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Sullivan AM, Hayes MM, Beltran CP, Cohen AP, Soffler M, Cooper S, Wisser W, Schwartzstein RM. Do we teach critical thinking? A mixed methods study of faculty and student perceptions of teaching and learning critical thinking at three professional schools. MEDICAL TEACHER 2024:1-8. [PMID: 38382446 DOI: 10.1080/0142159x.2024.2316862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Critical thinking (CT) is an essential set of skills and dispositions for professionals. While viewed as an important part of professional education, approaches to teaching and assessing critical thinking have been siloed within disciplines and there are limited data on whether student perceptions of learning align with faculty perceptions of teaching. MATERIALS AND METHODS The authors used a convergent mixed methods approach in required core courses in schools of education, government, and medicine at one university in the Northeast United States. Faculty surveys and student focus groups (FG) addressed definitions, strategies, and barriers to teaching CT. RESULTS AND CONCLUSIONS Sixty-four (51.6%) faculty completed the survey, and 34 students participated in FGs. Among faculty, 54.0% (34/63) reported explicitly teaching CT; but students suggested teaching CT was predominantly implicit. Faculty-reported strategies differed among schools. Faculty defined CT in process terms such as 'analyzing'; students defined CT in terms of viewpoints and biases. Our results reveal a lack of explicit, shared CT mental models between faculty and students and across professional schools. Explicit teaching of CT may help develop a shared language and lead to better understanding and application of the skills and dispositions necessary to succeed in professional life.
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Affiliation(s)
- Amy M Sullivan
- School of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Margaret M Hayes
- School of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Amy P Cohen
- School of Public Health, Harvard T.H. Chan, Boston, MA, USA
| | | | - Suzanne Cooper
- School of Government, Harvard University Kennedy, Cambridge, MA, USA
| | - William Wisser
- Education and Senior Director of the Teaching and Learning Lab, Harvard Graduate School of Education, Cambridge, MA, USA
| | - Richard M Schwartzstein
- School of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
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Cornell EG, Harris E, McCune E, Fukui E, Lyons PG, Rojas JC, Santhosh L. Scaling up a diagnostic pause at the ICU-to-ward transition: an exploration of barriers and facilitators to implementation of the ICU-PAUSE handoff tool. Diagnosis (Berl) 2023; 10:417-423. [PMID: 37598362 DOI: 10.1515/dx-2023-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES The transition from the intensive care unit (ICU) to the medical ward is a high-risk period due to medical complexity, reduced patient monitoring, and diagnostic uncertainty. Standardized handoff practices reduce errors associated with transitions of care, but little work has been done to standardize the ICU to ward handoff. Further, tools that exist do not focus on preventing diagnostic error. Using Human-Centered Design methods we previously created a novel EHR-based ICU-ward handoff tool (ICU-PAUSE) that embeds a diagnostic pause at the time of transfer. This study aims to explore barriers and facilitators to implementing a diagnostic pause at the ICU-to-ward transition. METHODS This is a multi-center qualitative study of semi-structured interviews with intensivists from ten academic medical centers. Interviews were analyzed iteratively through a grounded theory approach. The Sittig-Singh sociotechnical model was used as a unifying conceptual framework. RESULTS Across the eight domains of the model, we identified major benefits and barriers to implementation. The embedded pause to address diagnostic uncertainty was recognized as a key benefit. Participants agreed that standardization of verbal and written handoff would decrease variation in communication. The main barriers fell within the domains of workflow, institutional culture, people, and assessment. CONCLUSIONS This study represents a novel application of the Sittig-Singh model in the assessment of a handoff tool. A unique feature of ICU-PAUSE is the explicit acknowledgement of diagnostic uncertainty, a practice that has been shown to reduce medical error and prevent premature closure. Results will be used to inform future multi-site implementation efforts.
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Affiliation(s)
- Ella G Cornell
- University of California San Francisco, San Francisco, CA, USA
| | - Emily Harris
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Emma McCune
- University of California San Francisco, San Francisco, CA, USA
| | - Elle Fukui
- University of California San Francisco, San Francisco, CA, USA
| | - Patrick G Lyons
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Juan C Rojas
- Rush University Medical Center, Chicago, IL, USA
| | - Lekshmi Santhosh
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
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Moulder G, Harris E, Santhosh L. Teaching the science of uncertainty. Diagnosis (Berl) 2023; 10:13-18. [PMID: 36087299 DOI: 10.1515/dx-2022-0045] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022]
Abstract
As we increasingly acknowledge the ubiquitous nature of uncertainty in clinical practice (Meyer AN, Giardina TD, Khawaja L, Singh H. Patient and clinician experiences of uncertainty in the diagnostic process: current understanding and future directions. Patient Educ Counsel 2021;104:2606-15; Han PK, Klein WM, Arora NK. Varieties of uncertainty in health care: a conceptual taxonomy. Med Decis Making 2011;31:828-38) and strive to better define this entity (Lee C, Hall K, Anakin M, Pinnock R. Towards a new understanding of uncertainty in medical education. J Eval Clin Pract 2020; Bhise V, Rajan SS, Sittig DF, Morgan RO, Chaudhary P, Singh H. Defining and measuring diagnostic uncertainty in medicine: a systematic review. J Gen Intern Med 2018;33:103-15), as educators we should also design, implement, and evaluate curricula addressing clinical uncertainty. Although frequently encountered, uncertainty is often implicitly referred to rather than explicitly discussed (Gärtner J, Berberat PO, Kadmon M, Harendza S. Implicit expression of uncertainty - suggestion of an empirically derived framework. BMC Med Educ 2020;20:83). Increasing explicit discussion of - and comfort with -uncertainty has the potential to improve diagnostic reasoning and accuracy and improve patient care (Dunlop M, Schwartzstein RM. Reducing diagnostic error in the intensive care unit. Engaging. Uncertainty when teaching clinical reasoning. Scholar;1:364-71). Discussion of both diagnostic and prognostic uncertainty with patients is central to shared decision-making in many contexts as well, (Simpkin AL, Armstrong KA. Communicating uncertainty: a narrative review and framework for future research. J Gen Intern Med 2019;34:2586-91) from the outpatient setting to the inpatient setting, and from undergraduate medical education (UME) trainees to graduate medical education (GME) trainees. In this article, we will explore the current status of how the science of uncertainty is taught from the UME curriculum to the GME curriculum, and describe strategies how uncertainty can be explicitly discussed for all levels of trainees.
