Principles and Practice of Case-based Clinical Reasoning Education: A Method for Preclinical Students

This volume describes and explains the educational method of Case-Based Clinical Reasoning (CBCR) used successfully in medical schools to prepare students to think like doctors before they enter the clinical arena and become engaged in patient care. Although this approach poses the paradoxical problem of a lack of clinical experience that is so essential for building proficiency in clinical reasoning, CBCR is built on the premise that solving clinical problems involves the ability to reason about disease processes. This requires knowledge of anatomy and the working and pathology of organ systems, as well as the ability to regard patient problems as patterns and compare them with instances of illness scripts of patients the clinician has seen in the past and stored in memory. CBCR stimulates the development of early, rudimentary illness scripts through elaboration and systematic discussion of the courses of action from the initial presentation of the patient to the final steps of clinical management. The book combines general backgrounds of clinical reasoning education and assessment with a detailed elaboration of the CBCR method for application in any medical curriculum, either as a mandatory or as an elective course. It consists of three parts: a general introduction to clinical reasoning education, application of the CBCR method, and cases that can used by educators to try out this method

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 influence of medical expertise, case typicality and illness script component on case processing and disease probability estimates

The present study investigated the influence of medical expertise, case typicality, and illness script component (enabling conditions vs. consequences) on the speed of case informati

A Recognition Study Testing the Psychological Validity and Development of Illness Scripts

Purpose: This study investigates whether the recognition memory phenomena previously found for script-based stories also apply to illness scripts, the hypothesized mental structures expert physicians apply in medical diagnosis. In addition, the development of these scripts is investigated. Method: Second and sixth year students and experienced family physicians participated; the influence of typicality of information (prototypical versus atypical statements), textual presence (verbatim or implicit), and delay (15 min or 1 week) on recognition memory discrimination was investigated in a 3×2×2 ANOVA design and on recognition reaction times (RTs) in a 3×2×2×2 ANOVA design. Results: The expected developmental differences could not be replicated; all participants appear to dispose of illness script structures, which explains poorer memory discrimination for prototypical than atypical information. The results also show that at a longer delay, medical students and physicians are more inclined to infer unstated, but script-typical information. With regard to the RTs, the interaction between typicality and textual presence on RTs could be replicated: RTs for prototypical unstated items were longer than for any of the other types of information. Apart from this, RTs for different statements did not show a consistent pattern. Discussion: The superior memory discrimination for script atypical, compared with script prototypical, information, and at immediate retention, compared to delayed retention supports theoretical notions as well as previous research on illness scripts as general event representations with actual case information “tagged” to these stored representations. This tagged information decays over time. In terms of script development, all participants appear to have their knowledge structured in illness scripts, even students who have little experience with the diseases included in the study. Keywords: Medical expertise, Illness scripts, Diagnosis, Recognition memory, Memory discriminatio

Thirty years of illness scripts : Theoretical origins and practical applications

Aim: This study describes the introduction and spread of the concept of "illness script" in the medical education literature. Method: First, I will concisely discuss the development of the "script" concept in the general psychological literature and the results of the studies performed to provide it with the necessary empirical basis. Next, I will sketch how "scripts" entered the medical domain via efforts to develop diagnostic systems in the field of artificial intelligence. Subsequently, I will describe how the illness script concept was elaborated and specified by medical educators and educational researchers. Results and discussion: The illness script concept has solid underpinnings and can be used to elucidate aspects of medical expertise development. It can also be used to formulate recommendations for clinical teaching and has yielded a specific test, the Script Concordance Test

Thirty years of illness scripts : Theoretical origins and practical applications

Aim: This study describes the introduction and spread of the concept of "illness script" in the medical education literature. Method: First, I will concisely discuss the development of the "script" concept in the general psychological literature and the results of the studies performed to provide it with the necessary empirical basis. Next, I will sketch how "scripts" entered the medical domain via efforts to develop diagnostic systems in the field of artificial intelligence. Subsequently, I will describe how the illness script concept was elaborated and specified by medical educators and educational researchers. Results and discussion: The illness script concept has solid underpinnings and can be used to elucidate aspects of medical expertise development. It can also be used to formulate recommendations for clinical teaching and has yielded a specific test, the Script Concordance Test

The influence of a digital clinical reasoning test on medical student learning behavior during clinical clerkships

Recently, a new digital clinical reasoning test (DCRT) was developed to evaluate students’ clinical-reasoning skills. Although an assessment tool may be soundly constructed, it may still prove inadequate in practice by failing to function as intended. Therefore, more insight is needed into the effects of the DCRT in practice. Individual semi-structured interviews and template analysis were used to collect and process qualitative data. The template, based on the interview guide, contained six themes: (1) DCRT itself, (2) test debriefing, (3) reflection, (4) practice/workplace, (5) DCRT versus practice and (6) ‘other’. Thirteen students were interviewed. The DCRT encourages students to engage more in formal education, self-study and workplace learning during their clerkships, particularly for those who received insufficient results. Although the faculty emphasizes the different purposes of the DCRT (assessment of/as/for learning), most students perceive the DCRT as an assessment of learning. This affects their motivation and the role they assign to it in their learning process. Although students appreciate the debriefing and reflection report for improvement, they struggle to fill the identified knowledge gaps due to the timing of receiving their results. Some students are supported by the DCRT in exhibiting lifelong learning behavior. This study has identified several ways in which the DCRT influences students’ learning practices in a way that can benefit their clinical-reasoning skills. Additionally, it stresses the importance of ensuring the alignment of theoretical principles with real-world practice, both in the development and utilization of assessment tools and their content. Further research is needed to investigate the long-term impact of the DCRT on young physicians’ working practice.</p