Teaching and Assessing Critical Thinking and Clinical Reasoning Skills in Medical Education

2019 ◽  
pp. 213-233
Author(s):  
Md. Anwarul Azim Majumder ◽  
Bidyadhar Sa ◽  
Fahad Abdullah Alateeq ◽  
Sayeeda Rahman
Keyword(s):  
Medical Education ◽  
Critical Thinking ◽  
Clinical Reasoning ◽  
Cognitive Biases ◽  
Diagnostic Errors ◽  
Higher Order Thinking ◽  
Recent Trends ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills ◽  
And Training

In recent years, there has been more emphasis on developing higher order thinking (e.g., critical thinking and clinical reasoning) processes to tackle the recent trends and challenges in medical education. Critical thinking and clinical reasoning are considered to be the cornerstones for teaching and training tomorrow's doctors. Lack of training of critical thinking and clinical reasoning in medical curricula causes medical students and physicians to use cognitive biases in problem solving which ultimately leads to diagnostic errors later in their professional practice. Moreover, there is no consensus on the most effective teaching model to teach the critical thinking and clinical reasoning skills and even the skill is not effectively tested in medical schools. This chapter will focus on concepts, contemporary theories, implications, issues and challenges, characteristics, various steps, teaching models and strategies, measuring and intervention tools, and assessment modalities of critical thinking and clinical reasoning in medical education settings.

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.

scholarly journals Clinical Correlations as a Tool in Basic Science Medical Education

2016 ◽  
Vol 3 ◽  
pp. JMECD.S18919 ◽  
Author(s):  
Brenda J. Klement ◽  
Douglas F. Paulsen ◽  
Lawrence E. Wineski
Keyword(s):  
Medical Education ◽  
Clinical Reasoning ◽  
Basic Science ◽  
Clinical Information ◽  
Medical Application ◽  
Knowledge Retention ◽  
Clinical Correlations ◽  
Reasoning Skills ◽  
Science Concepts ◽  
Clinical Reasoning Skills

Clinical correlations are tools to assist students in associating basic science concepts with a medical application or disease. There are many forms of clinical correlations and many ways to use them in the classroom. Five types of clinical correlations that may be embedded within basic science courses have been identified and described. (1) Correlated examples consist of superficial clinical information or stories accompanying basic science concepts to make the information more interesting and relevant. (2) Interactive learning and demonstrations provide hands-on experiences or the demonstration of a clinical topic. (3) Specialized workshops have an application-based focus, are more specialized than typical laboratory sessions, and range in complexity from basic to advanced. (4) Small-group activities require groups of students, guided by faculty, to solve simple problems that relate basic science information to clinical topics. (5) Course-centered problem solving is a more advanced correlation activity than the others and focuses on recognition and treatment of clinical problems to promote clinical reasoning skills. Diverse teaching activities are used in basic science medical education, and those that include clinical relevance promote interest, communication, and collaboration, enhance knowledge retention, and help develop clinical reasoning skills.

Enhancing Clinical Reasoning Skills through Structured Reflection Models

2020 ◽  
Author(s):  
EMAD ALI ALMOMANI ◽  
Karim Attallah
Keyword(s):  
Critical Care ◽  
Reflective Practice ◽  
Clinical Reasoning ◽  
Positive Impact ◽  
Diagnostic Errors ◽  
Reflective Learning ◽  
Cross Sectional ◽  
Hamad Medical Corporation ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills

Abstract Background:Clinical reasoning is an essential skill to all health care practitioners. McGlynn et al, 2015 mention that lower level of clinical reasoning skills are associated with higher rates of medical and diagnostic errors.. To enhance the clinical reasoning through reflection Hamad Medical Corporation (HMC) – Qatar established a new educational initiative under the title of reflective learning conversation and debriefing.Method:A prospective cross sectional exploratory of mixed methodology research conducted at Qatar- Hamad Medical Corporation (HMC) – In the critical care and trauma units. Anonymous self-reported questionnaires were collected from 236 critical care and trauma nurses who attended the reflective learning conversation and debriefing activities. Semi structured Interviews conducted for 10 nurses who facilitated the reflective learning conversation and debriefing activities. Content analysis and thematic analysis were applied.Results:Attending the reflective learning conversations and debriefing educational activities have a significant positive impact on the clinical reasoning skills of the critical care and trauma nurses. Moreover, attending the group level reflection, feeling threatened, are limitations and barriers for the reflective learning conversation and debriefing. Additionally, reflective practice can be encouraged and enhanced through; having reflective conversation and debriefing models and guidelines, and reflecting on both good and bad experiences.Conclusion:There is a positive correlation between the clinical reasoning and the structured reflections in the format of reflective learning conversation and debriefing. Reflective practice can be enhanced through attending the reflective learning conversation and debriefing activities. There are some limitations and challenges to the reflective learning conversation and debriefing method.

