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Ovitsh RK, Gupta S, Kusnoor A, Jackson JM, Roussel D, Mooney CJ, Pinto-Powell R, Appel JL, Mhaskar R, Gold J. Minding the gap: towards a shared clinical reasoning lexicon across the pre-clerkship/clerkship transition. Med Educ Online 2024; 29:2307715. [PMID: 38320116 PMCID: PMC10848998 DOI: 10.1080/10872981.2024.2307715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
Teaching and learning of clinical reasoning are core principles of medical education. However, little guidance exists for faculty leaders to navigate curricular transitions between pre-clerkship and clerkship curricular phases. This study compares how educational leaders in these two phases understand clinical reasoning instruction. Previously reported cross-sectional surveys of pre-clerkship clinical skills course directors, and clerkship leaders were compared. Comparisons focused on perceived importance of a number of core clinical reasoning concepts, barriers to clinical reasoning instruction, level of familiarity across the undergraduate medical curriculum, and inclusion of clinical reasoning instruction in each area of the curriculum. Analyses were performed using the Mann Whitney U test. Both sets of leaders rated lack of curricular time as the largest barrier to teaching clinical reasoning. Clerkship leaders also noted a lack of faculty with skills to teach clinical reasoning concepts as a significant barrier (p < 0.02), while pre-clerkship leaders were more likely to perceive that these concepts were too advanced for their students (p < 0.001). Pre-clerkship leaders reported a higher level of familiarity with the clerkship curriculum than clerkship leaders reported of the pre-clerkship curriculum (p < 0.001). As faculty transition students from the pre-clerkship to the clerkship phase, a shared understanding of what is taught and when, accompanied by successful faculty development, may aid the development of longitudinal, milestone-based clinical reasoning instruction.
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Affiliation(s)
- Robin K. Ovitsh
- Department of Pediatrics, Downstate Health Sciences University College of Medicine, Brooklyn, NY, USA
| | - Shanu Gupta
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Anita Kusnoor
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer M. Jackson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Danielle Roussel
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christopher J. Mooney
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Roshini Pinto-Powell
- Department of Medicine and Medical Education, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Joel L. Appel
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa, FL, USA
| | - Jonathan Gold
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, MI, USA
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2
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Çetinkaya L, Keser İ, Yildirim S, Keser H. The effect of case-based mobile virtual patient application on students' academic achievement in clinical reasoning skills. Med Educ Online 2024; 29:2322223. [PMID: 38445566 PMCID: PMC10919315 DOI: 10.1080/10872981.2024.2322223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
This mixed-method study aims to determine the effect of the use of mobile virtual patient application with narrated case-based virtual patients as an assistive technology on students' clinical reasoning skills. It makes a notable contribution by exploring the impact of mobile virtual patient applications on healthcare students' clinical skills and their preparation for real-world patient care. In addition, the accuracy of the analysis results regarding the effect on student achievement was analyzed with a second dataset tool, and thus, aiming to increase reliability by verifying the same research question with a different quantitative analysis technique. In the qualitative part of the study, students' views on the implementation were collected through an open-ended questionnaire and the data were subjected to content analysis. An achievement test was also developed to determine the development of students' clinical reasoning skills, which revealed that each of the learning environments had different outcomes regarding students' achievement and that supporting the traditional environment with the mobile virtual patient application yielded better results for increasing students' achievement. Students' opinions about the mobile virtual patient application and the process also support the increase in academic achievement aimed at measuring clinical reasoning skills. The content analysis showed that the students, who generally reported multiple positive factors related to the application, thought that the stories and cases presented created a perception of reality, and they especially highlighted the contribution of the application to learning the story organization. Based on all these results, it can be said that the application supports clinical reasoning, provides practical experience, improves academic achievement, and contributes positively to motivation.
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Affiliation(s)
- Levent Çetinkaya
- Department of Computer Education and Instructional Technology, Canakkale Onsekiz Universty, Canakkale, Türkiye
| | - İ̇lke Keser
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Türkiye
| | - Serkan Yildirim
- Department of Computer Education and Instructional Technology, Ankara University, Ankara, Türkiye
| | - Hafize Keser
- Faculty of Educational Sciences, Department of Computer Education and Instructional Technology, Ankara University, Ankara, Türkiye
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3
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Rêgo Barbosa A, de Moraes MPM, Silva TYT, Pedroso JL, Barsottini OGP. Clinical Reasoning: A 24-Year-Old Man With Gait Impairment, Hearing Loss, and Recurrent Fever. Neurology 2024; 102:e209358. [PMID: 38593395 DOI: 10.1212/wnl.0000000000209358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
We present a case study of a 24-year-old man who reported mild balance and walking difficulties for 2 years. He had a history of recurrent fever, skin lesions, headache, and elbow pain, but most of these events resolved spontaneously. There was no significant family history. On examination, we observed frontal bossing, sensorineural hearing loss, and gait ataxia. This case underscores the significance of identifying clinical indicators in patients with neurologic symptoms, particularly recurrent fever, to establish a precise and thorough differential diagnosis.
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Affiliation(s)
| | | | | | - José Luiz Pedroso
- From the Department of Neurology, Universidade Federal de São Paulo, Brazil
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Mayston MJ, Saloojee GM, Foley SE. The Bobath Clinical Reasoning Framework: A systems science approach to the complexity of neurodevelopmental conditions, including cerebral palsy. Dev Med Child Neurol 2024; 66:564-572. [PMID: 37653669 DOI: 10.1111/dmcn.15748] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 05/04/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023]
Abstract
The current recommended developmental Bobath practice within the Bobath Clinical Reasoning Framework (BCRF) can be conceptualized using the lens of systems science, thereby providing a holistic perspective on the interrelatedness and interconnectedness of the variables associated with childhood-onset disability. The BCRF is defined as an in-depth clinical reasoning framework that can be applied to help understand the relationships between the domains of the International Classification of Functioning, Disability and Health, how those domains can be influenced, and how they impact each other. The BCRF is a transdisciplinary observational system and practical reasoning approach that results in an intervention plan. This provides a holistic understanding of the complexity of situations associated with disorders such as cerebral palsy (CP) and the basis for the lifelong management and habilitation of people living with neurological disorders. The clinical reasoning used by the BCRF draws on the important contextual factors of the individual and their social environment, primarily the family unit. It is rooted in an understanding of the interrelationships between typical and atypical development, pathophysiology (sensorimotor, cognitive, behavioural), and neuroscience, and the impact of these body structure and function constructs on activity and participation. The systems science model integral to the BCRF is a useful way forward in understanding and responding to the complexity of CP, the overarching goal being to optimize the lived experience of any individual in any context.
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Affiliation(s)
| | - Gillian M Saloojee
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah E Foley
- Kids Plus Foundation, Deakin University, Melbourne, VIC, Australia
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Hornos E, Pleguezuelos EM, Bala L, van der Vleuten C, Sam AH. Online clinical reasoning simulator for medical students grounded on dual-process theory. Med Educ 2024; 58:580-581. [PMID: 38385574 DOI: 10.1111/medu.15322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024]
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Mayston M, Saloojee G, Foley S. The Bobath Clinical Reasoning Framework: Open to debate. Dev Med Child Neurol 2024; 66:671-672. [PMID: 38343029 DOI: 10.1111/dmcn.15881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 04/04/2024]
Abstract
This letter to the editor is a response to the letters to the editor by Blomme, Damiano et al., and Coughlan et al. on pages 667, 668, and 669–670 respectively.
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Mackintosh JA, Keir G, Corte TJ. Reply to: Optimal clinical practice in IPF and PPF: Integrating scientific ethos and clinical reasoning. Respirology 2024; 29:432-433. [PMID: 38539057 DOI: 10.1111/resp.14717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/20/2024] [Indexed: 04/18/2024]
Abstract
See related editorial
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Affiliation(s)
- John A Mackintosh
- Department of Respiratory Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Centre of Research Excellence in Pulmonary Fibrosis, Sydney, New South Wales, Australia
| | - Gregory Keir
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Tamera J Corte
- Centre of Research Excellence in Pulmonary Fibrosis, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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Wells AU. Optimal clinical practice in IPF and PPF: Integrating the scientific ethos and clinical reasoning. Respirology 2024; 29:356-358. [PMID: 38537694 DOI: 10.1111/resp.14710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 04/18/2024]
Abstract
See related article
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Affiliation(s)
- Athol U Wells
- Royal Brompton Hospital and Imperial College, London, UK
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Blomme S. The Bobath Clinical Reasoning Framework for neurodevelopmental conditions: A call for collaboration instead of de-implementation. Dev Med Child Neurol 2024; 66:667. [PMID: 37814491 DOI: 10.1111/dmcn.15776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
This letter to the editor is on the invited review by Mayston et al. on pages 564–572 of this issue.
