Responding in Writing to Clinical Cases: The Development of Clinical Reasoning in Nursing

Abstract Background Health service evaluation studies point to the low quality of care, however the permanent education of health professionals is a major challenge. Within the scope of the Open University for the Unified Health System (SUS), the Department of Social Medicine of the Federal University of Pelotas produced open access self-learning courses, for primary health care, based on interactive clinical cases, through distance learning. Methods The courses, with 45 hours, provides interactive clinical cases, medical calculators and textual materials for use by the professional or with the community. The cases are presented and followed by multiple choice questions, focusing diagnosis and treatment. The feedback is automatic. An expanded theoretical content ('learn more') that privileges the use of illustrations, images, infographics and flowcharts useful for professional practice can be accessed. Bibliographical references on the subject are also available. The courses are available in a responsive web client app, for various types of devices, providing control of progress and automatic certification. The app allows the work offline, enabling the permanent education of professionals working in remote areas. Results Six courses were produced for doctors, nurses and dentists, more than 30,000 users were certified. Conclusions This problem-based learning initiative allows the student to have a menu of cases, providing a choice of the subject, decision on the time allocated to the activity, repetition according to its need, access to a large bibliography and reading in the quantity and depth chosen by the student. In addition, the format is challenging and develops clinical reasoning. The proposition of questions promotes the reflection of the student in relation to his knowledge on the subject. Automatic feedback, 'learn more' and selected bibliographies provide formative assessment and subsidize students to define their study needs in each subject. Key messages Distance learning expands the possibility of qualifying the clinical practice of health professionals, especially those in remote areas. Interactive clinical cases provide the development of clinical reasoning, content review and promote formative assessment.

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How to apply clinical cases and medical literature in the framework of a modified “failure mode and effects analysis” as a clinical reasoning tool – an illustration using the human biliary system

Journal of Medical Case Reports ◽

10.1186/s13256-016-0850-6 ◽

2016 ◽

Vol 10 (1) ◽

Cited By ~ 4

Author(s):

Kam Cheong Wong

Keyword(s):

Failure Mode ◽

Clinical Reasoning ◽

Medical Literature ◽

Biliary System ◽

Clinical Cases

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Estratégias educativas utilizadas nos sistemas de linguagens padronizadas por enfermeiros: revisão integrativa

Online Brazilian Journal of Nursing ◽

10.17665/1676-4285.20175549 ◽

2018 ◽

Vol 16 (3) ◽

pp. 366 ◽

Cited By ~ 1

Author(s):

Luciana Silva de Melo ◽

Lyvia Da Silva Figueiredo ◽

Juliana De Melo Vellozo Pereira ◽

Paula Vanessa Peclat Flores ◽

Marina Einstoss Barbosa Siqueira ◽

...

Keyword(s):

Clinical Reasoning ◽

Clinical Studies ◽

Relevant Literature ◽

Study Groups ◽

Integrative Review ◽

Nursing Process ◽

Educational Strategies ◽

Practical Guide ◽

Nursing Processes ◽

Clinical Cases

Aim: to identify educational strategies used in the training of nurses regarding the process of nursing involving standardized language systems. Method: this is an integrative review of the relevant literature, performed using the following databases: MEDLINE, via PUBMED; CINAHL; SCOPUS; and LILACS. Results: six papers were selected. The main features of such papers were: the use of a practical guide, workshops, study groups, recording using standardized instruments, discussion of studies based on fictitious and real cases, theoretical-practical classes using clinical cases, and guided clinical reasoning. Discussion: the knowledge produced regarding the strategies used to train nurses about the nursing process – with or without standardized language systems – reinforced the importance of such strategies to produce clearer recorded information, as seen in four clinical studies and two descriptive ones. Conclusion: educational strategies involving standardized language systems in the training of nurses promote development in the implementation of nursing processes.

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Effects of reflection and immediate feedback to improve clinical reasoning of medical students in the assessment of dermatologic conditions: A randomised controlled trial

10.21203/rs.3.rs-24301/v1 ◽

2020 ◽

Author(s):

Sungjun Choi ◽

Sohee Oh ◽

Dong-Hun Lee ◽

Hyun-Sun Yoon

Keyword(s):

