Group items tagged

"It is important that the clinical teacher teaches trainees the specific skills sets of the expert general practitioner (e.g. synthesising skills, recognising prototypes, focusing on cues and clues, using community resources and dealing with uncertainty) in order to promote clinical reasoning in the context of general practice or family medicine. Clinical teachers need to understand their own reasoning processes as well as be able to convey that knowledge to their trainees. They also need to understand the developmental stages of clinical reasoning and be able to nurture each trainee's own expertise. Strategies for facilitating effective clinical reasoning in trainees include adequate exposure to patients, offering the trainees opportunity for reflection and feedback, and coaching on the techniques of reasoning in the general practice context."

"linical teachers differ from clinicians in a fundamental way. They must simultaneously foster high-quality patient care and assess the clinical skills and reasoning of learners in order to promote their progress toward independence in the clinical setting.1 Clinical teachers must diagnose both the patient's clinical problem and the learner's ability and skill."

By considering clinical reasoning as a skill to be learnt rather than a concept to be understood, a framework for teaching this skill can be developed. The learner initially observes a consultation by the teaching clinician, followed by the teacher explaining the reasoning processes used including hypothesising, hypothesis testing, re-analysis and differential diagnosis. The student then comments on the reasoning of the teacher in a subsequent consultation, followed by feedback from the teacher on the student's reasoning in a third consultation.

"Welcome to the Virtual Interactive Case (VIC) system for creating simulations of encounters with patients in clinics. VIC cases are clinical reasoning exercises with feedback. Their role is to provide a bridge between theory and seeing patients in clinic (or ER), providing students with what Ericsson has called "deliberate practice" as a way of gaining clinical expertise. The strength of VIC is that it is optimized for rapidly creating a large number of cases, by using a patient template, and creating variations of cases with different differential diagnoses for the same presenting complaint."

The Expert Skills Program (ESP) at Texas Tech was implemented in March, 2012, as a free access professional skill development opportunity for all interested students regardless of their institution. The ESP is named to reflect the broad goal of acquiring expert skills in areas ranging from clinical reasoning, patient examination, and communication to the fine motor skills employed in clinical procedures. We have been able to initiate skill development prior to formal clinical training by matching the steps used in clinical skills to the steps involved in higher order thinking skills.

"We suggest that the making thinking visible approach has potential to assist educators to become more reflective about their clinical reasoning teaching and acts as a scaffold to assist them to articulate their own expert reasoning and for students to access and use."

"Teaching clinical reasoning is important and feasible. Teachers who explicitly teach problem solving and decision making may help learners to improve their diagnostic accuracy and treatment choices."

Despite the relative brevity of the intervention, our course appeared to be effective in improving diagnostic performance in simulated clinical reasoning skills problems, as measured by the CRP, and was generally well received by students.

By considering clinical reasoning as a skill to be learnt rather than a concept to be understood, a framework for teaching this skill can be developed.

"This report focuses on how clinical teachers can facilitate the learning process to help learners make the transition from being diagnostic novices to becoming expert clinicians"

" They then outline four different theoretical frameworks held by medical educators that the authors believe guide educators' views on the topic, knowingly or not. Within each theoretical framework, the authors begin with a definition of clinical reasoning (from that viewpoint) and then discuss learning, assessment, and research implications."

"All of these suggestions are about 'making sense common'. Clinical teachers are encouraged to use questions accompanying the main text to make a self-assessment of their current practice and consider potential changes to provide additional value for students during AEE."

Diagnosis is the foundation of medicine. Effective treatment cannot begin until an accurate diagnosis has been made. Diagnostic reasoning is a critical aspect of clinical performance. It is vulnerable to a variety of failings, the most prevalent arising through cognitive and affective influences. The impact of diagnostic failure on patient safety does not appear to have been fully recognized. Ideally, all information used in diagnostic reasoning is objective and all thinking is logical and valid, but these conditions are not always met.

Conclusions: The successful execution of the CPS engages both the audience and the discussant in real-time problem solving and relies upon the tenants of experiential learning and clinical reasoning rather than the traditional structure of the medical case presentation.

"Diagnostic accuracy was moderately associated with higher certainty only when clinical data were consistent. This correlation disappeared when incon sistent data were provided, possi bly reflecting changes in reasoning strategies among diagnostically success ful trainees. The relationship between certainty and diagnostic accuracy is context dependent. Certainty is an unreliable surrogate for diagnostic accuracy."

"In this blog, we discussed diagnostic tests and their relationship with likelihood ratios as well as heuristics and cognitive errors."

"The purpose of this article is to argue for the further investigation and revision of these initial attempts to apply checklists to the diagnostic process. The basic idea behind checklists is to provide an alternative to reliance on intuition and memory in clinical problem solving. This kind of solution is demanded by the complexity of diagnostic reasoning, which often involves sense-making under conditions of great uncertainty and limited time."

"The study results further indicated that VPs reduced cognitive load, focused attention, encouraged interaction, motivated participants, stimulated reflection, and supported analytical reasoning. The tutor played a significant role in promoting reflection-on-action and resolving cognitive conflict."

The human error problem can be viewed in two ways: the person approach and the system approach. Each has its model of error causation and each model gives rise to quite different philosophies of error management. Understanding these differences has important practical implications for coping with the ever present risk of mishaps in clinical practice.