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

2021 ◽  
Vol 13 (2) ◽  
pp. 76-80
Author(s):  
Barry Costello ◽  
Simon Downs

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.

2020 ◽  
Vol 8 (2) ◽  
pp. 215
Author(s):  
Roger Kerry ◽  
Matthew Low ◽  
Peter O'Sullivan

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.


2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann

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.


2019 ◽  
Vol 40 (03) ◽  
pp. 151-161 ◽  
Author(s):  
Sebastian Doeltgen ◽  
Stacie Attrill ◽  
Joanne Murray

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.


1999 ◽  
Vol 15 (3) ◽  
pp. 585-592 ◽  
Author(s):  
Alicia Granados

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.


2007 ◽  
Vol 15 (3) ◽  
pp. 508-511 ◽  
Author(s):  
Cristina Mamédio da Costa Santos ◽  
Cibele Andrucioli de Mattos Pimenta ◽  
Moacyr Roberto Cuce Nobre

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.


2016 ◽  
Vol 179 (7) ◽  
pp. 175-176
Author(s):  
Natalie Robinson ◽  
Marnie Brennan

BestBETs for Vets are generated by the Centre for Evidence-based Veterinary Medicine at the University of Nottingham to help answer specific questions and assist in clinical decision making. Although evidence is often limited, they aim to find, present and draw conclusions from the best available evidence, using a standardised framework. A more detailed description of how BestBETs for Vets are produced was published in VR, April 4, 2015, vol 176, pp 354-356.


2021 ◽  
Vol 3 (3) ◽  
pp. 120-123
Author(s):  
Adam Bedson

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


2021 ◽  
Author(s):  
Adrian Ahne ◽  
Guy Fagherazzi ◽  
Xavier Tannier ◽  
Thomas Czernichow ◽  
Francisco Orchard

BACKGROUND The amount of available textual health data such as scientific and biomedical literature is constantly growing and it becomes more and more challenging for health professionals to properly summarise those data and in consequence to practice evidence-based clinical decision making. Moreover, the exploration of large unstructured health text data is very challenging for non experts due to limited time, resources and skills. Current tools to explore text data lack ease of use, need high computation efforts and have difficulties to incorporate domain knowledge and focus on topics of interest. OBJECTIVE We developed a methodology which is able to explore and target topics of interest via an interactive user interface for experts and non-experts. We aim to reach near state of the art performance, while reducing memory consumption, increasing scalability and minimizing user interaction effort to improve the clinical decision making process. The performance is evaluated on diabetes-related abstracts from Pubmed. METHODS The methodology consists of four parts: 1) A novel interpretable hierarchical clustering of documents where each node is defined by headwords (describe documents in this node the most); 2) An efficient classification system to target topics; 3) Minimized users interaction effort through active learning; 4) A visual user interface through which a user interacts. We evaluated our approach on 50,911 diabetes-related abstracts from Pubmed which provide a hierarchical Medical Subject Headings (MeSH) structure, a unique identifier for a topic. Hierarchical clustering performance was compared against the implementation in the machine learning library scikit-learn. On a subset of 2000 randomly chosen diabetes abstracts, our active learning strategy was compared against three other strategies: random selection of training instances, uncertainty sampling which chooses instances the model is most uncertain about and an expected gradient length strategy based on convolutional neural networks (CNN). RESULTS For the hierarchical clustering performance, we achieved a F1-Score of 0.73 compared to scikit-learn’s of 0.76. Concerning active learning performance, after 200 chosen training samples based on these strategies, the weighted F1-Score over all MeSH codes resulted in satisfying 0.62 F1-Score of our approach, compared to 0.61 of the uncertainty strategy, 0.61 the CNN and 0.45 the random strategy. Moreover, our methodology showed a constant low memory use with increased number of documents but increased execution time. CONCLUSIONS We proposed an easy to use tool for experts and non-experts being able to combine domain knowledge with topic exploration and target specific topics of interest while improving transparency. Furthermore our approach is very memory efficient and highly parallelizable making it interesting for large Big Data sets. This approach can be used by health professionals to rapidly get deep insights into biomedical literature to ultimately improve the evidence-based clinical decision making process.


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