, Université de Montréal, Montréal, Canada
| | - Claire Peltier
- Unit for Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Faculty of Educational Sciences, Université Laval, Quebec City, Canada
| | - Marie-Claude Audétat
- Unit for Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Isbej L, Fuentes-Cimma J, Véliz Paiva C, Valladares-Pérez S, Riquelme A. A comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:859-868. [PMID: 36458893 DOI: 10.1111/eje.12876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/05/2022] [Accepted: 10/30/2022] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Lorena Isbej
- Faculty of Medicine, School of Dentistry, Pontificia Universidad Católica de Chile, Santiago, Chile
- Pharmacology and Toxicology Programme, Faculty of Medicine Pontificia Universidad Católica de Chile, Santiago, Chile
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Javiera Fuentes-Cimma
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
- Department of Health Sciences, Faculty of Medicine Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Véliz Paiva
- Faculty of Medicine, School of Dentistry, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Arnoldo Riquelme
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centre of Medical Education and Health Sciences, Faculty of Medicine Pontificia Universidad Católica de Chile, Santiago, Chile
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Williams CR, Wolcott MD, Whitlock SN, Vernon-Platt T, Anksorus HN, Hitch WJ. Design, Implementation, and Outcomes of an Interprofessional Mobile Web Application for Preceptors for Challenging Issues. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100105. [PMID: 37597918 DOI: 10.1016/j.ajpe.2023.100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 08/21/2023]
Abstract
OBJECTIVE The purpose of this study was to develop and assess an easily accessible interprofessional mobile web application to assist preceptors with challenging teaching and learning situations. METHODS Phase 1 was a modified Delphi process of 48 advanced practice nursing, dentistry, medicine, and pharmacy preceptors to determine the content of the application. Phase 2 consisted of 12 preceptors from the 4 disciplines piloting a prototype to refine the tool using design-thinking principles. Feedback was analyzed using inductive coding and thematic analysis. Phase 3 evaluated the impact of the final tool on 80 preceptors' satisfaction, knowledge, self-efficacy, and perception of behavior change. RESULTS Consensus on 10 topics was reached in the following 3 themes: feedback and communication, clinical and professional development of learners, and precepting efficiency. Preceptors rated the tool as efficient and applicable. Features perceived as useful included concise and applicable content that was easy to navigate with practical video examples. Features to improve included academic jargon, length of content, and lack of connectivity with other preceptors. Knowledge and self-efficacy improved after the use of the refined tool. Change in perceptions of behavior after 1 month was mixed, with a significant change in accessing resources to address challenging situations and regularly reflecting on challenging situations and no significant change in awareness, frequency, or success in managing challenging situations. CONCLUSION An interprofessional mobile web application for challenging teaching and learning situations developed through a modified Delphi process was deemed efficient and relevant and demonstrated positive knowledge and self-efficacy change.
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Affiliation(s)
- Charlene R Williams
- The University of North Carolina Chapel Hill Eshelman School of Pharmacy, Asheville, NC, USA.
| | - Michael D Wolcott
- The University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA; The University of North Carolina Adams School of Dentistry, Chapel Hill, NC, USA; High Point University School of Dental Medicine and Oral Health, High Point, NC, USA
| | - Sandra N Whitlock
- University of North Carolina School of Medicine Asheville Campus, Asheville, NC, USA
| | | | - Heidi N Anksorus
- The University of North Carolina Chapel Hill Eshelman School of Pharmacy, Asheville, NC, USA
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Hermasari BK, Nugroho D, Maftuhah A, Pamungkasari EP, Budiastuti VI, Laras AA. Promoting medical student's clinical reasoning during COVID-19 pandemic. KOREAN JOURNAL OF MEDICAL EDUCATION 2023; 35:187-198. [PMID: 37291847 DOI: 10.3946/kjme.2023.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/17/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The development of students' clinical reasoning skills should be a consideration in the design of instruction and evaluation in medical education. In response to the coronavirus disease 2019 (COVID-19) pandemic, several changes in the medical curriculum have been implemented in promoting clinical reasoning. This study aims to explore medical students' perceptions and experiences with the clinical reasoning curriculum during the COVID-19 pandemic and determine their skills development. METHODS The study used a mixed-method design with a concurrent approach. A cross-sectional study was conducted to compare and examine the relationship between the outcomes of the structured oral examination (SOE) and the Diagnostic Thinking Inventory (DTI). Then, the qualitative method was used. A focus group discussion using a semi-structured interview guide with open-ended questions was conducted, then the verbatim transcript was subjected to thematic analysis. RESULTS There is an increase in SOE and DTI scores between second-year to fourth-year students. The diagnostic thinking domains and SOE are significantly correlated (r=0.302, 0.313, and 0.241 with p<0.05). The three primary themes from the qualitative analysis are perceptions regarding clinical reasoning, clinical reasoning activities, and the learning component. CONCLUSION Even if students are still studying throughout the COVID-19 pandemic, their clinical reasoning skills can improve. The clinical reasoning and diagnostic thinking skills of medical students increase as the length of the school year increases. Online case-based learning and assessment support the development of clinical reasoning skills. The skills are supported in their development by positive attitudes toward faculty, peers, case type, and prior knowledge.
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Affiliation(s)
| | - Dian Nugroho
- Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Atik Maftuhah
- Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
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Croskerry P, Campbell SG, Petrie DA. The challenge of cognitive science for medical diagnosis. Cogn Res Princ Implic 2023; 8:13. [PMID: 36759370 PMCID: PMC9911579 DOI: 10.1186/s41235-022-00460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/23/2022] [Indexed: 02/11/2023] Open
Abstract
The historical tendency to view medicine as both an art and a science may have contributed to a disinclination among clinicians towards cognitive science. In particular, this has had an impact on the approach towards the diagnostic process which is a barometer of clinical decision-making behaviour and is increasingly seen as a yardstick of clinician calibration and performance. The process itself is more complicated and complex than was previously imagined, with multiple variables that are difficult to predict, are interactive, and show nonlinearity. They appear to characterise a complex adaptive system. Many aspects of the diagnostic process, including the psychophysics of signal detection and discrimination, ergonomics, probability theory, decision analysis, factor analysis, causal analysis and more recent developments in judgement and decision-making (JDM), especially including the domain of heuristics and cognitive and affective biases, appear fundamental to a good understanding of it. A preliminary analysis of factors such as manifestness of illness and others that may impede clinicians' awareness and understanding of these issues is proposed here. It seems essential that medical trainees be explicitly and systematically exposed to specific areas of cognitive science during the undergraduate curriculum, and learn to incorporate them into clinical reasoning and decision-making. Importantly, this understanding is needed for the development of cognitive bias mitigation and improved calibration of JDM in clinical practice.
