Clinical Reasoning Learning with Simulated Patients

2005 ◽  
pp. 385-394 ◽  
Author(s):  
Froduald Kabanza ◽  
Guy Bisson
Keyword(s):  
Clinical Reasoning ◽  
Simulated Patients

scholarly journals Assessing clinical reasoning in undergraduate medical students during history taking with an empirically derived scale for clinical reasoning indicators

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sophie Fürstenberg ◽  
Tillmann Helm ◽  
Sarah Prediger ◽  
Martina Kadmon ◽  
Pascal O. Berberat ◽  
...  
Keyword(s):  
Medical Students ◽  
Clinical Reasoning ◽  
Medical Training ◽  
Diagnostic Procedures ◽  
Daily Practice ◽  
Simulated Patients ◽  
Reasoning Ability ◽  
History Taking ◽  
Undergraduate Medical Students ◽  
Biomedical Knowledge

Abstract Background The clinical reasoning process, which requires biomedical knowledge, knowledge about problem-solving strategies, and knowledge about reasons for diagnostic procedures, is a key element of physicians’ daily practice but difficult to assess. The aim of this study was to empirically develop a Clinical Reasoning Indicators-History Taking-Scale (CRI-HT-S) and to assess the clinical reasoning ability of advanced medical students during a simulation involving history taking. Methods The Clinical Reasoning Indictors-History Taking-Scale (CRI-HT-S) including a 5-point Likert scale for assessment was designed from clinical reasoning indicators identified in a qualitative study in 2017. To assess indicators of clinical reasoning ability, 65 advanced medical students (semester 10, n = 25 versus final year, n = 40) from three medical schools participated in a 360-degree competence assessment in the role of beginning residents during a simulated first workday in hospital. This assessment included a consultation hour with five simulated patients which was videotaped. Videos of 325 patient consultations were assessed using the CRI-HT-S. A factor analysis was conducted and the students’ results were compared according to their advancement in undergraduate medical training. Results The clinical reasoning indicators of the CRI-HT-S loaded on three factors relevant for clinical reasoning: 1) focusing questions, 2) creating context, and 3) securing information. Students reached significantly different scores (p < .001) for the three factors (factor 1: 4.07 ± .47, factor 2: 3.72 ± .43, factor 3: 2.79 ± .83). Students in semester 10 reached significantly lower scores for factor 3 than students in their final year (p < .05). Conclusions The newly developed CRI-HT-S worked well for quantitative assessment of clinical reasoning indicators during history taking. Its three-factored structure helped to explore different aspects of clinical reasoning. Whether the CRI-HT-S has the potential to be used as a scale in objective structured clinical examinations (OCSEs) or in workplace-based assessments of clinical reasoning has to be investigated in further studies with larger student cohorts.

scholarly journals Efektifitas Berbagai Metode Pembelajaran untuk Partisipasi Aktif Mahasiswa dan Stimulasi Proses Clinical Reasoning

2013 ◽  
Vol 2 (3) ◽  
pp. 174
Author(s):  
Widyandana Widyandana
Keyword(s):  
Medical Students ◽  
Clinical Reasoning ◽  
Role Play ◽  
Skills Training ◽  
Active Participation ◽  
Simulated Patients ◽  
Learning Method ◽  
Reasoning Process ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills

Background: Skills lab program can be conducted by several methods, such as training by mannequin, role play with peers, simulated patients, and training in community. Medical students are expected to play an active role in training and always practice their clinical reasoning skills. However, there are still many students not ready for implementing some medical procedure in their clerkship. Therefore, this study aimed to compare the level of active participation and the clinical reasoning process of students obtained in four learning methods in skills lab.Method: This study used a cross-sectional design with random survey questioner to 150 medical students in Medical Faculty of GMU (n=150). This survey were expected to explore the impression of students to each learning method, particularly in the active participation in practice and the clinical reasoning process. The results were analyzed using descriptive quantitative method by comparing total score of each learning method.Results: The results showed that the learning method of medical skills in community is superior to 3 other methods, namely practice with mannequins, role play with peers, as well as simulated patients, both in promoting the active participation of students and stimulating the clinical reasoning skills (p<0.05).Conclusion: Medical skills training in community is more effective in promoting the active participation of students in practice and stimulating the clinical reasoning skills. However, it should considerate with compatibility of topic, students’ readiness, and combined methods if needed.

Enhancing Child Trauma Assessment Practices, Clinical Reasoning an Organizational Change Using the NCTSN Core Curriculum on Child Trauma

2012 ◽  
Author(s):  
Robert Abramovitz ◽  
Lisa Amaya Jackson ◽  
Angel Knoverek ◽  
Christopher Layne ◽  
Leslie Ross ◽  
...  
Keyword(s):  
Organizational Change ◽  
Clinical Reasoning ◽  
Core Curriculum ◽  
Child Trauma ◽  
Assessment Practices ◽  
Trauma Assessment

Introductory Clinical Reasoning Curriculum

MedEdPORTAL ◽  
2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Adam Weinstein ◽  
Roshini Pinto-Powell
Keyword(s):  
Clinical Reasoning

Effect of Guided Clinical Reasoning on Nursing Students' Knowledge and Achievement Regarding Management of Primary Postpartum Hemorrhage

2020 ◽  
Vol 11 (4) ◽  
pp. 83-95
Author(s):  
Hanan El-Sayed Mohamed El-Sayed ◽  
Samia I Hassan ◽  
Suzan El-Said Mansour
Keyword(s):  
Nursing Students ◽  
Clinical Reasoning ◽  
Postpartum Hemorrhage

Unannounced Simulated Patients’ Observations of Physician STD/HIV Prevention Practices

