Developing clinical decision making skills: A collaborative, evidence based project for integrating diagnostic imaging into the clinical work-up

Abstract

The need to transition students from an academic mindset towards an evidence based approach to the clinical work-up of their client/patient is an important component of the training of chiropractic students. Within the broad spectrum of diagnostic procedures students must become familiar with, imaging is an important tool in their decision making armament. With increasing awareness of the need to apply evidence based practice to this decision making process, the concept of "just do as you were taught" is slowly disappearing from the chiropractic practice ethos. Consequently, as teachers of clinical practice we must begin to place more onus on the students to find and use the best evidence before they "leave the educational nest". To move towards this outcome, we have implemented a unit in the first trimester of our Year 5 chiropractic course in which the students engage in their own, and each others, learning by becoming the principle teachers. Small groups of 4-5 students actively work-up all aspects of a clinical case from its initial presentation, learning how to grapple with clinical uncertainty and seek out the best evidence to support their next step in the diagnostic work-up. Students then present a full case to the class and ultimately develop the notes for the unit and their future clinical practice. This presentation will focus on the thought process underpinning the development of the unit, its basic design and operation, and the role of technology. A brief overview of the outcomes of a post unit survey will be offered. Overall, the students found the concepts and activities of the unit to be of great value in helping them understand how to find and apply new evidence to clinical practice. They felt that having the responsibility of developing the lectures and learning materials for the unit improved their learning experience