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Affiliation(s)
- Pat Croskerry
- Department of Emergency Medicine, Faculty of Medicine, Dalhousie University, Halifax, Canada.
| | - Samuel G. Campbell
- grid.55602.340000 0004 1936 8200Department of Emergency Medicine, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - David A. Petrie
- grid.55602.340000 0004 1936 8200Department of Emergency Medicine, Faculty of Medicine, Dalhousie University, Halifax, Canada
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Carr A(MN, Kirkwood RN, Petrovski KR. Facilitating Development of Problem-Solving Skills in Veterinary Learners with Clinical Examples. Vet Sci 2022; 9:510. [PMID: 36288123 PMCID: PMC9611840 DOI: 10.3390/vetsci9100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/31/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022] Open
Abstract
This paper seeks to open discussion on the teaching of problem-solving skills in veterinary learners. We start by defining the term problem before discussing what constitutes problem-solving. For veterinary medical learners, problem-solving techniques are similar to those of decision-making and are integral to clinical reasoning. Problem-solving requires the veterinary learner to organize information logically to allow application of prior or new knowledge in arriving at a solution. The decision-making must encompass choices that provide the most beneficial and economical approach. In a modification of an existing protocol, we suggest the inclusion of the 5 elements: (1) define the problem list; (2) create an associated timeline; (3) describe the (anatomical) system involved or the pathophysiological principle applicable to the case; (4) propose management for the case; and (5) identify unique features of the case. During problem-solving activities, the instructor should take the role of facilitator rather than teacher. Skills utilized in the facilitation of problem-solving by learners include coaching, differential reinforcement, effective feedback, modelling and 'think out loud'. Effective feedback must inform learners of their progress and performance, as this is fundamental to continued learning and motivation to succeed. In order to put the above into context, we end with an example case scenario showing how we would approach the teaching of problem-solving to veterinary learners.
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Affiliation(s)
- Amanda (Mandi) Nichole Carr
- Davies Livestock Research Centre, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA 5371, Australia
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA 5371, Australia
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA 5371, Australia
| | - Roy Neville Kirkwood
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA 5371, Australia
| | - Kiro Risto Petrovski
- Davies Livestock Research Centre, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA 5371, Australia
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA 5371, Australia
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA 5371, Australia
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Newsom LC, Augustine J, Momary K. Development of a script concordance test to assess clinical reasoning in a pharmacy curriculum. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1135-1142. [PMID: 36154958 DOI: 10.1016/j.cptl.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Clinical reasoning is a vital skill for student pharmacists in the provision of patient-centered care, but these skills are often difficult to assess in the didactic curriculum. A script concordance test (SCT) is an innovative assessment method that can be used to assess clinical reasoning skills. The objective of this study was to develop and refine an SCT to assess clinical reasoning skills of third year student pharmacists (P3s). METHODS An SCT was written and administered to P3s. Pharmacy practice faculty members served as the expert group. The SCT was scored and Rasch analysis was performed. RESULTS The SCT included 20 case vignettes and 60 questions. Test reliability was 0.34 with mean square values for all items between 0.7 and 1.3. Forty-two questions had a difficulty score between 0 and - 1 logits, indicating there were multiple questions with similar difficulty levels. Two case vignettes and 43.3% of questions (n = 26) were revised to enhance clarity and decrease ambiguity. CONCLUSIONS The SCT is a tool to assess clinical reasoning in the didactic curriculum. Faculty can create the SCT and use statistical methods such as Rasch analysis to assess validity and reliability of the SCT.
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Affiliation(s)
- Lydia C Newsom
- Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341-4115, United States.
| | - Jill Augustine
- Department of Pharmacy Practice and the Department of Pharmaceutical Sciences, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341-4115, United States.
| | - Kathryn Momary
- Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341-4115, United States.
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Cheong CWS, Quah ELY, Chua KZY, Lim WQ, Toh RQE, Chiang CLL, Ng CWH, Lim EG, Teo YH, Kow CS, Vijayprasanth R, Liang ZJ, Tan YKI, Tan JRM, Chiam M, Lee ASI, Ong YT, Chin AMC, Wijaya L, Fong W, Mason S, Krishna LKR. Post graduate remediation programs in medicine: a scoping review. BMC MEDICAL EDUCATION 2022; 22:294. [PMID: 35443679 PMCID: PMC9020048 DOI: 10.1186/s12909-022-03278-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the 'deliberate practice of improving performance through practising beyond one's comfort level under guidance'. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs. METHODS Krishna's Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA's Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions. RESULTS The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs. CONCLUSION Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy's Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation's role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.
