Clinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings

Abstract

Introduction: There is a need for educational resources supporting the practice and assessment of the complex processes of clinical reasoning in the inpatient setting along a continuum of physician experience levels. Methods: Using participatory design, we created a scenario-based simulation integrating diagnostic ambiguity, contextual factors, and rising patient acuity to increase complexity. Resources include an open-ended written exercise and think-aloud reflection protocol to elicit diagnostic and management reasoning and reflection on that reasoning. Descriptive statistics were used to analyze the initial implementation evaluation results. Results: Twenty physicians from multiple training stages and specialties (interns, residents, attendings, family physicians, internists, surgeons) underwent the simulated scenario. Participants engaged in clinical reasoning processes consistent with the design, considering a total of 19 differential diagnoses. Ten participants provided the correct leading diagnosis, tension pneumothorax, with an additional eight providing pneumothorax and all participants offering relevant supporting evidence. There was also good evidence of management reasoning, with all participants either performing an intervention or calling for assistance and reflecting on management plans in the think-aloud. The scenario was a reasonable approximation of clinical practice, with a mean authenticity rating of 4.15 out of 5. Finally, the scenario presented adequate challenge, with interns and residents rating it as only slightly more challenging (means of 7.83 and 7.17, respectively) than attendings (mean of 6.63 out of 10). Discussion: Despite the challenges of scenario complexity, evaluation results indicate that this resource supports the observation and analysis of diagnostic and management reasoning of diverse specialties from interns through attendings.

Standardized acute care doctors training on the emerging pandemic of coronavirus pneumonia

“…With the development of information and communication technology and distance medical education, in addition to traditional online teaching, it is possible to add standard online classrooms for critical care medicine and infectious disease prevention and control series. This is also in line with Nepal current requirements for vigorously developing distance education and improving the distance continuing medical education network 8,20 . Comprehensive use of modern education technology, virtual reality, audio-visual and other multimedia and computer network technologies to conduct online theoretical knowledge training for residents, and link it to training and assessment, and listen to the class and answer questions when the line is capped.…”

“…various reasons; the major of critical care medicine is not included in the training professional category. At the same time, the related research on intensive care medicine training and personnel training is relatively limited, and most of them are research on specific teaching methods 7,8,9 , Or thinking about the current teaching situation due to lack of a feasible solution to the problem. 10,11 The authors of this article are involved in patient care and management with critical team at B&C teaching hospital and research center participated in the treatment of severe patients with new coronary pneumonia since first wave of COVID.…”