Investigating Student Satisfaction and Perception in Clinical Reasoning Skills With Simulated Case-Based Learning as a Level I Fieldwork Experience

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Simulation as a Level I fieldwork (FW) has not been widely studied in OT. This presentation will portray student satisfaction outcomes from a 1-week Level I FW using the Simucase™ platform. This descriptive study investigated students' satisfaction with simulated case-based learning and their perception of clinical reasoning skill development compared with paper case scenarios. Students showed a statistically significant change in debrief and reflection, clinical reasoning, and clinical learning (p < .05). Primary Author and Speaker: Amy Mattila Additional Authors and Speakers: Elizabeth Dwyer DeIuliis Contributing Authors: Retta Martin, Emily Casile

“The Heart is a House”: A Heuristic for Generating Cardiac Differential Diagnoses

BACKGROUND Differential diagnosis (DDx) is a core clinical reasoning skill that all medical students and physicians must acquire and develop. Metamemory techniques (MMTs), including mnemonic devices and other heuristics, are frequently taught to students as a means of enhancing DDx generation. The Heart is A House (HIAH) , an MMT that works by prompting students to think about cardiac disease in terms of four structural subsystems, can be used to facilitate the generation of cardiac differentials, but its efficacy has not been studied. METHODS In a 3-hour DDx workshop, second-year medical students were given a brief case vignette of a patient with chest pain and dyspnea and asked to generate initial differential diagnoses before and after learning HIAH. Descriptive statistics and paired T-tests were used to compare the sizes of cardiac-only and total differentials pre-/post-HIAH. Cardiac diagnoses were classified according to the structural categories described by HIAH, and Simpson's Diversity Index (SDI) was used to evaluate the effect of HIAH on the variety of cardiac diagnoses produced. RESULTS All students in the course ( N = 111) submitted pre-post differential lists. The mean number of diagnoses included in their differentials did not change significantly after exposure to HIAH (7.98 vs. 8.71, P = .09). However, the number of potentially correct cardiac diagnoses increased from 1.79 to 4.75 ( P < .0001), and the variety of structure/function cardiac categories considered by students increased more than twofold (from an SDI of 0.16 to 0.4, P < .0001). These increases were accompanied by a small increase in incorrect diagnoses ( + 2.47%, P = .0003) and a larger decrease in potentially correct noncardiac diagnoses (−41.88%, P < .0001). CONCLUSION The use of HIAH was associated with an increase in the size and variety of cardiac differentials. This increase may have come at the cost of a reduced noncardiac differential. Educators may find HIAH useful for guiding students as they reason through cases involving potential cardiac etiologies. As with all heuristics, care must be exercised to avoid introducing unwanted bias.

Clinical reasoning in veterinary practice

Clinical reasoning is the process by which veterinary surgeons integrate a multitude of clinical and contextual factors to make decisions about the diagnoses, treatment options and prognoses of their patients. The brain utilises two methods to achieve this: type one and type two reasoning. Type one relies on shortcuts such as pattern-recognition and heuristics to deduce answers without involving working memory. Type two uses working memory to deliberately compute logical analyses. Both reasoning methods have sources of errors, and research has shown that diagnostic accuracy is increased when they are used together when problem-solving. Despite this, it appears unlikely that clinical reasoning ‘skill’ can be improved; instead, the most effective way to improve reasoning performance experimentally appears to be by increasing and rearranging knowledge. As yet, there is no evidence that overall clinical reasoning error can be reduced in practice.

KEMAMPUAN CLINICAL REASONING PADA UJIAN OSCE MAHASISWA KEDOKTERAN TAHUN KETIGA

ABSTRACT Background : Clinical reasoning is one of the clinical skill competencies that must be owned by a doctor so it needs to be studied and tested. The OSCE is one method of assessment that can be used to assess the achievement of clinical reasoning. OSCE in the third year at Faculty of Medicine Islamic University of Indonesia (FM IUI) has been using clinical case OSCE so that can be used to assess clinical reasoning skill in addition to others clinical skills such as physical examination and clinical procedural skills. This study aimed to evaluate the clinical reasoning skills of students in the third year of the OSCE exam at FM IUI. Methods : The cross sectional study method was used in this study. OSCE test result semesters 5 and 6 of the academic year 2015/2016 collected. Clinical reasoning skills of students in OSCE obtained from the score of the diagnosis ability in clinical case OSCE station. The difference between clinical reasoning skill on each OSCE station and its correlation with the written test on the corresponding block were analyzed. Results: There is differences between clinical reasoning skill in OSCE stations semester 5 and 6. There was no relationship between the score clinical reasoning skills at the OSCE with written test achievement on the corresponding block. Conclusion: The clinical reasoning skills on the OSCE semesters 5 and 6 do not illustrate the clinical reasoning skills of third-year medical students in this study. This study supports the need for further development of the assessment of clinical reasoning skills on the OSCE for medical students. Keywords : clinical reasoning, OSCE, medical student ABSTRAK Latar Belakang: Penalaran klinis atau clinical reasoning merupakan salah satu kompetensi keterampilan klinis yang harus dimiliki oleh seorang dokter sehingga perlu dipelajari dan diujikan. OSCE merupakan salah satu metode assessment yang dapat digunakan untuk menilai pencapaian clinical reasoning. OSCE pada tahun ketiga di FK UII telah menggunakan kasus klinis untuk dapat juga menilai clinical reasoning disamping keterampilan klinis yang lain seperti pemeriksaan fisik dan tindakan prosedural. Penelitian ini bertujuan mengevaluasi kemampuan clinical reasoning mahasiswa kedokteran pada ujian OSCE tahun ketiga di FK UII. Metode : Metode yang digunakan adalah cross sectional dari hasil ujian OSCE semester 5 dan 6 tahun akademik 2015/2016. Kemampuan clinical reasoning mahasiswa pada ujian OSCE didapatkan dari nilai kemampuan menegakkan diagnosis pada stasion OSCE yang berupa manajemen kasus klinis. Nilai OSCE direkap pada semua mahasiswa yang mengikuti ujian pada periode tersebut. Analisis dilakukan dengan melihat perbedaan kemampuan clinical reasoning antar station OSCE dan menilai korelasinya dengan ujian tulis pada blok yang bersesuain . Hasil: Terdapat perbedaan kemampuan clinical reasoning antar stasion OSCE baik di semester ke 5 maupun ke 6. Tidak terdapat hubungan antara nilai kemampuan diagnosis pada ujian OSCE dengan pencapaian nilai ujian tulis blok yang berkaitan dengan konten OSCE yang diujikan. Kesimpulan: Kemampuan diagnosis pada ujian OSCE semester 5 dan 6 tidak menggambarkan kemampuan clinical reasoning mahasiswa tahun ketiga pada penelitian ini. Diperlukan evaluasi dan pengembangan lebih lanjut mengenai penilaian dan pencapaian kemampuan clinical reasoning pada ujian OSCE bagi mahasiswa kedokteran. Kata kunci : clinical reasoning, OSCE, mahasiswa kedokteran