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Affiliation(s)
- Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elijah Gin Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Cheryl Shumin Kow
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Raveendran Vijayprasanth
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Zhen Jonathan Liang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yih Kiat Isac Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Javier Rui Ming Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, 117599 Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854 Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
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Smith KJ, Childs‐Kean LM, Smith MD. Developing Clinical Reasoning: An Introduction for Pharmacy Preceptors. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kathryn J. Smith
- University of Oklahoma Health Sciences Center College of Pharmacy 1110 N. Stonewall Ave CPB 229 Oklahoma City Oklahoma
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Newsom L, Augustine J, Funk K, Janke KK. Enhancing the "What" and "Why" of the Pharmacists' Patient Care Process With the "How" of Clinical Reasoning. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:8697. [PMID: 34385175 PMCID: PMC10159414 DOI: 10.5688/ajpe8697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/30/2021] [Indexed: 05/06/2023]
Abstract
Objectives. Clinical reasoning is integral to the provision of patient-centered care as outlined in the Pharmacists' Patient Care Process (PPCP). However, the PPCP was not created to foster clinical reasoning in student pharmacists and cannot be the sole tool used to characterize or cultivate these skills. This article describes elements of clinical reasoning, the relationship between clinical reasoning and PPCP, and concepts from the clinical reasoning literature that should inform the teaching of clinical reasoning skills.Findings. Key elements of the PPCP were identified in clinical reasoning definitions, but differences emerged. The literature supports clinical reasoning as a bidirectional, fluid process that is highly collaborative. Effective clinical reasoning requires multiple types of "thinking," interaction with others and the environment, self-assessment, and a tolerance for nuance or ambiguity. Teaching strategies can be used in the didactic and experiential setting to target the cognitive and contextual factors associated with clinical reasoning.Summary. Educators should consult the literature to enhance our understanding of clinical reasoning in seeking to teach, model, and foster these skills in our students. Future scholarship should include the development of models to support clinical reasoning within the profession of pharmacy, adoption and experimentation with clinical reasoning teaching techniques, and valuation of the utility of various assessment tools and processes.
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Affiliation(s)
- Lydia Newsom
- Mercer University, College of Pharmacy, Atlanta, Georgia
| | - Jill Augustine
- Mercer University, College of Pharmacy, Atlanta, Georgia
| | - Kylee Funk
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
| | - Kristin K Janke
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
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Sam AH, Wilson R, Westacott R, Gurnell M, Melville C, Brown CA. Thinking differently - Students' cognitive processes when answering two different formats of written question. MEDICAL TEACHER 2021; 43:1278-1285. [PMID: 34126840 DOI: 10.1080/0142159x.2021.1935831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Single-best answer questions (SBAQs) are common but are susceptible to cueing. Very short answer questions (VSAQs) could be an alternative, and we sought to determine if students' cognitive processes varied across question types and whether students with different performance levels used different methods for answering questions. METHODS We undertook a 'think aloud' study, interviewing 21 final year medical students at five UK medical schools. Each student described their thought processes and methods used for eight questions of each type. Responses were coded and quantified to determine the relative frequency with which each method was used, denominated on the number of times a method could have been used. RESULTS Students were more likely to use analytical reasoning methods (specifically identifying key features) when answering VSAQs. The use of test-taking behaviours was more common for SBAQs; students frequently used the answer options to help them reach an answer. Students acknowledged uncertainty more frequently when answering VSAQs. Analytical reasoning was more commonly used by high-performing students compared with low-performing students. CONCLUSIONS Our results suggest that VSAQs encourage more authentic clinical reasoning strategies. Differences in cognitive approaches used highlight the need for focused approaches to teaching clinical reasoning and dealing with uncertainty.
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Affiliation(s)
- Amir H Sam
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Rebecca Wilson
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Rachel Westacott
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Mark Gurnell
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Colin Melville
- School of Medical Sciences, University of Manchester, Manchester, UK
| | - Celia A Brown
- Division of Health Sciences, University of Warwick, Coventry, UK
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Kawase Y, Miyashita M, Okayasu M, Hirai Y. Development of a Clinical Judgment Scale for Japanese Nurses. J Contin Educ Nurs 2021; 52:383-391. [PMID: 34324379 DOI: 10.3928/00220124-20210714-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to develop a scale to assess the clinical judgment of nurses based on the clinical judgment process. METHOD Based on a qualitative analysis of interviews with specialized and certified nurses and extant literature, a scale comprising 44 question items was created. A questionnaire survey was conducted with 1,444 nurses working in 28 general hospitals, psychiatric wards, cardiac care units, and intensive care units in Japan. RESULTS Valid responses were obtained from 610 nurses. Exploratory factor analysis was performed on the 23 items extracted by item analysis, and two factors, "theoretical and practical reasoning" and "grasping the condition by observation," were extracted. Confirmatory factor analysis revealed the fit of the model. Cronbach's alpha confidence factor was 0.943 for the first factor and 0.924 for the second factor. CONCLUSION These results support the factor validity and reliability of the clinical judgment scale. [J Contin Educ Nurs. 2021;52(8):383-391.].
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Lanier C, Muller-Juge V, Dominicé Dao M, Gaspoz JM, Junod Perron N, Audétat MC. Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary! PLoS One 2021; 16:e0254336. [PMID: 34283854 PMCID: PMC8291751 DOI: 10.1371/journal.pone.0254336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
AIMS OF THE STUDY Residents in difficulty are a major cause for concern in medical education, with a prevalence of 7-15%. They are often detected late in their training and cannot make use of remediation plans. Nowadays, most training hospitals in Switzerland do not have a specific program to identify and manage residents in difficulty. The aim of the study was to explore the challenges perceived by physicians regarding the process of identifying, diagnosing, and supporting residents in difficulty in a structured and programmatic way. We explored perceptions of physicians at different hierarchical levels (residents (R), Chief residents (CR), attending physicians (A), Chief Physician (CP)) in order to better understand these challenges. METHODS We conducted an exploratory qualitative study between December 2015 and July 2016. We asked volunteers from the Primary Care Division of the Geneva University Hospitals to partake to three focus groups (with CR, A, R) and one interview with the division's CP. We transcribed, coded, and qualitatively analyzed the three focus groups and the interview, using a content thematic approach and Fishbein's conceptual framework. RESULTS We identified similarities and differences in the challenges of the management of residents in difficulty on a programmatic way amongst physicians of different hierarchical levels. Our main findings: Supervisors (CR, A, CP) have good identification skills of residents in difficulty, but they did not put in place systematic remediation strategies.Supervisors (CR, A) were concerned about managing residents in difficulty. They were aware of the possible adverse effects on patient care, but "feared to harm" resident's career by documenting a poor institutional assessment.Residents "feared to share" their own difficulties with their supervisors. They thought that it would impact their career negatively.The four physician's hierarchical level reported environmental constraints (lack of funding, time constraint, lack of time and resources…). CONCLUSION Our results add two perspectives to specialized recommendations regarding the implementation of remediation programs for residents in difficulty. The first revolves around the need to identify and fully understand not only the beliefs but also the implicit norms and the feeling of self-efficacy that are shared by teachers and that are likely to motivate them to engage in the management of residents in difficulty. The second emphasizes the importance of analyzing these elements that constitute the context for a change and of identifying, in close contact with the heads of the institutions, which factors may favor or hinder it. This research action process has fostered awareness and discussions at different levels. Since then, various actions and processes have been put in place at the Faculty of Medicine in Geneva.
