scholarly journals Using script theory to cultivate illness script formation and clinical reasoning in health professions education

2015 ◽  
Vol 6 (2) ◽  
pp. e61-e70 ◽  
Author(s):  
Stuart Lubarsky ◽  
Valérie Dory ◽  
Marie-Claude Audétat ◽  
Eugène Custers ◽  
Bernard Charlin
Keyword(s):  
Clinical Reasoning ◽  
Medical Knowledge ◽  
Human Mind ◽  
Script Theory ◽  
Basic Principles ◽  
Disease States ◽  
Clinical Encounters ◽  
Illness Script ◽  
Illness Scripts ◽  
Fine Tune

Background: Script theory proposes an explanation for how information is stored in and retrieved from the human mind to influence individuals’ interpretation of events in the world. Applied to medicine, script theory focuses on knowledge organization as the foundation of clinical reasoning during patient encounters. According to script theory, medical knowledge is bundled into networks called ‘illness scripts’ that allow physicians to integrate new incoming information with existing knowledge, recognize patterns and irregularities in symptom complexes, identify similarities and differences between disease states, and make predictions about how diseases are likely to unfold. These knowledge networks become updated and refined through experience and learning. The implications of script theory on medical education are profound. Since clinician-teachers cannot simply transfer their customized collections of illness scripts into the minds of learners, they must create opportunities to help learners develop and fine-tune their own sets of scripts. In this essay, we provide a basic sketch of script theory, outline the role that illness scripts play in guiding reasoning during clinical encounters, and propose strategies for aligning teaching practices in the classroom and the clinical setting with the basic principles of script theory.

scholarly journals How to develop clinical reasoning in medical students and interns based on illness script theory: An experimental study

2020 ◽  
Author(s):  
Somayeh Delavari ◽  
Alireza Monajemi ◽  
Hamid Reza Baradaran ◽  
Phyo Kyaw Myint ◽  
Minoo Yaghmae ◽  
...  
Keyword(s):  
Experimental Study ◽  
Medical Students ◽  
Clinical Reasoning ◽  
Script Theory ◽  
Illness Script

Situativity: a family of social cognitive theories for understanding clinical reasoning and diagnostic error

Diagnosis ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. 169-176 ◽  
Author(s):  
Jerusalem Merkebu ◽  
Michael Battistone ◽  
Kevin McMains ◽  
Kathrine McOwen ◽  
Catherine Witkop ◽  
...  
Keyword(s):  
Clinical Reasoning ◽  
Distributed Cognition ◽  
Social Cognitive ◽  
Diagnostic Error ◽  
Dynamic Interactions ◽  
Clinical Encounters ◽  
Cognitive Theories ◽  
Context Specific ◽  
Social Cognitive Theories ◽  
Physician Patient

AbstractThe diagnostic error crisis suggests a shift in how we view clinical reasoning and may be vital for transforming how we view clinical encounters. Building upon the literature, we propose clinical reasoning and error are context-specific and proceed to advance a family of theories that represent a model outlining the complex interplay of physician, patient, and environmental factors driving clinical reasoning and error. These contemporary social cognitive theories (i.e. embedded cognition, ecological psychology, situated cognition, and distributed cognition) can emphasize the dynamic interactions occurring amongst participants in particular settings. The situational determinants that contribute to diagnostic error are also explored.

The Student-Generated Reasoning Tool (SGRT): Linking medical knowledge and clinical reasoning in preclinical education

2021 ◽  
pp. 1-9
Author(s):  
Ivry Zagury-Orly ◽  
Daniel S. Kamin ◽  
Edward Krupat ◽  
Bernard Charlin ◽  
Nicolas Fernandez ◽  
...  
Keyword(s):  
Clinical Reasoning ◽  
Medical Knowledge

scholarly journals What does research on clinical reasoning have to say to clinical teachers?