scholarly journals Online patient simulation training to improve clinical reasoning: A feasibility randomised controlled trial

2020 ◽  
Author(s):  
Ruth Plackett ◽  
Angelos P Kassianos ◽  
Maria Kambouri ◽  
Natasha Kay ◽  
Sophie Mylan ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Clinical Reasoning ◽  
Controlled Trial ◽  
Intervention Group ◽  
Diagnostic Errors ◽  
Control Group ◽  
Feasibility Randomised Controlled Trial ◽  
Reasoning Skills ◽  
Randomised Controlled ◽  
Clinical Reasoning Skills

Abstract Background: Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. However, little is known about how best to implement and evaluate OPS in medical curricula. The aim of this study was to assess the feasibility, acceptability and potential effects of eCREST — the electronic Clinical Reasoning Educational Simulation Tool.Methods: A feasibility randomised controlled trial was conducted with final year undergraduate students from three UK medical schools in academic year 2016/2017 (cohort one) and 2017/2018 (cohort two). Student volunteers were recruited in cohort one via email and on teaching days, and in cohort two eCREST was also integrated into a relevant module in the curriculum. The intervention group received three patient cases and the control group received teaching as usual; allocation ratio was 1:1. Researchers were blind to allocation. Clinical reasoning skills were measured using a survey after one week and a patient case after one month.Results: Across schools, 264 students participated (18.2% of all eligible). Cohort two had greater uptake (183/833, 22%) than cohort one (81/621, 13%). After one week, 99/137 (72%) of the intervention and 86/127 (68%) of the control group remained in the study. eCREST improved students’ ability to gather essential information from patients over controls (OR =1.4; 95% CI 1.1-1.7, n =148). Of the intervention group, most (84/98, 82%) agreed eCREST helped them to learn clinical reasoning skills.Conclusions: eCREST was highly acceptable and improved data gathering skills that could reduce diagnostic errors. Uptake was low but improved when integrated into course delivery. A summative trial is needed to estimate effectiveness.

Analisis Capaian Kompetensi Mahasiswa dalam Objective Structured Clinical Examination (OSCE) Semester Ganjil Tahun Ajaran 2017/2018 Fakultas Kedokteran Universitas HKBP Nommensen Medan

2020 ◽  
Vol 5 (2) ◽  
pp. 28-35
Author(s):  
Jenny Novina Sitepu
Keyword(s):  
Clinical Examination ◽  
Clinical Reasoning ◽  
Clinical Skills ◽  
Objective Structured Clinical Examination ◽  
Treatment Practice ◽  
Standard Patient ◽  
The Mean ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills ◽  
Academic Year

Backgroud: Clinical skills is one of competency as a doctor. Objective Structured Clinical Examination (OSCE) is an ideal way to assess clinical skills for undergraduated, graduated, and postdraduated clinical students. The low score in some OSCE station can be an input for teaching and curriculum improvement. This study aim to analyzed student competency achievement in first term in 2017/2018 academic year in  Fakultas Kedokteran Universitas HKBP Nommensen. Methods: This study was qualitative study with descriptive design. The sample was OSCE score in first term in 2017/2018 academic year. Student achievement was the mean score of every student in all station in OSCE. Competency achievement was the mean of students score for every competency in OSCE. Next, the stations was categorized in practice/ procedure skills station and clinical reasoning skills station. Skills achievement was got form the mean of score (in percent) of procedure skills and clinical reasoning station. Indept interview with students and lectures was held to knowed their perception about OSCE. Results: Students’ achievement in OSCE of first term academic year 2017/2018 was 62.4% for 2015’s students, and 64.6% for 2016’ students. The lowest competency achievement of 2015’s students was diagnosis and differential diagnosis. For the 2016’s students, it was farmacology treatment. Practice/ procedure skills achievement in OSCE of first term academic year 2017/2018 was 61.34% (2015’s students) and 74.4% (2016’s students). The clinical reasoning skills achievement was 62.80% (2015’s students), and 58.77% (2016’s students). Based on indept interview, the things that make student’s achievement low were the clinical reasoning ability of students was still low, the standard patient that involved in OSCE didn’t acted properly, the students’ knowledge about medicine and prescription was poor, and there were lot of learning schedules and learning subjects that students must did and learned. Conclusions:  Students’ achievement in OSCE of first term academic year 2017/2018 is need to  be improved.

