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.

Integrating research and evidence-based guidance into prescribing practice

2021 ◽  
Vol 3 (3) ◽  
pp. 120-123
Author(s):  
Adam Bedson
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Primary Source ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Multiple Sources ◽  
Prescribing Practice ◽  
Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal check lists and research reporting tools

Integrating research and evidence-based guidance into prescribing practice

2021 ◽  
Vol 13 (1) ◽  
pp. 10-13
Author(s):  
Adam Bedson
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Primary Source ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Multiple Sources ◽  
Prescribing Practice ◽  
Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal checklists and research reporting tools.

scholarly journals Evaluating Evidence-Informed Clinical Reasoning Proficiency in Oral Practical Examinations

2014 ◽  
Vol 9 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Paul R. Geisler ◽  
Chris Hummel ◽  
Sarah Piebes
Keyword(s):  
Athletic Training ◽  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Clinical Performance ◽  
Clinical Decision ◽  
Athletic Injury ◽  
Evidence Based ◽  
Biomedical Knowledge ◽  
Relevant Evidence ◽  
Key Features

Clinical reasoning is the specific cognitive process used by health care practitioners to formulate accurate diagnoses for complex patient problems and to set up and carry out effective care. Athletic training students and practitioners need to develop and display effective clinical reasoning skills in the assessment of injury and illness as a first step towards evidence-based functional outcomes. In addition to the proper storage of and access to appropriate biomedical knowledge, an equally important component of effective clinical reasoning is the ability to select and interpret various conclusions from the mounting quantity of evidence-based medicine (EBM) sources. In assessing injury and illness, this competency is particularly reliant upon experience, skill execution, and available evidence pertaining to the diagnostic accuracy and utility of various special tests and physical examination procedures. In order to both develop and assess the ability of our students to integrate EBM into their clinical reasoning processes, we have designed exercises and evaluations that pertain to evidence-based clinical decision making during oral practical examinations in our assessment of athletic injury labs. These integrated oral practical examinations are designed to challenge our students' thinking and clinical performance by providing select key features of orthopaedic case pattern presentations and asking students to pick the most fitting diagnostic tests to fit that particular case. Students must not only match the appropriate special/functional tests, etc, to the case's key features, but also choose and explain how useful the chosen tests are for the differential diagnosis process, relative to the best diagnostic evidence. This manuscript will present a brief theoretical framework for our model and will discuss the process we use to evaluate our students' ability to properly select, perform, and explain various orthopaedic examination skills and the relevant evidence available. Specific examples of oral practical exam modules are also provided for elucidation.

Multicentered Study Evaluating Pharmacy Students’ Perception of Palliative Care and Clinical Reasoning Using Script Concordance Testing

2018 ◽  
Vol 35 (11) ◽  
pp. 1394-1401
Author(s):  
Rabia S. Atayee ◽  
Kashelle Lockman ◽  
Cara Brock ◽  
Daniel T. Abazia ◽  
Tracy L. Brooks ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Pharmacy Students ◽  
Significant Difference ◽  
Before And After ◽  
Script Concordance ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills

Introduction: As the role of the pharmacist on the transdisciplinary palliative care team grows, the need for adequate instruction on palliative care and clinical reasoning skills in schools of pharmacy grows accordingly. Methods: This study evaluates second- and third-year pharmacy students from 6 accredited schools of pharmacy that participated in surveys before and after the delivery of a didactic palliative care elective. The survey collected student demographics, perceptions of the importance of and student skill level in palliative care topics. The script concordance test (SCT) was used to assess clinical decision-making skills on patient cases. Student scores on the SCT were compared to those of a reference panel of experts. Results: A total of 89 students completed the pre-/postsurveys and were included in data analysis. There was no statistically significant difference in student perceived importance of palliative care skills before and after the elective. Students from all 6 institutions showed significant increase in confidence in their palliative care skills at the end of the course. There was also a significant improvement across all institutions in clinical reasoning skills in most of the SCT questions used to assess these skills. Conclusions: Students choosing an elective in palliative care likely do so because they already have an understanding of the importance of these topics in their future practice settings. Delivery of a palliative care elective in the pharmacy curriculum significantly increases both student confidence in their palliative care skills and their clinical reasoning skills in these areas.

