scholarly journals A Three-Question Framework to Facilitate Clinical Decision Making

2012 ◽  
Vol 7 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Jeremy Sibold
Keyword(s):  
Decision Making ◽  
Athletic Training ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Therapeutic Interventions ◽  
Target Tissue ◽  
Clinical Decisions ◽  
Athletic Training Students ◽  
Physically Active ◽  
Therapeutic Modalities

Context: Highly developed critical thinking and the ability to discriminate among many possible therapeutic interventions is a core behavior for the practicing athletic trainer. However, while athletic training students receive a great deal of clinically applicable information, many are not explicitly trained in efficient methods for channeling this great volume of data into sound clinical decisions. Objective: To propose a simple, three-question framework for prudent clinical decision making in therapeutic modalities and rehabilitation contexts. Background: Athletic training education occurs in various settings, where students are immersed in basic cognitive and psychomotor proficiencies germane to the prevention, evaluation, treatment, and rehabilitation of injury and illness in the physically active. In clinical practice, the knowledge and demonstration of these proficiencies are vital to the development of sound clinical decision making. Description: I propose a simple and repeatable three-question decision making scheme that includes questions related to clinical goal(s), target tissue(s), and modality choice(s), as a potential mechanism to improve athletic training students' decision making in the clinical arena. Clinical Advantage(s): This simple framework is adaptable to many clinical settings and can help cultivate decision making abilities and confidence, especially in the less experienced clinician. Conclusions: The ability to make sound clinical decisions is fundamental to athletic training. With simple cognitive frameworks, clinical educators can empower students to make sensible decisions in the clinical arena leading to improved student self-confidence and patient outcomes.

scholarly journals Promoting Interprofessional Communication through Situation, Background, Assessment, and Recommendation (SBAR): An Educational Technique

2021 ◽  
Vol 16 (4) ◽  
pp. 255-261
Author(s):  
Jennifer Cuchna ◽  
Sarah Manspeaker ◽  
Alison Wix
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Athletic Training ◽  
Clinical Decision Making ◽  
Athletic Trainers ◽  
Clinical Decision ◽  
Content Standards ◽  
Athletic Training Students ◽  
Interprofessional Communication ◽  
Curricular Content

Context The Board of Certification Standards of Professional Practice and the 2020 Curricular Content Standards indicate athletic trainers should establish working relationships with collaborating medical professionals and be able to communicate effectively. In addition, increased emphasis on interprofessional collaboration (IPC) in practice is apparent throughout health care professions and their educational programs. However, integrating both interprofessional communication and IPC within 1 learning opportunity can be difficult. Objective To share an educational approach aimed to enhance athletic training students' abilities and confidence in delivering patient information to physician assistant students via the situation, background, assessment, and recommendation (SBAR) technique. Background As part of the health care team, athletic trainers need to communicate with various providers while making clinically based decisions. Anecdotally, learners in their final year of health care education are not confident in their ability to make recommendations to other health care professionals. The SBAR communication strategy from the evidence-based framework TeamSTEPPS has become widely adopted in health care disciplines and may help to enhance confidence in communication. Description This learning activity enables athletic training students to use a patient case scenario to develop an SBAR for delivery via phone to a physician assistant studies student. This article describes the content, delivery methods, outcomes to date, and connection to the 2020 Curricular Content Standards. Clinical Advantage(s) This clinically relevant activity provides a low-stakes, real-life opportunity for students to practice communication skills, including the following: condensing the evaluation process, clinical decision-making skills, and the ability to make recommendations for a plan of care. Active participation in the communication process enhances reasoning skills needed for collaborative clinical decision making and the transfer of care, when applicable. Conclusion(s) Developing and implementing an interprofessional SBAR communication experience with 2 health care disciplines is an innovative strategy that bridges the gap between clinical education and actual patient care experiences while addressing curricular content needs.

