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 Observable phenomena that reveal medical students' clinical reasoning ability during expert assessment of their history taking: a qualitative study

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Catharina M. Haring ◽  
Bernadette M. Cools ◽  
Petra J. M. van Gurp ◽  
Jos W. M. van der Meer ◽  
Cornelis T. Postma
Keyword(s):  
Medical Students ◽  
Qualitative Study ◽  
Clinical Reasoning ◽  
Expert Assessment ◽  
Reasoning Ability ◽  
History Taking

scholarly journals Interactive whiteboard use in clinical reasoning sessions to teach diagnostic test ordering and interpretation to undergraduate medical students

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Fares Gouzi ◽  
Christophe Hédon ◽  
Léo Blervaque ◽  
Emilie Passerieux ◽  
Nils Kuster ◽  
...  
Keyword(s):  
Medical Students ◽  
Student Perceptions ◽  
Clinical Reasoning ◽  
Diagnostic Tests ◽  
Clinical Medicine ◽  
Positive Impact ◽  
Interactive Whiteboard ◽  
Respiratory Physiology ◽  
Undergraduate Medical Students ◽  
Test Ordering

Abstract Background Over-testing of patients is a significant problem in clinical medicine that can be tackled by education. Clinical reasoning learning (CRL) is a potentially relevant method for teaching test ordering and interpretation. The feasibility might be improved by using an interactive whiteboard (IWB) during the CRL sessions to enhance student perceptions and behaviours around diagnostic tests. Overall, IWB/CRL could improve their skills. Methods Third-year undergraduate medical students enrolled in a vertically integrated curriculum were randomized into two groups before clinical placement in either a respiratory disease or respiratory physiology unit: IWB-based CRL plus clinical mentoring (IWB/CRL + CM: n = 40) or clinical mentoring only (CM-only: n = 40). Feasibility and learning outcomes were assessed. In addition, feedback via questionnaire of the IWB students and their classmates (n = 233) was compared. Results Analyses of the IWB/CRL sessions (n = 40, 27 paperboards) revealed that they met validated learning objectives. Students perceived IWB as useful and easy to use. After the IWB/CRL + CM sessions, students mentioned more hypothesis-based indications in a test ordering file (p <  0.001) and looked for more nonclinical signs directly on raw data tests (p <  0.01) compared with students in the CM-only group. Last, among students who attended pre- and post-assessments (n = 23), the number of diagnostic tests ordered did not change in the IWB/CRL + CM group (+ 7%; p = N.S), whereas it increased among CM-only students (+ 30%; p <  0.001). Test interpretability increased significantly in the IWB/CRL + CM group (from 4.7 to 37.2%; p <  0.01) but not significantly in the CM-only group (from 2.4 to 9.8%; p = 0.36). Conclusions Integrating IWB into CRL sessions is feasible to teach test ordering and interpretation to undergraduate students. Moreover, student feedback and prospective assessment suggested a positive impact of IWB/CRL sessions on students’ learning.

scholarly journals Validation of a competence-based assessment of medical students’ performance in the physician’s role

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sarah Prediger ◽  
Kristina Schick ◽  
Fabian Fincke ◽  
Sophie Fürstenberg ◽  
Viktor Oubaid ◽  
...  
Keyword(s):  
Medical Students ◽  
Convergent Validity ◽  
Medical Training ◽  
Assessment Instrument ◽  
Choice Test ◽  
Undergraduate Medical Students ◽  
Physician’S Role ◽  
Physician's Role ◽  
Gap Test ◽  
Assessment Format

Abstract Background Assessing competence of advanced undergraduate medical students based on performance in the clinical context is the ultimate, yet challenging goal for medical educators to provide constructive alignment between undergraduate medical training and professional work of physicians. Therefore, we designed and validated a performance-based 360-degree assessment for competences of advanced undergraduate medical students. Methods This study was conducted in three steps: 1) Ten facets of competence considered to be most important for beginning residents were determined by a ranking study with 102 internists and 100 surgeons. 2) Based on these facets of competence we developed a 360-degree assessment simulating a first day of residency. Advanced undergraduate medical students (year 5 and 6) participated in the physician’s role. Additionally knowledge was assessed by a multiple-choice test. The assessment was performed twice (t1 and t2) and included three phases: a consultation hour, a patient management phase, and a patient handover. Sixty-seven (t1) and eighty-nine (t2) undergraduate medical students participated. 3) The participants completed the Group Assessment of Performance (GAP)-test for flight school applicants to assess medical students‘ facets of competence in a non-medical context for validation purposes. We aimed to provide a validity argument for our newly designed assessment based on Messick’s six aspects of validation: (1) content validity, (2) substantive/cognitive validity, (3) structural validity, (4) generalizability, (5) external validity, and (6) consequential validity. Results Our assessment proved to be well operationalised to enable undergraduate medical students to show their competences in performance on the higher levels of Bloom’s taxonomy. Its generalisability was underscored by its authenticity in respect of workplace reality and its underlying facets of competence relevant for beginning residents. The moderate concordance with facets of competence of the validated GAP-test provides arguments of convergent validity for our assessment. Since five aspects of Messick’s validation approach could be defended, our competence-based 360-degree assessment format shows good arguments for its validity. Conclusion According to these validation arguments, our assessment instrument seems to be a good option to assess competence in advanced undergraduate medical students in a summative or formative way. Developments towards assessment of postgraduate medical trainees should be explored.