2020 ◽  
Vol 30 (1) ◽  
pp. e37350
Author(s):  
Silvia Mamede
Keyword(s):  
Clinical Reasoning ◽  
Correct Diagnosis ◽  
Diagnostic Process ◽  
Instructional Approaches ◽  
Clinical Teachers ◽  
Reasoning Strategy ◽  
Therapeutic Decisions ◽  
Illness Scripts ◽  
Underlying Mechanisms ◽  
Clinical Problems

Clinical reasoning is a crucial determinant of physicians’ performance. It is key to arrive at a correct diagnosis, which substantially increases the chance of appropriate therapeutic decisions. Clinical teachers face the daily challenge of helping their students to develop clinical reasoning. To select appropriate teaching strategies, it may be useful to become acquainted with the results of the research on clinical reasoning that has been conducted over the last decades. This article synthesizes the findings of this research that help in particular to understand the cognitive processes involved in clinical reasoning, the trajectory that leads the student from novice to expert, and instructional approaches that have been shown to be useful to facilitating this trajectory. The focus of the article is the diagnostic process, because it is about it that most research has been conducted. This research indicates that there is not a particular reasoning strategy that is specific to expert physicians and could be taught to students. It is the availability of a large knowledge base organized in memory in illness scripts of different formats that explains the expert’s better performance. The more, the richer, and the more well-structured are the illness scripts a physician has stored in memory, the more he/she would be able to make accurate diagnoses. These scripts are formed gradually over the years of education. To help develop them, students should be exposed to a wide variety of clinical problems, with which they must interact actively. Instructional approaches that require students to systematically reflect on problems, analyzing differences and similarities between them, explaining underlying mechanisms, comparing and contrasting alternative diagnoses, have proved useful to help refine disease scripts. These approaches are valuable tools for teachers concerned with the development of their students clinical reasoning.

scholarly journals Letter from the Editors

2020 ◽  
Vol 2 ◽  
pp. 1
Author(s):  
Editorial Office
Keyword(s):  
Medical Knowledge ◽  
Human Mind ◽  
Professional Communication ◽  
Medical Community ◽  
Critical Fields ◽  
Medical Practitioners ◽  
Clinical Journal ◽  
New Ideas ◽  
Research Findings

Dear Colleagues! Friends! Happy New Year! A sunny new day!                                                  With new bright thoughts, new horizons!                                                    With new ideas and progressive projects! With new warm light feelings!  With new hopes! Yes, the world is faced with horrendous challenges in 2020: environmental and, one by one, natural disasters, pandemic, hunger, political and financial crises, permanent "hot" and "cold" wars between countries, governments, minds ... But new promising solutions were also born: truces, negotiations, small and not so victories, alliances of progressive forces, new vaccines and medications, new experiences in all earthly spheres of life, and the development on the Moon and Mars! The editorial board of JIMSA, a clinical journal born in this challenging time of trials for the survival of the planet Earth, believes that the Human mind will prevail. Good thoughts and intentions will prevail. And we will all share experiences of big and small victories in the name of preserving the lives of our loved ones, our compatriots, our equals in mind, and so different in the mental and spiritual makeup of earthlings. JIMSA in New 2021 is a stable international platform for professional communication! We are opened to new scientific and clinical research discussions and ideas. We, under no circumstances, will put up with informational deprivation. We are pleased with your desire to share research findings, new ideas, discuss results and cases with the international medical community to benefit our patients. We welcome international cooperation in the critical fields of Global Human Health using our journal's pages. We are open to effective partnerships with authors, experts, reviewers, and medical practitioners to advance medical knowledge. We sincerely wish every, every, every one: no grief, no melancholy and only good intentions, incredible travel and new interesting acquaintances, a surge of energy and creative strength, each of the presented New 365 days of the New Year.

scholarly journals From principles to practice: embedding clinical reasoning as a longitudinal curriculum theme in a medical school programme