Take a Page from Your Coach's Play Book: Teaching Technical and Tactical Skills in Athletic Training

2015 ◽  
Vol 10 (3) ◽  
pp. 244-248
Author(s):  
Jeremy R. Hawkins ◽  
Elizabeth B. Sharp ◽  
Skip M. Williams
Keyword(s):  
Decision Making ◽  
Athletic Training ◽  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Training Programs ◽  
Teaching Method ◽  
Technical Skills ◽  
Clinical Decision ◽  
Athletic Training Students ◽  
Good Decision

Context The ability to demonstrate sound clinical reasoning is needed for a practicing athletic trainer. However, instruction on how to make a correct clinical decision may be deficient in many athletic training programs. Objective To provide an overview of how to teach technical and tactical skills, using both a tradition and a nontraditional approach, and to apply this teaching method to athletic training education. Background The teaching of technical skills involves four steps: (1) introduction, (2) demonstration and explanation, (3) practice, and (4) error correction. The teaching of tactical skills takes technical skills a step further by putting them into action. To teach a tactical skill, coaches (1) identify the decision to be made, (2) determine knowledge needed to make a good decision, (3) identify cues that should or should not be attended to, and help to ensure the cues are interpreted correctly, (4) determine appropriate tactical options, and (5) design an opportunity to practice reading the situation and choosing appropriate tactics. Applying this approach to athletic training, students may be better prepared to make good decisions when placed in a situation to do so. Description This paper discusses how applying a methodology for teaching technical and tactical skills will help athletic training students to become better at clinical decision making. It also provides an application example that can be adapted to other situations aiding in the implementation of this approach. Clinical Advantage(s) This approach can be applied to numerous situations and scenarios, preparing athletic training students to be better clinicians through proper clinical reasoning and decision making. Conclusion(s) The ability to reason clinically is a foundational skill that needs to be taught in athletic training programs. Teaching technical and tactical skills is a viable method to help athletic training students develop this skill.

Clinical decision-making and its place in paramedic practice

2019 ◽  
Vol 11 (5) ◽  
pp. 1-5
Author(s):  
Samantha Murdoch
Keyword(s):  
Decision Making ◽  
Clinical Outcome ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Hospital Environment ◽  
Decision Making Process ◽  
Clinical Decisions ◽  
Correct Treatment ◽  
Health And Wellbeing

In the pre-hospital environment, paramedics are required to make clinical decisions, often rapidly to ensure correct treatment and care is provided. Decisions made by paramedics majorly impacts on the life, clinical outcome, safety, health and wellbeing of their patients. With the introduction of the Newly Qualified Paramedic Framework, it potentially has never been more pertinent to examine the decision-making process-an integral part of paramedicine. The implementation of the NQP framework has prompted an exploration into clinical decision making and its place in an ever-evolving profession. Through examination of theories and frameworks, this article aims to identify the underpinning evidence that enables a paramedic to reach a competent decision and the barriers experienced in the process.

scholarly journals Value-impregnated factual claims may undermine medical decision-making

2018 ◽  
Vol 13 (3) ◽  
pp. 151-158 ◽  
Author(s):  
Niels Lynøe ◽  
Gert Helgesson ◽  
Niklas Juth
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Clinical Decision Making ◽  
Negative Impact ◽  
Personal Values ◽  
Healthcare Providers ◽  
Clinical Decision ◽  
Medical Decision ◽  
Clinical Decisions ◽  
Soft Laws

Clinical decisions are expected to be based on factual evidence and official values derived from healthcare law and soft laws such as regulations and guidelines. But sometimes personal values instead influence clinical decisions. One way in which personal values may influence medical decision-making is by their affecting factual claims or assumptions made by healthcare providers. Such influence, which we call ‘value-impregnation,’ may be concealed to all concerned stakeholders. We suggest as a hypothesis that healthcare providers’ decision making is sometimes affected by value-impregnated factual claims or assumptions. If such claims influence e.g. doctor–patient encounters, this will likely have a negative impact on the provision of correct information to patients and on patients’ influence on decision making regarding their own care. In this paper, we explore the idea that value-impregnated factual claims influence healthcare decisions through a series of medical examples. We suggest that more research is needed to further examine whether healthcare staff’s personal values influence clinical decision-making.

