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Koelewijn G, Hennus MP, Kort HSM, Frenkel J, van Houwelingen T. Games to support teaching clinical reasoning in health professions education: a scoping review. MEDICAL EDUCATION ONLINE 2024; 29:2316971. [PMID: 38394053 PMCID: PMC10896137 DOI: 10.1080/10872981.2024.2316971] [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: 10/27/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Given the complexity of teaching clinical reasoning to (future) healthcare professionals, the utilization of serious games has become popular for supporting clinical reasoning education. This scoping review outlines games designed to support teaching clinical reasoning in health professions education, with a specific emphasis on their alignment with the 8-step clinical reasoning cycle and the reflective practice framework, fundamental for effective learning. METHODS A scoping review using systematic searches across seven databases (PubMed, CINAHL, ERIC, PsycINFO, Scopus, Web of Science, and Embase) was conducted. Game characteristics, technical requirements, and incorporation of clinical reasoning cycle steps were analyzed. Additional game information was obtained from the authors. RESULTS Nineteen unique games emerged, primarily simulation and escape room genres. Most games incorporated the following clinical reasoning steps: patient consideration (step 1), cue collection (step 2), intervention (step 6), and outcome evaluation (step 7). Processing information (step 3) and understanding the patient's problem (step 4) were less prevalent, while goal setting (step 5) and reflection (step 8) were least integrated. CONCLUSION All serious games reviewed show potential for improving clinical reasoning skills, but thoughtful alignment with learning objectives and contextual factors is vital. While this study aids health professions educators in understanding how games may support teaching of clinical reasoning, further research is needed to optimize their effective use in education. Notably, most games lack explicit incorporation of all clinical reasoning cycle steps, especially reflection, limiting its role in reflective practice. Hence, we recommend prioritizing a systematic clinical reasoning model with explicit reflective steps when using serious games for teaching clinical reasoning.
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Affiliation(s)
- Gilbert Koelewijn
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Department of Pediatrics, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marije P. Hennus
- Department of Pediatrics, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
- Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Helianthe S. M. Kort
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Building Healthy Environments for Future Users Group, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Joost Frenkel
- Department of Pediatrics, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thijs van Houwelingen
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
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Sader J, Diana A, Coen M, Nendaz M, Audétat MC. A GP's clinical reasoning in the context of multimorbidity: beyond the perception of an intuitive approach. Fam Pract 2023; 40:113-118. [PMID: 35849124 DOI: 10.1093/fampra/cmac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION GP's clinical reasoning processes in the context of patients suffering from multimorbidity are often a process which remains implicit. Therefore, the goal of this case study analysis is to gain a better understanding of the processes at play in the management of patients suffering from multimorbidity. METHODS A case study analysis, using a qualitative thematic analysis was conducted. This case follows a 54-year-old woman who has been under the care of her GP for almost 10 years and suffers from a number of chronic conditions. The clinical reasoning of an experienced GP who can explicitly unfold his processes was chosen for this case analysis. RESULTS Four main themes emerged from this case analysis: The different roles that GPs have to manage; the GP's cognitive flexibility and continual adaptation of their clinical reasoning processes, the patient's empowerment, and the challenges related to the collaboration with specialists and healthcare professionals. CONCLUSION This could help GPs gain a clearer understanding of their clinical reasoning processes and motivate them to communicate their findings with others during clinical supervision or teaching. Furthermore, this may emphasize the importance of valuing the role of the primary care physician in the management of multimorbid patients.
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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
| | - Alessandro Diana
- IuMFE-Institute of Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Matteo Coen
- 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
| | - 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.,IuMFE-Institute of Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Ritz C, Sader J, Cairo Notari S, Lanier C, Caire Fon N, Nendaz M, Audétat MC. Multimorbidity and clinical reasoning through the eyes of GPs: a qualitative study. Fam Med Community Health 2021; 9:fmch-2020-000798. [PMID: 34556495 PMCID: PMC8461689 DOI: 10.1136/fmch-2020-000798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives Despite the high prevalence of patients suffering from multimorbidity, the clinical reasoning processes involved during the longitudinal management are still sparse. This study aimed to investigate what are the different characteristics of the clinical reasoning process clinicians use with patients suffering from multimorbidity, and to what extent this clinical reasoning differs from diagnostic reasoning. Design Given the exploratory nature of this study and the difficulty general practitioners (GPs) have in expressing their reasoning, a qualitative methodology was therefore, chosen. The Clinical reasoning Model described by Charlin et al was used as a framework to describe the multifaceted processes of the clinical reasoning. Setting Semistructured interviews were conducted with nine GPs working in an ambulatory setting in June to September 2018, in Geneva, Switzerland. Participants Participants were GPs who came from public hospital or private practice. The interviews were transcribed verbatim and a thematic analysis was conducted. Results The results highlighted how some cognitive processes seem to be more specific to the management reasoning. Thus, the main goal is not to reach a diagnosis, but rather to consider several possibilities in order to maintain a balance between the evidence-based care options, patient’s priorities and maintaining quality of life. The initial representation of the current problem seems to be more related to the importance of establishing links between the different pre-existing diseases, identifying opportunities for actions and trying to integrate the new elements from the patient’s context, rather than identifying the signs and symptoms that can lead to generating new clinical hypotheses. The multiplicity of options to resolve problems is often perceived as difficult by GPs. Furthermore, longitudinal management does not allow them to achieve a final resolution of problems and that requires continuous review and an ongoing prioritisation process. Conclusion This study contributes to a better understanding of the clinical reasoning processes of GPs in the longitudinal management of patients suffering from multimorbidity. Through a practical and accessible model, this qualitative study offers new perspectives for identifying the components of management reasoning. These results open the path to new research projects.