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Affiliation(s)
- Sofie Blomme
- Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
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Nyiringango G, Fors U, Forsberg E, Tumusiime DK. Enhancing clinical reasoning for management of non-communicable diseases: virtual patient cases as a learning strategy for nurses in primary healthcare centers: a pre-post study design. BMC Med Educ 2024; 24:441. [PMID: 38654323 PMCID: PMC11036556 DOI: 10.1186/s12909-024-05440-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND In Rwanda, nurses manage all primary care at health centres, and therefore are their clinical reasoning skills important. In this study, a web-based software that allows the creation of virtual patient cases (VP cases) has been used for studying the possibility of using VP cases for the continuous professional development of nurses in primary health care in Rwanda. Previous studies in pre-service education have linked VP cases with the enhancement of clinical reasoning, a critical competence for nurses. This study investigated the feasibility of continuous professional development through VP cases to further train in-service nurses in clinical reasoning. METHOD The study used a pre-post test design. Initially, seventy-six participants completed a questionnaire as part of the pre-test phase, subsequently invited to engage with all four VP cases, and finally responded to the post-test questionnaire evaluating clinical reasoning skills. Fifty-six participants successfully completed the entire study process and were considered in the analysis. The primary outcomes of this study were evaluated using a paired t-test for the statistical analysis. RESULTS The results show that the mean score of clinical reasoning increased significantly from the pre-test to the post-test for all four illness areas (p < 0.001). The study findings showed no statistically significant difference in participants' scores based on demographic factors, including whether they worked in urban or rural areas. CONCLUSION AND RECOMMENDATION: Utilizing VP cases appears to significantly enhance the continuous professional development of nurses, fostering a deliberate learning process that enables them to reflect on how they manage cases and, in turn, refine their clinical reasoning skills. This study strongly recommends incorporating VP cases in the continuous professional development of nurses at the primary health level (health centers). This is especially pertinent in a context where nurses are required to perform diagnostic processes similar to those employed by physicians.
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Affiliation(s)
- Gerard Nyiringango
- Department of Computer and Systems Sciences (DSV), Stockholm University, Borgarfjordsgatan 12, PO Box 7003, 164 07, Kista, Sweden.
- Department of Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, P.O.Box 3286, Kigali, Rwanda.
| | - Uno Fors
- Department of Computer and Systems Sciences (DSV), Stockholm University, Borgarfjordsgatan 12, PO Box 7003, 164 07, Kista, Sweden
| | - Elenita Forsberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - David K Tumusiime
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Malik TG, Mahboob U, Khan RA, Alam R. Virtual patients versus standardized patients for improving clinical reasoning skills in ophthalmology residents. A randomized controlled trial. BMC Med Educ 2024; 24:429. [PMID: 38649884 PMCID: PMC11034047 DOI: 10.1186/s12909-024-05241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND History taking and clinical reasoning are important skills that require knowledge, cognition and meta-cognition. It is important that a trainee must experience multiple encounters with different patients to practice these skills. However, patient safety is also important, and trainees are not allowed to handle critically ill patients. To address this issue, a randomized controlled trial was conducted to determine the effectiveness of using Virtual Patients (VP) versus Standardized Patients (SP) in acquiring clinical reasoning skills in ophthalmology postgraduate residents. METHODS Postgraduate residents from two hospitals in Lahore, Pakistan, were randomized to either the VP group or the SP group and were exposed to clinical reasoning exercise via the VP or SP for 30 min after the pretest. This was followed by a posttest. One month after this activity, a follow-up posttest was conducted. The data were collected and analysed using IBM-SPSS version 25. Repeated measures ANOVA was used to track the effect of learning skills over time. RESULTS The mean age of the residents was 28.5 ± 3 years. The male to female ratio was 1:1.1. For the SP group, the mean scores were 12.6 ± 3.08, 16.39 ± 3.01 and 15.39 ± 2.95, and for the VP group, the mean scores were 12.7 ± 3.84, 16.30 ± 3.19 and 15.65 ± 3.18 for the pretest, posttest and follow-up posttest, respectively (p value < 0.00). However, the difference between the VP and SP groups was not statistically significant (p = 0.896). Moreover, there was no statistically significant difference between the VP and SP groups regarding the retention of clinical reasoning ability. In terms of learning gain, compared with the VP group, the SP group had a score of 51.46% immediately after clinical reasoning exercise as compared to VP group, in which it was 49.1%. After one month, it was 38.01 in SP and 40.12% in VP group. CONCLUSION VPs can be used for learning clinical reasoning skills in postgraduate ophthalmology residents in a safe environment. These devices can be used repeatedly without any risk to the real patient. Although similarly useful, SP is limited by its nonavailability for repeated exercises.
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Affiliation(s)
- Tayyaba Gul Malik
- Masters in Medical Education (Scholar), University of Lahore, Lahore, Pakistan.
| | - Usman Mahboob
- Institute of Health Professions Education & Research, Khyber Medical University, Peshawar, Pakistan
| | - Rehan Ahmed Khan
- Dean Riphah Institute of Assessment, Riphah International University, Islamabad, Pakistan
| | - Rabail Alam
- IMBB, University of Lahore, Lahore, Punjab, Pakistan
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Ventres WB, Stone LA, Gibson-Oliver LE, Meehan EK, Ricker MA, Loxterkamp D, Ogbeide SA, deGruy FV, Mahoney MR, Lin S, MacRae C, Mercer SW. Storylines of family medicine VIII: clinical approaches. Fam Med Community Health 2024; 12:e002795. [PMID: 38609085 PMCID: PMC11029325 DOI: 10.1136/fmch-2024-002795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VIII: clinical approaches', authors address the following themes: 'Evaluation, diagnosis and management I-toward a working diagnosis', 'Evaluation, diagnosis and management II-process steps', 'Interweaving integrative medicine and family medicine', 'Halfway-the art of clinical judgment', 'Seamless integration in family medicine-team-based care', 'Technology-uncovering stories from noise' and 'Caring for patients with multiple long-term conditions'. May readers recognise in these essays the uniqueness of a family medicine approach to care.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Lauren E Gibson-Oliver
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Elizabeth Kyle Meehan
- Family and Community Medicine, The University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Mari A Ricker
- Family and Community Medicine, The University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | | | - Stacy A Ogbeide
- Family and Community Medicine, UT Health San Antonio Long School of Medicine, San Antonio, Texas, USA
| | - Frank V deGruy
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Megan R Mahoney
- Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Steven Lin
- Division of Primary Care and Population Health, Stanford Medicine, Palo Alto, California, USA
| | - Clare MacRae
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
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Wu Y, Zheng Y, Feng B, Yang Y, Kang K, Zhao A. Embracing ChatGPT for Medical Education: Exploring Its Impact on Doctors and Medical Students. JMIR Med Educ 2024; 10:e52483. [PMID: 38598263 PMCID: PMC11043925 DOI: 10.2196/52483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/03/2023] [Accepted: 01/17/2024] [Indexed: 04/11/2024]
Abstract
ChatGPT (OpenAI), a cutting-edge natural language processing model, holds immense promise for revolutionizing medical education. With its remarkable performance in language-related tasks, ChatGPT offers personalized and efficient learning experiences for medical students and doctors. Through training, it enhances clinical reasoning and decision-making skills, leading to improved case analysis and diagnosis. The model facilitates simulated dialogues, intelligent tutoring, and automated question-answering, enabling the practical application of medical knowledge. However, integrating ChatGPT into medical education raises ethical and legal concerns. Safeguarding patient data and adhering to data protection regulations are critical. Transparent communication with students, physicians, and patients is essential to ensure their understanding of the technology's purpose and implications, as well as the potential risks and benefits. Maintaining a balance between personalized learning and face-to-face interactions is crucial to avoid hindering critical thinking and communication skills. Despite challenges, ChatGPT offers transformative opportunities. Integrating it with problem-based learning, team-based learning, and case-based learning methodologies can further enhance medical education. With proper regulation and supervision, ChatGPT can contribute to a well-rounded learning environment, nurturing skilled and knowledgeable medical professionals ready to tackle health care challenges. By emphasizing ethical considerations and human-centric approaches, ChatGPT's potential can be fully harnessed in medical education, benefiting both students and patients alike.
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Affiliation(s)
- Yijun Wu
- Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Clinical Cell Therapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Zheng
- Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Clinical Cell Therapy, West China Hospital, Sichuan University, Chengdu, China
| | - Baijie Feng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuqi Yang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Kai Kang
- Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Clinical Cell Therapy, West China Hospital, Sichuan University, Chengdu, China
| | - Ailin Zhao
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
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Lail G, Siu VM, Leung A. Clinical Reasoning: A 19-Month-Old Girl With Infantile-Onset Myopathy and White Matter Changes. Neurology 2024; 102:e209258. [PMID: 38484275 DOI: 10.1212/wnl.0000000000209258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/17/2024] [Indexed: 03/19/2024] Open
Abstract
We describe the case of a 19-month-old girl presenting with gross motor delays, hypotonia, diminished deep tendon reflexes, hyperCKaemia, extensive white matter changes on MRI brain, and electromyography studies consistent with myopathy. The differential diagnosis for infantile-onset hypotonia and muscle weakness is broad. It includes numerous subtypes of genetic disorders, including congenital muscular dystrophies, congenital myopathies, congenital myasthenic syndromes, spinal muscular atrophy, single-gene genetic syndromes, and inborn errors of metabolism. We outline our clinical approach leading to the diagnosis of a distinctive genetic neuromuscular condition essential for neurologists and geneticists working with patients of all ages to recognize.
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Affiliation(s)
- Gurnoor Lail
- From the Department of Paediatrics, Division of Medical Genetics (G.L., V.M.S.), and Department of Medical Imaging (A.L.), Western University, London, Ontario, Canada
| | - Victoria M Siu
- From the Department of Paediatrics, Division of Medical Genetics (G.L., V.M.S.), and Department of Medical Imaging (A.L.), Western University, London, Ontario, Canada
| | - Andrew Leung
- From the Department of Paediatrics, Division of Medical Genetics (G.L., V.M.S.), and Department of Medical Imaging (A.L.), Western University, London, Ontario, Canada
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Penner JC, Schuwirth L, Durning SJ. From Noise to Music: Reframing the Role of Context in Clinical Reasoning. J Gen Intern Med 2024; 39:851-857. [PMID: 38243110 PMCID: PMC11043232 DOI: 10.1007/s11606-024-08612-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Affiliation(s)
- John C Penner
- Department of Medicine, University of California, San Francisco, CA, USA.
- Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Lambert Schuwirth
- Prideaux Discipline of Clinical Education, Flinders University, Adelaide, SA, Australia
| | - Steven J Durning
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Moadeli F, Bahrami M, Namdar H. Hope: Clinical Reasoning in Heart Diseases from Avicenna's Viewpoint. Curr Probl Cardiol 2024; 49:102054. [PMID: 37648040 DOI: 10.1016/j.cpcardiol.2023.102054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Fatemeh Moadeli
- Persian Medicine Department, School of Persian Medicine, Shahed University of Medical Sciences, Tehran, Iran
| | - Mohsen Bahrami
- Persian Medicine Department, Expert and researcher MD, PhD in Persian Medicine Qom, Qom, Iran
| | - Hasan Namdar
- Persian Medicine Department, School of Persian Medicine, Shahed University of Medical Sciences, Tehran, Iran.
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Wang AP, Hernandez ST, Kaderali Z, Heran N, Erdenebold UE, Fahed R, Walker GB. Clinical Reasoning: A 24-Year-Old Woman With Penetrating Neck Injury From a Needlefish. Neurology 2024; 102:e209225. [PMID: 38377451 DOI: 10.1212/wnl.0000000000209225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
Evaluating patients with a traumatic spinal cord injury can be complicated by other injuries. In this case, a 24-year-old woman injured by a needlefish presented with combined motor and sensory defects, cranial nerve deficits, and a blunt vascular injury. This case highlights the importance of neurologic and vascular localizations and an understanding of spinal cord injuries involving various ascending and descending tracts. Appreciation of these anatomical considerations through this case illustrates the diagnostic approach to neurologic evaluation. While we present a traumatic etiology for multiple neurologic syndromes, this case gives readers an opportunity to develop a comprehensive differential diagnosis and tailor investigations for other relevant etiologies. Readers walking through this stepwise process will ultimately arrive at several distinct but related diagnoses.
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Affiliation(s)
- Alick P Wang
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Sean T Hernandez
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Zul Kaderali
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Navraj Heran
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Undrakh-Erdene Erdenebold
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Robert Fahed
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Gregory B Walker
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
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Kojich L, Miller SA, Axman K, Eacret T, Koontz JA, Smith C. Evaluating clinical reasoning in first year DPT students using a script concordance test. BMC Med Educ 2024; 24:329. [PMID: 38519915 DOI: 10.1186/s12909-024-05281-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND A script concordance test (SCT) provides a series of clinical vignettes to assess clinical reasoning in uncertainty. Appraised throughout health education literature, SCTs are cognitive assessments of clinical reasoning, though their use in Doctor of Physical Therapy (DPT) entry-level education has not been investigated. The purpose of this study was to develop and explore the reliability and validity of a SCT for first year DPT students. METHODS The SCT was developed and implemented over four phases. During phases one and two, DPT program faculty consulted on course content from the first-year curriculum. Thirty clinical vignettes with three follow-up questions each were constructed. The SCT was pilot tested with five clinicians in phase three to assess question clarity. During phase four, the SCT was administered to students and a reference panel via Qualtrics. First year DPT students (n = 44) and reference panel physical therapists with at least two years of experience and advanced certification (n = 15) completed the SCT. Internal consistency was analyzed using Cronbach's Alpha. Differences between student and reference panel percent-correct scores were analyzed with a t-test. Relationships between student SCT scores and academic records were explored with Spearman's Rho. RESULTS The SCT had an internal consistency of 0.74. A significant difference in scores was found between the students [mean 58.5 (+/-5.31)] and reference panel [65.8 (+/-4.88), p < .01]. No significant correlations between student SCT scores and academic records were found. CONCLUSIONS The developed SCT was reliable and demonstrated satisfactory internal consistency among test items. The SCT successfully differentiated between groups, with the reference panel demonstrating statistically significant higher percent-correct scores compared to students. SCTs may provide means to measure clinical reasoning in DPT students and lead to novel pedagogical approaches to enhance clinical reasoning.
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Affiliation(s)
- Lindsey Kojich
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA.
| | - Stephanie A Miller
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - Katelyn Axman
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - Timothy Eacret
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - J Atticus Koontz
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - Caroline Smith
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
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Madduri GB, Torwekar EL, Demirel S, Durham M, Hauff KI, Kaul R, Nichols T, Ravid NL, Shaner MA, Rassbach CE. CRISP: An Inpatient Pediatric Curriculum for Family Medicine Residents Using Clinical Reasoning and Illness Scripts. MedEdPORTAL 2024; 20:11393. [PMID: 38524942 PMCID: PMC10957791 DOI: 10.15766/mep_2374-8265.11393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/04/2024] [Indexed: 03/26/2024]
Abstract
Introduction Clinical reasoning enables safe patient care and is an important competency in medical education but can be challenging to teach. Illness scripts facilitate clinical reasoning but have not been used to create pediatric curricula. Methods We created CRISP (Clinical Reasoning with Illness Scripts in Pediatrics), a curriculum comprising four 1-hour learning sessions that deliberately incorporated clinical reasoning concepts and illness scripts to organize how four common chief complaints were taught to family medicine residents on inpatient pediatric rotations. We performed a multisite curriculum evaluation project over 6 months with family medicine residents at four institutions to assess whether the use of clinical reasoning concepts to structure CRISP was feasible and acceptable for learners and instructors and whether the use of illness scripts increased knowledge of four common pediatric chief complaints. Results For all learning sessions, family medicine residents and pediatric hospitalists agreed that CRISP's format was preferable to traditional didactic lectures. Pre-/posttest scores showed statistically significant increases in family medicine resident knowledge (respiratory distress [n = 42]: pretest, 72%, posttest, 92%; abdominal pain [n = 44]: pretest, 82%, posttest, 96%; acute febrile limp [n = 44]: pretest, 68%, posttest, 81%; well-appearing febrile infant [n = 42]: pretest, 58%, posttest, 73%; ps < .05). Discussion By using clinical reasoning concepts and illness script comparison to structure a pediatric curriculum, CRISP represents a novel instructional approach that can be used by pediatric hospitalists to increase family medicine resident knowledge about diagnoses associated with common pediatric chief complaints.
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Affiliation(s)
- Gayatri B. Madduri
- Assistant Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine; Family Medicine Inpatient Pediatrics Rotation Director, John Muir Medical Center
| | - Elizabeth L. Torwekar
- GME Director of Pediatric Education and Pediatric Hospitalist, Department of Pediatrics, Randall Children's Hospital, Legacy Health
| | - Shaban Demirel
- Vice President of Research, Legacy Research Institute, and Director of Clinical Research, Legacy Health
| | - Megan Durham
- Clinical Instructor, Department of Pediatrics, Randall Children's Hospital, Legacy Health
| | - Kimberlee I. Hauff
- Associate Professor, Department of Family Medicine, University of Washington; Family Medicine Inpatient Pediatrics Rotation Director, Swedish Medical Center
| | - Rajat Kaul
- Associate Professor, Division of Hospital Medicine, Department of Pediatrics, Ebeid Children's Hospital; Pediatric Clerkship Director, University of Toledo College of Medicine and Life Sciences
| | - Tristan Nichols
- Assistant Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine; Family Medicine Inpatient Pediatrics Rotation Director, John Muir Medical Center
| | - Noga L. Ravid
- Assistant Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine; Chair, Department of Pediatrics, John Muir Medical Center
| | - Mason A. Shaner
- Third-Year Medical Student, University of Michigan Medical School
| | - Caroline E. Rassbach
- Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, and Program Director, Pediatrics Residency and Pediatrics-Anesthesiology Residency, Stanford University School of Medicine
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Maitland A, Fowkes R, Maitland S. Can ChatGPT pass the MRCP (UK) written examinations? Analysis of performance and errors using a clinical decision-reasoning framework. BMJ Open 2024; 14:e080558. [PMID: 38490655 PMCID: PMC10946340 DOI: 10.1136/bmjopen-2023-080558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE Large language models (LLMs) such as ChatGPT are being developed for use in research, medical education and clinical decision systems. However, as their usage increases, LLMs face ongoing regulatory concerns. This study aims to analyse ChatGPT's performance on a postgraduate examination to identify areas of strength and weakness, which may provide further insight into their role in healthcare. DESIGN We evaluated the performance of ChatGPT 4 (24 May 2023 version) on official MRCP (Membership of the Royal College of Physicians) parts 1 and 2 written examination practice questions. Statistical analysis was performed using Python. Spearman rank correlation assessed the relationship between the probability of correctly answering a question and two variables: question difficulty and question length. Incorrectly answered questions were analysed further using a clinical reasoning framework to assess the errors made. SETTING Online using ChatGPT web interface. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the score (percentage questions correct) in the MRCP postgraduate written examinations. Secondary outcomes were qualitative categorisation of errors using a clinical decision-making framework. RESULTS ChatGPT achieved accuracy rates of 86.3% (part 1) and 70.3% (part 2). Weak but significant correlations were found between ChatGPT's accuracy and both just-passing rates in part 2 (r=0.34, p=0.0001) and question length in part 1 (r=-0.19, p=0.008). Eight types of error were identified, with the most frequent being factual errors, context errors and omission errors. CONCLUSION ChatGPT performance greatly exceeded the passing mark for both exams. Multiple choice examinations provide a benchmark for LLM performance which is comparable to human demonstrations of knowledge, while also highlighting the errors LLMs make. Understanding the reasons behind ChatGPT's errors allows us to develop strategies to prevent them in medical devices that incorporate LLM technology.