Diagnostic conversations: Clinical Decision Making in surgery – Part 2

Diagnosis ◽  
2014 ◽  
Vol 1 (2) ◽  
pp. 189-193 ◽  
Author(s):  
David Allan Watters ◽  
Spencer Wynyard Beasley ◽  
Wendy Crebbin
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Learning Opportunities ◽  
Clinical Decisions ◽  
Decision Making Processes ◽  
Royal Australasian College ◽  
Insight Into ◽  
Made In

AbstractProceduralists who fail to review their decision making are unlikely to learn from their experiences, irrespective of whether the operative outcome is successful or not. Teaching junior surgeons to develop ‘insight’ into their own decision making has long been a challenge. Surgeons and staff of the Royal Australasian College of Surgeons worked together to develop a model to help explain the processes around clinical decision making and incorporated this model into a Clinical Decision Making (CDM) training course. In this course, faculty apply the model to specific surgical cases, within the model’s framework of how clinical decisions are made; thus providing an opportunity to identify specific decision making processes as they occur and to highlight some of the learning opportunities they provide. The conversation in this paper illustrates the kinds of case-based interactions which typically occur in the development and teaching of the CDM course.The focus in this, the second of two papers, is on reviewing post-operative clinical decisions made in relation to one case, to improve the quality of subsequent decision making.

scholarly journals Medical Simulation in Relapsed Follicular Lymphoma Improves Clinical Decision Making of Hematologists/Oncologists

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 33-34
Author(s):  
Lauren Willis ◽  
Donna Topping ◽  
Sarah Atwood ◽  
Jonathon B. Cohen
Keyword(s):  
Decision Making ◽  
Follicular Lymphoma ◽  
Treatment Option ◽  
Clinical Decision Making ◽  
Response Rates ◽  
Clinical Decision ◽  
Evidence Based ◽  
Cell Transplant ◽  
Clinical Decisions ◽  
Appropriate Treatment

Background: Frontline treatment of follicular lymphoma (FL) yields high response rates, but most patients relapse. In addition, response rates and duration of response have historically declined with subsequent treatments. These factors make management of this disease challenging. Therefore, this study was conducted to determine if an online, simulation-based continuing medical education (CME) intervention could improve clinical decision making of hematologists/oncologists (hem/oncs) regarding treatment selection for relapsed/refractory (R/R) FL. Description of Intervention: A CME certified virtual patient simulation (VPS) was made available via a website dedicated to continuous professional development. The VPS consisted of 2 cases of R/R FL presented in a platform that allows hem/oncs to assess the patients and make diagnostic and therapeutic decisions supported by an extensive database of diagnostic and treatment possibilities, matching the scope and depth of actual practice. Case 1: Patient with FL who failed 2 prior lines of therapy (R-CHOP, bendamustine/obinutuzumab), past medical history (PMH) well controlled hypertension and poorly controlled type 2 diabetes, presenting with constitutional symptoms and needs 3rd line treatment. Case 2: Patient with FL who failed 2 prior lines of therapy (bendamustine/rituximab, lenalidomide/rituximab), PMH well controlled atrial fibrillation and ulcerative colitis, patient requests intravenous therapy because he has trouble remembering to take oral medications. Methods: Clinical decisions were analyzed using a sophisticated decision engine, and tailored clinical guidance (CG) employing up-to-date evidence-base and faculty recommendations was provided after each decision. Decisions were collected post-CG and compared with each user's baseline (pre-CG) decisions using McNemar's test to determine p-values (P < .05 indicates significance). Data were collected between 11/20/19 and 2/19/20. Results: At the time of assessment, 154 hem/oncs who made clinical decisions were included in the analysis. From pre- to post-CG in the VPS, hem/oncs were more likely to make evidence-based practice decisions in: -Diagnosing patients with relapsed FL: 55% pre-CG and 73% post-CG (P < 0.001) -Starting an appropriate treatment for a patient with R/R FL ----Case 1: Ordering idelalisib: 7% pre-CG and 33% post-CG (P < 0.001) ----Case 1: Ordering lenalidomide + rituximab: 6% pre-CG and 28% post-CG (P < 0.001) ----Case 1: Ordering duvelisib: 2% pre-CG and 9% post-CG (P < 0.001) ----Case 2: Ordering copanlisib: 32% pre-CG and 73% post-CG (P < 0.001) The top rationales for selecting an appropriate treatment option were: recommended by guidelines, convenience of administration route, better efficacy compared to other agents, and best option based on patient comorbidities. Other relevant concomitant therapies ordered were consult for chimeric antigen receptor (CAR) T-cell therapy, consult for stem cell transplant, radiation therapy, refer to a clinical trial, and Pneumocystis jirovecii pneumonia (PJP) prophylaxis (Figure 1). Conclusion: This study demonstrates that VPS that immerses and engages hem/oncs in an authentic and practical learning experience improved evidence-based clinical decisions related to the management of R/R FL. This VPS increased the percentage of heme/oncs who correctly diagnosed R/R FL and selected an appropriate treatment option. This study indicates that unique educational methodologies and platforms, which are available on-demand, can be effective tools for promoting guideline-based therapy selection and clinical decision making. Acknowledgement: This CME activity was supported by an independent educational grant from Bayer, Celgene Corporation, and Verastem Oncology. Jake Cohen contributed to data analysis for this research. Reference: https://www.medscape.org/viewarticle/915986 Figure Disclosures Cohen: Janssen, Adicet, Astra Zeneca, Genentech, Aptitude Health, Cellectar, Kite/Gilead, Loxo: Consultancy; Genentech, BMS, Novartis, LAM, BioInvent, LRF, ASH, Astra Zeneca, Seattle Genetics: Research Funding.

