Diagnostic Decisions in Child Language Assessment: Findings From a Case Review Assessment Task

2019 ◽  
Vol 50 (3) ◽  
pp. 385-398 ◽  
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Decision Making ◽  
Standardized Testing ◽  
Clinical Decision Making ◽  
Child Language ◽  
Language Assessment ◽  
Clinical Decision ◽  
Case Review ◽  
Assessment Data ◽  
Assessment Task ◽  
Diagnostic Decision

Purpose The current study used a case review diagnostic assessment task to examine the diagnostic decisions speech-language pathologists (SLPs) working in the United States made after reviewing child language cases. Method Fourteen SLPs were given 5 case studies that presented either congruent or incongruent results between standardized testing and informal measures. After reviewing the assessment data, SLPs were asked to make a diagnostic decision. Results Unanimous consensus regarding diagnostic decisions was found when the assessment data were congruent. When the data were incongruent, unanimous consensus was not achieved. Standardized testing seemed to guide the diagnostic decision. This pattern of reliance on standardized testing was evident even when 80% of SLPs reviewed informal language data. In 97% of cases, a standardized test was used to guide clinical decision making. Conclusion Three patterns of clinical decision making in child language assessment emerged: (a) use of both standardized testing and informal measures, (b) a reported concern tool as a 1st step in the process, and (c) standardized testing as the most influential data for guiding diagnostic decisions. Although this study provides initial evidence regarding the process of diagnostic decision making, future studies should examine decision making in real time to further validate the implicit rules used during decision making. Supplemental Material https://doi.org/10.23641/asha.7991174

Creation of a palliative care advanced practice registered nurse peer-review process

2019 ◽  
Vol 25 (12) ◽  
pp. 596-602
Author(s):  
Patrice R. Fedel ◽  
Nicole E. Hembel ◽  
Lindsey M. Mueller
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Peer Review ◽  
Professional Growth ◽  
Review Process ◽  
Clinical Decision Making ◽  
Peer Review Process ◽  
Clinical Decision ◽  
Advanced Practice ◽  
Case Review

The mark of a true profession is the ability to self-regulate. As such, advanced practice registered nurses (APRNs) are challenged by their professional organisations to participate in self-evaluation and peer review. Peer review is a method for evaluating the care provided by the APRN to both ensure quality nursing care and promote professional growth. Despite guidelines to participate in a formal peer-review process, there is little information within the nursing profession on how to accomplish peer review. A comprehensive literature review failed to provide a framework for peer review that is practice focused, fosters a learning environment and encompasses the thought process and clinical decision-making of the palliative care advanced practice nurse. A group of palliative care APRNs set out to create a process that encompassed the breadth of clinical decision-making in palliative care advanced nursing practice. Using the eight domains of palliative care, a narrative case review structure was created. The resulting process both assisted the APRNs in professional growth and provided timely feedback for the annual performance evaluation.

A simulation-based approach to training in heuristic clinical decision-making

Diagnosis ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 91-99 ◽  
Author(s):  
Ghazwan Altabbaa ◽  
Amanda D. Raven ◽  
Jason Laberge
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Cognitive Biases ◽  
Clinical Decision ◽  
Order Effect ◽  
Medical Residents ◽  
Scenario Design ◽  
Diagnostic Decision ◽  
Momentum Bias ◽  
Diagnostic Decision Making

Abstract Background Cognitive biases may negatively impact clinical decision-making. The dynamic nature of a simulation environment can facilitate heuristic decision-making which can serve as a teaching opportunity. Methods Momentum bias, confirmation bias, playing-the-odds bias, and order-effect bias were integrated into four simulation scenarios. Clinical simulation educators and human factors specialists designed a script of events during scenarios to trigger heuristic decision-making. Debriefing included the exploration of frames (mental models) resulting in the observed actions, as well as a discussion of specific bias-prone frames and bias-resistant frames. Simulation sessions and debriefings were coded to measure the occurrence of bias, recovery from biased decision-making, and effectiveness of debriefings. Results Twenty medical residents and 18 medical students participated in the study. Twenty pairs (of one medical student and one resident) and two individuals (medical residents alone) completed a simulation session. Evidence of bias was observed in 11 of 20 (55%) sessions. While most participant pairs were able to avoid or recover from the anticipated bias, there were three sessions with no recovery. Evaluation of debriefings showed exploration of frames in all the participant pairs. Establishing new bias-resistant frames occurred more often when the learners experienced the bias. Conclusions Instructional design using experiential learning can focus learner attention on the specific elements of diagnostic decision-making. Using scenario design and debriefing enabled trainees to experience and analyze their own cognitive biases.

scholarly journals Measuring the Impact of Diagnostic Decision Support on the Quality of Clinical Decision Making: Development of a Reliable and Valid Composite Score

2003 ◽  
Vol 10 (6) ◽  
pp. 563-572 ◽  
Author(s):  
Padmanabhan Ramnarayan ◽  
Ritika R. Kapoor ◽  
Michael Coren ◽  
Vasantha Nanduri ◽  
Amanda L. Tomlinson ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Composite Score ◽  
Diagnostic Decision ◽  
The Impact

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

Sign in / Sign up

Export Citation Format

Share Document