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Affiliation(s)
- Cédric Lanier
- Family Medicine Unit (UIGP), University of Geneva, Geneva, Switzerland
- * E-mail:
| | | | - Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Noëlle Junod Perron
- Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Marie-Claude Audétat
- Family Medicine Unit (UIGP), University of Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
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Dy-Boarman EA, Bryant GA, Herring MS. Faculty preceptors' strategies for teaching clinical reasoning skills in the advanced pharmacy practice experience setting. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:623-627. [PMID: 33867056 DOI: 10.1016/j.cptl.2021.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 11/23/2020] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Clinical reasoning is essential to providing quality patient care. However, advanced pharmacy practice experience (APPE) students may struggle with the real-life aspects of patient care, and it may be difficult to quickly identify these students in order to make meaningful interventions. The purpose of this study was to explore pharmacy faculty preceptors' strategies for identifying gaps and teaching clinical reasoning in the APPE setting. METHODS A qualitative study utilizing 30-min, one-on-one phone interviews was conducted with faculty members from two schools of pharmacy. Faculty participants were invited based on their APPE preceptor role and expertise in adult general medicine. Interview questions collected faculty demographics and reflections on evaluation and instruction of clinical reasoning skills. Demographics were analyzed using descriptive statistics. Thematic analysis was completed to identify themes from qualitative interview data. RESULTS Fifteen faculty preceptors participated. The cohort had an average of 17.1 pharmacy practice years and an average of 11.9 faculty member years. Interviews yielded a 7735-word document for data analysis, which resulted in 11 themes. CONCLUSIONS This study explored pharmacy faculty preceptors' strategies for identifying gaps in clinical reasoning and their instructional methods to improve those skills, which resulted in 11 themes. Future directions include implementation of a standardized clinical reasoning assessment tool in the APPE setting and exploration of targeted educational interventions.
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Affiliation(s)
- Eliza A Dy-Boarman
- Associate Professor, Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Avenue, Des Moines, IA 50311-4505, United States.
| | - Ginelle A Bryant
- Associate Professor, Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Avenue, Des Moines, IA 50311-4505, United States.
| | - Morgan S Herring
- Clinical Associate Professor, Department of Pharmacy Practice and Science/Division of Applied Clinical Sciences, University of Iowa College of Pharmacy, 115 South Grand Avenue, Iowa City, Iowa 52242, United States.
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Petersen EJ, Thurmond SM, Jensen GM. Severity, Irritability, Nature, Stage, and Stability (SINSS): A clinical perspective. J Man Manip Ther 2021; 29:297-309. [PMID: 33999785 DOI: 10.1080/10669817.2021.1919284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Clinical reasoning errors in health-care can be mitigated with the use of systematic strategies and tools. One of these strategies is the SINSS construct, an acronym for Severity, Irritability, Nature, Stage, and Stability. The construct of SINSS appears in several textbooks and peer-reviewed articles. However, it has been inconsistently defined and applied in clinical practice. In this clinical perspective, the terms of the SINSS construct are defined in detail and their application to clinical practice is discussed. Current research showing the application of SINSS as a whole in clinical practice and educational settings is also presented. Recommendations for future application of SINSS are provided to advance the study of clinical reasoning and help minimize diagnostic, prognostic, and interventional clinical errors. The systematic use of SINSS allows the clinician to gain a thorough understanding of the patient's condition and symptoms, which can lead to a well-tolerated and appropriately tailored physical examination and intervention. Additionally, the proper use of this construct can result in more optimal patient outcomes, as well as provide a structure for the mentor and learner in helping uncover errors in the learner's clinical reasoning process.
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Affiliation(s)
- Evan J Petersen
- University of the Incarnate Word, School of Physical Therapy, San Antonio, TX, USA
| | - Stephanie M Thurmond
- Bowling Green State University, School of Physical Therapy, Bowling Green, OH, USA
| | - Gail M Jensen
- Creighton University, Graduate School and College of Professional Studies, Omaha, NE, USA
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Minshew LM, Williams CR, Dinkins MM, Haltom WR, Brown KPD, McLaughlin JE. Developing a process to manage challenges encountered by experiential education administrators. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:318-326. [PMID: 33715791 DOI: 10.1016/j.cptl.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/16/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION This study explored preceptor and student related issues reported in pharmacy experiential education settings and solutions that experiential education administrators (EEAs) applied to inform a process to manage these challenges. METHODS This mixed-methods study was conducted in two phases. In phase one, five EEAs from three schools of pharmacy collected quantitative and qualitative data over a two-year period on issues reported by students and preceptors and the solutions EEAs employed. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data, respectively. Interviews with six EEAs from four schools were completed in phase two. An additional school was added in phase two. Open coding, pattern coding, and summative analysis were completed on interview data. RESULTS Preceptors and students reported 156 and 65 issues, respectively. The most common issues reported were student reliability/responsibility (22, 14%) and preceptor communication (13, 20%). The most frequently applied solutions were coach preceptor (51, 24%) and meet with student (20, 24%). Interviews revealed more information about the strategies EEAs used. Approaches included reactive responses such as talking to and coaching preceptors or students. Preventative strategies were desired, such as tracking data and training. CONCLUSIONS Results informed two approaches that EEAs can employ to resolve student and preceptor issues. In the proactive process, issues are tracked to inform student and preceptor development. The reactive approach involves meeting with the preceptor or student, gathering information from both parties, coaching the preceptor or student, and involving other administrators as needed for serious concerns.
