scholarly journals Assessing Clinical Reasoning Ability in Fourth-year Medical Students via an Integrative Group History-taking Workshop With an Individual Reasoning Teaching Programme

2021 ◽  
Author(s):  
Jian-Han Lai ◽  
Kuan-Hao Cheng ◽  
Yih-Jer Wu ◽  
Ching-Chung Lin
Keyword(s):  
Abdominal Pain ◽  
Medical Students ◽  
Clinical Reasoning ◽  
Training Programme ◽  
History Taking ◽  
Teaching Programme ◽  
Diagnosis Rate ◽  
Fourth Year Medical Students ◽  
Information Number ◽  
Standardised Patients

Abstract Background: The most important factor in evaluating a physician’s competence is strong clinical reasoning ability, leading to correct principal diagnoses. The process of clinical reasoning includes history taking, physical examinations, validating medical records, and determining a final diagnosis. In this study, we designed a teaching programme to evaluate the clinical reasoning competence of fourth-year medical students.Methods: We created five patient scenarios for our standardised patients, including haemoptysis, abdominal pain, fever, anaemia, and chest pain. A group history-taking workshop with individual reasoning principles was implemented to teach and evaluate students’ abilities to take histories, document key information, and arrive at the most likely diagnosis. Residents were trained to act as teachers, and a post-study questionnaire was employed to evaluate the students’ satisfaction with the training programme.Results: A total of 76 students, five teachers, and five standardised patients participated in this clinical reasoning training programme. The average history-taking score was 64%, the average key information number was 7, the average diagnosis number was 1.1, and the average correct diagnosis rate was 38%. Standardised patients presenting with abdominal pain (8.3%) and anaemia (18.2%) had the lowest diagnosis rates. The scenario of anaemia presented the most difficult challenge for students in history taking (3.5/5) and clinical reasoning (3.5/5). The abdominal pain scenario yielded even worse results (history taking: 2.9/5 and clinical reasoning 2.7/5). We found a correlation in the clinical reasoning process between the correct and incorrect most likely diagnosis groups (group history-taking score, p=0.045; key information number, p=0.009 and diagnosis number, p=0.004). The post-study questionnaire results indicated significant satisfaction with the teaching programme (4.7/5) and the quality of teacher feedback (4.9/5).Conclusions: We concluded that the clinical reasoning skills of fourth-year medical students benefited from this training programme, and the lower correction of the most likely diagnosis rate found with abdominal pain, anaemia, and fever might be due to a system-based teaching programme in fourth-year medical students; cross-system remedial reasoning training is recommended for fourth-year medical students in the future.

scholarly journals Virtual Integrated Patient: An AI supplementary tool for second-year medical students

2021 ◽  
Vol 6 (3) ◽  
pp. 87-90
Author(s):  
Juanita S. M. Kong ◽  
Boon See Teo ◽  
Yueh Jia Lee ◽  
Anu Bharath Pabba ◽  
Edmund J.D. Lee ◽  
...  
Keyword(s):  
Medical Students ◽  
Pilot Study ◽  
Physical Examination ◽  
Clinical Skills ◽  
History Taking ◽  
Clinical Rotations ◽  
Face To Face ◽  
Second Year ◽  
Standardised Patients ◽  
Real Patients

Introduction: With the COVID-19 pandemic, Singapore underwent a national lockdown in which most organisations, including schools were closed. Halting face-to-face tutorials resulting in decreased clinical contact for medical students. Prior to the pandemic, we had developed the Virtual Integrated Patient (VIP). Equipped with conversational technology, it provides students online practice in various clinical skills such as history-taking, physical examination and investigations. The aim of this paper is to describe the supplementary use of VIP in the second-year class, in which a pilot study was conducted. Methods: The VIP platform was introduced to the cohort and used to supplement the teaching of history-taking in the “Communication with Patients” (CWP) module for second-year students. Traditionally, CWP tutorials involve face-to-face history-taking from standardised patients (SPs). Students, who consented to participating in the trial, had an additional 3 weeks’ access to VIP to practice their history-taking skills. They completed a survey on their user experience and satisfaction at the end of the 3 weeks. Results: Out of the 106 participants, 87% strongly agreed or agreed that using VIP helped in remembering the content while 69% of them felt that VIP increased their confidence and competence in history-taking. Conclusion: VIP was well-received by students and showed promise as a tool to supplement history-taking tutorials, prior to students’ encounter with SPs and real patients. Hence, this trend showed its potential as an alternative when clinical rotations were delayed or cancelled. Further research can be done to evaluate its effectiveness in this context.

