scholarly journals Validity, reliability and feasibility of a new observation rating tool and a post encounter rating tool for the assessment of clinical reasoning skills of medical students during their internal medicine clerkship. A pilot study.

2020 ◽  
Author(s):  
Catharina Maria Haring ◽  
Claudia Klaarwater ◽  
Geert Bouwmans ◽  
Bernadette Cools ◽  
Petra van Gurp ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Clinical Practice ◽  
Medical Students ◽  
Clinical Reasoning ◽  
Intraclass Correlation ◽  
Medicine Clerkship ◽  
Systematic Assessment ◽  
Internal Medicine Clerkship ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills

Abstract Background Systematic assessment of clinical reasoning skills of medical students in clinical practice is very difficult. This is partly caused by the lack of understanding of the fundamental mechanisms underlying the process of clinical reasoning. Methods We previously developed an observation tool to assess the clinical reasoning skills of medical students during clinical practice. This observation tool consists of an 11-item observation rating form (ORT). In the present study we verified the validity, reliability and feasibility of this tool and of an already existing post-encounter rating tool (PERT) in clinical practice among medical students during the internal medicine clerkshipResults Six raters each assessed the same 15 student-patient encounters. The internal consistency (Cronbach’s alfa) for the (ORT) was 0.87 (0.71-0.84) and the 5-item (PERT) was 0.81 (0.71-0.87). The intraclass-correlation coefficient for single measurements was poor for both the ORT; 0.32 (p<0.001) as well as the PERT; 0.36 (p<0.001). The Generalizability study (G-study) and decision study (D-study) showed that 6 raters are required to achieve a G-coefficient of > 0.7 for the ORT and 7 raters for the PERT. The largest sources of variance are the interaction between raters and students. There was a consistent correlation between the ORT and PERT of 0.53 (p=0.04)Conclusions The ORT and PERT are both feasible, valid and reliable instruments to assess students’ clinical reasoning skills in clinical practice.

scholarly journals Validity, reliability and feasibility of a new observation rating tool and a post encounter rating tool for the assessment of clinical reasoning skills of medical students during their internal medicine clerkship. A pilot study.

2020 ◽  
Author(s):  
Catharina Maria Haring ◽  
Claudia Klaarwater ◽  
Geert Bouwmans ◽  
Bernadette Cools ◽  
Petra van Gurp ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Clinical Practice ◽  
Medical Students ◽  
Clinical Reasoning ◽  
Intraclass Correlation ◽  
Medicine Clerkship ◽  
Systematic Assessment ◽  
Internal Medicine Clerkship ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills

Abstract Background Systematic assessment of clinical reasoning skills of medical students in clinical practice is very difficult. This is partly caused by the lack of understanding of the fundamental mechanisms underlying the process of clinical reasoning. Methods We previously developed an observation tool to assess the clinical reasoning skills of medical students during clinical practice. This observation tool consists of an 11-item observation rating form (ORT). In the present study we verified the validity, reliability and feasibility of this tool and of an already existing post-encounter rating tool (PERT) in clinical practice among medical students during the internal medicine clerkshipResults Six raters each assessed the same 15 student-patient encounters. The internal consistency (Cronbach’s alfa) for the (ORT) was 0.87 (0.71-0.84) and the 5-item (PERT) was 0.81 (0.71-0.87). The intraclass-correlation coefficient for single measurements was poor for both the ORT; 0.32 (p<0.001) as well as the PERT; 0.36 (p<0.001). The Generalizability study (G-study) and decision study (D-study) showed that 6 raters are required to achieve a G-coefficient of > 0.7 for the ORT and 7 raters for the PERT. The largest sources of variance are the interaction between raters and students. There was a consistent correlation between the ORT and PERT of 0.53 (p=0.04)Conclusions The ORT and PERT are both feasible, valid and reliable instruments to assess students’ clinical reasoning skills in clinical practice.

scholarly journals Validity, reliability and feasibility of assessment of cilinical reasoning of medical students by observation versus post encounter assessment in a clinical practice setting.

2020 ◽  
Author(s):  
Catharina Maria Haring ◽  
Claudia Klaarwater ◽  
Geert Bouwmans ◽  
Bernadette Cools ◽  
Petra van Gurp ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Medical Students ◽  
Clinical Reasoning ◽  
Intraclass Correlation ◽  
Medicine Clerkship ◽  
Internal Medicine Clerkship ◽  
Rating Form ◽  
Clinical Practice Setting ◽  
Generalizability Study ◽  
Clinical Reasoning Skills