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Affiliation(s)
- Amy Maitland
- Health Education England North East, Newcastle upon Tyne, UK
| | - Ross Fowkes
- Health Education England North East, Newcastle upon Tyne, UK
| | - Stuart Maitland
- The Newcastle Upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
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Javedani Masroor M, Rezaei S, Hashemi Kiapey SA, Hakiminezhad M, Ahmadi SAY. Knowledge, Attitude, and Practice (KAP) Status toward Clinical Reasoning and Evidence-Based Medicine among the Medical Interns and Gynecology Residents of Iran University of Medical Sciences. ScientificWorldJournal 2024; 2024:6546432. [PMID: 38510568 PMCID: PMC10954360 DOI: 10.1155/2024/6546432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
Background Clinical reasoning and evidence-based medicine (EBM) are important concepts in modern medicine. Objective We performed this study to investigate the knowledge, attitude, and practice (KAP) status toward clinical reasoning and EBM among the medical interns and gynecology resident physicians of Iran University of Medical Sciences and related factors. Methods A cross-sectional study (Tehran, Iran, first half of 2022) was conducted based on two researcher-made questionnaires consisting of three components for each including clinical reasoning attitude (CR-A), clinical reasoning knowledge (CR-K), clinical reasoning practice (CR-P), EBM attitude (EBM-A), EBM knowledge (EBM-K), and EBM practice (EBM-P). The related factors were age, gender, educational level, score of general practice education, having research experience, and general practice experience. Results A total of 60 individuals participated. The mean score was good for CR-A, moderate for CR-K, moderate for CR-P, good for EBM-A, moderate for EBM-K, and moderate for EBM-P. The total score was moderate in both clinical reasoning and EBM. Among the related factors, CR-P was associated with higher educational levels and having experience in general practice (P < 0.05). Research experience was associated with better CR-K and all KAP components for EBM (P < 0.05). Conclusion The total score and many of the KAP components had moderate status for clinical reasoning and EBM. Planning on the associated factors should be regarded in the future. Such questionnaires are suggested to be validated for use in quasi-experimental studies.
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Affiliation(s)
- Mojgan Javedani Masroor
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Shahid AkbarAbadi Clinical Research Development Unit (SHACRDU), School of Medicine, Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Rezaei
- Eye and Skull Base Research Centers, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Hashemi Kiapey
- Department of Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Hakiminezhad
- Firoozgar Clinical Research Development Center (FCRDC), Department of Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Seyyed Amir Yasin Ahmadi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Bai X, Xiang J, Deng J, Ding WH, Luan X, Geng Z. Clinical Reasoning: A 30-Year-Old Woman Presenting With Rapidly Progressive Dementia and Extreme Hypoglycorrhachia. Neurology 2024; 102:e209188. [PMID: 38315946 DOI: 10.1212/wnl.0000000000209188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024] Open
Abstract
A 30-year-old woman presented with rapidly progressive dementia 1 month after the coronavirus disease 2019 infection. Repeated CSF analysis showed extreme hypoglycorrhachia, while cultures, metagenomic next-generation sequencing, and cytopathology testing of CSF were negative. Laboratory investigations for possible etiologies revealed elevated blood ammonia and cancer antigen 125. Brain MRI demonstrated bilateral symmetric diffuse cortical lesions with mild hyperintensity on T1-weighted image and postcontrast enhancement. A more thorough history and specific examinations subsequently indicated an underlying etiology. This case provides an approach for evaluating young patients with rapidly progressive dementia, extreme hypoglycorrhachia, and diffuse CNS lesions, highlighting the importance of considering a broad differential diagnosis.
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Affiliation(s)
- Xiaolin Bai
- From the Department of Neurology (X.B., J.X., J.D., X.L., Z.G.), Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital; and Department of Neurosurgery (W.-H.D.), Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Jingyan Xiang
- From the Department of Neurology (X.B., J.X., J.D., X.L., Z.G.), Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital; and Department of Neurosurgery (W.-H.D.), Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Jiangshan Deng
- From the Department of Neurology (X.B., J.X., J.D., X.L., Z.G.), Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital; and Department of Neurosurgery (W.-H.D.), Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Wan Hai Ding
- From the Department of Neurology (X.B., J.X., J.D., X.L., Z.G.), Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital; and Department of Neurosurgery (W.-H.D.), Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Xinghua Luan
- From the Department of Neurology (X.B., J.X., J.D., X.L., Z.G.), Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital; and Department of Neurosurgery (W.-H.D.), Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Zhi Geng
- From the Department of Neurology (X.B., J.X., J.D., X.L., Z.G.), Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital; and Department of Neurosurgery (W.-H.D.), Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
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Cheng Y, Zachariah J. Clinical Reasoning: A 54-Year-Old Woman With Progressive Headache and Neurologic Decline. Neurology 2024; 102:e209190. [PMID: 38330283 DOI: 10.1212/wnl.0000000000209190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/05/2024] [Indexed: 02/10/2024] Open
Abstract
A 54-year-old woman presented with headache and vasculopathy. She was treated for reversible cerebral vasoconstriction syndrome but continued to have clinicoradiographic decline with headache, seizures, systemic symptoms, and progression of vasculopathy on imaging. We present the diagnosis of a rare genetic disease with its various neurologic complications and systemic manifestations. Our case also illustrates the importance of differences in the metabolism of various antiseizure medications, recognition of which may avoid precipitating the disease.
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Affiliation(s)
- Yao Cheng
- From Corewell Health, Grand Rapids, MI
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Chen RT, Liu CY, Lin SY, Shu CC, Sheng WH. The prevalence, clinical reasoning and impact of non-standard anti-tuberculosis regimens at the initial prescription. Sci Rep 2024; 14:5631. [PMID: 38453976 PMCID: PMC10920864 DOI: 10.1038/s41598-024-55273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
Regarding clinically-concerning non-standard initial anti-tuberculous (TB) regimens, few studies have examined their prevalence, risk factors and impacts. We recruited patients with drug susceptible TB and non-standard initial anti-TB regimens (NSTB group) and matched them with patients with standard initial regimens (STB group) in a 1:1 ratio. The risk factors and outcomes were analyzed. During the 11-year study period, we analyzed 50 (3.7%) patients with NSTB from a total set of 1337 patients with drug-susceptible TB. Pyrazinamide (60%) was the drug most commonly not prescribed in the NSTB group, followed by ethambutol (34%). Multivariable logistic regression identified independent risk factors as underlying eye disease (adjusted odds ratio [aOR]: 8.869; 95% CI 2.542-30.949; p = 0.001), gout/hyperuricemia (aOR: 4.012 [1.196-13.425]; p = 0.024), and liver disease (aOR: 12.790 [3.981-41.089]; p < 0.001). The NSTB group had longer treatment durations (281 ± 121 vs. 223 ± 63 days; p = 0.003) and more occurrences of treatment interruption (26% vs. 8%; p = 0.021) than the STB group. In conclusion, NSTB occurs in around 3.7% of patients and is associated with longer treatment and more treatment interruption. The risk factors might include underlying liver and eye diseases, and gout. Further studies to improve non-standard initial regimens and prevent negative outcomes are warranted.
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Affiliation(s)
- Rou-Tsern Chen
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Yu Liu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Yung Lin
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, No 7, Chung Shan South Road, Taipei, Taiwan
| | - Chin-Chung Shu
- College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, No 7, Chung Shan South Road, Taipei, Taiwan.
| | - Wang-Huei Sheng
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, No 7, Chung Shan South Road, Taipei, Taiwan
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Lee CY, Lai HY, Lee CH, Chen MM, Yau SY. Collaborative clinical reasoning: a scoping review. PeerJ 2024; 12:e17042. [PMID: 38464754 PMCID: PMC10924455 DOI: 10.7717/peerj.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Background Collaborative clinical reasoning (CCR) among healthcare professionals is crucial for maximizing clinical outcomes and patient safety. This scoping review explores CCR to address the gap in understanding its definition, structure, and implications. Methods A scoping review was undertaken to examine CCR related studies in healthcare. Medline, PsychInfo, SciVerse Scopus, and Web of Science were searched. Inclusion criteria included full-text articles published between 2011 to 2020. Search terms included cooperative, collaborative, shared, team, collective, reasoning, problem solving, decision making, combined with clinical or medicine or medical, but excluded shared decision making. Results A total of 24 articles were identified in the review. The review reveals a growing interest in CCR, with 14 articles emphasizing the decision-making process, five using Multidisciplinary Team-Metric for the Observation of Decision Making (MDTs-MODe), three exploring CCR theory, and two focusing on the problem-solving process. Communication, trust, and team dynamics emerge as key influencers in healthcare decision-making. Notably, only two articles provide specific CCR definitions. Conclusions While decision-making processes dominate CCR studies, a notable gap exists in defining and structuring CCR. Explicit theoretical frameworks, such as those proposed by Blondon et al. and Kiesewetter et al., are crucial for advancing research and understanding CCR dynamics within collaborative teams. This scoping review provides a comprehensive overview of CCR research, revealing a growing interest and diversity in the field. The review emphasizes the need for explicit theoretical frameworks, citing Blondon et al. and Kiesewetter et al. The broader landscape of interprofessional collaboration and clinical reasoning requires exploration.
