Information and Communication Technologies (ICT) in Medical Education and Practice: The Major Challenges

This literature review addresses the main effects and challenges in using information and communication technologies (ICT) in medical education and practice. The first challenge is to better prepare future physicians for the changing behaviours of patients, who are increasingly Internet-savvy and who sometimes appear to know more about their diseases than their physicians. The second challenge, which is closely linked to the first, is to raise awareness among physicians in training of the many benefits of using ICT to improve not only the quality of interventions and health care delivery but, from a broader perspective, the organization of the health care system itself. The third challenge is to motivate medical students and practitioners to use ICT to find information, learn and develop. It is proposed that information literacy should be a mandatory skill for all medical students. The e-learning mode of training is also addressed. Although underemployed in most medical faculties, it represents the future of initial and continuous medical training. Virtual resources and communities, simulations and 3D animations are also discussed. The fourth and final challenge is to change medical teaching practices.Cette revue de la littérature présente les principaux impacts et défis engendrés par les technologies de l’information et de la communication (TIC) sur l’éducation médicale et la pratique de la médecine. Le premier défi est celui de mieux préparer les futurs médecins à l’évolution du comportement des patients qui sont de plus en plus branchés et qui, parfois, semblent mieux informés sur leur maladie que ne l’est le praticien. Le deuxième défi, intimement lié au premier, est celui de sensibiliser les futurs praticiens aux nombreux avantages que comportent les TIC pour la qualité des interventions et des soins fournis aux patients mais également, à un niveau plus large, pour l’organisation du système des soins de santé. Amener les futurs médecins à faire usage des TIC pour s’informer, apprendre et se perfectionner constitue le troisième défi présenté. La compétence informationnelle est notamment mise de l’avant comme une habileté devant impérativement faire partie de la formation de tout médecin. La question du e-learning est également abordée puisque ce mode d’enseignement, encore trop peu répandu dans bon nombre de facultés de médecine, constitue l’avenir de la formation médicale initiale ou continue. Les ressources et les communautés virtuelles, les simulateurs et l’animation 3D sont également évoqués. Changer les pratiques en pédagogie médicale constitue le quatrième et dernier défi relevé dans la littérature scientifique

The Reliability and Validity of a Paediatric Script Concordance Test with Medical Students, Paediatric Residents and Experienced Paediatricians

Background: The Script Concordance (SC) approach was used as an alternative test format to measure the presence of knowledge organization reflective in one’s clinical reasoning skills (i.e., diagnostic, investigation and treatment knowledge).Methods:  The present study investigated the reliability and validity of a 40-item paediatric version of the SC test with three groups representing 53 medical students (novices), 42 paediatric residents (intermediates) and 11 paediatricians (experts).Results:  A comparison between scoring techniques based on experts’ ratings of the items showed internal reliability coefficients from .74 for the one-best answer up to .78 for alternative scoring techniques.  An ANOVA showed an increase in test performance from medical students through to expert paediatricians (F(2,103) = 84.05, p < .001), but did not differentiate between the postgraduate year 1 to 3 paediatric residents.  A large effect size (Cohen’s d) difference of 1.06 was found between medical students and residents total SC test scores.Conclusions:  These results support other findings indicating the SC test format can be used to differentiate between the clinical reasoning skills of novices, intermediates and experts in paediatrics.  An alternative scoring method that includes one best answer and partial marks was also supported for grading SC test items

Twenty questions on script concordance tests

Le présent article se donne comme objectif de répondre, en 20 questionsréponses, aux principales préoccupations que les équipes d’enseignants potentiellement intéressées par le test de concordance de script (TCS) peuvent se poser. Les questions et objections souvent rapportées par les étudiants sont également prises en compte. Exégèse : Les principes qui sous-tendent le TCS sont rappelés. Ses atouts et ses limites sont évoqués. Les étapes de construction, de validation, de passation, de calcul de la note sont développées. Les auteurs illustrent le propos en s’appuyant sur une expérience concrète menée au Département de médecine générale de l’Université de Liège Most teacher concerns about Script Concordance Tests (SCT) are the object of some 20 questions and answers. The questions and objections most commonly reported by students are also taken into account. Analysis: The principles of SCT are described. Their strengths and limitations are discussed. The steps in designing, validating, testing and calculating scores are developed. The authors depict the concepts based an experiment led in the Department of Family Practice at the University of Liège

An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory

Context. Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward.Purpose. This paper aims at exploring a comprehensive approach: the “dual-process theory”, a model developed by cognitive psychologists over the last few years.Discussion. After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians’ intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed

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

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

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

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

The script concordance test in radiation oncology: validation study of a new tool to assess clinical reasoning