Abstract Background The assessment of clinical reasoning by medical students in clinical practice is very difficult. Partly this is because the fundamental mechanisms of clinical reasoning are difficult to uncover and when known, hard to observe and interpret. Methods We developed an observation tool to assess the clinical reasoning ability of medical students during clinical practice. The observation tool consists of an 11-item observation rating form. The validity, reliability and feasibility of this tool were verified among medical students during the internal medicine clerkship and compared to an existing post-encounter rating tool. Results Six raters assessed each, the same 15 student-patient encounters. The internal consistency (Cronbach’s alfa) for the observation rating tool (ORT) was 0.87 (0.71-0.84) and the 5-item post encounter rating tool (PERT) was 0.81 (0.71-0.87). The intraclass-correlation coefficient for single measurements was poor for both the ORT; 0.32 (p<0.001) as well as the PERT; 0.36 (p<0.001). The generalizability study (G-study) and decision study (D-study) showed that 6 raters are required to achieve a G-coefficient of > 0.7 for the ORT and 7 raters for the PERT. The largest sources of variance are the interaction between raters and students. There was a correlation between the ORT and PERT of 0.53 (p=0.04) Conclusions The ORT and PERT are both feasible, valid and reliable instruments to assess students’ clinical reasoning skills in clinical practice.

scholarly journals Validity, reliability and feasibility of assessment of cilinical reasoning of medical students by observation versus post encounter assessment in a clinical practice setting.

2020 ◽  
Author(s):  
Catharina Maria Haring ◽  
Claudia Klaarwater ◽  
Geert Bouwmans ◽  
Bernadette Cools ◽  
Petra van Gurp ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Medical Students ◽  
Clinical Reasoning ◽  
Intraclass Correlation ◽  
Reasoning Ability ◽  
Medicine Clerkship ◽  
Internal Medicine Clerkship ◽  
Rating Form ◽  
Clinical Practice Setting ◽  
Clinical Reasoning Skills

Abstract Background The assessment of clinical reasoning by medical students in clinical practice is very difficult. Partly this is because the fundamental mechanisms of clinical reasoning are difficult to uncover and when known, hard to observe and interpret. We developed an observation tool to assess the clinical reasoning ability of medical students during clinical practice. The observation tool consists of an 11-item observation rating form. The validity, reliability and feasibility of this tool were verified among medical students during the internal medicine clerkship and compared to a post-encounter rating tool. Results Six raters assessed each the same 15 student patient encounters. The internal consistency (Cronbach’s alfa) for the observation rating tool (ORT) was 0.87 (0.71-0.84) and the 5-item post encounter rating tool (PERT) was 0.81 (0.71-0.87). The intraclass-correlation coefficient for single measurements was poor for both the ORT; 0.32 (p<0.001) as well as the PERT; 0.36 (p<0.001). The G and D-study showed that 6 raters are required to achieve a G-coefficient of > 0.7 for the ORT and 7 raters for the PERT. The largest sources of variance are the interaction between raters and students. There was a correlation between the ORT and PERT of 0.53 (p=0.04) Conclusions The ORT and PERT are both feasible, valid and reliable instruments to assess students’ clinical reasoning skills in clinical practice.

scholarly journals Implementation of a clinical reasoning curriculum for clerkship-level medical students: a pseudo-randomized and controlled study

Diagnosis ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 165-172 ◽  
Author(s):  
Eliana Bonifacino ◽  
William P. Follansbee ◽  
Amy H. Farkas ◽  
Kwonho Jeong ◽  
Melissa A. McNeil ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Medical Students ◽  
Clinical Reasoning ◽  
Intervention Group ◽  
Superior Performance ◽  
Controlled Study ◽  
Medicine Clerkship ◽  
Internal Medicine Clerkship ◽  
Reasoning Skills ◽  
The Impact

Abstract Background The National Academies of Sciences report Improving Diagnosis in Healthcare highlighted the need for better training in medical decision-making, but most medical schools lack formal education in clinical reasoning. Methods We conducted a pseudo-randomized and controlled study to evaluate the impact of a clinical reasoning curriculum in an internal medicine clerkship. Students in the intervention group completed six interactive online modules focused on reasoning concepts and a skills-based workshop. We assessed the impact of the curriculum on clinical reasoning knowledge and skills and perception of education by evaluating: (1) performance on a clinical reasoning concept quiz, (2) demonstration of reasoning in hospital admission notes, and (3) awareness of attending physician utilization of clinical reasoning concepts. Results Students in the intervention group demonstrated superior performance on the clinical reasoning knowledge quiz (67% vs. 54%, p < 0.001). Students in the intervention group demonstrated superior written reasoning skills in the data synthesis (2.3 vs. 2.0, p = 0.02) and diagnostic reasoning (2.2 vs. 1.9, p = 0.02) portions of their admission notes, and reported more discussion of clinical reasoning by their attending physicians. Conclusions Exposure to a clinical reasoning curriculum was associated with superior reasoning knowledge and superior written demonstration of clinical reasoning skills by third-year medical students on an internal medicine clerkship.