1992 ◽  
Vol 8 (4) ◽  
pp. 235-240 ◽  
Author(s):  
Nancy K. Russell ◽  
Bradley O. Boekeloo ◽  
Ishrat Z. Rafi ◽  
David L. Rabin
Keyword(s):  
Hiv Prevention ◽  
Simulated Patients

Supporting the Development of Clinical Reasoning of Preprofessional Novices in Dysphagia Management

2019 ◽  
Vol 40 (03) ◽  
pp. 151-161 ◽  
Author(s):  
Sebastian Doeltgen ◽  
Stacie Attrill ◽  
Joanne Murray
Keyword(s):  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Management Practice ◽  
Clinical Decision ◽  
Assessment Process ◽  
Evidence Based ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Implicit Processing ◽  
Reasoning Skills

AbstractProficient clinical reasoning is a critical skill in high-quality, evidence-based management of swallowing impairment (dysphagia). Clinical reasoning in this area of practice is a cognitively complex process, as it requires synthesis of multiple sources of information that are generated during a thorough, evidence-based assessment process and which are moderated by the patient's individual situations, including their social and demographic circumstances, comorbidities, or other health concerns. A growing body of health and medical literature demonstrates that clinical reasoning skills develop with increasing exposure to clinical cases and that the approaches to clinical reasoning differ between novices and experts. It appears that it is not the amount of knowledge held, but the way it is used, that distinguishes a novice from an experienced clinician. In this article, we review the roles of explicit and implicit processing as well as illness scripts in clinical decision making across the continuum of medical expertise and discuss how they relate to the clinical management of swallowing impairment. We also reflect on how this literature may inform educational curricula that support SLP students in developing preclinical reasoning skills that facilitate their transition to early clinical practice. Specifically, we discuss the role of case-based curricula to assist students to develop a meta-cognitive awareness of the different approaches to clinical reasoning, their own capabilities and preferences, and how and when to apply these in dysphagia management practice.

scholarly journals Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e030430
Author(s):  
Thomas Ott ◽  
Jascha Stracke ◽  
Susanna Sellin ◽  
Marc Kriege ◽  
Gerrit Toenges ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Primary Outcome ◽  
Research Study ◽  
University Hospital ◽  
Simulated Patients ◽  
Stressful Situation ◽  
Simulation Research ◽  
Simulation Centre

ObjectivesDuring a ‘cannot intubate, cannot oxygenate’ situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient’s life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, due to concurrent cardiopulmonary resuscitation in a ‘cannot intubate, cannot oxygenate’ situation.DesignDue to the rare incidence and dynamics of such a situation, we conducted a randomised crossover simulation research study.SettingWe collected data in our institutional simulation centre between November 2016 and November 2017.ParticipantsWe included 40 experienced staff anaesthesiologists at our tertiary university hospital centre.InterventionThe participants treated two simulated patients, both requiring cricothyrotomy: one patient required cardiopulmonary resuscitation due to asphyxia, and one patient did not require cardiopulmonary resuscitation. Cardiopulmonary resuscitation was the intervention. Participants were evaluated by video records.Primary outcome measuresThe difference in ‘time to ventilation through cricothyrotomy’ between the two situations was the primary outcome measure.ResultsThe results of 40 participants were analysed. No carry-over effects were detected in the crossover design. During cardiopulmonary resuscitation, the median time to ventilation was 22 s (IQR 3–40.5) longer than that without cardiopulmonary resuscitation (p=0.028), including the decision-making time.ConclusionCricothyrotomy, which is the most crucial treatment for cardiac arrest in a ‘cannot intubate, cannot oxygenate’ situation, was delayed by concurrent cardiopulmonary resuscitation. If cardiopulmonary resuscitation delays cricothyrotomy, it should be interrupted to first focus on cricothyrotomy.

scholarly journals Determining the impact of postoperative complications in neurosurgery based on simulated longitudinal smartphone app-based assessment

2021 ◽  
Author(s):  
Lion D. Comfort ◽  
Marian C. Neidert ◽  
Oliver Bozinov ◽  
Luca Regli ◽  
Martin N. Stienen
Keyword(s):  
Postoperative Complications ◽  
Feasibility Study ◽  
Well Being ◽  
Smartphone Application ◽  
Simulated Patients ◽  
Subjective Well Being ◽  
Longitudinal Assessment ◽  
User Friendliness ◽  
User Friendly ◽  
The Impact

Abstract Background Complications after neurosurgical operations can have severe impact on patient well-being, which is poorly reflected by current grading systems. The objective of this work was to develop and conduct a feasibility study of a new smartphone application that allows for the longitudinal assessment of postoperative well-being and complications. Methods We developed a smartphone application “Post OP Tracker” according to requirements from clinical experience and tested it on simulated patients. Participants received regular notifications through the app, inquiring them about their well-being and complications that had to be answered according to their assigned scenarios. After a 12-week period, subjects answered a questionnaire about the app’s functionality, user-friendliness, and acceptability. Results A total of 13 participants (mean age 34.8, range 24–68 years, 4 (30.8%) female) volunteered in this feasibility study. Most of them had a professional background in either health care or software development. All participants downloaded, installed, and applied the app for an average of 12.9 weeks. On a scale of 1 (worst) to 4 (best), the app was rated on average 3.6 in overall satisfaction and 3.8 in acceptance. The design achieved a somewhat favorable score of 3.1. One participant (7.7%) reported major technical issues. The gathered patient data can be used to graphically display the simulated outcome and assess the impact of postoperative complications. Conclusions This study suggests the feasibility to longitudinally gather postoperative data on subjective well-being through a smartphone application. Among potential patients, our application indicated to be functional, user-friendly, and well accepted. Using this app-based approach, further studies will enable us to classify postoperative complications according to their impact on the patient’s well-being.

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