Medical Students ◽

Clinical Reasoning ◽

Outpatient Clinic ◽

Controlled Trial ◽

Educational Interventions ◽

Training Set ◽

Immediate Feedback ◽

Significant Interaction Effect ◽

Experimental Group ◽

Clinical Cases

Abstract BACKGROUND: There are few studies that directly compared different interventions to improve medical students’ clinical reasoning for dermatologic conditions. OBJECTIVE: To investigate the effectiveness of adding practice with reflection and immediate feedback on traditional dermatology electives in improving medical students' ability in evaluating skin lesions.METHODS: The participants were fourth-year medical students of Seoul National University College of Medicine, Korea, who were enrolled to take a 2-week dermatology elective course (n=87). Students were assigned to one of the three educational interventions: 2-hour training involving 10 written clinical cases (experimental); 1-hour lecture and 1-hour outpatient clinic (lecture); and 2-hour outpatient clinic (no intervention). Before and at the end of rotation, diagnostic accuracy was estimated using 20 written clinical cases with photographs (10 novel cases presented in diagnostic training [training set], 10 cases with diagnoses not included in training [control set]).RESULTS: There was a significant interaction effect of intervention×set×time. A post hoc analysis indicated that the students in the experimental group outperformed students in the other two groups only in the training set of the final tests; after completing the 2-week rotation, for the training set, the mean score was higher in the experimental group (7.5±1.3) than in the lecture (5.7±1.6) and no intervention (5.6±1.3) groups, producing an effect size of 1.2 standard deviation (SD) and 1.5 SD, respectively. CONCLUSION: Practicing written clinical cases with reflection and feedback is superior to a lecture-based approach and yields additional benefits to a dermatology elective, thereby enhancing medical students’ ability to accurately diagnose skin lesions.

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Effects of reflection and immediate feedback to improve clinical reasoning of medical students in the assessment of dermatologic conditions: A randomised controlled trial

10.21203/rs.3.rs-24301/v2 ◽

2020 ◽

Author(s):

Sungjun Choi ◽

Sohee Oh ◽

Dong-Hun Lee ◽

Hyun-Sun Yoon

Keyword(s):

Medical Students ◽

Clinical Reasoning ◽

Outpatient Clinic ◽

Controlled Trial ◽

Educational Interventions ◽

Skin Lesions ◽

Training Set ◽

Immediate Feedback ◽

Experimental Group ◽

Clinical Cases

Abstract BACKGROUND: There are few studies that directly compared different interventions to improve medical students’ clinical reasoning for dermatologic conditions. OBJECTIVE: To investigate the effectiveness of adding practice with reflection and immediate feedback on traditional dermatology electives in improving medical students' ability in evaluating skin lesions. METHODS: The participants were fourth-year medical students of Seoul National University College of Medicine, Korea, who were enrolled to take a 2-week dermatology elective course (n=87). Students were assigned to one of the three educational interventions: 2-hour training involving 10 written clinical cases (experimental); 1-hour lecture and 1-hour outpatient clinic (lecture); and 2-hour outpatient clinic (no intervention). Before and at the end of rotation, diagnostic accuracy was estimated using 20 written clinical cases with photographs (10 novel cases presented in diagnostic training [training set], 10 cases with diagnoses not included in training [control set]). RESULTS: There was a significant interaction effect of intervention×set×time. A post hoc analysis indicated that the students in the experimental group outperformed students in the other two groups only in the training set of the final tests; after completing the 2-week rotation, for the training set, the mean score was higher in the experimental group (7.5±1.3) than in the lecture (5.7±1.6) and no intervention (5.6±1.3) groups, producing an effect size of 1.2 standard deviation (SD) and 1.5 SD, respectively. CONCLUSION: Practicing written clinical cases with reflection and feedback is superior to a lecture-based approach and yields additional benefits to a dermatology elective, thereby enhancing medical students’ ability to accurately diagnose skin lesions. Trial registration: ClinicalTrials.gov, NCT03472001. Registered 21 March 2018, https://clinicaltrials.gov/ct2/show/NCT03472001

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Type V Bekesy Pattern: Interpretation and Clinical Utility

Journal of Speech and Hearing Research ◽

10.1044/jshr.1004.733 ◽

1967 ◽

Vol 10 (4) ◽

pp. 733-744 ◽

Cited By ~ 2

Author(s):

William F. Rintelmann ◽

Earl R. Harford

Keyword(s):

Clinical Utility ◽

The Past ◽

Type V ◽

Clinical Cases

Recent studies indicate there is some disagreement concerning the interpretation and clinical utility of the Type V Bekesy pattern. Bekesy tracings obtained over the past six years from a sample of clinical cases were analyzed and a definition was established for the Type V pattern. This definition was applied to Bekesy tracings obtained from normal listeners, hypoacusics, and pseudohypoacusics. The Type V pattern was found frequently among pseudohypoacusics and only rarely among other individuals.

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