The Effect of Resident Duty-Hours Restrictions on Internal Medicine Clerkship Experiences: Surveys of Medical Students and Clerkship Directors

2015 ◽  
Vol 27 (1) ◽  
pp. 37-50 ◽  
Author(s):  
Jennifer R. Kogan ◽  
Jennifer Lapin ◽  
Eva Aagaard ◽  
Christy Boscardin ◽  
Meenakshy K. Aiyer ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Medical Students ◽  
Medicine Clerkship ◽  
Duty Hours ◽  
Internal Medicine Clerkship ◽  
Resident Duty

Medical Students’ Professionalism Narratives Reveal That Experiences With Death, Dying, or Palliative Care Are More Positive Than Other Experiences During Their Internal Medicine Clerkship

2016 ◽  
Vol 34 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Larry D. Cripe ◽  
David G. Hedrick ◽  
Kevin L. Rand ◽  
Debra Burns ◽  
Daniella Banno ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Palliative Care ◽  
Medical Students ◽  
Educational Strategies ◽  
Barriers To Learning ◽  
Medicine Clerkship ◽  
Student Preparedness ◽  
Internal Medicine Clerkship ◽  
The Common ◽  
And Control

Purpose: More physicians need to acquire the skills of primary palliative care. Medical students’ clerkship experiences with death, dying, and palliative care (DDPC), however, may create barriers to learning such skills during residency. Whether professional development is differentially affected by DDPC is unknown. This knowledge gap potentially hinders the development of educational strategies to optimize students’ preparedness for primary palliative care. Method: Third-year students submitted professionalism narratives (N = 4062) during their internal medicine clerkship between 2004 and 2011. We identified DDPC-related narratives and then randomly selected control narratives. Narratives were compared by valence (positive or negative) and professionalism-related themes. Results and Conclusion: Less than 10% of the narratives were related to DDPC, but the majority was positive. There was a significant overlap in professionalism themes between DDPC and control narratives. The results suggest student preparedness for primary palliative care may be improved by addressing the common professionalism challenges of clinical clerkships.

scholarly journals Development and evaluation of a clinical reasoning curriculum as part of an Internal Medicine Residency Program

Diagnosis ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Shwetha Iyer ◽  
Erin Goss ◽  
Casey Browder ◽  
Gerald Paccione ◽  
Julia Arnsten
Keyword(s):  
Internal Medicine ◽  
Clinical Reasoning ◽  
Residency Program ◽  
Cognitive Biases ◽  
Diagnostic Errors ◽  
Internal Medicine Residency ◽  
Case Vignette ◽  
Internal Medicine Residency Program ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills

Abstract Background Errors in medicine are common and often tied to diagnosis. Educating physicians about the science of cognitive decision-making, especially during medical school and residency when trainees are still forming clinical habits, may enhance awareness of individual cognitive biases and has the potential to reduce diagnostic errors and improve patient safety. Methods The authors aimed to develop, implement and evaluate a clinical reasoning curriculum for Internal Medicine residents. The authors developed and delivered a clinical reasoning curriculum to 47 PGY2 residents in an Internal Medicine Residency Program at a large urban hospital. The clinical reasoning curriculum consists of six to seven sessions with the specific aims of: (1) educating residents on cognitive steps and reasoning strategies used in clinical reasoning; (2) acknowledging the pitfalls of clinical reasoning and learning how cognitive biases can lead to clinical errors; (3) expanding differential diagnostic ability and developing illness scripts that incorporate discrete clinical prediction rules; and (4) providing opportunities for residents to reflect on their own clinical reasoning (also known as metacognition). Results Forty-seven PGY2 residents participated in the curriculum (2013–2016). Self-assessed comfort in recognizing and applying clinical reasoning skills increased in 15 of 15 domains (p < 0.05 for each). Resident mean scores on the knowledge assessment improved from 58% pre-curriculum to 81% post curriculum (p = 0.002). Conclusions A case vignette-based clinical reasoning curriculum can effectively increase residents’ knowledge of clinical reasoning concepts and improve residents’ self-assessed comfort in recognizing and applying clinical reasoning skills.

Ten tips for organising a Bleep Roulette for final year medical students and new foundation trainees

2020 ◽  
pp. postgradmedj-2020-138683
Author(s):  
Yagazie Zina Udeaja ◽  
Rynda Nitiahpapand
Keyword(s):  
Clinical Practice ◽  
Medical Student ◽  
Medical Students ◽  
Clinical Reasoning ◽  
Initial Period ◽  
Clinical Placements ◽  
Student Preparedness ◽  
Roles And Responsibilities ◽  
Medical Educators ◽  
Clinical Reasoning Skills

The initial period adjusting to the roles and responsibilities of a new foundation doctor can be a challenging and anxious time for graduating medical students and new trainees. Over recent years, many educational initiatives such as shadowing placements, assistantships and compulsory induction programmes have been implemented to improve medical student preparedness for clinical practice. Despite this, many graduates still report a lack of confidence and preparedness when starting their clinical placements, specifically within the context of on-call shifts. Bleep Roulette simulation sessions are progressively being used to further bridge the gap from student to trainee and ensure trainees develop prioritisation, organisational and clinical reasoning skills, improving trainee efficiency during an on-call shift. In this article, we provide 10 tips for medical educators, detailing how to design an efficacious Bleep Roulette session for final year medical students and new foundation trainees.

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