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

Are Commonly Used Resident Measurements Associated with Procedural Skills in Internal Medicine Residency Training?

BACKGROUND: Acquisition of competence in performing a variety of procedures is essential during Internal Medicine (IM) residency training. PURPOSES: Determine the rate of procedural complications by IM residents; determine whether there was a correlation between having 1 or more complications and institutional procedural certification status or attending ratings of resident procedural skill competence on the American Board of Internal Medicine (ABIM) monthly evaluation form (ABIM-MEF). Assess if an association exists between procedural complications and in-training examination and ABIM board certification scores. METHODS: We retrospectively reviewed all procedure log sheets, procedural certification status, ABIM-MEF procedural skills ratings, in-training exam and certifying examination (ABIM-CE) scores from the period 1990–1999 for IM residency program graduates from a training program. RESULTS: Among 69 graduates, 2,212 monthly procedure log sheets and 2,475 ABIM-MEFs were reviewed. The overall complication rate was 2.3/1,000 procedures (95% CI: 1.4–3.1/1,000 procedure). With the exception of procedural certification status as judged by institutional faculty, there was no association between our resident measurements and procedural complications. CONCLUSIONS: Our findings support the need for a resident procedural competence certification system based on direct observation. Our data support the ABIM’s action to remove resident procedural competence from the monthly ABIM-MEF ratings

Even a little sleepiness influences neural activation and clinical reasoning in novices

Funding: This study was funded by a grant from the Scottish Medical EducationResearch Consortium (SMERC). SMERC had no involvement in thestudy design; collection, analysis, and interpretation of data; writing ofthe report; or the decision to submit the report for publication. Acknowledgements: We thank the students who took part in this project, and the Instituteof Education for Medical and Dental Sciences, University of Aber-deen, for supporting this project. We thank the American College ofPhysicians for the questions used in this study. We thank ProfessorCLELANDET AL.7of9&C?JRFѥ1AGCLACѥ0CNMPRQSusan Jamieson, University of Glasgow, for her support at the stageof seeking funding for this work.Peer reviewedPublisher PD

A portable mnemonic to facilitate checking for cognitive errors

Background Although a clinician may have the intention of carrying out strategies to reduce cognitive errors, this intention may not be realized especially under heavy workload situations or following a period of interruptions. Implementing strategies to reduce cognitive errors in clinical setting may be facilitated by a portable mnemonic in the form of a checklist. Methods A 2-stage approach using both qualitative and quantitative methods was used in the development and evaluation of a mnemonic checklist. In the development stage, a focus-driven literature search and a face-to-face discussion with a content expert in cognitive errors were carried out. Categories of cognitive errors addressed and represented in the checklist were identified. In the judgment stage, the face and content validity of the categories of cognitive errors represented in the checklist were determined. This was accomplished through coding responses of a panel of experts in cognitive errors. Results From the development stage, a preliminary version of the checklist in the form of four questions represented by four specific letters was developed. The letter ‘T’ in the TWED checklist stands for ‘Threat’ (i.e., ‘is there any life or limb threat that I need to rule out in this patient?’), ‘W’ for ‘Wrong/What else’ (i.e., ‘What if I am wrong? What else could it be?’), ‘E’ for ‘evidences’ (i.e., ‘Do I have sufficient evidences to support or exclude this diagnosis?’), and ‘D’ for ‘dispositional factors’ (i.e., ‘is there any dispositional factor that influence my decision’). In the judgment stage, the content validity of most categories of cognitive errors addressed in the checklist was rated highly in terms of their relevance and representativeness (with modified kappa values ranging from 0.65 to 1.0). Based on the coding of responses from seven experts, this checklist was shown to be sufficiently comprehensive to activate the implementation intention of checking cognitive errors. Conclusion The TWED checklist is a portable mnemonic checklist that can be used to activate implementation intentions for checking cognitive errors in clinical settings. While its mnemonic structure eases recall, its brevity makes it portable for quick application in every clinical case until it becomes habitual in daily clinical practice. Electronic supplementary materia

When will I get my paper back? A replication study of publication timelines for health professions education research.

INTRODUCTION: Biomedical researchers have lamented the lengthy timelines from manuscript submission to publication and highlighted potential detrimental effects on scientific progress and scientists\u27 careers. In 2015, Himmelstein identified the mean time from manuscript submission to acceptance in biomedicine as approximately 100 days. The length of publication timelines in health professions education (HPE) is currently unknown. METHODS: This study replicates Himmelstein\u27s work with a sample of 14 HPE journals published between 2008-2018. Using PubMed, 19,182 article citations were retrieved. Open metadata for each were downloaded, including the date the article was received by the journal, date the authors resubmitted revisions, date the journal accepted the article, and date of entry into PubMed. Journals without publication history metadata were excluded. RESULTS: Publication history data were available for 55% (n = 8) of the journals sampled. The publication histories of 4,735 (25%) articles were analyzed. Mean time from: (1) author submission to journal acceptance was 180.93 days (SD = 103.89), (2) author submission to posting on PubMed was 263.55 days (SD = 157.61), and (3) journal acceptance to posting on PubMed was 83.15 days (SD = 135.72). DISCUSSION: This study presents publication metadata for journals that openly provide it-a first step towards understanding publication timelines in HPE. Findings confirm the replicability of the original study, and the limited data suggest that, in comparison to biomedical scientists broadly, medical educators may experience longer wait times for article acceptance and publication. Reasons for these delays are currently unknown and deserve further study; such work would be facilitated by increased public access to journal metadata

Clinical reasoning: What do nurses, physicians, and students reason about.

Clinical reasoning is a core ability in the health professions, but the term is conceptualised in multiple ways within and across professions. For interprofessional teamwork it is indispensable to recognise the differences in understanding between professions. Therefore, our aim was to investigate how nurses, physicians, and medical and nursing students define clinical reasoning. We conducted 43 semi-structured interviews with an interprofessional group from six countries and qualitatively analysed their definitions of clinical reasoning based on a coding guide. Our results showed similarities across professions, such as the emphasis on clinical skills as part of clinical reasoning. But we also revealed differences, such as a more patient-centered view and a broader understanding of the clinical reasoning concept in nurses and nursing students. The explicit sharing and discussion of differences in the understanding of clinical reasoning across health professions can provide valuable insights into the perspectives of different team members on clinical practice and education. This understanding may lead to improved interprofessional collaboration, and our study's categories and themes can serve as a basis for such discussions

Exploring the institutional logics of health professions education scholarship units

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137533/1/medu13334.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137533/2/medu13334_am.pd