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 Use of clinical reasoning tasks by medical students

Diagnosis ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 127-135 ◽  
Author(s):  
Elexis McBee ◽  
Christina Blum ◽  
Temple Ratcliffe ◽  
Lambert Schuwirth ◽  
Elizabeth Polston ◽  
...  
Keyword(s):  
Medical Students ◽  
Clinical Reasoning ◽  
Comparative Approach ◽  
Think Aloud ◽  
Clinical Encounters ◽  
Complex Process ◽  
Fourth Year Medical Students ◽  
Type Frequency ◽  
Reasoning Tasks ◽  
Study Participants

Abstract Background A framework of clinical reasoning tasks used by physicians during clinical encounters was previously developed proposing that clinical reasoning is a complex process composed of 26 possible tasks. The aim of this paper was to analyze the verbalized clinical reasoning processes of medical students utilizing commonly encountered internal medicine cases. Methods In this mixed-methods study, participants viewed three video recorded clinical encounters. After each encounter, participants completed a think-aloud protocol. The qualitative data from the transcribed think-aloud transcripts were analyzed by two investigators using a constant comparative approach. The type, frequency, and pattern of codes used were analyzed. Results Seventeen third and fourth year medical students participated. They used 15 reasoning tasks across all cases. The average number of tasks used in cases 1, 2, and 3 was (respectively) 5.6 (range 3–8), 5.9 (range 4–8), and 5.3 (range 3–10). The order in which medical students verbalized reasoning tasks varied and appeared purposeful but non-sequential. Conclusions Consistent with prior research in residents, participants progressed through the encounter in a purposeful but non-sequential fashion. Reasoning tasks related to framing the encounter and diagnosis were not used in succession but interchangeably. This suggests that teaching successful clinical reasoning may involve encouraging or demonstrating multiple pathways through a problem. Further research exploring the association between use of clinical reasoning tasks and clinical reasoning accuracy could enhance the medical community’s understanding of variance in clinical reasoning.

scholarly journals Effects of a new parallel primary healthcare centre and on-campus training programme on history taking, physical examination skills and medical students' preparedness: a prospective comparative study in Taiwan

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016294 ◽  
Author(s):  
Ying-Ying Yang ◽  
Shuu-Jiun Wang ◽  
Ling-Yu Yang ◽  
Jiing-Feng Lirng ◽  
Chia-Chang Huang ◽  
...  
Keyword(s):  
Medical Students ◽  
Physical Examination ◽  
Comparative Study ◽  
Positive Association ◽  
Skills Training ◽  
Training Programme ◽  
Patient Contact ◽  
History Taking ◽  
Hospital Practice ◽  
Academic Year

ObjectivesThe primary healthcarecentre (PHCC) is the first place that medical students experience patient contact. Usually, medical students are frustrated by a lack of proper skills training for on-campus history taking (HT), physical examination (PE) and self-directed learning (SDL) to prepare for their PHCC and inhospital patient contact. For pre-clerks, this study aims to compare the effectiveness of PHCC training and PHCC training in combination with on-campus HT and PE training modules (PHCC+on-campus) on their clerkship preparedness.DesignThis comparative study utilised prospective, consecutive, end of pre-clerkship group objective structured clinical examination (GOSCE), beginning of clerkship OSCE and self-administered Preparation for Hospital Practice Questionnaire (PHPQ).Setting/participants128 pre-clinical clerk volunteers (64 each year) receiving PHCC training (7 week PHCCtraining in addition to 7 week assignment based group learning, academic year 2014, controls) and PHCC training in combination with on-campus module training (academic year 2015, 7 week PHCCtraining in addition to 7 week on-campus sessions) were sequentially assessed before the module (week 1), at the end of the module (week 14) and at the beginning of clerkship (week 25).ResultsFor overall HT and PE skills, both PHCC and PHCC+on-campus module trained pre-clerks performed better on OSCE than GOSCE. Additionally, the improvement was accompanied by higher self-reported PHPQ scores in ‘confidence/coping’ and ‘SDL’ domains. At the end of the pre-clerkship and the beginning of the clerkship stages, the degree of improvement in preparedness in ‘confidence/coping’ and ‘SDL’ domains was higher for those in the PHCC+on-campus group than for those in the PHCC group. Among the PHCC+on-campus module participants, a positive association was observed between high mean PHPQ-SDL scores and high OSCE scores.ConclusionsOur study suggests that the PHCC+on-campus module, which is paired faculty led and pre-trained dyad student assisted, is effective in developing a preclinical clerk’s HT and PE skills and intensifying SDL/patient management abilities to prepare for hospital practice in clerkship.