scholarly journals Children in Situation of Intra-Family Violence: Concepts, Personal Experiences and Feelings of Undergraduate Medical Students

2020 ◽  
Vol 44 (1) ◽  
Author(s):  
Nilma Lazara de Almeida Cruz Santos ◽  
Isabel Maria Sampaio Oliveira Lima ◽  
Rosely Cabral de Carvalho
Keyword(s):  
Medical Students ◽  
Medical Training ◽  
Social Issues ◽  
The State ◽  
Subjective Perception ◽  
Undergraduate Medical Students ◽  
Medical Undergraduate ◽  
Personal Experiences ◽  
The Subject ◽  
Different Dimensions

ABSTRACT: Introduction: The objective of the study was to learn about the concepts of violence among medical undergraduate students in the state of Bahia, their personal experiences with the phenomenon and advice regarding case referral. Method: a qualitative research was carried out with 20 undergraduate medical students from public institutions in the state of Bahia. The data were collected via the web through an electronic file made available by Google Forms. The students were informed about the page address through an e-mail. Results: Most of the students said that the topic of “Violence against Children” was addressed during their undergraduate years. Shared conceptions by most of the students on the subject are related to the definitions of violence as physical injuries inflicted on the victims, but broader definitions of social and subjective perception, encompassing different dimensions of the phenomenon were also identified. The most frequently cited feelings experienced in situations of violence were the following: helplessness, fear, sadness, unpreparedness, compassion, empathy, anger and rage. The difficulties that the students encountered in approaching the victims of violence stem from the lack of preparation in the training and from the positions related to the physicians themselves, such as fear of involvement and accountability. The inherent characteristics of children and distrust in protective services were also mentioned. Conclusion: Although the students reported having contact with the topic during graduation, most of them evaluated the training as insufficient. The lack of professional preparation to approach the medical-social issues, such as violence, has been partially attributed to the biologicist bias of the medical training. In this sense, we highlight the understanding of violence as an essentially social and historical phenomenon, to the detriment of the different dimensions of the illness that imply in the health-disease process. From this perspective, this bias obscure the recognition of the different manifestations of violence as objects of healthcare work, suggesting a need for a broader approach in medical education, which can help to contemplate the complexity of the subject.

scholarly journals Simulating Dynamic Facial Expressions of Pain From Visuo-Haptic Interactions With a Robotic Patient

2021 ◽  
Author(s):  
Yongxuan Tan ◽  
Sibylle Rérolle ◽  
Thilina Dulantha Lalitharatne ◽  
Nejra Van Zalk ◽  
Rachael E. Jack ◽  
...  
Keyword(s):  
Medical Students ◽  
Physical Examination ◽  
Real Time ◽  
Facial Expressions ◽  
Medical Training ◽  
White Male ◽  
Rate Of Change ◽  
Simulated Patients ◽  
White Female ◽  
Haptic Interactions

Abstract Medical training simulators can provide a safe and controlled environment for medical students to practice their physical examination skills. Visual feedback of involuntary pain expressions in response to physical palpation on an affected area of a patient is an important source of information for physicians. However, most existing robotic medical training simulators that can capture physical examination behaviours in real-time cannot display facial expressions or comprise a limited range of patient identities in terms of ethnicity and gender. Together, these limitations restrict the utility of medical training simulators because they do not provide medical students with a representative diversity both of pain facial expressions and face identities, which could result in biased practice. Further, these limitations restrict the utility of such medical simulators to be used to detect and correct early signs of bias in medical training. Here, for the first time, we present a robotic system that can simulate facial expressions of pain in response to palpations, displayed on a range of patient face identities. We use the unique approach of modelling dynamic pain facial expressions using the data-driven psychophysical method of reverse correlation and incorporating the visuo-haptic interactions of users performing palpation to a robot medical simulator. Specifically, participants performed palpation actions on the abdomen phantom of simulated patients, which triggered the real-time display of 6 pain-related facial Action Units (AUs) on a robotic face (MorphFace), each controlled by two pseudo randomly generated transient parameters: rate of change β and activation delay τ. Participants then rated the appropriateness of the facial expression displayed in response to their palpations on a 4-point scale. Each participant (n = 16, 4 Asian female, 4 Asian male, 4 White female and 4 White male) performed 200 palpation trials on 4 patient identities (Black female, Black male, White female and White male) simulated using MorphFace. Results showed that a gradual decrease of β and increase of τ from upper face AUs (around the eyes) to those in the lower face (around the mouth) is rated to be appropriate by all participants. We found that transient parameter values that generated the appropriate pain facial expressions as rated by participants, palpation forces, and delays between palpation actions varied across gender and ethnicity of participant-simulated patient pairs. These findings suggest that gender and ethnicity biases affect the participants’ palpation strategies and their perception of the pain facial expressions displayed on MorphFace. We anticipate our approach could be utilised to generate physical examination models with diverse patient demographic groups to reduce erroneous judgments in medical students, and provide focused training to address these errors.

