Group items matching

in title, tags, annotations or url

"WHAT TO DO WHEN A PATIENT LACKS CAPACITY - The degree and urgency with which to act on findings of impaired capacity depends on multiple factors, including the expected duration of impairment, the severity of the impairment, and the seriousness of the decision. Unless the urgency of a patient's medical condition requires that a substituted decision be made immediately, efforts should be made to identify and correct any reversible causes of the impairment [26]. This is particularly relevant in hospitalized patients with impaired capacity due to delirium. Treatment of the underlying causes of delirium may restore decision-making capacity. Patients with mild to moderate cognitive impairment that is not expected to fluctuate may benefit from more intensive efforts at education to improve understanding of the relevant facts, followed by reassessment of decision-making abilities. A randomized trial found that a memory and organizational aid given to patients with mild stage Alzheimer disease dementia (n = 80) improved performance on understanding, which in turn increased the likelihood of being judged capable of providing informed consent to enroll in a clinical trial [34]. This enhancement was also effective in a randomized trial with middle-aged and older adults with schizophrenia [35]. For patients whose impairments are severe enough that they are judged to lack the capacity to make a decision, there is a clear ethical obligation to seek out a substitute decision maker. Substitute or surrogate decision makers should ideally have been chosen by the patient in advance. In the absence of a designated surrogate, laws may vary in terms of which people can serve in this proxy role and their hierarchy; in general, the order is the spouse, adult children, parents, siblings, and other relatives. (See "Legal aspects in palliative and end of life care", section on 'Surrogate decision makers'.) When making a substituted decision, the proxy should take into consideration

"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 the General Medical Council's 2013 national training survey, 13.2% of respondents said that they had been victims of bullying and harassment in their posts, nearly one in five had seen someone else being bullied or harassed, and over a quarter had experienced "undermining" (unfair or belittling treatment)."

"The study provides insight as to why supervisors fail to fail the poorly performing student and resident. It also offers suggestions of how to support supervisors, increasing the likelihood that they will provide a valid ITER "

"Feedback is a crucial element in the educational process and it is shown that we are still behind in the optimal use of it; thus, learners need to be taught how to better receive and utilize feedback."

"The authors describe the use of the portfolio as a pilot project aimed at introducing reflective thinking and measuring clinical learning in undergraduate nursing education."

" Reflection is a clinically relevant skill, you can improve and use throughout your career if you choose to."

The reflective writing of the group collectively demonstrated engagement with themes commensurate with deeper levels of learning: the feelings, assumptions, beliefs and values of clinical practice

" LICs are environments rich in opportunity for self-regulated learning. Tablets can enhance students' ability to develop and employ self-regulatory skills in a clinical context."

"A large number of medical residents are unable to correctly interpret crucial statistical concepts that are commonly found in the medical literature. They are also especially prone to the gambler's fallacy bias, which may undermine clinical judgment and medical decision making. Formalized systematic teaching of biostatistics during residency will be required to de-bias residents and ensure that they are proficient in understanding and communicating statistical information."

"This study demonstrates a reliable and valid clinical performance assessment system for residents at all levels of training."

"Conclusion: The construct and criterion validity of the MSF system is supported by small to large effect size differences based on the MSF process and physician/surgeon performance across different clinical and nonclinical domain measures."

"To maximize the educational potential of clinical role modeling, medical schools have to consider strategies both on the individual as well as on the institutional level. Several suggestions are offered on both levels."

"Recognizing those limitations, the success of the program, and the fundamental role of patient participation in evolving care models, Mayo is rebuilding the software platform so it can be used to create and deliver care plans in multiple types of surgical practices. "

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

" Groundbreaking research has pointed to "grit" as a better predictor of success than IQ, while psychologists have admonished against the dangers of slipping into autopilot in the quest for skill improvement."

"In this report, the determinants and characteristics of the major CDRs and ADRs are reviewed, as are a variety of de-biasing strategies that may mitigate their influence."

"Making a Diagnosis: New Models for Old Presented by Patrick Croskerry, MD, PhD Professor, Department of Emergency Medicine, and Division of Medical Education, Faculty of Medicine, Dalhousie Universit"

"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."

"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."