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Affiliation(s)
- Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Yi Lai
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Hsin Lee
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Mi-Mi Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sze-Yuen Yau
- (CG-MERC) Chang Gung Medical Education Research Centre, Linkou, Taoyuan, Taiwan
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Abstract
BACKGROUND The introduction of the Next Generation NCLEX (NGN) necessitates the need to prepare students to demonstrate appropriate clinical judgment and reasoning. Innovative teaching strategies, such as the use of QR codes, may help to engage learners and promote the transition to the new NCLEX testing format. METHOD A three-phase pediatric-based case study was used to introduce NGN style questions. The QR codes provided resources, answers, and rationales for the case study questions. RESULTS The students reported an increase in perceived confidence with a case study-based NGN testing item. Student feedback was positive for this active and collaborative learning experience. CONCLUSION Nurse educators are challenged with finding methods to engage learners and prepare students for practice. Using QR codes in the classroom is an innovative approach to expose students to NGN questions and may help increase students confidence as they prepare for the new NGN. [J Nurs Educ. 2024;63(3):186-187.].
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Sullivan K, Kolcun K, King TS. Classroom Innovation Using the NCJMM: Preparing Nursing Students for the Next Generation NCLEX. J Nurs Educ 2024; 63:188-191. [PMID: 38442392 DOI: 10.3928/01484834-20240108-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND There is a growing demand for classroom creativity to increase engagement and build clinical judgment skills for nursing students. This article describes the design and implementation of an interactive classroom activity to enhance the development of clinical judgment while simultaneously orienting students to the new NCLEX Next Generation testing model. METHOD Faculty developed an interactive unfolding case study incorporating the six dimensions of the NCSBN Clinical Judgment Measurement Model. The case study question types were adapted to use an interactive learning platform for first-year nursing students. Students' perceptions of learning, engagement, and clinical judgment were surveyed. RESULTS Student responses regarding the case study implementation indicated this method was effective in maintaining engagement and persistence, as well as promoting nursing decision making. CONCLUSION The time used for building innovative classroom activities is well spent to meet the objective of enhancing clinical judgment in the next generation of nursing students. [J Nurs Educ. 2024;63(3):188-191.].
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Södervik I, Hanski L, Boshuizen HPA, Katajavuori N. Clinical reasoning in pharmacy: What do eye movements and verbal protocols tell us about the processing of a case task? Adv Health Sci Educ Theory Pract 2024; 29:45-65. [PMID: 37273029 PMCID: PMC10240483 DOI: 10.1007/s10459-023-10242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/14/2023] [Indexed: 06/06/2023]
Abstract
This study investigates pharmacy students' reasoning while solving a case task concerning an acute patient counselling situation in a pharmacy. Participants' (N = 34) reasoning processes were investigated with written tasks utilizing eye-tracking in combination with verbal protocols. The case was presented in three pages, each page being followed by written questions. Eye movements were recorded during case processing. Success in the task required differentiating the relevant information from the task redundant information, and initial activation of several scripts and verification of the most likely one, when additional information became available. 2nd (n = 16) and 3rd (n = 18)-year students' and better and worse succeeding students' processes were compared. The results showed that only a few 2nd-year students solved the case correctly, whereas almost all of the 3rd-year students were successful. Generally, the average total processing times of the case material did not differ between the groups. However, better-succeeding and 3rd-year students processed the very first task-relevant sentences longer, indicating that they were able to focus on relevant information. Differences in the written answers to the 2nd and 3rd question were significant, whereas differences regarding the first question were not. Thus, eye-tracking seems to be able to capture illness script activation during case processing, but other methods are needed to depict the script verification process. Based on the results, pedagogical suggestions for advancing pharmacy education are discussed.
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Affiliation(s)
- Ilona Södervik
- Centre for University Teaching and Learning (HYPE), Faculty of Educational Sciences, University of Helsinki, Siltavuorenpenger 5B, 00170 Helsinki, Finland
| | - Leena Hanski
- Faculty of Pharmacy, University of Helsinki, Biocenter 2, PO Box 56, 00014 Helsinki, Finland
| | - Henny P. A. Boshuizen
- Faculty of Educational Sciences, Open University of the Netherlands, Valkenburgerweg 177, 6419 AT Heerlen, The Netherlands
| | - Nina Katajavuori
- Centre for University Teaching and Learning (HYPE), Faculty of Educational Sciences, University of Helsinki, Viikinkaari 9, 00140 Helsinki, Finland
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Barton AJ. Models and Methods to Prepare Nursing Students in Clinical Judgment. J Nurs Educ 2024; 63:139-140. [PMID: 38442396 DOI: 10.3928/01484834-20240212-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Amy J Barton
- Professor and Senior Associate Dean for Faculty and Students Daniel and Janet Mordecai Endowed Chair in Rural Health Nursing University of Colorado College of Nursing Editor, Journal of Nursing Education
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Lasater K, Nielsen A. The Lasater Clinical Judgment Rubric: 17 Years Later. J Nurs Educ 2024; 63:149-155. [PMID: 38442394 DOI: 10.3928/01484834-20240108-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Nearly 17 years ago, the Lasater Clinical Judgment Rubric (LCJR) was published to provide a common language and trajectory of students' development to think like a nurse. METHOD This article traces the uses of the LCJR from creation to the present and cites lessons learned from its use. RESULTS During the intervening years, the LCJR has been used effectively as a debriefing guide in simulation and as a research instrument, as well as for formative assessment. The LCJR has been translated or is in process in 19 languages besides English. CONCLUSION This article provides evidence of the efficacy of the LCJR and discusses important lessons learned. [J Nurs Educ. 2024;63(3):149-155.].
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Schooley A, Spoljoric D, Covington K, Garwood J, Klosinski K, Mordi S. Reflective Clinical Judgment Questions to Educate the Next Generation of Nurses. J Nurs Educ 2024; 63:182-185. [PMID: 38442403 DOI: 10.3928/01484834-20240108-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND The complexity of health care requires entry-level nurses to have competent clinical judgment skills. In response, a nursing program created Reflective Clinical Judgment Questions (RCJQ) to guide students in the development of clinical judgment. METHOD The RCJQ incorporates the Clinical Judgment Measurement Model, the National Council of State Boards of Nursing's action questions, and the American Association of Colleges of Nursing's core competencies for professional nursing education. The RCJQ includes cognitive process questions and self-reflection questions aligned to the prelicensure subcompetencies to direct student thinking and build a routine for clinical decision making. RESULTS The RCJQ provides faculty with a framework to teach clinical judgment and incorporates self-reflective questions to guide decision making for safe and effective client care. CONCLUSION The RCJQ streamlines the clinical judgment process and guides students to achieve essential outcomes in classroom, clinical, and simulation settings to prepare for clinical practice. [J Nurs Educ. 2024;63(3):182-185.].
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Betts J, Muntean W, Dickison P. Evaluating the Importance of Clinical Judgment in Entry-Level Nursing. J Nurs Educ 2024; 63:156-162. [PMID: 38442395 DOI: 10.3928/01484834-20240108-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND This study investigated the extent to which clinical judgment is important in entry-level nursing practice. METHOD A task analysis linkage study methodology based on a large-scale, comprehensive practice analysis was used for the study. The practice analysis validated more than 200 entry-level nursing tasks, and the linkage study sought to evaluate the importance of clinical judgment overall and for each specific task expectation. RESULTS The results provide confirmatory evidence of the importance of clinical judgment. In addition, the work provides a comprehensive list of entry-level tasks and their associated clinical judgment importance. CONCLUSION Clinical judgment is a vital skill at entry into the profession and is expected to grow over time. This study offers insights on the extent to which clinical judgment is a necessary skill and provides direct evidence of its importance for specific entry-level tasks. [J Nurs Educ. 2024;63(3):156-162.].
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Peters M, Becker T, Jeschke K. [Clinical Judgement and Relational Competence in the Psychotherapy of Older Patients]. Psychother Psychosom Med Psychol 2024; 74:103-111. [PMID: 38552616 DOI: 10.1055/a-2250-5405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The negative attitude of psychotherapists towards the treatment of older patients in the past has weakened in the recent past. Nevertheless, the question remains as to how therapists perceive older patients in comparison to younger patients, what clinical judgements they arrive at and how they perceive the relationship with them. In the present study, which was conducted as part of the ÄPP study (Older Patients in Psychotherapy), therapists were asked to assess a self-selected younger (<40 years) or an older patient (>65) with regard to various variables. A total of 527 completed questionnaires were available. Two-factor analyses of variance were used to show, among other things, that younger therapists (compared to their older colleagues) rate older patients more negatively in terms of suitability for psychotherapy, the patient's ability to establish a therapeutic working relationship and other parameters. In comparison with their older colleagues, younger therapists perceive themselves as less competent in their relationships with older patients. There are only slight differences with younger patients.
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Affiliation(s)
- Meinolf Peters
- FB Erziehungswissenschaften, Institut für Alterspsychotherapie und Angewandte Gerontologie, Universität Marburg
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Bussard ME, Jessee MA, El-Banna MM, Cantrell MA, Alrimawi I, Marchi NM, Gonzalez LI, Rischer K, Coy ML, Poledna M, Lavoie P. Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review. Nurse Educ Today 2024; 134:106078. [PMID: 38184981 DOI: 10.1016/j.nedt.2023.106078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice. DESIGN Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). DATA SOURCES Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment. METHODS Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics. RESULTS Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study. CONCLUSION In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.
