The development of scientific reasoning in medical education: a psychological perspective

The importance of theory and method: A brief reflection on an innovative program of research examining how situational factors influence physicians' clinical reasoning

Clinical reasoning, a complex process that involves gathering and synthesizing information to make diagnostic and treatment decisions, is a topic researchers frequently study to mitigate errors. Scientific reasoning has several similarities with clinical reasoning, including the need to generate hypotheses; observe, gather, and interpret evidence; engage in the process of elimination; draw conclusions; and refine and test new hypotheses. However, researchers have only recently begun to take into consideration the role that situational factors (also known as contextual factors), such as language barriers or the lack of diagnostic test results, can play in diagnostic error. Additionally, questions remain about the best ways to teach these complex processes.

Clinical Case Discussions - a novel, supervised peer-teaching format to promote clinical reasoning in medical students

Background: Clinical reasoning (CR) is a clinical core competence for medical students to acquire. While the necessity for CR teaching has been recognized since the early 20^th century, to this day no consensus on how to best educate students in CR exists. Hence, few universities have incorporated dedicated CR teaching formats into their medical curriculum. We propose a novel case-based, peer-taught and physician-supervised collaborative learning format, dubbed "Clinical Case Discussions" (CCDs) to foster CR in medical students. Project description: We present the curricular concept of CCDs and its development according to a six-step approach (problem identification and general needs assessment; targeted needs assessment; goals and objectives; educational strategies; implementation; evaluation and feedback). Our goal is to strengthen the physician roles (CanMEDS/NKLM) and CR competence of medical students. CCDs are offered at our institution as an elective course and students work on real-life, complex medical cases through a structured approach. Over the course of five years we evaluated various aspects of the course and trained student teachers to optimize our course concept according to the feedback of our participants. We also obtained intro and exit self-assessments of CR competence using an established CR questionnaire. Results: We found an unmet need for CR teaching, as medical students in their clinical years view CR as highly important for later practice, but only 50% have ever heard of CR within the curriculum. Acceptance of CCDs was consistently high with over 85% of participants strongly agreeing that they would re-participate in the course and recommend it to a friend. Additionally, we observed significant improvements in CR self-assessments of participants. Conclusion: CCDs are a feasible teaching format to improve students' CR competence, have a high acceptance and involve students in medical education through peer-teaching.

Assessing Pharmacy Students' Scientific Reasoning After Completing a Physics Course Taught Using Active-Learning Methods

Objective. To assess the degree of change in the level of scientific reasoning in first-year pharmacy students by applying active-learning methods during a physics course. Methods. The efficiency of the active-learning methods of experimentation and discussion in the development of scientific reasoning in 90 pharmacy students was determined by comparing it to the efficiency of using traditional learning methods (eg, lecture) with 60 students. The Lawson Classroom Test of Scientific Reasoning was used to measure change. Results. The data from this five-year study showed that of all pharmacy students in the active-learning group who were functioning on a stable or transitional level of thinking at the time of the pretest, 28.6% achieved a shift towards a higher level of scientific thinking. The active-learning group also achieved better overall results in the course. Conclusion. Using active-learning methods (experimentation and discussion) in a physics course enabled pharmacy students to better master the content. By elevating students' level of scientific reasoning, a foundation for using evidence-based medicine was established.

Symmetry for Multimedia-Aided Art Teaching Based on the Form of Animation Teaching Organization and Social Network

Symmetries play a vital role in multimedia-aided art teaching activities. The relevant teaching systems designed with a social network, including the optimized teaching methods, are on the basis of symmetry principles. In order to study art teaching, from the perspective of the teaching organization form, combined with the survey method, multimedia-aided art classroom teaching was explained in detail. Based on the symmetrical thinking in art teaching, the multimedia-aided teaching mode of art classroom was discussed. The reasons for the misunderstanding of multimedia-aided art teaching were analyzed, and the core factors affecting the use of multimedia art teaching were found. In art teaching, more real pictures were shown aided by multimedia; students could experience the beauty of symmetrical things in real life and were guided to find the artistic characteristics of these kinds of graphics, analyze them, and summarize them. The results showed that this method enriched the art multimedia teaching theory and improved the efficiency of art teaching. The blind use of multimedia technology by teachers in art classroom teaching was avoided. Therefore, the method can develop individualized teaching, develop students’ potential, and cultivate innovative consciousness and practical ability.

Prediction of loss to follow-up in long-term supportive periodontal therapy in patients with chronic periodontitis

AIM

This study examined the predictors of loss to follow-up in long-term supportive periodontal therapy in patients with chronic periodontitis.

METHODS

A total of 280 patients with moderate to severe chronic periodontitis in a tertiary care hospital in China were investigated and followed over the course of study. Questionnaires on clinical and demographic characteristics, self-efficacy for oral self-care and dental fear at baseline were completed. Participants were followed to determine whether they could adhere to long-term supportive periodontal therapy. Binary logistic regression analysis was used to examine the association between clinical and demographic characteristics, self-efficacy for oral self-care, dental fear and loss to follow-up in long-term supportive periodontal therapy.

RESULTS

The loss to follow-up in long-term supportive periodontal therapy was significantly associated with age [adjusted OR = 1.042, 95% confidence interval (CI): 1.012-1.074, p = 0.006], severe periodontitis [adjusted OR = 4.892, 95%CI: 2.280-10.499, p<0.001], periodontal surgery [adjusted OR = 11.334, 95% CI: 2.235-57.472, p = 0.003], and middle and low-scoring of self-efficacy scale for self-care groups. The adjusted ORs of loss to follow-up for the middle- (54-59) and low-scoring groups (15-53) were 71.899 (95%CI: 23.926-216.062, p<0.001) and 4.800 (95% CI: 2.263-10.182, p<0.001), respectively, compared with the high-scoring SESS group (60-75).

CONCLUSION

Age, severity of periodontitis, periodontal surgery and the level of self-efficacy for self-care may be effective predictors of loss to follow-up in long-term supportive periodontal therapy in patients with chronic periodontitis.