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Affiliation(s)
- Lana M Minshew
- UNC Eshelman School of Pharmacy, CB # 7355, 321 Beard Hall, 301 Pharmacy lane, Chapel Hill, NC 27599, United States.
| | - Charlene R Williams
- UNC Eshelman School of Pharmacy, CB #2125, 114D Karpen Hall, One University Heights, Asheville, NC 28804, United States.
| | - Melissa M Dinkins
- Wingate University School of Pharmacy, 515 N Main Street, Wingate, NC 28714, United States.
| | - Wesley R Haltom
- Wingate University School of Pharmacy, 515 N Main Street, Wingate, NC 28714, United States.
| | - K Paige D Brown
- Campbell University College of Pharmacy & Health Sciences, PO Box 1090, Buies Creek, NC 27506, United States.
| | - Jacqueline E McLaughlin
- UNC Eshelman School of Pharmacy, Campus Box 7574, 321 B Beard Hall, 301 Pharmacy Lane, Chapel Hill, NC 27599, United States.
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Sader J, Clavien C, Korris J, Hurst S, Nendaz M, Audétat MC. Serious game training in medical education: potential to mitigate cognitive biases of healthcare professionals. Diagnosis (Berl) 2021; 8:536-537. [PMID: 33607705 DOI: 10.1515/dx-2021-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Julia Sader
- UDREM - Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,iEH2 - Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christine Clavien
- iEH2 - Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - James Korris
- CTI - Creative Technologies, Inc., Los Angeles, CA, USA
| | - Samia Hurst
- iEH2 - Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mathieu Nendaz
- UDREM - Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,HUG - Department of Medicine University Hospitals Geneva, Geneva, Switzerland
| | - Marie-Claude Audétat
- UDREM - Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Deschênes MF, Goudreau J, Fernandez N. Learning strategies used by undergraduate nursing students in the context of a digitial educational strategy based on script concordance: A descriptive study. NURSE EDUCATION TODAY 2020; 95:104607. [PMID: 33045676 DOI: 10.1016/j.nedt.2020.104607] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/27/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND the digital educational strategy based on script concordance is an educational method that has been attracting increasing attention in healthcare education programs to fostering the development of clinical reasoning. It includes a digitized Script Concordance Test with incorporated expert feedback. However, the learning strategies required of students in the context of its use remain unknown. OBJECTIVE This study aimed to identify the learning strategies that undergraduate nursing students need to use in the context of the digital educational strategy based on script concordance. METHOD A qualitative descriptive design was used to identify student learning strategies. Data was collected using an online questionnaire and semi-directed focus group interviews. Bégin's taxonomy provided the framework for linking the data collected to learning strategies required of students. RESULTS Forty-four students participated in the study. Results show that when using a digital educational strategy based on script concordance, students are called to rely on their nascent scripts in order to select the data in short ill-defined clinical vignettes, evaluate new information repeatedly, anticipate microjudgments, and thus, gradually increase their knowledge and refine their scripts. Viewing the experts' feedback and consulting the referencing tools helped students self-monitor their knowledge, a key metacognitive strategy to learning clinical reasoning. Completed individually or with peers, the digital educational strategy could be used to learn a particular concept or as an integrative activity before an evaluation. CONCLUSION This original study has allowed us to link nursing clinical reasoning teaching conditions to the learning strategies used to develop this competency. Study results inform instructors about digital educational strategy based on script concordance to make it complementary with other educational strategies to better support complex learning of nursing clinical reasoning.
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Affiliation(s)
- Marie-France Deschênes
- Faculty of Nursing, Université de Montréal, Canada; Center for innovation in nursing education (CIFI), Faculty of Nursing, Université de Montréal, Quebec, Canada.
| | - Johanne Goudreau
- Faculty of Nursing, Université de Montréal, Canada; Center for innovation in nursing education (CIFI), Faculty of Nursing, Université de Montréal, Quebec, Canada
| | - Nicolas Fernandez
- Center of heath science pedagogy - Centre de pédagogie appliquées aux sciences de la santé (CPASS), Faculty of Famility Medicine and Emergency Medecine, Université de Montréal, Quebec, Canada
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Gruppetta M, Mallia M. Clinical reasoning: exploring its characteristics and enhancing its learning. Br J Hosp Med (Lond) 2020; 81:1-9. [DOI: 10.12968/hmed.2020.0227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical reasoning is an extensive and intricate field, dealing with the process of thinking and decision making in practice. Its study can be quite challenging because it is context and task dependent. Educational frameworks such as the conscious competence model and the dual process reasoning model have been developed to help its understanding. To enhance the learning of clinical reasoning, there are significant areas that can be targeted through learning processes. These include knowledge adequacy; ability to gather appropriate patient data; use of proper reasoning strategies to address specific clinical questions; and the ability to reflect and evaluate on decisions taken, together with the role of the wider practice community and the activity of professional socialisation. This article explores the characteristics of clinical reasoning and delves deeper into the various strategies that prove useful for learning.
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Affiliation(s)
- Mark Gruppetta
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Mater Dei Hospital, Msida, Malta
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Maria Mallia
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Mater Dei Hospital, Msida, Malta
- Department of Neuroscience, Mater Dei Hospital, Msida, Malta
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Covin Y, Longo P, Wick N, Gavinski K, Wagner J. Empirical comparison of three assessment instruments of clinical reasoning capability in 230 medical students. BMC MEDICAL EDUCATION 2020; 20:264. [PMID: 32787953 PMCID: PMC7425135 DOI: 10.1186/s12909-020-02185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Several instruments intend to measure clinical reasoning capability, yet we lack evidence contextualizing their scores. The authors compared three clinical reasoning instruments [Clinical Reasoning Task (CRT), Patient Note Scoring rubric (PNS), and Summary Statement Assessment Rubric (SSAR)] using Messick's convergent validity framework in pre-clinical medical students. Scores were compared to a validated clinical reasoning instrument, Clinical Data Interpretation (CDI). METHOD Authors administered CDI and the first clinical case to 235 students. Sixteen randomly selected students (four from each CDI quartile) wrote a note on a second clinical case. Each note was scored with CRT, PNS, and SSAR. Final scores were compared to CDI. RESULTS CDI scores did not significantly correlate with any other instrument. A large, significant correlation between PNS and CRT was seen (r = 0.71; p = 0.002). CONCLUSIONS None of the tested instruments outperformed the others when using CDI as a standard measure of clinical reasoning. Differing strengths of association between clinical reasoning instruments suggest they each measure different components of the clinical reasoning construct. The large correlation between CRT and PNS scoring suggests areas of novice clinical reasoning capability, which may not be yet captured in CDI or SSAR, which are weighted toward knowledge synthesis and hypothesis testing.
