Clinical Reasoning Tasks and Resident Physicians: What Do They Reason About?

McBee, Elexis; Ratcliffe, Temple; Goldszmidt, Mark; Schuwirth, Lambertus; Picho, Katherine; Artino, Anthony R.; Masel, Jennifer; Durning, Steven J.

doi:10.1097/acm.0000000000001024

Cited by 34 publications

(35 citation statements)

References 10 publications

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“…Congruent assignment of internists’ characteristics increased significantly from S1 to S12 with the most congruent assignment of the characteristic “… are the keenest thinkers of all doctors” by 31.1% in S12. During their undergraduate studies, medical students become increasingly exposed to clinical reasoning processes and especially observe residents in their daily practice of how they reason and what they reason about [ 35 ]. This might also explain why “… ponder everything.” and “… are hesitant and have a ‘wait and see attitude’.” reached high assignment scores as well.…”

Section: Discussionmentioning

confidence: 99%

Just fun or a prejudice? – physician stereotypes in common jokes and their attribution to medical specialties by undergraduate medical students

Harendza

Pyra

2017

BMC Med Educ

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BackgroundMany jokes exist about stereotypical attributes of physicians in various specialties, which could lead to prejudices against physicians from a specific specialty. It is unknown whether and when medical students are aware of stereotypes about different specialties. The goal of this study was to analyze the degree of stereotypes that exist about medical specialties amongst undergraduate medical students at different stages of their education.MethodsOne hundred fifty-two jokes with different content about attributes of physicians from different specialties were found by an internet search. In total, 36 characteristics of the five specialties of anesthesia, general surgery, internal medicine, orthopedics, and psychiatry were extracted from the jokes and they constituted the basis for the development of an online questionnaire. The questionnaire allowed each characteristic to be assigned to one of the five specialties and was sent to 999 undergraduate medical students from semester 1, 7, and 12 at the Medical Faculty of Hamburg University.ResultsThree hundred eight (30.8%) of the invited students completed the survey. The characteristics of general surgeons and psychiatrists were assigned congruently most frequently (>50%). For internists and orthopedics, there was a significantly more congruent assignment of the characteristics by final year students versus students in their first semester. Male students assigned the characteristics of anesthetists and internists significantly more congruently than female students. The three characteristics “…are a bit slow on the uptake”, “…consider income to be relatively unimportant”, and “...apologize a lot” were not assigned to any of the five specialties by more than 50% of the students.ConclusionsWhile stereotypes about physicians from certain specialties seem to exist commonly, medical educators need to be aware that stereotypes about specialties might develop during undergraduate medical training. In order to support students in their professional identity formation without developing stereotypes, medical educators should receive training. Performing a similar study with physicians in postgraduate training would shed some light on stereotypes and prejudices that might develop at a later stage in medical education.

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Section: Discussionmentioning

confidence: 99%

Just fun or a prejudice? – physician stereotypes in common jokes and their attribution to medical specialties by undergraduate medical students

Harendza

Pyra

2017

BMC Med Educ

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“…The only study exploring their use in clinical practice involved a think-aloud protocol of three diagnostic, video-based scenarios (McBee et al 2015). And, while several new insights were gained about the tasks themselves and their relationships to each other, the study findings may not have been fully reflective of the use of reasoning tasks in real world settings.…”

Section: Introductionmentioning

confidence: 99%

What physicians reason about during admission case review

Juma

Goldszmidt

2016

Adv in Health Sci Educ

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Research suggests that physicians perform multiple reasoning tasks beyond diagnosis during patient review. However, these remain largely theoretical. The purpose of this study was to explore reasoning tasks in clinical practice during patient admission review. The authors used a constant comparative approach—an iterative and inductive process of coding and recoding—to analyze transcripts from 38 audio-recorded case reviews between junior trainees and their senior residents or attendings. Using a previous list of reasoning tasks, analysis focused on what tasks were performed, when they occurred, and how they related to the other tasks. All 24 tasks were observed in at least one review with a mean of 17.9 (Min = 15, Max = 22) distinct tasks per review. Two new tasks—assess illness severity and patient decision-making capacity—were identified, thus 26 tasks were examined. Three overarching tasks were identified—assess priorities, determine and refine the most likely diagnosis and establish and refine management plans—that occurred throughout all stages of the case review starting from patient identification and continuing through to assessment and plan. A fourth possible overarching task—reflection—was also identified but only observed in four instances across three cases. The other 22 tasks appeared to be context dependent serving to support, expand, and refine one or more overarching tasks. Tasks were non-sequential and the same supporting task could serve more than one overarching task. The authors conclude that these findings provide insight into the ‘what’ and ‘when’ of physician reasoning during case review that can be used to support professional development, clinical training and patient care. In particular, they draw attention to the iterative way in which each task is addressed during a case review and how this finding may challenge conventional ways of teaching and assessing clinical communication and reasoning. They also suggest that further research is needed to explore how physicians decide why a supporting task is required in a particular context.

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“…In recent studies, important tasks identified during clinical encounters have included framing the problem, diagnosis, management, and reflection. 5,6 However, physicians generally use intuitive reasoning and omit reflective reasoning in their routine mode of thought. 7 As the physician processes the initial history and exam, he or she begins to form a problem representation and an initial diagnosis and plan for further workup and treatment.…”

Section: Discussionmentioning

confidence: 99%