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 Teaching clinical reasoning to undergraduate medical students by illness script method: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mana Moghadami ◽  
Mitra Amini ◽  
Mohsen Moghadami ◽  
Bhavin Dalal ◽  
Bernard Charlin
Keyword(s):  
Medical Students ◽  
Clinical Reasoning ◽  
Controlled Trial ◽  
Intervention Group ◽  
Signs And Symptoms ◽  
Control Group ◽  
Illness Script ◽  
Fourth Year Medical Students ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills

Abstract Background The illness script method employs a theoretical outline (e.g., epidemiology, pathophysiology, signs and symptoms, diagnostic tests, interventions) to clarify how clinicians organized medical knowledge for clinical reasoning in the diagnosis domain. We hypothesized that an educational intervention based on the illness script method would improve medical students’ clinical reasoning skills in the diagnosis domain. Methods This study is a randomized controlled trial involving 100 fourth-year medical students in Shiraz Medical School, Iran. Fifty students were randomized to the intervention group, who were taught clinical reasoning skills based on the illness script method for three diseases during one clinical scenario. Another 50 students were randomized to the control group, who were taught the clinical presentation based on signs and symptoms of the same three diseases as the intervention group. The outcomes of interest were learner satisfaction with the intervention and posttest scores on both an internally developed knowledge test and a Script Concordance Test (SCT). Results Of the hundred participating fourth-year medical students, 47 (47%) were male, and 53 (53%) were female. On the knowledge test, there was no difference in pretest scores between the intervention and control group, which suggested a similar baseline knowledge in both groups; however, posttest scores in the intervention group were (15.74 ± 2.47 out of 20) statistically significantly higher than the control group (14.38 ± 2.59 out of 20, P = 0.009). On the SCT, the mean score for the intervention group (6.12 ± 1.95 out of 10) was significantly higher than the control group (4.54 ± 1.56 out of 10; P = 0.0001). Learner satisfaction data indicated that the intervention was well-received by students. Conclusion Teaching with the illness script method was an effective way to improve students’ clinical reasoning skills in the diagnosis domain suggested by posttest and SCT scores for specific clinical scenarios. Whether this approach translates to improved generalized clinical reasoning skills in real clinical settings merits further study.

Observer Variation in Clinical Diagnosis - A Computer-Aided Assessment of its Magnitude and Importance in 552 Patients with Abdominal Pain

1973 ◽  
Vol 12 (02) ◽  
pp. 108-113 ◽  
Author(s):  
P. W. Gill ◽  
D. J. Leaper ◽  
P. J. Guillou ◽  
J. R. Staniland ◽  
J. C. Horhocks ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Clinical Diagnosis ◽  
Error Rate ◽  
Diagnostic System ◽  
Diagnostic Error ◽  
Observer Variation ◽  
History Taking ◽  
Computer Aided ◽  
Computer Based ◽  
Initial Survey

This report describes an evaluation of »observer variation« in history taking and examination of patients with abdominal pain. After an initial survey in which the degree of observer variation amongst the present authors fully confirmed previous rather gloomy forecasts, a system of »agreed definitions« was produced, and further studies showed a rapid and considerable fall in the degree of observer variation between the data recorded by the same authors. Finally, experience with a computer-based diagnostic system using the same system of agreed definitions showed the maximum diagnostic error rate due to faulty acquisition of data to be low (4.7°/o in a series of 552 cases). It is suggested as a result of these studies that — at least in respect of abdominal pain — errors in data acquisition by the clinician need not be the prime cause of faulty diagnoses.

A Quantitative Assessment of the Need for Offering Counselling Services to Medical Students attending University of Zambia, School of Medicine.

2020 ◽  
Vol 7 (2) ◽  
pp. 93-103
Author(s):  
Gretchen Slover
Keyword(s):  
Medical Students ◽  
Counseling Services ◽  
Student Responses ◽  
Counselling Services ◽  
School Of Medicine ◽  
Comprehensive Picture ◽  
Fourth Year Medical Students ◽  
The Subject ◽  
The University ◽  
Therapy Sessions

Background: This research was birthed in 2017 during a trip to Lusaka, Zambia, with the purpose of offering fourth-year, medical students attending the University of Zambia, School of Medicine, lectures on psychology topics as part of their clinical studies.  Students were also offered brief therapy sessions where they could process thoughts and feelings causing them internal struggles.  The subject of offering counseling on a regular basis was randomly discussed with the students.  From these discussions the need for this research became evident, with the intent of becoming the launching pad to brainstorm the most effective ways of developing a plan to offer counseling services for all medical students attending the University of Zambia School of Medicine. Methods: An-experimental research design, consisting of completion of a 12-item questionnaire administered by paper and pen. The inclusion criteria were the fourth year, medical students attending the University of Zambia, School of Medicine. Results:  The student responses revealed that most of them had little to no experience with counseling services, but a strong desire for them. Discussion: The goal of this study was to simply establish a need for an on-campus counseling service, the need of which has been established by the very students who would benefit.  With the acceptance of this need, the future plan is to explore the different ways in which this need can be fulfilled with minimal costs to the Medical School Program. Conclusion:  This study is the first step towards identifying the needs of the medical students and sets the ground-work for further research into the specific areas of need and mental health challenges.  More specificity in the area of demographics of students will produce a more comprehensive picture of the areas of concentration for the therapists offering services.

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