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Affiliation(s)
- Yvonne Covin
- Department of Internal Medicine, Division of General and Hospital Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA.
| | - Palma Longo
- Department of Healthcare Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Neda Wick
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Katherine Gavinski
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - James Wagner
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Garraud O, Vuk T, Brand A, de Angelis V, Politis C, Haddad A, Vlaar APJ, Lozano M, Ertuğrul Örüç N, Laspina S, Tissot JD. Medical student education in transfusion medicine, part II: Moving forward to building up a "Know How" education program in transfusion medicine for under-graduate medical students. Transfus Apher Sci 2020; 59:102879. [PMID: 32718832 DOI: 10.1016/j.transci.2020.102879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 01/24/2023]
Abstract
There is a general trend in changing paradigm in teaching medicine; the emerging concept relies on a competence-based approach. Transfusion is either a discipline or a subsidiary of others depending on the countries and systems; this variability can be explained because transfusion is a medical care that is transdisciplinary. As a collective of professionals in both transfusion medicine practice and education, authors aim to propose a revision of the way education in transfusion medicine is delivered in this era of the 'global competency approach'. They advocate in favor of a Know How on 5 key issues: Diagnosing the patient condition in line with the Patient Blood Management principles; Facing acute blood loss; Addressing compatibility and avoiding immunization; Seeking for maximized benefits and dampening complications; and Inlaying competence within global health care issues, also comprising od economy. The methods used would be those developed for medical education at large, such as assessment tools. The global objective is to deliver the necessary competence to manage patients by an intern/resident. At the end of the curriculum, students should be able to self-evaluate the following items: 1) Do I know why my patient is anemic, thrombocytopenic, bleeding….? 2) Do I know the best approach to treat anemia, thrombocytopenia, bleeding (including the "no treatment" option)? 3) Do I know whether a transfusion approach is appropriate for my patients? 4) Do I know how to evaluate and anticipate benefits from blood transfusion and to avoid side-effects in the patient? 5) Do I know how to avoid unnecessary use of the products?
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Affiliation(s)
- Olivier Garraud
- Faculty of Medicine of Saint-Etienne, University of Lyon, Saint-Etienne, France; Institut National De La Transfusion Sanguine, Paris, France; Palliative Care Unit, Ruffec Hospital, Ruffec, France.
| | - Tomislav Vuk
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia; Josip Juraj Strossmayer University of Osijek - Faculty of Medicine, Osijek, Croatia
| | - Anneke Brand
- Transfusion Medicine, Leiden University Medical Center, Leiden University, the Netherlands
| | | | - Constantina Politis
- Coordinating Haemovigilance Centre (SKAE), Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - Antoine Haddad
- Faculty of Medicine of Saint-Etienne, University of Lyon, Saint-Etienne, France; Department of Clinical Pathology and Blood Bank, Sacre-Coeur Hospital, Lebanese University, Beirut, Lebanon
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Miquel Lozano
- Clinic University Hospital Barcelona, University of Barcelona, Spain
| | - Nigar Ertuğrul Örüç
- Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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[How to formalise the supervision of learning of clinical reasoning]. Rev Med Interne 2020; 41:529-535. [PMID: 32674893 DOI: 10.1016/j.revmed.2020.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/14/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022]
Abstract
Since clinical reasoning is central to most decisions made in the clinic, it is essential to teach it with the greatest relevance. Knowing that around 10% of learners encounter major difficulties in clinical reasoning during their course, training supervisors in effective pedagogical interventions is crucial. Here we summarize the methods allowing supervisors to identify errors of clinical reasoning in medical students and interns and we explain remediation techniques adapted to the types of error identified. Access to short illustrative videos of a MOOC (Massive Open On line Course) devoted to the supervision of clinical reasoning constitutes practical help for supervisors who are not expert in the complexity of medical pedagogy at bedside.
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Firouzi M, Dadmehr M, Soltani Arabshahi SK, Bahrami M. The earliest recorded model of clinical reasoning in Persian medicine: A historical perspective from the viewpoint of Haly Abbas. MEDICAL TEACHER 2020; 42:481. [PMID: 31402783 DOI: 10.1080/0142159x.2019.1643458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Mojdeh Firouzi
- Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
- School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Dadmehr
- Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
- School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kamran Soltani Arabshahi
- Medical Education Department, Faculty of Medicine, CERMS (Center of Educational Research in Medical Sciences), Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Bahrami
- Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
- School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
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Gagnon N, Bernier C, Houde S, Xhignesse M. Teaching and learning clinical reasoning: a teacher's toolbox to meet different learning needs. Br J Hosp Med (Lond) 2020; 81:1-8. [PMID: 32239995 DOI: 10.12968/hmed.2019.0406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical reasoning is an essential part of medical practice and therefore should be an important part of clinical teaching. However, it has been and is still a challenge for clinical teachers to support learners in the development of their clinical reasoning skills. As learners progress in clerkship, so do their learning needs. As a result, teachers need multiple tools to foster the development of clinical reasoning and should know when and why to use them. This article presents tools gathered as part of a clinical teacher's toolbox aimed at coaching learners towards the next step in their clinical reasoning development as well as helping teachers diagnose clinical reasoning difficulties and meet the diverse learning needs of their learners. The article focuses on three tools that were developed by faculty at the University of Sherbrooke Faculty of Medicine and Health Sciences: the iSNAPPS-OMP Technique, the Anticipatory Supervision Technique and the Clinical Sudoku or table of discriminating clues. This article uses the term 'tools' as a generic expression to signify 'items in a toolbox'. It includes all kinds of resources (techniques, strategies, models) that were gathered to help clinical teachers with the teaching of clinical reasoning.