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Mini Singh ◽  
Lisa Collins ◽  
Rebecca Farrington ◽  
Matthew Jones ◽  
Harish Thampy ◽  
...  
Keyword(s):  
Faculty Development ◽  
Medical School ◽  
Clinical Reasoning ◽  
Lessons Learned ◽  
Medical Decision ◽  
Implementation Phase ◽  
Existing Structures ◽  
Illness Script ◽  
Undergraduate Study ◽  
Competency Frameworks

Abstract There is consensus that clinical reasoning (CR) is crucial for increasing the value of diagnosis, medical decision-making and error reduction. These skills should be developed throughout medical education, starting with undergraduate study. International guidance provides principles for CR curricula but interventions to date, are short term in nature. In this report, we describe the creation of a longitudinal, spiral CR curriculum within a large UK medical school programme (2500 students). A working group drove systematic evidence-based reform of existing structures. We utilised recognised models for curriculum development and mapping, relating learning outcomes to competency frameworks. Application of multiple teaching methodologies, rooted in enquiry-based learning and reported in CR literature, encourage metacognition for information-processing and illness script development. Development of CR is emphasised with recurrent, progressive learning opportunities, each stage purposefully building upon previous experiences. Formative and summative assessment approaches to drive learning, encouraging students’ ability to apply and articulate CR, is constructed via Miller’s Prism of Clinical Competence. Implementation of pedagogy is contingent on faculty development. Whilst many clinicians practice sound CR, the ability to articulate it to students is often a novel skill. Engagement in faculty development was strengthened through cross-institutional recognition of teaching workload and flexibility of delivery. We report lessons learned from the implementation phase and plans for measuring impact.

scholarly journals Do different response formats affect how test takers approach a clinical reasoning task? An experimental study on antecedents of diagnostic accuracy using a constructed response and a selected response format

2021 ◽  
Author(s):  
Stefan K. Schauber ◽  
Stefanie C. Hautz ◽  
Juliane E. Kämmer ◽  
Fabian Stroben ◽  
Wolf E. Hautz
Keyword(s):  
Experimental Study ◽  
Clinical Reasoning ◽  
Medical Knowledge ◽  
List Type ◽  
Reasoning Task ◽  
Self Monitoring ◽  
Constructed Response ◽  
Response Formats ◽  
Different Response ◽  
Short Essay

AbstractThe use of response formats in assessments of medical knowledge and clinical reasoning continues to be the focus of both research and debate. In this article, we report on an experimental study in which we address the question of how much list-type selected response formats and short-essay type constructed response formats are related to differences in how test takers approach clinical reasoning tasks. The design of this study was informed by a framework developed within cognitive psychology which stresses the importance of the interplay between two components of reasoning—self-monitoring and response inhibition—while solving a task or case. The results presented support the argument that different response formats are related to different processing behavior. Importantly, the pattern of how different factors are related to a correct response in both situations seem to be well in line with contemporary accounts of reasoning. Consequently, we argue that when designing assessments of clinical reasoning, it is crucial to tap into the different facets of this complex and important medical process.

scholarly journals ContExtended Questions (CEQ) to Teach and Assess Clinical Reasoning: A New Variant of F-Type Testlets

2021 ◽  
Vol 2 (1) ◽  
pp. 48-56
Author(s):  
Yavuz Selim Kıyak ◽  
Işıl İrem Budakoğlu ◽  
Serdar Kula ◽  
Özlem Coşkun
Keyword(s):  
Medical Education ◽  
Clinical Reasoning ◽  
Assessment Tool ◽  
Multiple Choice ◽  
Multiple Choice Questions ◽  
Multiple Choice Tests ◽  
Education And Health ◽  
New Variant ◽  
Illness Scripts ◽  
Randomized Controlled Experiment

