Clinical diagnostic decision-making in real life contexts: A trans-theoretical approach for teaching: AMEE Guide No. 95

Abstract

Making an accurate clinical diagnosis is an essential skill for all medical students and doctors, with important implications for patient safety. Current approaches to teaching how to make a clinical diagnosis tend to lack the complexity that faces clinicians in real -life contexts. In this Guide, we propose a new trans-theoretical model for teaching how to make an appropriate clinical diagnosis that can be used by teachers as an additional technique to their current approach. This educational model integrates situativity theory, dual-information processing theory and socio-cognitive theory. Mapping and microanalysis help the teacher to identify the main processes involved in making an accurate clinical diagnosis so that feedback can be provided that is focused on improving key aspects of the skill. An essential aspect of using the new educational model is the role of the experienced clinical teacher in making judgments about the appropriateness of the learner's attempts to make clinical diagnosis. Practice Points Making an accurate clinical diagnosis is an essential skill for all medical students and doctors, with important implications for patient safety.  Current approaches to teaching how to make a clinical diagnosis tend to lack the complexity that faces clinicians in real-life contexts. A new trans-theoretical model for teaching how to make an appropriate clinical diagnosis integrates situativity theory, dual-information processing theory and socio-cognitive theory.

Context matters when striving to promote active and lifelong learning in medical education

“…Additionally, LICs are suitable to provide scaffolded support because faculty members can get to know individual students and better understand individual students' needs. Mentoring, mapping and using microanalysis protocols to gain an insight into learners’ current engagement in SRL may provide insight into the needs of learners, which may prove to be especially important for learners who are struggling . Using this knowledge to engage in a form of co‐regulated learning from the onset of clinical learning, with generally decreasing support over time (both within a single clerkship and throughout the curriculum), seems promising …”

Self-regulated learning: the challenge of learning in clinical settings

“…4 The key features of all self-regulated learning models are the cyclical processes by which the learner can exert some meta-cognitive control over the way he thinks, feels and acts insights from situativity theory, dual-information processing theory and social-cognitive theories. 5 This model highlights the importance of learning in the complexity of authentic clinical settings in order to develop the capacity to self-regulate the knowledge required to perform the diagnostic task, the appropriate use of intuitive and analytical decision making, and the essential control of the self-efficacy beliefs and emotions created by the complex environment.…”

“…Most research on the development of the learner's capacity to self‐regulate has not been conducted in complex situations; however, we consider that it is essential for medical students to be taught in authentic clinical settings with all the attendant demands on their capacity to self‐regulate. We have recently proposed a practical trans‐theoretical educational model for teaching clinical diagnostic decision making that integrates key insights from situativity theory, dual‐information processing theory and social‐cognitive theories . This model highlights the importance of learning in the complexity of authentic clinical settings in order to develop the capacity to self‐regulate the knowledge required to perform the diagnostic task, the appropriate use of intuitive and analytical decision making, and the essential control of the self‐efficacy beliefs and emotions created by the complex environment.…”

A preliminary investigation to explore the cognitive resources of physicians experiencing difficulty in training

“…poor clinical judgement, insufficient medical knowledge, and inefficient use of time), leading to significant gaps in basic clinical knowledge, diagnoses and management of patients. There have been several different explanatory frameworks put forward to explain difficulties faced by both physicians [2, 14, 15] and medical students [16–19], and these have included not only cognitive resources, but also factors such as personal circumstance, learning style, personality and experience. Existing research suggests that differences in cognitive resources may provide an explanation for some of the difficulties faced by physicians.…”