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Affiliation(s)
- Nathalie Gagnon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Carolle Bernier
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sylvie Houde
- Centre de Pédagogie des Sciences de la Santé, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marianne Xhignesse
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Covin YN, Wick N, Longo PJ. Convergent Validity of a Novel Clinical Reasoning Tool in Clerkship Medical Students: Pilot Study. MEDICAL SCIENCE EDUCATOR 2020; 30:61-64. [PMID: 34457638 PMCID: PMC8368568 DOI: 10.1007/s40670-019-00857-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Medical student educators have limited tools for standardized clinical reasoning assessment. The clinical reasoning task (CRT) checklist has been shown to identify specific tasks in the diagnostic process among residents and faculty. Authors assessed a novel student think aloud protocol strategy, the CRT, compared with the validated clinical data interpretation (CDI) test in six third-year medical students. The CRT was scored by two independent reviewers (kappa = 0.88). CRT and CDI scores were strongly positively correlated (r = 0.768, p = 0.074, df = 4). CRT provides both a global assessment of clinical reasoning and specific clinical reasoning deficits.
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Affiliation(s)
- Yvonne N. Covin
- Department of Internal Medicine, UT Health San Antonio, San Antonio, TX USA
| | - Neda Wick
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX USA
| | - Palma J. Longo
- Department of Healthcare Sciences, UT Southwestern Medical Center, Dallas, TX USA
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Hellwig T, Williams CR, Jen C, Raub JN, Scalese M, Smith WJ, Parbuoni KA. Current practices for identifying and managing challenging pharmacy residents: A needs assessment. Am J Health Syst Pharm 2020; 77:52-55. [DOI: 10.1093/ajhp/zxz257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thaddaus Hellwig
- South Dakota State University, College of Pharmacy and Allied Health Professions, Sioux Falls, SD
- Sanford USD Medical Center, Sioux Falls, SD
| | - Charlene R Williams
- Eshelman School of Pharmacy, University of North Carolina Chapel Hill, Asheville, NC
| | - Christi Jen
- HonorHealth Deer Valley Medical Center, Phoenix, AZ
- Department of Pharmacy Practice, University of Arizona College of Pharmacy, Phoenix, AZ
| | - Joshua N Raub
- Department of Pharmacy Services, Detroit Receiving Hospital, Detroit, MI
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Michael Scalese
- Department of Pharmacy Practice, Prisma Health Richland, Columbia, SC
| | - Winter J Smith
- Department of Clinical Sciences, Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, TX
| | - Kristine A Parbuoni
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
- University of Maryland Medical Center, Baltimore, MD
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Homberg A, Oberhauser H, Kaap-Fröhlich S. Clinical reasoning - an approach for decision-making in education and training for biomedical scientists. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc81. [PMID: 31844653 PMCID: PMC6905367 DOI: 10.3205/zma001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 11/05/2018] [Accepted: 02/06/2019] [Indexed: 06/10/2023]
Abstract
Aim: Explicitly addressing clinical reasoning (CR) is seen as a promising opportunity in the teaching of the biomedical sciences to enable students to acquire the skills to meet the challenges posed by ever more complex health care processes. The quality of diagnostic decisions plays an essential role here. Our aim is to examine if biomedical scientists recognize the practical relevance of CR and are able to apply it as a reflective framework for their professional practice. Method: In two different educational settings, biomedical science students were asked to look closely at CR in the context of the degree program and to indentify the different forms of reasoning used in their internships and professional practice. The written descriptions were analyzed for content and discussed in the seminars. Results: In both scenarios, the analyses of the students' descriptions and discussions showed that examining the different forms of CR helped to raise conscious awareness of thought and decision-making processes, encouraging students to think critically about them and to articulate insights about them, as well as recognize the importance of different reasoning strategies when making specific medical decisions. Conclusion: CR for biomedical scientists could help make decision-making processes visible for other occupational groups and thus advantageously integrate specific professional expertise into health care. Over the long term, an interdisciplinary focus on CR could foster and promote the development of a shared discourse and interprofessional collaboration.
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Affiliation(s)
- Angelika Homberg
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg, Germany
| | - Heidi Oberhauser
- fh gesundheit, Bachelor/Master Biomedizinische Analytik, Innsbruck, Austria
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Ghasemi A, Bahadoran Z, Mirmiran P, Hosseinpanah F, Shiva N, Zadeh-Vakili A. The Principles of Biomedical Scientific Writing: Discussion. Int J Endocrinol Metab 2019; 17:e95415. [PMID: 31497043 PMCID: PMC6679622 DOI: 10.5812/ijem.95415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022] Open
Abstract
The discussion section of a scientific paper is supposed to interpret and elucidate the significance of the study findings, highlight current knowledge available on the research problem being investigated, and explain the novel aspects emerging from the findings of the study in moving the field forward. A well-written discussion should provide clear "statements of the main findings", "possible explanations and implications", "strengths and weaknesses of the study and other studies", "unanswered questions", and "suggestions for future research". The authors also need to clarify the external validity of the findings and show how the findings can be generalized. In this review, we focus on the function, content, and organization of the "discussion section" of a hypothesis-testing paper. Beyond providing the most important principles and common strategies for organizing the discussion section, we also discuss metadiscourse, scientific explanation (reasoning and contextualization), and models of scientific explanation.
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Affiliation(s)
- Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Shiva
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Zadeh-Vakili
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Anakin M, Jouart M, Timmermans J, Pinnock R. Student experiences of learning clinical reasoning. CLINICAL TEACHER 2019; 17:52-57. [PMID: 30907049 DOI: 10.1111/tct.13014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Students find learning clinical reasoning skills challenging. Viewing how students learn clinical reasoning skills from a sociocultural perspective, however, may allow helpful and unhelpful descriptions to be interpreted as experiences that promote or inhibit their participation in and opportunities to co-construct their clinical reasoning skills. METHODS This interview study was conducted with 25 Year-6 undergraduate medical students. Interview data were first analysed thematically, and then the findings were analysed with the concepts of participation and co-construction. RESULTS The themes identified were: (1) practising with undifferentiated patients; (2) teachers who were willing to make thinking explicit; (3) a lack of independence and involvement; (4) a lack of communication and feedback; and (5) confusion from different sources of information. When further analysed, the themes could be represented as points along a continuum of participating in, and co-constructing, clinical reasoning skills. DISCUSSION Clinical educators will find the themes identified from students' experiences learning in a workplace environment helpful for understanding why some students may struggle to develop their clinical reasoning skills. An interpretation of findings from a sociocultural perspective offers a different approach for understanding students' difficulties when learning clinical reasoning: one where students are able to increase their participation in, and co-construction of, clinical reasoning in the context of working collaboratively to provide patient care. Students find learning clinical reasoning skills challenging.