scholarly journals Wearable technology to inform the prediction and diagnosis of cardiorespiratory events: a scoping review

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12598
Author(s):  
Hamzeh Khundaqji ◽  
Wayne Hing ◽  
James Furness ◽  
Mike Climstein
Keyword(s):  
Decision Making ◽  
Cardiac Arrhythmias ◽  
Observational Studies ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Case Control ◽  
Physiological Data ◽  
Clinical Decisions ◽  
Control Series ◽  
The Impact

Background The need for health systems that allow for continuous monitoring and early adverse event detection in individuals outside of the acute care setting has been highlighted by the global rise in chronic cardiorespiratory diseases and the recent COVID-19 pandemic. Currently, it is unclear what type of evidence exists concerning the use of physiological data collected from commercially available wrist and textile wearables to assist in clinical decision making. The aim of this review was therefore to systematically map and summarize the scientific literature surrounding the use of these wearables in clinical decision making as well as identify knowledge gaps to inform further research. Methodology Six electronic bibliographic databases were systematically searched (Ovid MEDLINE, EMBASE, CINAHL, PubMed, Scopus, and SportsDiscus). Publications from database inception to May 6, 2020 were reviewed for inclusion. Non-indexed literature relevant to this review was also searched systematically. Results were then collated, summarized and reported. Results A total of 107 citations were retrieved and assessed for eligibility with 31 citations included in the final analysis. A review of the 31 papers revealed three major study designs which included (1) observational studies (n = 19), (2) case control series and reports (n = 8), and (3) reviews (n = 2). All papers examined the use of wearable monitoring devices for clinical decisions in the cardiovascular domain, with cardiac arrhythmias being the most studied. When compared to electrocardiogram (ECG) the performance of the wearables in facilitating clinical decisions varied depending upon the type of wearable, user’s activity levels and setting in which they were employed. Observational studies collecting data in the inpatient and outpatient settings were equally represented. Eight case control series and reports were identified which reported on the use of wrist wearables in patients presenting to an emergency department or clinic to aid in the clinical diagnosis of a cardiovascular event. Two narrative reviews were identified which examined the impact of wearable devices in monitoring cardiovascular disease as well as potential challenges they may pose in the future. Conclusions To date, studies employing wearables to facilitate clinical decisions have largely focused upon the cardiovascular domain. Despite the ability of some wearables to collect physiological data accurately, there remains a need for a specialist physician to retrospectively review the raw data to make a definitive diagnosis. Analysis of the results has also highlighted gaps in the literature such as the absence of studies employing wearables to facilitate clinical decisions in the respiratory domain. The disproportionate study of wearables in atrial fibrillation detection in comparison to other cardiac arrhythmias and conditions, as well as the lack of diversity in the sample populations used prevents the generalizability of results.

Sign in / Sign up

Export Citation Format

Share Document