Lessons in clinical reasoning ‒ pitfalls, myths and pearls: a case of recurrent pancreatitis

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Vita Jaspan ◽  
Verity Schaye ◽  
Andrew S. Parsons ◽  
David Kudlowitz
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Reasoning ◽  
Cognitive Biases ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
First Episode ◽  
Gut Flora ◽  
Case Presentation ◽  
Early Hypothesis ◽  
Elevated Transaminases

Abstract Objectives Cognitive biases can result in clinical reasoning failures that can lead to diagnostic errors. Autobrewery syndrome is a rare, but likely underdiagnosed, condition in which gut flora ferment glucose, producing ethanol. It most frequently presents with unexplained episodes of inebriation, though more case studies are necessary to better characterize the syndrome. Case presentation This is a case of a 41-year old male with a past medical history notable only for frequent sinus infections, who presented with recurrent episodes of acute pancreatitis. In the week prior to his first episode of pancreatitis, he consumed four beers, an increase from his baseline of 1–2 drinks per month. At home, he had several episodes of confusion, which he attributed to fatigue. He underwent laparoscopic cholecystectomy and testing for genetic and autoimmune causes of pancreatitis, which were non-revealing. He was hospitalized 10 more times during that 9-month period for acute pancreatitis with elevated transaminases. During these admissions, he had elevated triglycerides requiring an insulin drip and elevated alcohol level despite abstaining from alcohol for the prior eight months. His alcohol level increased after consumption of complex carbohydrates, confirming the diagnosis of autobrewery syndrome. Conclusions Through integrated commentary on the diagnostic reasoning process, this case underscores how overconfidence can lead to premature closure and anchoring resulting in diagnostic error. Using a metacognitive overview, case discussants describe the importance of structured reflection and a standardized approach to early hypothesis generation to navigate these cognitive biases.

The Use of a Modified Script Concordance Test in Clinical Rounds to Foster and Assess Clinical Reasoning Skills

2021 ◽  
Author(s):  
Jordan D. Tayce ◽  
Ashley B. Saunders
Keyword(s):  
Clinical Reasoning ◽  
Assessment For Learning ◽  
Learning Activity ◽  
Free Text ◽  
Valuable Insight ◽  
Script Concordance Test ◽  
Concordance Test ◽  
Script Concordance ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills

The development of clinical reasoning skills is a high priority during clinical service, but an unpredictable case load and limited time for formal instruction makes it challenging for faculty to foster and assess students’ individual clinical reasoning skills. We developed an assessment for learning activity that helps students build their clinical reasoning skills based on a modified version of the script concordance test (SCT). To modify the standard SCT, we simplified it by limiting students to a 3-point Likert scale instead of a 5-point scale and added a free-text box for students to provide justification for their answer. Students completed the modified SCT during clinical rounds to prompt a group discussion with the instructor. Student feedback was positive, and the instructor gained valuable insight into the students’ thought process. A modified SCT can be adopted as part of a multimodal approach to teaching on the clinic floor. The purpose of this article is to describe our modifications to the standard SCT and findings from implementation in a clinical rounds setting as a method of formative assessment for learning and developing clinical reasoning skills.

scholarly journals Critical Thinking and Debiasing: Experimentation in an Academic Writing Course

2020 ◽  
Vol 2019 (1) ◽  
pp. 443
Author(s):  
Guy Smith ◽  
John Peloghitis
Keyword(s):  
Decision Making ◽  
Critical Thinking ◽  
Academic Writing ◽  
Cognitive Biases ◽  
Judgment And Decision Making ◽  
Classroom Teaching ◽  
Negative Effects ◽  
Fields Of Study ◽  
Writing Course ◽  
And Training

In the last two decades, interest in cognitive biases has rapidly grown across various fields of study. The research so far has shown that cognitive biases have significant and sometimes adverse effects on decision making. Thus, it is increasingly being argued that classroom teaching of critical thinking needs to include instruction and training that help students understand cognitive biases and reduce their negative effects on judgment and decision making. Teaching students to be aware of biases and to develop and maintain strategies to reduce their influence is known as debiasing. The purpose of this paper is to provide an overview of cognitive biases and a framework for debiasing proposed by Wilson and Brekke (1994). Two approaches, modifying the person and modifying the environment, are discussed to help teachers introduce activities and strategies to mitigate biases. 認知バイアスへの関心は、この20年で様々な領域で急激に高まってきた。認知バイアスが、意思決定に対し有意な影響、時には逆効果を及ぼすことが、これまでの研究で明らかになった。そのため、教室で批判的思考を教える場合も、学生の認知バイアスへの理解に役立ち、認知バイアスが判断力や意思決定に対して及ぼす、時には有害な影響を弱める思考法を教える練習ないし訓練を組み込む必要があるのではないだろうか。学生がバイアスを認識し、その影響を払拭ないし弱める思考法を身につけてそれを維持するよう教えることは、デバイアスという名称で知られている。本稿では、認知バイアスとWilson and Brekke (1994) が提案するデバイアスのプロセスを概観する。教師がバイアスを和らげるための活動と戦略を紹介できるように、人間を修正し、環境を修正するという二つの取り組みについても検討する。

Sign in / Sign up

Export Citation Format

Share Document