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Affiliation(s)
- Megan Anakin
- Education Unit, The Office of the Dean, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Madelyne Jouart
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Julie Timmermans
- Higher Education Development Centre, University of Otago, Dunedin, New Zealand
| | - Ralph Pinnock
- Education Unit, The Office of the Dean, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Duca NS, Glod S. Bridging the Gap Between the Classroom and the Clerkship: A Clinical Reasoning Curriculum for Third-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10800. [PMID: 31139730 PMCID: PMC6507921 DOI: 10.15766/mep_2374-8265.10800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/23/2018] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Clinical reasoning is the complex cognitive process that drives the diagnosis of disease and treatment of patients. There is a national call for medical educators to develop clinical reasoning curricula in undergraduate medical education. To address this need, we developed a longitudinal clinical reasoning curriculum for internal medicine clerkship students. METHODS We delivered six 1-hour sessions to approximately 40 students over the 15-week combined medicine-surgery clerkship at Penn State College of Medicine. We developed the content using previous work in clinical reasoning, including the American College of Physicians' Teaching Medicine Series book Teaching Clinical Reasoning. Students applied a clinical reasoning diagnostic framework to written cases during each workshop. Each session followed a scaffold approach and built upon previously learned clinical reasoning skills. We administered a pre- and postsurvey to assess students' baseline knowledge of clinical reasoning concepts and perceived confidence in performing clinical reasoning skills. Students also provided open-ended responses regarding the effectiveness of the curriculum. RESULTS The curriculum was well received by students and led to increased perceived knowledge of clinical reasoning concepts and increased confidence in applying clinical reasoning skills. Students commented on the usefulness of practicing clinical reasoning in a controlled environment while utilizing a framework that could be deliberately applied to patient care. DISCUSSION The longitudinal clinical reasoning curriculum was effective in reinforcing key concepts of clinical reasoning and allowed for deliberate practice in a controlled environment. The curriculum is generalizable to students in both the preclinical and clinical years.
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Affiliation(s)
- Nicholas S. Duca
- Assistant Professor, Division of General Internal Medicine, Penn State Health Milton S. Hershey Medical Center
| | - Susan Glod
- Associate Professor, Division of General Internal Medicine, Penn State Health Milton S. Hershey Medical Center
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The Assessment of Reasoning Tool (ART): structuring the conversation between teachers and learners. Diagnosis (Berl) 2018; 5:197-203. [DOI: 10.1515/dx-2018-0052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/19/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Excellence in clinical reasoning is one of the most important outcomes of medical education programs, but assessing learners’ reasoning to inform corrective feedback is challenging and unstandardized.
Methods
The Society to Improve Diagnosis in Medicine formed a multi-specialty team of medical educators to develop the Assessment of Reasoning Tool (ART). This paper describes the tool development process. The tool was designed to facilitate clinical teachers’ assessment of learners’ oral presentation for competence in clinical reasoning and facilitate formative feedback. Reasoning frameworks (e.g. script theory), contemporary practice goals (e.g. high-value care [HVC]) and proposed error reduction strategies (e.g. metacognition) were used to guide the development of the tool.
Results
The ART is a behaviorally anchored, three-point scale assessing five domains of reasoning: (1) hypothesis-directed data gathering, (2) articulation of a problem representation, (3) formulation of a prioritized differential diagnosis, (4) diagnostic testing aligned with HVC principles and (5) metacognition. Instructional videos were created for faculty development for each domain, guided by principles of multimedia learning.
Conclusions
The ART is a theory-informed assessment tool that allows teachers to assess clinical reasoning and structure feedback conversations.
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Georg C, Karlgren K, Ulfvarson J, Jirwe M, Welin E. A Rubric to Assess Students' Clinical Reasoning When Encountering Virtual Patients. J Nurs Educ 2018; 57:408-415. [DOI: 10.3928/01484834-20180618-05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 03/06/2018] [Indexed: 11/20/2022]
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Ulfvarson J, Oxelmark L, Jirwe M. Assessment in clinical education: A comparison between a generic instrument and a course-specific criterion-based instrument. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2057158518768404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Assessment of students’ clinical performance and reasoning raises critical questions of whether learning outcomes have been reached and whether the aims of a course/education programme have been fulfilled. The aim of this study was to compare two assessment instruments in clinical education. A cross-sectional, comparative design was used. Nursing students and supervisors from five universities and university colleges in Sweden were included in the study. A sample of 435 students was used. Data were collected with study-specific questionnaires targeted for the two groups, nursing students and supervisors, and were analysed using cross-tabulation, chi-square with WinSTAT. Students perceived supervisors using the instrument Assessment of Clinical Education (AClEd) to be more aware of what to assess and they experienced more support from the ‘AClEd supervisors’ as compared to the supervisors using the second instrument, the Assessment form for Clinical education (AssCe). Furthermore, the AClEd assessment was perceived to be fairer compared to the AssCe assessment. The criterion-referenced assessment instrument AClEd was perceived, by both nursing students and supervisors, to give a clearer view of the learning outcome and the possibility of a fair and comprehensive assessment.
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Affiliation(s)
- Johanna Ulfvarson
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Lena Oxelmark
- Institute of Care and Health Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Jirwe
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
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Sciomachen P, Arienti C, Bergna A, Castagna C, Consorti G, Lotti A, Lunghi C, Tramontano M, Longobardi M. Core competencies in osteopathy: Italian register of osteopaths proposal. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2018.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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