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Affiliation(s)
- Claire Ritz
- Faculty of Medicine (IuMFE), University of Geneva, Geneva, Switzerland
| | - Julia Sader
- Faculty of Medicine, (UDREM), University of Geneva, Geneva, Switzerland
| | | | - Cedric Lanier
- Faculty of Medicine (IuMFE), University of Geneva, Geneva, Switzerland
| | | | - Mathieu Nendaz
- Faculty of Medicine (IuMFE), University of Geneva, Geneva, Switzerland
| | - Marie-Claude Audétat
- Faculty of Medicine (IuMFE), University of Geneva, Geneva, Switzerland .,Faculty of Medicine, (UDREM), University of Geneva, Geneva, Switzerland.,Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada
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Cairo Notari S, Sader J, Caire Fon N, Sommer JM, Pereira Miozzari AC, Janjic D, Nendaz M, Audétat M. Understanding GPs' clinical reasoning processes involved in managing patients suffering from multimorbidity: A systematic review of qualitative and quantitative research. Int J Clin Pract 2021; 75:e14187. [PMID: 33783098 PMCID: PMC8459259 DOI: 10.1111/ijcp.14187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/25/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Most consultations in primary care involve patients suffering from multimorbidity. Nevertheless, few studies exist on the clinical reasoning processes of general practitioners (GPs) during the follow-up of these patients. The aim of this systematic review is to summarise published evidence on how GPs reason and make decisions when managing patients with multimorbidity in the long term. METHODS A search of the relevant literature from Medline, Embase, PsycINFO, and ERIC databases was conducted in June 2019. The search terms were selected from five domains: primary care, clinical reasoning, chronic disease, multimorbidity, and issues of multimorbidity. Qualitative, quantitative, and mixed-methods studies published in English and French were included. Quality assessment was performed using the Mixed Methods Appraisal Tool. RESULTS A total of 2 165 abstracts and 362 full-text articles were assessed. Thirty-two studies met the inclusion criteria. Results showcased that GPs' clinical reasoning during the long-term management of multimorbidity is about setting intermediate goals of care in an ongoing process that adapts to the patients' constant evolution and contributes to preserve their quality of life. In the absence of guidelines adapted to multimorbidity, there is no single correct plan, but competing priorities and unavoidable uncertainties. Thus, GPs have to consider and weigh multiple factors simultaneously. In the context of multimorbidity, GPs describe their reasoning as essentially intuitive and seem to perceive it as less accurate. These clinical reasoning processes are nevertheless more analytical as they might think and rooted in deep knowledge of the individual patient. CONCLUSIONS Although the challenges GPs are facing in the long-term follow-up of patients suffering from multimorbidity are increasingly known, the literature currently offers limited information about GPs' clinical reasoning processes at play. GPs tend to underestimate the complexity and richness of their clinical reasoning, which may negatively impact their practice and their teaching.
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Affiliation(s)
- Sarah Cairo Notari
- Primary Care UnitFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Faculty of Psychology and Educational SciencesUniversity of GenevaGenevaSwitzerland
| | - Julia Sader
- Unit of Development and Research in Medical EducationFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Nathalie Caire Fon
- Department of Family Medicine and Emergency MedicineFaculty of MedicineUniversité de MontréalMontrealQCCanada
| | | | | | - Danilo Janjic
- Primary Care UnitFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical EducationFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Department of Internal MedicineUniversity Hospitals of GenevaGenevaSwitzerland
| | - Marie‐Claude Audétat
- Primary Care UnitFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Unit of Development and Research in Medical EducationFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Department of Family Medicine and Emergency MedicineFaculty of MedicineUniversité de MontréalMontrealQCCanada
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Audétat MC, Cairo Notari S, Sader J, Ritz C, Fassier T, Sommer JM, Nendaz M, Caire-Fon N. Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research. BMC MEDICAL EDUCATION 2021; 21:31. [PMID: 33413342 PMCID: PMC7792096 DOI: 10.1186/s12909-020-02459-w] [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: 11/21/2020] [Accepted: 12/16/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients. METHODS A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a "button camera" (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches. CONCLUSION Study results will contribute to the scientific community's overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient's care and treatments.
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Affiliation(s)
- M-C Audétat
- Primary Care Institut (iuMFE), Faculty of Medicine, University of Geneva, CMU 5-6, Rue Michel-Servet 1, 1211, Geneva, Switzerland.
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada.
| | - S Cairo Notari
- Primary Care Institut (iuMFE), Faculty of Medicine, University of Geneva, CMU 5-6, Rue Michel-Servet 1, 1211, Geneva, Switzerland
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - J Sader
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - C Ritz
- Primary Care Institut (iuMFE), Faculty of Medicine, University of Geneva, CMU 5-6, Rue Michel-Servet 1, 1211, Geneva, Switzerland
| | - T Fassier
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Internal Medicine for the elderly, University Hospitals of Geneva, Geneva, Switzerland
| | - J M Sommer
- Primary Care Institut (iuMFE), Faculty of Medicine, University of Geneva, CMU 5-6, Rue Michel-Servet 1, 1211, Geneva, Switzerland
| | - M Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - N Caire-Fon
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
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