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

Background: Teaching clinical reasoning and reflection skills in skills laboratory are usually neglected, therefore Skills Lab of FM UGM initiate to teach those skills for undergraduate students. This study aimed to evaluate student’s assignment of clinical reasoning and reflection skills and explore how to improve it.Method: An experimental study by giving student assignments to make an essay about particular disease based on SKDI level 4 that written on a medical record and reflection form format. All 4th-year medical students of FM GMU (n=186) and skills lab instructors (n=5) were involved. Assignments were assessed (by the instructors) using instrument by Driessen (2008), and analyzed by correlating those scores with students’ OSCE score and GPA using Pearson Correlation test. Qualitative data collected by deep interview with assessors and analyzed using Inductive Content Analysis by 2 coders.Results: There were no significant correlation between assignment score with OSCE score and GPA. However, there were significant correlations (p<0.05) between score of clinical reasoning with reflection skills, and OSCE score with GPA. Assessors conclude that assignment has been good enough to stimulate clinical reasoning and reflection skills, but still had weaknesses e.g. incompatibility of assignment’s format to assessment’s checklist, unclear instructions, and no assignment’s sample that made students submitted in various format.Conclusion: The assignment has been successfully conducted in Skills Lab FM UGM, however it needs some improvement, such as giving detail instructions, examples, and matching it with assessment instrument.

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

Canadian Medical Education Journal ◽

10.36834/cmej.36631 ◽

2015 ◽

Vol 6 (2) ◽

pp. e61-e70 ◽

Cited By ~ 20

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.

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Teaching Clinical Reasoning to Medical Students: A Case-Based Illness Script Worksheet Approach

MedEdPORTAL ◽

10.15766/mep_2374-8265.10445 ◽

2016 ◽

Vol 12 (1) ◽

Cited By ~ 5

Author(s):

Michael Levin ◽

David Cennimo ◽

Sophia Chen ◽

Sangeeta Lamba

Keyword(s):

Medical Students ◽

Clinical Reasoning ◽

Illness Script ◽

Case Based

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

BMC Medical Education ◽

10.1186/s12909-021-02522-0 ◽

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.

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Use of a flipped classroom in ophthalmology courses for nursing, dental and medical students: A quasi-experimental study using a mixed-methods approach

Nurse Education Today ◽

10.1016/j.nedt.2019.104262 ◽

2020 ◽

Vol 85 ◽

pp. 104262 ◽

Cited By ~ 2

Author(s):

Li Zhu ◽

Zhengmei Lian ◽

Maria Engström

Keyword(s):

Experimental Study ◽

Mixed Methods ◽

Medical Students ◽

Flipped Classroom ◽

Mixed Methods Approach ◽

Quasi Experimental

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199 Evaluation of students’ knowledge and confidence following a student-led diversity teaching intervention on UK medical students: a quasi-experimental study

10.1136/leader-2020-fmlm.199 ◽

2020 ◽

Author(s):

Alexander Mafi ◽

Sumaiyah Al-Aidarous ◽

Zara Markovic-Obiago

Keyword(s):

Experimental Study ◽

Medical Students ◽

Teaching Intervention ◽

Quasi Experimental

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Immunization competence retention in medical students: a comparation between conventional lectures and lectures with simulations method

Paediatrica Indonesiana ◽

10.14238/pi55.6.2015.339-44 ◽

2016 ◽

Vol 55 (6) ◽

pp. 339 ◽

Cited By ~ 1

Author(s):

Hartono Gunadi ◽

Rini Sekartini ◽

Retno Asti Werdhani ◽

Ardi Findyartini ◽

Muhammad Arvianda Kevin Kurnia

Keyword(s):

Experimental Study ◽

Medical Students ◽

Medical School ◽

Intervention Group ◽

Control Group ◽

Vaccine Preventable Diseases ◽

Before And After ◽

Quasi Experimental

Background Immunization is recognized as one of the strategiesto reduce vaccine preventable diseases. Competency related toimmunization are consequently important for medical students andthe medical school needs to assure the competence acquisition.Objective To assess competence related to immunization andits retention following lectures with simulations compared tolectures only.Methods A quasi-experimental study was conducted to the 5th yearstudents of University of Indonesia Medical School during the ChildAdolescent Health Module in 2012-2013. The intervention grouphad lectures with simulations and the control group had lecturesonly. Immunization knowledge was assessed with a 30 multiplechoice question (MCA) items performed before and after themodule. Competence retention was assessed by MCQ (knowledge)and OSCE (skills) 2-6 months afterwards.Results Sixty eight subjects for each group with similarcharacteristics were analyzed. There was significant differenceafter module MCQ score between two groups. Competenceretention in 2-6 months after module completion was betterin intervention group, both for the knowledge (median MCQscore of 70.00 (range 37-93) vs. mean score of 58.01 (SD 12.22),respectively; P<0.001) and skill (OSCE mean scores of 75.21 (SD10.74) vs. 62.62 (SD 11.89), respectively; P < 0.001). Proportionof subjects in the intervention group who passed both the MCQand OSCE were also significantly greater.Conclusion Lectures with simulations are proved to bemore effective in improving medical students’ immunizationcompetence as well as its retention compared to lectures onlyapproach.

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