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Affiliation(s)
- Glenn Moulder
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Emily Harris
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Lekshmi Santhosh
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
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von Hoyer J, Bientzle M, Cress U, Grosser J, Kimmerle J. False certainty in the acquisition of anatomical and physiotherapeutic knowledge. BMC MEDICAL EDUCATION 2022; 22:765. [PMID: 36348330 PMCID: PMC9641864 DOI: 10.1186/s12909-022-03820-x] [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: 12/06/2021] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Efficient metacognitive monitoring, that is the monitoring of one's own thought processes and specifically one's state of knowledge, is essential for effective clinical reasoning. Knowing what one does and does not know is a competency that students of health professions need to develop. Students often tend to develop false certainty in their own knowledge in the longer course of their education, but the time frame that is required for this effect to occur has remained unclear. We investigated whether students developed false certainty already after one course unit. METHODS This study analysed data from one sample of medical students and four samples of physiotherapy students in two formal educational settings (total N = 255) who took knowledge tests before and after a course unit. We examined changes in students' confidence separately for correctly and incorrectly answered questions and analysed their ability to assign higher levels of confidence to correct answers than to incorrect answers (discrimination ability). RESULTS Students' knowledge as well as confidence in their correct answers in knowledge tests increased after learning. However, consistently for all samples, confidence in incorrect answers increased as well. Students' discrimination ability improved only in two out of the five samples. CONCLUSIONS Our results are in line with recent research on confidence increase of health professions students during education. Extending those findings, our study demonstrated that learning in two different formal educational settings increased confidence not only in correct but also in incorrect answers to knowledge questions already after just one learning session. Our findings highlight the importance of improving metacognition in the education of health professionals-especially their ability to know what they do not know.
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Affiliation(s)
- Johannes von Hoyer
- Knowledge Construction Lab. Leibniz-Institut Für Wissensmedien, Schleichstr. 6, 72076, Tuebingen, Germany.
| | - Martina Bientzle
- Knowledge Construction Lab. Leibniz-Institut Für Wissensmedien, Schleichstr. 6, 72076, Tuebingen, Germany
| | - Ulrike Cress
- Knowledge Construction Lab. Leibniz-Institut Für Wissensmedien, Schleichstr. 6, 72076, Tuebingen, Germany
- Department of Applied Cognitive Psychology and Media Psychology, University of Tuebingen, Schleichstr.4, D-72070 Tuebingen, Germany, Tuebingen, Germany
| | - Johannes Grosser
- Knowledge Construction Lab. Leibniz-Institut Für Wissensmedien, Schleichstr. 6, 72076, Tuebingen, Germany
| | - Joachim Kimmerle
- Knowledge Construction Lab. Leibniz-Institut Für Wissensmedien, Schleichstr. 6, 72076, Tuebingen, Germany
- Department of Applied Cognitive Psychology and Media Psychology, University of Tuebingen, Schleichstr.4, D-72070 Tuebingen, Germany, Tuebingen, Germany
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Diagnostic Time-Outs to Improve Diagnosis. Crit Care Clin 2022; 38:185-194. [DOI: 10.1016/j.ccc.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Barskaya A, Wang DS, Moitra VK. Mitigating cognitive biases OFTEN, a hypothesis-based approach to diagnose hypotension. J Crit Care 2021; 68:104-106. [PMID: 34968945 DOI: 10.1016/j.jcrc.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Angela Barskaya
- Department of Anesthesiology, Division of Critical Care Medicine, Columbia University, New York, NY, United States of America; Department of Emergency Medicine, Columbia University, New York, NY, United States of America
| | - David S Wang
- Department of Anesthesiology, Division of Critical Care Medicine, Columbia University, New York, NY, United States of America
| | - Vivek K Moitra
- Department of Anesthesiology, Division of Critical Care Medicine, Columbia University, New York, NY, United States of America.
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