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Affiliation(s)
- Michelle E Bussard
- School of Nursing, Bowling Green State University, 924 Ridge St., Bowling Green, OH 43403, USA.
| | - Mary Ann Jessee
- School of Nursing, Vanderbilt University, 461 21(st) Avenue South, Nashville, TN 37240, USA.
| | - Majeda M El-Banna
- School of Nursing, George Washington University, 45085 University Drive, Innovation Hall, Ashburn, VA 20147, USA.
| | - Mary Ann Cantrell
- College of Nursing, Villanova University, 800 E. Lancaster Ave., Villanova, PA 19085, USA.
| | - Intima Alrimawi
- School of Nursing, Georgetown University, St. Mary's Hall, 3700 Reservoir Rd. NW, Washington, DC 20057, USA.
| | - Nadine M Marchi
- Inova Health System, 3300 Gallows Road, Falls Church, VA 22042-3300, USA.
| | - Lisa I Gonzalez
- College of Southern Maryland, 8730 Mitchell Rd, La Plata, MD 20646, USA.
| | - Keith Rischer
- KeithRN, 6417 Penn Ave S, Ste 8, iPMB 1383, Minneapolis, MN 55423, USA.
| | - Michelle L Coy
- Mayo Clinic College of Medicine and Science, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Mari Poledna
- Arizona State University, 411 North Central Ave, Phoeniz, AZ 85004, USA.
| | - Patrick Lavoie
- Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, Quebec H1T 1C8, Canada.
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Gonullu I, Bayazit A, Erden S. Exploring medical students' perceptions of individual and group-based clinical reasoning with virtual patients: a qualitative study. BMC Med Educ 2024; 24:189. [PMID: 38403641 PMCID: PMC10895817 DOI: 10.1186/s12909-024-05121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Virtual Patients are computer-based simulations used to teach and evaluate patient interviews, medical diagnoses, and treatment of medical conditions. It helps develop clinical reasoning skills, especially in undergraduate medical education. This study aimed to and investigate the medical students' perceptions of individual and group-based clinical reasoning and decision-making processes by using Virtual Patients. METHODS The study group comprised 24 third-year medical students. Body Interact® software was utilized as a VP tool. The students' readiness and the courses' learning goals were considered when choosing the scenarios. Semi-structured interview forms were employed for data collection. MAXQDA 2020 qualitative analysis software was used to analyze the data. The students' written answers were analyzed using content analysis. RESULTS The participants perceived individual applications as beneficial when making clinical decisions with Virtual Patients, but they suggested that group-based applications used with the same cases immediately following individual applications were a more appropriate decision-making method. The results indicated that students learn to make decisions through trial and error, based on software scoring priorities, or using clinical reasoning protocols. CONCLUSION In group-based reasoning, the discussion-conciliation technique is utilized. The students stated that the individual decision-making was advantageous because it provided students with the freedom to make choices and the opportunity for self-evaluation. On the other hand, they stated that the group based decision-making process activated their prior knowledge, assisted in understanding misconceptions, and promoted information retention. Medical educators need to determine the most appropriate method when using Virtual Patients, which can be structured as individual and/or group applications depending on the competency sought.
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Affiliation(s)
- Ipek Gonullu
- Faculty of Medicine, Department of Medical Education and Informatics, Ankara University, Cebeci, Ankara, Turkey.
| | - Alper Bayazit
- Faculty of Medicine, Department of Medical Education and Informatics, Ankara University, Cebeci, Ankara, Turkey
| | - Sengul Erden
- Faculty of Medicine, Department of Medical Education and Informatics, Ankara University, Cebeci, Ankara, Turkey
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Chen TC, Couldwell MW, Singer J, Singer A, Koduri L, Kaminski E, Nguyen K, Multala E, Dumont AS, Wang A. Assessing the clinical reasoning of ChatGPT for mechanical thrombectomy in patients with stroke. J Neurointerv Surg 2024; 16:253-260. [PMID: 38184368 DOI: 10.1136/jnis-2023-021163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/15/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Artificial intelligence (AI) has become a promising tool in medicine. ChatGPT, a large language model AI Chatbot, shows promise in supporting clinical practice. We assess the potential of ChatGPT as a clinical reasoning tool for mechanical thrombectomy in patients with stroke. METHODS An internal validation of the abilities of ChatGPT was first performed using artificially created patient scenarios before assessment of real patient scenarios from the medical center's stroke database. All patients with large vessel occlusions who underwent mechanical thrombectomy at Tulane Medical Center between January 1, 2022 and December 31, 2022 were included in the study. The performance of ChatGPT in evaluating which patients should undergo mechanical thrombectomy was compared with the decisions made by board-certified stroke neurologists and neurointerventionalists. The interpretation skills, clinical reasoning, and accuracy of ChatGPT were analyzed. RESULTS 102 patients with large vessel occlusions underwent mechanical thrombectomy. ChatGPT agreed with the physician's decision whether or not to pursue thrombectomy in 54.3% of the cases. ChatGPT had mistakes in 8.8% of the cases, consisting of mathematics, logic, and misinterpretation errors. In the internal validation phase, ChatGPT was able to provide nuanced clinical reasoning and was able to perform multi-step thinking, although with an increased rate of making mistakes. CONCLUSION ChatGPT shows promise in clinical reasoning, including the ability to factor a patient's underlying comorbidities when considering mechanical thrombectomy. However, ChatGPT is prone to errors as well and should not be relied on as a sole decision-making tool in its present form, but it has potential to assist clinicians with more efficient work flow.
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Affiliation(s)
- Tse Chiang Chen
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Jorie Singer
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Alyssa Singer
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Laila Koduri
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Emily Kaminski
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Khoa Nguyen
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Evan Multala
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Arthur Wang
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Collins AR, Lee K, Li D. Perspectives on Clinical Reasoning in Psychiatry in a Small Academic and Community-Based Residency Program. Acad Psychiatry 2024; 48:112-113. [PMID: 37919539 DOI: 10.1007/s40596-023-01894-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Affiliation(s)
| | - Kewchang Lee
- University of California San Francisco, San Francisco, CA, USA
| | - Descartes Li
- University of California San Francisco, San Francisco, CA, USA.
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Mertens JF, Kempen TGH, Koster ES, Deneer VHM, Bouvy ML, van Gelder T. Cognitive processes in pharmacists' clinical decision-making. Res Social Adm Pharm 2024; 20:105-114. [PMID: 37945418 DOI: 10.1016/j.sapharm.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/06/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Pharmacists' clinical decision-making is a core process in pharmaceutical care. However, the practical aspects and effective teaching methods of this process remain largely unexplored. OBJECTIVE To examine the cognitive processes involved in pharmacists' perceptions of how they make clinical decisions in pharmacy practice. METHODS Semi-structured, face-to-face interviews were conducted with pharmacists working in community, outpatient, and hospital care in the Netherlands between August and December 2021. Participants were explicitly asked for examples when asked how they make clinical decisions in practice and how they teach this to others. After transcribing audio-recorded interviews, an inductive thematic analysis was conducted to identify cognitive processes. A theoretical model of clinical decision-making was then used and adapted to structure the identified processes. RESULTS In total, 21 cognitive processes were identified from interviews with 16 pharmacists working in community (n = 5), outpatient (n = 2), and hospital care (n = 9). These cognitive processes were organized into 8 steps of the adapted theoretical model, i.e. problem and demand for care consideration, information collection, clinical reasoning, clinical judgment, shared decision-making, implementation, outcomes evaluation, and reflection. Pharmacists struggled to articulate their clinical decision-making and went back-and-forth in their explanations of this process. All pharmacists emphasized the importance of identifying the problem and described how they collect information through reviewing, gathering, recalling, and investigating. Clinical reasoning entailed various cognitive processes, of which comprehending the problem in the patient's context was deemed challenging at times. Pharmacists seemed least active in evaluating patient outcomes and reflecting on these outcomes. CONCLUSIONS Pharmacists use multiple cognitive processes when making clinical decisions in pharmacy practice, and their back-and-forth explanations emphasize its dynamic nature. This study adds to a greater understanding of how pharmacists make clinical decisions and to the development of a theoretical model that describes this process, which can be used in pharmacy practice and education.
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Affiliation(s)
- J F Mertens
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, the Netherlands.
| | - T G H Kempen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - E S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - V H M Deneer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - T van Gelder
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, the Netherlands
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Hirosawa T, Shimizu T. Enhancing clinical reasoning with Chat Generative Pre-trained Transformer: a practical guide. Diagnosis (Berl) 2024; 11:102-105. [PMID: 37779351 DOI: 10.1515/dx-2023-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES This study aimed to elucidate effective methodologies for utilizing the generative artificial intelligence (AI) system, namely the Chat Generative Pre-trained Transformer (ChatGPT), in improving clinical reasoning abilities among clinicians. METHODS We conducted a comprehensive exploration of the capabilities of ChatGPT, emphasizing two main areas: (1) efficient utilization of ChatGPT, with a focus on application and language selection, input methodology, and output verification; and (2) specific strategies to bolster clinical reasoning using ChatGPT, including self-learning via simulated clinical case creation and engagement with published case reports. RESULTS Effective AI-based clinical reasoning development requires a clear delineation of both system roles and user needs. All outputs from the system necessitate rigorous verification against credible medical resources. When used in self-learning scenarios, capabilities of ChatGPT in clinical case creation notably enhanced disease comprehension. CONCLUSIONS The efficient use of generative AIs, as exemplified by ChatGPT, can impressively enhance clinical reasoning among medical professionals. Adopting these cutting-edge tools promises a bright future for continuous advancements in clinicians' diagnostic skills, heralding a transformative era in digital healthcare.
