Wiki Page, OB/Gyn Residency - ACT: Module 3: Teaching Clinical Reasoning Skills

Wiki Page
2016-07-06T10:04:58-06:00

Learning Objectives:

Through course activities, readings, discussions, and assigned projects learners will be able to:

Identify the terms and constructs typically utilized in cognitive descriptions of the development of clinical reasoning

Discriminate between different cognitive stages in the development of clinical reasoning, from novice learners (i.e. medical students and interns) to expert clinicians (practicing physicians who’ve been exposed to numerous patients, conditions, diseases and syndromes.

Examine strategies that can be used to support the development of clinical reasoning at each stage.

Choose the best approach for teaching clinical reasoning by completing a series of multiple-choice questions with 100% accuracy.

This is Important Because…

Clinical reasoning is the decision making process that physicians go through to reach a diagnosis and treatment plan. Clinical reasoning is a critical component to delivering quality patient care, which requires physicians to integrate their clinical and biomedical knowledge with that of their patient. Clinical reasoning skills are difficult to describe since the process is complex and unique to each patient.

This module is based on various articles covering the topics of teaching clinical reasoning and critical thinking skills to learners. The module introduces clinical educators to the building blocks of clinical reasoning, as well as teaching tools (such as concept maps) that can facilitate passing on clinical reasoning skills to learners.

Some of the Benefits of Teaching Clinical Reasoning Skills Include:

Improving patient care and safety – Up until medical student's third year of training most of their learning is done outside of the clinical setting and/or has only been contextualized in a simulated clinical encounter. Novice clinicians, such as third year students, have not had enough experience to understand how to fully apply their biomedical and clinical knowledge, they rely on more advanced physicians to model clinical reasoning and to help them better understand how to "think" like a physician. Learning these skills will improve patient care and safety as they will be confident and competent in making decisions around patient diagnosis and treatment.

Increasing team oriented physicians – Clinical reasoning skills help physicians to make the best decisions by helping physicians to realize their own blind spots, biases, expertise and limitations. Having these self-reflective skills is a critical component of clinical reasoning and helps physicians identify the supportive resources they need to make a fully informed decision. Learners that incorporate these skills into their practice will be more open to the contributions of an interprofessional team, which has been proven to also improve patient care and safety.

How this Module Connects to the Other Modules:

Clinical reasoning is an advanced and very complex skill to pass on to learners, since it is training learners how to think. The module will build on the previous module by incorporating many of the teaching skills learned in previous modules, such as giving effective feedback (Module 2). In order to teach clinical reasoning, Clinical Educators will need to assess the level of their learner's clinical reasoning skills in order to identify gaps in the learner's thinking. Once Clinical Educators have identified gaps in the learner's thinking they will need to provide feedback and appropriate opportunities to advance the learner to more expert thinking.

Pathway to Clinical Reasoning Module

Direct any technical questions or concerns to the program manager, Monica.Bailey@ucf.edu.

Click the image below to enter the Pathway to Clinical Reasoning module. You will be brought to another page in the course.

Using Concept Maps for Teaching Clinical Reasoning

Concept maps provide one method for teaching clinical reasoning.

A concept map is a visual representation of your thinking. Concept maps are a powerful way to show novice learners how an expert thinks. Elements to include in a concept map are the relationship of relevant topics to the main one, short cuts in expert thinking, and highlight the main points.

Concept maps are commonly used in Evidence Based Medicine and Patient Safety to determine the various factors in a problem. Those concept maps are called fishbone maps. (See top picture below for an example) Other concept maps are less organized around a specific structure but take on their own form, like the Facebook concept map below that uses color to categorize the milestone of Facebook for each year. The key with concept maps is to use visual elements, such as space, color, and size to communicate the importance and relevance of different terms within the context of an overarching concept.

The effectiveness of concept maps in medical education has been well documented in recent articles, "Concept maps in medical education: an analytical literature review" and "Concept mapping: an effective, active teaching-learning method". Use the article "Twelve tips for teaching with concept maps in medical education" to learn more about using concept maps as a tool for teaching clinical reasoning.

Resources for Teaching Clinical Reasoning Skills

The module highlights different aspects of the following articles. Read the articles for further information on how to teach clinical reasoning skills.

Bordage G, Lemieux M. Semantic structures and diagnostic thinking of experts and novices. Academic medicine: Journal of the Association of American Medical Colleges. Sep 1991;66(9 Suppl):S70-72

Bowen JL. Educational strategies to promote clinical diagnostic reasoning. The New England journal of medicine. Nov 23 2006;355(21):2217-2225.

Charlin B, Boshuizen H, Custers E, Feltovich P. Scripts and clinical reasoning. Medical Education. December 2007;41(12):1178-1184.

Custers, E.J., Regehr, G & Norman, G. (1996). Mental representation of medical diagnostic knowledge: A review. Acad Med, 71:55-61

Durning SJ, Artino AR, Jr., Schuwirth L, van der Vleuten C. Clarifying assumptions to enhance our understanding and assessment of clinical reasoning. Academic medicine: Journal of the Association of American Medical Colleges. Apr 2013;88(4):442-448.

Harmon P, Evans K. When to Use Cognitive Modeling. Training & Development Journal [serial online]. March 1984;38(3):67. Available from: Business Source Premier, Ipswich, MA.

Kassirer JP. Teaching clinical reasoning: case-based and coached. Academic medicine: journal of the Association of American Medical Colleges. Jul 2010;85(7):1118-1124..

Schmidt, H. & Boshuizen, H. (1993). On the origin of intermediate effects in clinical case recall. Memory & Cognition. 21:338-351.

Schmidt HG, Boshuizen HPA, Hobus PPM. Transitory stages in the development of medical expertise: the ‘‘intermediate effect’’ in clinical case representation studies. In: Proceedings of the 10th Annual Conference of the Cognitive Science Society. Hillsdale, NJ: Erlbaum, 1988.

Schmidt H, Norman G. Transitory Stages In The Development Of Expertise In Medicine: Review Of The Evidence [e-book]. 1990. Available from: ERIC, Ipswich, MA.

Schmidt, H. Norman, G,. & Boshuizen, H. (1990). A cognitive perspective on medical expertise: Theory and implications. Acad Med, 65:611-621.

Schmidt H, Rikers R. How expertise develops in medicine: knowledge encapsulation and illness script formation. Medical Education. December 2007;41(12):1133-113).

*There are several resources and models that are used in clinical education. If you are familiar with resources that are not listed above please share them on the resources discussion board and I will add it for future residents.

Assignments

1. Readings:

Module 3 and associated articles

2. Practice and Application

Module must be completed by Wednesday July 20, 2016.

Complete module:

Self-assessment: Answer the questions about clinical reasoning to test your prior knowledge. Don't worry if you get the question wrong, you will be offered with increasingly more detailed hints as your progress. The questions in this module are designed so that residents don't invest their time relearning concepts they don't know, while spending additional time on topics residents know little about.

Complete Feedback form: Provide us with programmatic feedback to improve the module activities and scenarios.

The self-assessment is not graded however all the questions will need to be completed along with the feedback form in order to receive a certificate of completion.