This study introduces ContExtended Questions (CEQ), which is a tool both to teach and assess clinical reasoning particularly in the preclinical years, and the web-based program to implement. CEQ consists of text-based case-based multiple-choice questions that provide patient data in a fixed and predetermined sequence. It enables the examinees to develop and reshape their illness scripts by using feedback after every question. Feedback operates to transform the examinee’s failure into a “productive failure”. The preliminary results of the randomized controlled experiment of teaching clinical reasoning to preclinical students through CEQ is quite satisfactory. In the medical education literature, this would be the first time that students, who have no or very limited clinical experience, developed their illness scripts just by taking formative multiple-choice tests. The approach would be named “test-only learning”. The complete results of the experiment and then more experiments in other contexts and domains are necessary to establish a more powerful assessment tool and software. Furthermore, by changing the content of the questions, it is possible to use CEQ in every period of medical education and health professions education.

scholarly journals Perspektif Syaikh Ahmad Al-Fatani Tentang Kaedah Mengenalpasti Penyakit : Analisis Awal Terhadap Kitab Tayyib Al-Ihsan Fi Tibb Al-Insan (Perspectives of Syaikh Ahmad Al-Fatani About Methods of Identifying Illness : Early Analysis of Kitab Tayyib Al-Ihsan Fi Tibb Al-Insan)

2019 ◽  
Vol 6 (2-2) ◽  
Author(s):  
Fairuzah Mat Salleh ◽  
Zilal Saari ◽  
Nur Najwa Hanani Abdul Rahman ◽  
Norhissam Mustafa
Keyword(s):  
Healing Process ◽  
Medical Knowledge ◽  
Prescription Medication ◽  
Disease Diagnosis ◽  
Early Analysis ◽  
Basic Principles ◽  
Medical Practitioners ◽  
Library Research ◽  
The Right

Disease identification or disease diagnosis process is an important element in a treatment process. A complete diagnosis can lead to the determination of the right type of treatment and proper prescription medication in the disease healing process. Syaikh Ahmad Al-Fatani, is a great religious scholar and his medical knowledge in the Malay World, has produced a book manuscript that could be a guide to Malay medical practitioners, especially in the process of diagnosing patients. Hence, this study will discuss Shaykh Ahmad Al-Fatani’s perspective on the method of identifying illness by focusing on his manuscript, Tayyib Al-Ihsan Fi Tibb Al-Insan. The book discusses on Malay medicine, with main focus to determine the medicines and treatments against ailments. Data collection is done through library research and bibliogafi data analysis from this book, past studies and related journals to determine the method using by Syaikh Ahmad Al-Fatani for identification of illness. Although the method of identifying illnesses is not described in detail, the basic principles can be further studied in a more structured and scientific way to aid develop Malay medicine.

scholarly journals Assessing clinical reasoning: moving from in vitro to in vivo

Diagnosis ◽  
2014 ◽  
Vol 1 (1) ◽  
pp. 111-117 ◽  
Author(s):  
Eric S. Holmboe ◽  
Steven J. Durning
Keyword(s):  
Medical Education ◽  
Clinical Practice ◽  
Clinical Reasoning ◽  
Medical Knowledge ◽  
Diagnostic Errors ◽  
High Stakes ◽  
The Public ◽  
Vexing Problem

AbstractThe last century saw dramatic changes in clinical practice and medical education and the concomitant rise in high-stakes, psychometrically-based examinations of medical knowledge. Higher scores on these high-stakes “in-vitro” examinations are modestly associated with better performance in clinical practice and provide a meaningful degree of assurance to the public about physicians’ competency in medical knowledge. However, results on such examinations explain only a small fraction of the wide variation currently seen in clinical practice and diagnostic errors remain a serious and vexing problem for patients and the healthcare system despite decades of high-stakes examinations. In this commentary we explore some of the limitations of high-stakes examinations in assessing clinical reasoning and propose utilizing situated cognition theory to guide research and development of innovative modes of ”in-vivo” assessments that can be used in longitudinally and continuously in clinical practice.

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