<p>Abstract</p> <p>Background</p> <p>The Script Concordance test (SCT) is a reliable and valid tool to evaluate clinical reasoning in complex situations where experts' opinions may be divided. Scores reflect the degree of concordance between the performance of examinees and that of a reference panel of experienced physicians. The purpose of this study is to demonstrate SCT's usefulness in radiation oncology.</p> <p>Methods</p> <p>A 90 items radiation oncology SCT was administered to 155 participants. Three levels of experience were tested: medical students (n = 70), radiation oncology residents (n = 38) and radiation oncologists (n = 47). Statistical tests were performed to assess reliability and to document validity.</p> <p>Results</p> <p>After item optimization, the test comprised 30 cases and 70 questions. Cronbach alpha was 0.90. Mean scores were 51.62 (± 8.19) for students, 71.20 (± 9.45) for residents and 76.67 (± 6.14) for radiation oncologists. The difference between the three groups was statistically significant when compared by the Kruskall-Wallis test (p < 0.001).</p> <p>Conclusion</p> <p>The SCT is reliable and useful to discriminate among participants according to their level of experience in radiation oncology. It appears as a useful tool to document the progression of reasoning during residency training.</p

What can designing learning-by-concordance clinical reasoning cases teach us about instruction in the health sciences?

Introduction: Learning-by-concordance (LbC) is an online learning strategy to practice reasoning skills in clinical situations. Writing LbC clinical cases, comprising an initial hypothesis and supplementary data, differs from typical instructional design. We sought to gain a deeper understanding from experienced LbC designers to better support clinician educators’ broader uptake of LbC. Methods: A dialogic action research approach was selected because it yields triangulated data from a heterogeneous group. We conducted three 90-minute dialogue-group sessions with eight clinical educators. Discussions focused on the challenges and pitfalls of each LbC design stage described in the literature. Recordings were transcribed and analyzed thematically. Results: We identified three themes by thematic analysis about the challenges inherent in designing LbC that are unique for this type of learning strategy: 1) the distinction between pedagogical intent and learning outcome; 2) the contextual cues used to challenge students and advance their learning and 3) the integration of experiential with formalized knowledge for cognitive apprenticeship. Discussion: A clinical situation can be experienced and conceptualized in many ways, and multiple responses are appropriate. LbC designers use contextual cues from their experience and combine them with formalized knowledge and protocols to write effective LbC clinical reasoning cases. LbC focuses learners’ attention on decision-making in grey areas that characterize the nature of professional clinical work. This in-depth study on LbC design, indicating the integration of experiential knowledge, might call for new thinking about instructional design

Multifaceted Assessment in a Family Medicine Clerkship: A Pilot Study

Background and Objectives: Programs of assessment should reflect the multifaceted nature of medical competence. We experimented with new testing methods, ie, script concordance testing (SCT) and clinical reasoning problems (CRPs), combined with the habitual OSCE for an end of family medicine clerkship. Our aims were to compare students’ scores with experts’ scores, to determine whether the new tests detected learning over a 3-month period, and to examine whether the tests were redundant. Methods: We conducted a longitudinal study on one cohort of family medicine clerks. Two formative testing sessions using both SCT and CRPs were held 3 months apart. Students’ scores were compared to those of the panel of experts used to score the tests. We examined the difference in students’ scores between the two testing sessions. Finally, we computed correlation coefficients between these scores and the summative OSCE. Results: Panelists’ scores were significantly higher than students’ scores. SCT scores did not change significantly over 3 months whereas CRP scores improved (Wilcoxon z -3.058, effect size 0.461, P=.002). Correlations between the OSCE and the written tests were low or non-significant. There were low correlations between the first CRP and both SCTs (Spearman’s rho 0.357 and 0.358) but not between the second CRP and any SCT. Conclusions: Written tests of clinical reasoning could provide relevant additional information to the evaluation of students’ competence over the course of a family medicine clerkship. Further research is needed to determine the potential educational consequences of such programs of assessment

Online clinical reasoning assessment with the Script Concordance test: a feasibility study

BACKGROUND: The script concordance (SC) test is an assessment tool that measures capacity to solve ill-defined problems, that is, reasoning in context of uncertainty. This tool has been used up to now mainly in medicine. The purpose of this pilot study is to assess the feasibility of the test delivered on the Web to French urologists. METHODS: The principle of SC test construction and the development of the Web site are described. A secure Web site was created with two sequential modules: (a) The first one for the reference panel (n = 26) with two sub-tasks: to validate the content of the test and to elaborate the scoring system; (b) The second for candidates with different levels of experience in Urology: Board certified urologists, residents, medical students (5 or 6(th )year). Minimum expected number of participants is 150 for urologists, 100 for residents and 50 for medical students. Each candidate is provided with an individual access code to this Web site. He/she may complete the Script Concordance test several times during his/her curriculum. RESULTS: The Web site has been operational since April 2004. The reference panel validated the test in June of the same year during the annual seminar of the French Society of Urology. The Web site is available for the candidates since September 2004. In six months, 80% of the target figure for the urologists, 68% of the target figure for the residents and 20% of the target figure for the student passed the test online. During these six months, no technical problem was encountered. CONCLUSION: The feasibility of the web-based SC test is successful as two-thirds of the expected number of participants was included within six months. Psychometric properties (validity, reliability) of the test will be evaluated on a large scale (N = 300). If positive, educational impact of this assessment tool will be useful to help urologists during their curriculum for the acquisition of clinical reasoning skills, which is crucial for professional competence