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Affiliation(s)
- Takanobu Hirosawa
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
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Gonzalez L, Nielsen A. An integrative review of teaching strategies to support clinical judgment development in clinical education for nurses. Nurse Educ Today 2024; 133:106047. [PMID: 38039885 DOI: 10.1016/j.nedt.2023.106047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES Historically, emphasis on task-completion and lack of intentional approaches that develop students' thinking skills have dominated clinical education. One contributing factor may be the limited literature about teaching to develop clinical reasoning and clinical judgment in the clinical environment. This integrative review accessed available literature to answer the question, What strategies are used to develop clinical judgment in the clinical education environment? DESIGN The Whittemore and Knafl approach framed the integrative review. The framework includes the following steps 1) problem identification, 2) literature search, 3) data evaluation, 4) data analysis, and 5) presentation. DATASOURCES The data bases CINAHL Plus with Full Text, OVID, and ProQuest were searched through the period of January 2000 through July of 2022. REVIEW METHODS The PRISMA protocol informed review and screening of the literature. Authors assessed articles for eligibility via first screening by abstract review, followed by review of the full text. Both authors reviewed the articles, assessing qualification for inclusion and evaluating the content. Data from eligible articles were analyzed and synthesized to answer the research question. RESULTS Of the initial 427 articles, a total of 20 articles met inclusion criteria for final analysis. Five general themes emerged for clinical judgment during clinical education. The findings identified the teaching strategies nurse educators use. Many of the teaching methods include deliberateness and intentionality in planning and implementing the strategies. In addition to evaluating clinical judgment, nurse educators guided and mentored student thinking. Finally, this review identified reported outcomes and results of the teaching strategies and methods. CONCLUSIONS A limited number of articles describing teaching for clinical judgment in clinical environment were found. The articles analyzed found that nurse educators used a variety of teaching strategies for the purpose of developing students' clinical judgment. More research is needed to guide best-practices in clinical education. We must move the science forward to transform and leverage clinical education more deliberately to teach thinking in practice and decision-making about patient care.
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Affiliation(s)
- Lisa Gonzalez
- College of Southern Maryland, Center for Health Sciences, 6105 Foster Ln, Hughesville, MD 20637, United States of America.
| | - Ann Nielsen
- Oregon Health & Science University School of Nursing, 3455 SW US Veteran's Road, Portland, OR 97239-2941, United States of America
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Aron A, Cunningham S, Yoder I, Gravley E, Brown O, Dickson C. Diagnostic momentum in physical therapy clinical reasoning. J Eval Clin Pract 2024; 30:73-81. [PMID: 37338523 DOI: 10.1111/jep.13884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
RATIONALE AND OBJECTIVES Diagnostic momentum refers to ruling in a particular diagnosis without adequate evidence. As the field of physical therapy continues to transition more towards autonomous practitioners with direct access, there is a need to identify the effect of a physician diagnosis on a therapist's examination and treatment. The purpose of this study was to identify if diagnostic momentum exists in physical therapy and whether this phenomenon could affect the ability of the therapist to identify clinical red flags. METHODS An online survey with randomized case scenarios was completed by 75 licensed practicing physical therapists. Participants received one of two scenarios: a case vignette where the patient was referred to physical therapy for left shoulder pain and presented with 'red flags' indicative of myocardial infarction, or a similar vignette with additional results from an exercise stress test that ruled out myocardial infarction. The subjects were asked if they would 'treat' or 'refer' to another healthcare provider and the reason behind their decision. Independent t-tests and χ2 analyses were conducted to understand the differences between the groups. A thematic analysis was used to explore the therapists' responses regarding the reasoning for their decision. RESULTS There was no significant difference in clinical decision making based on age, gender, years of experience, advanced certification, primary caseload or primary practice setting. Among those who received the case without the stress test, 31.4% of participants indicated that they would refer, compared to 12.5% of the participants that had the additional stress test result included within their case. The presence of the negative stress test was indicated as the main reason for choosing to treat without referral by 65.7% of the subjects that received the additional stress test result. CONCLUSION This study suggests that practicing physical therapists may be influenced by diagnostic decisions made by other clinicians, causing them to overlook signs and symptoms of possible myocardial infarction.
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Affiliation(s)
- Adrian Aron
- Department of Physical Therapy, Radford University Carilion, Roanoke, Virginia, USA
| | - Shala Cunningham
- Department of Physical Therapy, Radford University Carilion, Roanoke, Virginia, USA
| | - Isaac Yoder
- Department of Physical Therapy, Radford University Carilion, Roanoke, Virginia, USA
| | - Elizabeth Gravley
- Department of Physical Therapy, Radford University Carilion, Roanoke, Virginia, USA
| | - Olivia Brown
- Department of Physical Therapy, Radford University Carilion, Roanoke, Virginia, USA
| | - Charles Dickson
- Department of Physical Therapy, Radford University Carilion, Roanoke, Virginia, USA
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Yang J, Zhou WJ, Zhou SC, Luo D, Liu Q, Wang AL, Yu SH, Zhu XP, He XY, Hu F, Yang BX, Chen J. Integrated virtual simulation and face-to-face simulation for clinical judgment training among undergraduate nursing students: a mixed-methods study. BMC Med Educ 2024; 24:32. [PMID: 38183036 PMCID: PMC10768231 DOI: 10.1186/s12909-023-04988-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Virtual simulation and face-to-face simulation are effective for clinical judgment training. Rare studies have tried to improve clinical judgment ability by applying virtual simulation and face-to-face simulation together. This study aimed to evaluate the effect of an integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program on enhancing nursing students' clinical judgment ability and understanding of nursing students' experiences of the combined simulation. METHODS A sequential exploratory mixed-methods study was conducted in a nursing simulation center of a university in Central China. Third-year nursing students (n = 122) taking clinical training in ICUs were subsequentially assigned to the integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program arm (n = 61) or the face-to-face simulation-only arm (n = 61) according to the order in which they entered in ICU training. Clinical judgment ability was measured by the Lasater Clinical Judgment Rubric (LCJR). Focus group interviews were conducted to gather qualitative data. RESULTS Students in both arms demonstrated significant improvement in clinical judgment ability scores after simulation, and students in the integrated arm reported more improvement than students in the face-to-face simulation-only arm. The qualitative quotes provided a context for the quantitative improvement measured by the LJCR in the integrated arm. Most of the quantitative findings were confirmed by qualitative findings, including the domains and items in the LJCR. The findings verified and favored the effect of the combination of non-immersive virtual simulation and high-fidelity face-to-face simulation integrated program on enhancing nursing students' clinical judgment ability. CONCLUSIONS The integrated virtual simulation and face-to-face simulation program was feasible and enhanced nursing students' self-reported clinical judgment ability. This integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program may benefit nursing students and newly graduated nurses in the ICU more than face-to-face simulation only.
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Affiliation(s)
- Jian Yang
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Wen Jie Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Si Chen Zhou
- School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Dan Luo
- School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Qian Liu
- School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Ai-Ling Wang
- School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Si-Hong Yu
- School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Xiao-Ping Zhu
- Hospital Quality and Safety Management Office, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Xue Yu He
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.
- Clinical Research Center of Hubei Critical Care Medicine, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, China.
- Center for Critical Care and Anesthesia Nursing Research, Wuhan University School of Nursing, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.
| | - Bing Xiang Yang
- School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.
| | - Jie Chen
- Florida State University College of Nursing, 98 Varsity Way, Tallahassee, FL, 32306, USA.
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Bergen T, Bae F. Cultivating Clinical Reasoning in Nursing Students Using the 3-Minute Memo. Nurs Educ Perspect 2024; 45:51-52. [PMID: 36730927 DOI: 10.1097/01.nep.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT The 3-Minute Memo was developed as an activity to synthesize clinical preparation in a preconference setting. The short, three-part tool requires students to develop and concisely present the patient's story, the patient's most significant priorities, and a planned intervention. It helps students make sense of their clinical preparation while demonstrating skills of clinical reasoning, priority setting, and communication. The 3-Minute Memo is an innovative tool to use in preconference to make sense of clinical preparation and develop the skills necessary to think like a nurse.
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Affiliation(s)
- Tania Bergen
- About the Authors Tania Bergen, MN, RN, and Faith Bae, MN, BSN, RN, are instructors at the University of Saskatchewan College of Nursing in Saskatoon, Saskatchewan, Canada. For more information, contact Tania Bergen at
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Stanley DE, Hanna R. Diagnosis: What Is the Structure of Its Reasoning? Perspect Biol Med 2024; 67:88-95. [PMID: 38662065 DOI: 10.1353/pbm.2024.a919712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
How does the diagnosis process work? This essay traces the philosophical underpinnings of diagnosis from Hume through Kant, Peirce, and Popper, analyzing how pathologists amalgamate sensibility, intuition, and imagination to form new hypotheses that can be tested by evidence and experience.
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Hosseinzadeh T, Mirfarhadi N, Pouralizadeh M, Tabrizi KN, Fallahi‐Khoshknab M, Khankeh HR, Shokooh F. Psychometric properties of the persian version of the nursing clinical reasoning scale. Nurs Open 2024; 11:e2041. [PMID: 38268299 PMCID: PMC10697119 DOI: 10.1002/nop2.2041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/07/2023] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIM The aim of this study was to translate the Nursing Clinical Reasoning Scale (NCRS) into Persian and evaluate its psychometric properties. DESIGN This study was a methodological and cross-sectional study. METHODS This methodological study was conducted in 2020 in a teaching hospital. After obtaining necessary permission from its developers, NCRS was translated into Persian through the method proposed by the World Health Organization. Then, its face, content, and construct validity and reliability were assessed. For construct validity assessment through exploratory and confirmatory factor analyses, 300 nurses (two 150-nurse samples), who had randomly been selected, completed the instrument. Reliability also assessed through the internal consistency and the stability methods. Data were analysed using the SPSS (v. 20.0) and the AMOS (v. 5.0) software. RESULTS The content validity indices of NCRS and its items were 0.97 and more than 0.79, respectively. Exploratory factor analysis revealed an assessment and confirmation factor and an implementation and reflection factor for the scale which together explained 57.30% of the total variance. Confirmatory factor analysis also confirmed this two-factor structure (χ2 /df = 2.11, NNFI = 0.952, RMSEA = 0.053, CFI = 0.91, GFI = 0.94, IFI = 0.95, and NFI = 0.96). The Cronbach's alpha and the intraclass correlation coefficient values of the scale were 0.96 and 0.94, respectively. PUBLIC CONTRIBUTION The Persian NCRS can help nursing policy makers and mentors identify the need for developing nurses' and nursing students' CR skills and implement need-based educational courses to improve these skills. Moreover, it helps determine whether the educational programmes are effective in improving nurses' CR skills and clinical competence.