Person-centred clinical reasoning and evidence-based healthcare

2020 ◽  
Vol 8 (2) ◽  
pp. 215
Author(s):  
Roger Kerry ◽  
Matthew Low ◽  
Peter O'Sullivan
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Population Data ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Evidence Based Healthcare ◽  
Causal Theories

Purpose: Clinical practice, and in particular decision-making, are dependent on data and knowledge which are relevant to the context at hand. Numerous frameworks have existed which aim to facilitate best clinical decision-making for healthcare professionals and their patients, for example clinical reasoning and the evidence-based healthcare models. The purpose of this paper is to provide some reconciliation between apparently conflicting models of healthcare practice with regards to best practice.Methods: We provide a theoretical narrative account of clinical practice with regards to clinical reasoning and best decision-making. We problematise the practice frameworks of clinical reasoning and evidence base healthcare by suggesting they are conflicting and contradictory to each other. We frame the arguments available with philosophical views of causation, making the assumption that causation lies central to all aspects of knowledge. We use the narrative to expose causal theories behind different practice models and illustrate our account with a case study.Results: Clinical reasoning and evidence-based healthcare are characterised by different causal theories which do not readily align with each other. By reconceptualising causation as a dispositional phenomenon, reconciliation between individualised person-centred care and the population data which are the core interest of evidence-based healthcare, can be found, thus preserving the most valuable aspects of each practice framework.Conclusion: Reconceptualising causation in dispositionalist terms facilitates a more person-centred, multi-dimensional clinical reasoning process. This in-turn allows for the integration of data from prioritised methods of evidence-based healthcare into complex and context-sensitive individualised clinical situations.

Student paramedic decision-making: a critical exploration of a patient interaction

2021 ◽  
Vol 13 (2) ◽  
pp. 76-80
Author(s):  
Barry Costello ◽  
Simon Downs
Keyword(s):  
Decision Making ◽  
Clinical Reasoning ◽  
Health Professionals ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Lead Author ◽  
Evidence Based ◽  
Patient Encounter ◽  
The Past ◽  
Patient Interaction

Clinical decision-making is a multifaceted construct, requiring the practitioner to gather, interpret and evaluate data to select and implement an evidence-based choice of action. Clinical reasoning is a difficult skill for students to develop due in part to the inability to guarantee awareness or opportunity to develop within time spent in practice. While professional developments within the past few years have established a supportive preceptorship programme within NHS trusts for new paramedic registrants, enhancing activities to develop these crucial skills within a pre-registrant programme should be prioritised to enhance the abilities of students and subsequent new registrants. A better understanding of the reasoning processes used during clinical decision-making may help health professionals with less experience to develop their processes in their own clinical reasoning. To embed such awareness and enhanced practice, the lead author, a third-year student paramedic at the time of writing, presents a reflective consideration of a patient encounter using the hypothetico-deductive model to evaluate and critically explore his own reasoning and processing within a meaningful patient interaction.

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.

HEALTH TECHNOLOGY ASSESSMENT AND CLINICAL DECISION MAKING:

1999 ◽  
Vol 15 (3) ◽  
pp. 585-592 ◽  
Author(s):  
Alicia Granados
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Technology Assessment ◽  
Case Studies ◽  
Technology Assessment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Technology ◽  
Evidence Based ◽  
Systematic Process

This paper examines the rationality of the concepts underlying evidence—based medicineand health technology assessment (HTA), which are part of a new current aimed at promoting the use of the results of scientific studies for decision making in health care. It describes the different approaches and purposes of this worldwide movement, in relation to clinical decision making, through a summarized set of specific HTA case studies from Catalonia, Spain. The examples illustrate how the systematic process of HTA can help in several types of uncertainties related to clinical decision making.

scholarly journals The PICO strategy for the research question construction and evidence search

2007 ◽  
Vol 15 (3) ◽  
pp. 508-511 ◽  
Author(s):  
Cristina Mamédio da Costa Santos ◽  
Cibele Andrucioli de Mattos Pimenta ◽  
Moacyr Roberto Cuce Nobre
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Scientific Evidence ◽  
Research Question ◽  
Clinical Decision ◽  
Evidence Based ◽  
Review Of The Literature

Evidence based practice is the use of the best scientific evidence to support the clinical decision making. The identification of the best evidence requires the construction of an appropriate research question and review of the literature. This article describes the use of the PICO strategy for the construction of the research question and bibliographical search.

Sign in / Sign up

Export Citation Format

Share Document