scholarly journals Student selected components as an educational platform for teaching medical students about clinical pharmacology and quality improvement activities

2021 ◽  
Vol 10 (3) ◽  
pp. 309
Author(s):  
Olayinka A. Ogundipe
Keyword(s):  
Clinical Pharmacology ◽  
Quality Improvement ◽  
Medical Students ◽  
Medical Training ◽  
The Elderly ◽  
Undergraduate Medical Students ◽  
Educational Value ◽  
Medical Undergraduate ◽  
Key Driver ◽  
Medical Undergraduate Education

Student selected components (SSCs) are increasingly described elements of medical undergraduate education, training and curricula. SSCs offer the potential for integration into both traditional (‘pre-clinical’ versus ‘clinical’) medical curricula, as well as into other innovative or evolving medical training curricula. This article employs a structured and descriptive approach to exemplify the process by which year 1 medical students were supported in a practical manner to undertake a distinct small group SSC project. In this illustration, the SSC was focused on a quality improvement (QI) topic of relevance to clinical pharmacology and therapeutics (CPT), and involved a review of the anticholinergic burden of inpatient prescriptions for a defined cohort. The SSC was completed in the context of a teaching hospital’s medicine of the elderly (MoE) clinical service. In a sequential manner, the paper describes experiential learning points from the perspective of a supervisor of an SSC project. The paper offers educational value with a potential for generalisable application to non-clinical and clinical educationalists. Furthermore, the paper offers guidance to supervisors, teachers, tutors and facilitators, with encouragement to consider how they may design similar projects for the training of undergraduate medical students in centres that they are affiliated with. The paper also highlights another key driver for productive SSCs i.e. the central principle of striving to promote projects and activities that support active student engagement, rather than merely passive inclusion.

The Effect of 360° Virtual Reality versus 2-Dimensional Video Reviews on History Taking and Physical Examination Skills Learning in Undergraduate Medical Students: A Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Yi-Ping Chao ◽  
Chung-Jan Kang ◽  
Ming-Ju Hsieh ◽  
Yu-Che Chang ◽  
Tuan-Jen Fang ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Standard Deviation ◽  
Medical Students ◽  
Physical Examination ◽  
Cognitive Load ◽  
Learning Outcome ◽  
History Taking ◽  
Undergraduate Medical Students ◽  
Video Review ◽  
Video Group

BACKGROUND History taking and physical examination (H&P) is an important core competency of undergraduate medical education. Recent advances in virtual reality (VR) simulation, lowering the complexity of learning tasks and the cognitive load of the learners, make this novel technology well suited for the initial training of novices. Reduced heart rate variation (HRV) is associated with decreased cognitive efficiency. Whether a 360° VR video review can impact learning outcome, cognitive load, and HRV while learning H&P skills in undergraduate medical students is unknown. OBJECTIVE We explored the effectiveness of 360° VR versus 2-dimensional (2D) video review to learn H&P skills with regards to learning outcome, cognitive load, and HRV. METHODS In 2018, we randomly assigned (1:1) 64 undergraduate medical students to either a 360° VR or 2D video group (matched by age, sex, and cognitive style) with allocation concealment to learn H&P skills using VR headsets and controllers. Subsequently, the participants each performed a focused H&P with a real outpatient. Two raters used the Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) questionnaires to assess the participants’ performance blindly. The Cognitive Load Component questionnaire and a portable electrocardiogram monitor were used to measure cognitive load and HRV, respectively. RESULTS All participants completed the study (mean age=24.2 years, standard deviation=0.9 years; 44 [69%] males and 20 [31%] females). The physical examination and student’s satisfaction scores (Mini-CEX), total DOPS score, total and intrinsic cognitive load scores, and standard deviation of normal to normal R-R intervals in the 360° VR video group were significantly higher than those in the 2D video group (effect size=0.63, 0.56, 0.72, 0.53, 0.67, and 0.52, respectively). Differences in the other aspects of the Mini-CEX and cognitive loads of both groups were not statistically significant. CONCLUSIONS This study provides a high level of evidence to confirm that 360° VR video review can help undergraduate medical students to perform fundamental H&P skills as effectively as traditional 2D video review. Furthermore, a 360° VR video review could be used to more efficiently examine the body of a real patient with higher learner’s satisfaction. These findings may inspire the design of 360° VR video-based training protocols to enhance competencies other than history taking. CLINICALTRIAL Clinicaltrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641 (Archived by WebCite at http://www.webcitation.org/72f59ImWm)

Sign in / Sign up

Export Citation Format

Share Document