Use of inductive, problem-based clinical reasoning enhances diagnostic accuracy in final year veterinary students

Despite tremendous progression in the medical field, levels of diagnostic error remain unacceptably high. Cognitive failures in clinical reasoning are believed to be the major contributor to diagnostic error. There is evidence in the literature that teaching problem-based, inductive reasoning has the potential to improve clinical reasoning skills. In this study, 47 final-year veterinary medicine students at the Royal Veterinary College (RVC) were presented with a complex small animal medicine case. The participants were divided into two groups, one of which received a prioritized problem list in addition to the history, physical exam, and diagnostic test results provided to both groups. The students’ written approaches to the case were then analyzed and assigned a diagnostic accuracy score (DAS) and an inductive reasoning score (IRS). The IRS was based on a series of predetermined characteristics consistent with the inductive reasoning framework taught at the RVC. No significant difference was found between the DAS scores of each group, indicating that the provision of a prioritized problem list did not impact diagnostic accuracy. However, a significant positive correlation between the IRS and DAS was illustrated for both groups of students, suggesting increased use of inductive reasoning is associated with increased diagnostic accuracy. These results contribute to a body of research proposing that inductive, problem-based reasoning teaching delivered in an additive model, can enhance the clinical reasoning skills of students and reduce diagnostic error

The ethical ambivalence of resistant violence: notes from postcolonial south Asia

In the face of mounting militarism in south Asia, this essay turns to anti-state, ‘liberatory’ movements in the region that employ violence to achieve their political aims. It explores some of the ethical quandaries that arise from the embrace of such violence, particularly for feminists for whom political violence and militarism is today a moot point. Feminist responses towards resistant political violence have, however, been less straightforward than towards the violence of the state, suggesting a more ambivalent ethical position towards the former than the latter. The nature of this ambivalence can be located in a postcolonial feminist ethics that is conceptually committed to the use of political violence in certain, albeit exceptional circumstances on the basis of the ethical ends that this violence (as opposed to other oppressive violence) serves. In opening up this ethical ambivalence – or the ethics of ambiguity, as Simone de Beauvoir says – to interrogation and reflection, I underscore the difficulties involved in ethically discriminating between forms of violence, especially when we consider the manner in which such distinctions rely on and reproduce gendered modes of power. This raises particular problems for current feminist appraisals of resistant political violence as an expression of women's empowerment and ‘agency’