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Affiliation(s)
- Touba Hosseinzadeh
- School of Nursing and MidwiferyGuilan University of Medical Science (GUMS)RashtIran
| | - Nastaran Mirfarhadi
- School of Nursing and MidwiferyGuilan University of Medical Science (GUMS)RashtIran
| | - Moluk Pouralizadeh
- School of Nursing and MidwiferyGuilan University of Medical Science (GUMS)RashtIran
| | - Kian Norouzi Tabrizi
- Department of Nursing, Social Determinants of Health Research CenterUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | | | - Hamid reza Khankeh
- Department of Health in Disasters & EmergenciesUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | - Forozan Shokooh
- Department of Basic SciencesUniversity of Social Welfare and Rehabilitation SciencesTehranIran
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Cuestas E. [ Clinical reasoning and artificial intelligence. Rev Fac Cien Med Univ Nac Cordoba 2023; 80:306-310. [PMID: 38150197 PMCID: PMC10851391 DOI: 10.31053/1853.0605.v80.n4.42544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Indexed: 12/28/2023] Open
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Boisclair M, Hadjinicolaou A, Nigam M. Clinical Reasoning: A 3-Year-Old Boy With Abnormal Movements During Sleep. Neurology 2023; 101:1134-1139. [PMID: 37857493 PMCID: PMC10791058 DOI: 10.1212/wnl.0000000000207980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Abstract
We report a case of a 3-year-old boy who presented with abnormal movements that initially occurred only during sleep. Three years later, he went on to develop hyperkinetic movements during the daytime while awake. There was a strong family history of various paroxysmal neurologic disorders. In this report, we discuss the clinical approach, differential diagnosis, investigation, and treatment options for nocturnal hyperkinetic movements and paroxysmal movement disorders.
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Affiliation(s)
- Mélissa Boisclair
- From the Centre Hospitalier de l'Université de Montréal (M.B.), Faculty of Medicine, University of Montreal; Department of Neurosciences (M.B., A.H., M.N.), Université de Montréal; Department of Pediatrics (A.H.), Division of Neurology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal; and Centre for Advanced Research in Sleep Medicine (M.N.), Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Aristides Hadjinicolaou
- From the Centre Hospitalier de l'Université de Montréal (M.B.), Faculty of Medicine, University of Montreal; Department of Neurosciences (M.B., A.H., M.N.), Université de Montréal; Department of Pediatrics (A.H.), Division of Neurology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal; and Centre for Advanced Research in Sleep Medicine (M.N.), Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Milan Nigam
- From the Centre Hospitalier de l'Université de Montréal (M.B.), Faculty of Medicine, University of Montreal; Department of Neurosciences (M.B., A.H., M.N.), Université de Montréal; Department of Pediatrics (A.H.), Division of Neurology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal; and Centre for Advanced Research in Sleep Medicine (M.N.), Hôpital du Sacré-Coeur de Montréal, Québec, Canada
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Christensen N, Black L, Gilliland S, Huhn K, Wainwright S. The Role of Movement in Physical Therapist Clinical Reasoning. Phys Ther 2023; 103:pzad085. [PMID: 37418230 DOI: 10.1093/ptj/pzad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/27/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The purpose of this study was to explore how physical therapists use movement as a component of their clinical reasoning. Additionally, this research explored whether movement as a component of clinical reasoning aligns with the proposed signature pedagogy for physical therapist education, human body as teacher. METHODS The study utilized qualitative, descriptive methods in a multiple case studies design (each practice setting represented a different case for analysis purposes) with cross-case comparisons. Researchers conducted 8 focus groups across practice settings including acute care, inpatient neurological, outpatient orthopedics, and pediatrics. Each focus group had 4 to 6 participants. Through an iterative, interactive process of coding and discussion among all researchers, a final coding scheme was developed. RESULTS Through exploration of the research aims, 3 themes emerged from the data. These primary themes are: (1) movement drives clinical reasoning to optimize function; (2) reasoning about movement is multisensory and embodied; and (3) reasoning about movement relies on communication. CONCLUSIONS This research supports a description of movement as the lens used by physical therapists in clinical reasoning and the integral role of movement in clinical reasoning and in learning from and through movement of the human body while learning from clinical reasoning experiences in practice. IMPACT As the understanding of the ways physical therapists use and learn from movement in clinical reasoning and practice continues to emerge, it is important to continue exploring ways to best make this expanded, embodied conception of clinical reasoning explicit in the education of future generations of physical therapists.
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Affiliation(s)
- Nicole Christensen
- Department of Physical Therapy, Samuel Merritt University, Oakland, California, USA
| | - Lisa Black
- Department of Physical Therapy, Creighton University, Omaha, Nebraska, USA
| | - Sarah Gilliland
- Department of Physical Therapy, Tufts University, Seattle, Washington, USA
| | - Karen Huhn
- School of Physical Therapy, Husson University, Bangor, Maine, USA
| | - Susan Wainwright
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Lang VJ, Readlynn J. 'Key findings', 'key features' and 'key clinical decisions' in clinical reasoning assessment. Med Teach 2023; 45:1439-1440. [PMID: 37572654 DOI: 10.1080/0142159x.2023.2247145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Affiliation(s)
- Valerie J Lang
- Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box MED-HMD, Rochester, NY 14642, USA
| | - Jennifer Readlynn
- Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box MED-HMD, Rochester, NY 14642, USA
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Paul A, Leung D, Salas RME, Cruz TE, Abras C, Saylor D, Gugliucciello V, Nunn J, Gamaldo CE, Strowd RE. Comparative effectiveness study of flipped classroom versus online-only instruction of clinical reasoning for medical students. Med Educ Online 2023; 28:2142358. [PMID: 36333903 PMCID: PMC9645276 DOI: 10.1080/10872981.2022.2142358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
CONTEXT Bedside clinical teaching is the backbone of clerkship education. Data-driven methods for supplementing bedside encounters with standardized content from vetted resources are needed. OBJECTIVE To compare a flipped-classroom versus an interactive online-only instruction for improving knowledge, skills, self-directed learning (SDL) behaviors, and satisfaction in a medical school clerkship. METHODS An IRB-approved prospective study employing a peer-reviewed clinical reasoning curriculum in neurology was conducted; 2nd-4th year medical students rotating through a required clerkship were enrolled. Students were randomized to flipped-classroom (i.e., flipped) or interactive asynchronous online instruction (i.e., online-only), which supplemented existing bedside teaching. Baseline and end-of-course knowledge, skill development, SDL behaviors, satisfaction, and long-term retention were assessed by peer-reviewed clinical reasoning exam, NBME scores, faculty/resident clinical evaluations, non-compulsory assignment completion, end-of-clerkship surveys, and objective structured clinical exam (OSCE). RESULTS 104 students (49 flipped, 55 online-only) were enrolled. Age, gender, and training level did not differ by group (all p > 0.43); baseline knowledge was higher in the flipped group (p = 0.003). Knowledge-based exam scores did not differ by group even after adjusting for differences in baseline knowledge (2.3-points higher in flipped group, 95%CI -0.4-4.8, p = 0.07). Clinical skills were significantly higher in the flipped group, including examination skills (4.2 ± 0.5 vs. 3.9 ± 0.7, p = 0.03) and future housestaff potential (4.8 ± 0.3 vs 4.5 ± 0.6, p = 0.03). Students in the online-only group were more likely to engage in SDL (42 vs. 12%, p = 0.001) and reported more hours studying (6.1 vs. 3.8 hours, p = 0.03). Satisfaction (p = 0.51) and OSCE scores (p = 0.28) were not different by group. CONCLUSIONS In this comparative study of two evidence-based curricular delivery approaches, we observed no difference in knowledge acquired. Greater clinical skills were observed with flipped instruction, while more SDL was observed with online-only instruction. Supplementing bedside teaching with blended instruction that balances live skill development with vetted online resources is optimal for clerkship education.
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Affiliation(s)
- Ashley Paul
- Department of Neurology, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA
| | - Doris Leung
- Department of Neurology, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA
| | - Rachel Marie E Salas
- Department of Neurology, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA
| | - Tiana E Cruz
- The Counseling Center, University of Maryland, College Park, 20742, MD, USA
| | - Chadia Abras
- Office of the Provost, Johns Hopkins University, 21218, Baltimore, MD, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA
| | - Veronique Gugliucciello
- Center for Technology in Education, Johns Hopkins School of Education, 21218, Baltimore, MD, USA
| | - Jaqueline Nunn
- Center for Technology in Education, Johns Hopkins School of Education, 21218, Baltimore, MD, USA
| | - Charlene E Gamaldo
- Department of Neurology, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA
| | - Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, 27104, Winston Salem, NC, USA
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