Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review

AIM/OBJECTIVE

To report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promote new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing.

BACKGROUND

Clinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice.

DESIGN

A scoping review was conducted using the framework developed by Arksey and O'Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established.

METHODS

The studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text.

RESULTS

1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions.

CONCLUSIONS

Among the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.

Conceptions of Learning and Teaching for Faculty Who Teach Basic Science

INTRODUCTION

Conceptions of learning and teaching refer to what faculty think about teaching effectiveness. Approaches to teaching refer to the methods they use to teach. Both conceptions and approaches range from student-centered/learning-focused (active learner engagement) to teaching-centered/content-focused (passive learner engagement). This study explored how faculty teaching experience influenced faculty conceptions and their approaches to teaching. The authors hypothesized that more experienced educators appreciate and apply active learning approaches.

METHODS

The authors used a cross-sectional survey to collect anonymous data from the Basic Science faculty at Virginia Tech Carilion School of Medicine (VTCSOM). The survey included the Conceptions of Learning and Teaching scale (COLT; Jacobs et al. 2012) and demographic information. They assessed instrument reliability with Cronbach's alpha and examined relationships between variables with correlation and chi-square and group differences with ANOVA.

RESULTS

Thirty-eight percent (50/130) of faculty responded to the survey. COLT scores for student-centered (4.06 ± 0.41) were significantly higher (p < 0.001) than teacher-centered (3.12 ± 0.6). Teacher-centered scores were lower (p < 0.05) for younger (30-39, 2.65 ± 0.48) than older faculty (50-59, 3.57 ± 0.71) and were negatively correlated with using multiple teaching methods (p = 0.022). However, 83% (39/50) reported using both traditional lectures and active approaches.

DISCUSSION

Faculty conceptions about teaching showed appreciation for active learning, but a tendency to use traditional teaching methods interspersed with student-centered ones. Teaching experience was not related to faculty conceptions but was related to their teaching approaches. The amount of time dedicated to teaching was related to the appreciation of active learning, and young teachers were more student-oriented.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01264-4.

iCBLS: An interactive case-based learning system for medical education

Medical students should be able to actively apply clinical reasoning skills to further their interpretative, diagnostic, and treatment skills in a non-obtrusive and scalable way. Case-Based Learning (CBL) approach has been receiving attention in medical education as it is a student-centered teaching methodology that exposes students to real-world scenarios that need to be solved using their reasoning skills and existing theoretical knowledge. In this paper, we propose an interactive CBL System, called iCBLS, which supports the development of collaborative clinical reasoning skills for medical students in an online environment. The iCBLS consists of three modules: (i) system administration (SA), (ii) clinical case creation (CCC) with an innovative semi-automatic approach, and (iii) case formulation (CF) through intervention of medical students' and teachers' knowledge. Two evaluations under the umbrella of the context/input/process/product (CIPP) model have been performed with a Glycemia study. The first focused on the system satisfaction, evaluated by 54 students. The latter aimed to evaluate the system effectiveness, simulated by 155 students. The results show a high success rate of 70% for students' interaction, 76.4% for group learning, 72.8% for solo learning, and 74.6% for improved clinical skills.

Simulation as a surgical teaching model

Teaching of surgery has been affected by many factors over the last years, such as the reduction of working hours, the optimization of the use of the operating room or patient safety. Traditional teaching methodology fails to reduce the impact of these factors on surgeońs training. Simulation as a teaching model minimizes such impact, and is more effective than traditional teaching methods for integrating knowledge and clinical-surgical skills. Simulation complements clinical assistance with training, creating a safe learning environment where patient safety is not affected, and ethical or legal conflicts are avoided. Simulation uses learning methodologies that allow teaching individualization, adapting it to the learning needs of each student. It also allows training of all kinds of technical, cognitive or behavioural skills.