Diagnosis and management of clinical reasoning difficulties: Part II. Clinical reasoning difficulties: Management and remediation strategies

Audétat, Marie-Claude; Laurin, Suzanne; Dory, Valérie; Charlin, Bernard; Nendaz, Mathieu

doi:10.1080/0142159x.2017.1331034

Cited by 37 publications

(26 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…'more of the same' , but rather customised remediation and Research faculty support, as discussed in the literature. [22,23] Second, we showed that the simple checklist used in this study helped clinician-educators/examiners without pedagogic expertise to diagnose and record CCDEs contributing to poor performance in high-stakes examinations. Furthermore, clinicianeducators/examiners were of the opinion that this tool might help them to provide comprehensive, standardised feedback to unsuccessful examination candidates and trainees making diagnostic errors at the bedside during ward rounds and teaching.…”

Section: Resultsmentioning

confidence: 83%

“…[20,21] Tools to assist clinician-educators to characterise CCDEs residents make in practice are limited. Audétat et al [21][22][23] published a taxonomy of 6 common cognitive contributions to diagnostic errors, and a guide to diagnose and manage these problems in clinical training settings. One of the ongoing challenges, however, especially for clinician-educators with limited pedagogic expertise, is a reluctance to provide feedback when there is a lack of documentation of errors and limited knowledge of what to specifically document (the educational diagnosis).…”

Section: Researchmentioning

confidence: 99%

See 1 more Smart Citation

Checklist of cognitive contributions to diagnostic errors: A tool for clinician-educators

Naudé

Burch

2018

AJHPE

View full text Add to dashboard Cite

Up to 5-15% of clinical encounters lead to diagnostic errors, i.e. delayed, incorrect or missed diagnoses. [1] The mortality, morbidity and cost of these errors are considerable; [2-5] despite 40 years of technological advances they remain largely unchanged. [6] Strategies to address this major cause of patient harm must identify healthcare professionals at increased risk of making errors, characterise the errors they make and provide targeted, evidencebased intervention. [1] Taxonomies of the 'root' causes of diagnostic errors have been developed with a view to error reduction and remediation. [1,7,8] Graber et al. [1] identified three types of diagnostic errors (no-fault, system and cognitive) and reported that cognitive and system factors contributed to diagnostic errors. They clustered the root cognitive contributions to diagnostic errors (CCDEs) in four categories: faulty knowledge, data-gathering errors, data synthesis difficulties and failed verification of the data used to make the diagnosis. Schiff et al. [7] categorised errors according to the phase of the patient consultation process: access/presentation to healthcare, patient-practitioner encounter (history and physical examination), ordering and interpreting tests, making a diagnosis (assessment) and further consultation or referral and follow-up. Retrospective studies using this taxonomy have found that practitioner-patient encounters (history and physical examination), ordering and interpreting of tests and making a diagnosis (assessment) contributed most to errors. [3,8-10] Most of these studies were conducted in mixed populations of healthcare professionals [1,3,9,10] and did not focus on residents who are known to be at increased risk of making medical errors. [11] Two studies of residents showed that both cognitive and system factors contributed to diagnostic errors. [12,13] These studies of malpractice claims or self-reported data are, however, >10 years old and did not focus on characterising CCDEs. Furthermore, their retrospective design limits the accuracy of the data owing to hindsight and outcomes biases, incomplete patient records, variable reviewer reliability and uncertainty about the final diagnoses made. [4,7,14] Prospective studies characterising CCDEs that residents make in patient consultations are needed to better align current training needs and remediation efforts. A central part of the diagnostic process is data gathering, i.e. taking a history and performing a physical examination of the patient. While a thoroughly conducted history and physical examination can lead to an assessment in at least 60% of cases, [6,15,16] errors related to these contribute to diagnostic errors in up to 61% of cases. [1,3,8-10] As summarised by Feddock, [17] the variable clinical competence of trainees [18,19] may be ascribed to many factors, including progressive decline in bedside teaching, limited direct observation during real patient encounters, and limited feedback regarding clinical skills and performance in the workplace. Knowledge of clin...

show abstract

Section: Resultsmentioning

confidence: 83%

Section: Researchmentioning

confidence: 99%

Checklist of cognitive contributions to diagnostic errors: A tool for clinician-educators

Naudé

Burch

2018

AJHPE

View full text Add to dashboard Cite

show abstract

“…Se sugiere que a partir de la didáctica en educación médica se unifiquen criterios para la enseñanza del razonamiento clínico 19 , incluyendo instancias formativas que permitan retroalimentar a los estudiantes durante su proceso de aprendizaje, y no solo como una evaluación terminal 20,21 . Esto requiere además, la formación de los docentes para la enseñanza e identificación precoz de los avances y problemas en la práctica del razonamiento clínico de los estudiantes de pregrado 22,23 .…”

Section: Discussionunclassified

Diseño e implementación de OSCE para evaluar competencias de egreso en estudiantes de medicina en un consorcio de universidades chilenas

et al. 2018

View full text Add to dashboard Cite

A standardized objective structured clinical examination to assess clinical competencies in medical students Background: Outcomes-based education is a trend in medical education and its assessment is one of the main challenges. The Objective Structured Clinical Examination (OSCE) is one of the tools used to assess clinical competencies. Although Chilean medical schools have used OSCEs for 18 years, there is a vast variability in the way these examinations are administered. Aim: To design and implement an integrated OSCE to assess clinical competencies at the end of the medical program in Chilean medical schools, aiming to reduce variability between these schools. Material and Methods: Seven medical schools, supported by experts from the National Board of Medical Examiners, designed a 12 station OSCE to measure clinical outcomes at the end of the seventh year of medical training. Unlike traditional OSCEs, this new examination incorporated the assessment of clinical reasoning and communication skills, evaluated from patients' perspective. Results: One hundred twenty-five volunteers took the same exam at five different venues. The internal consistency was 0.62. Following a compensatory approach, 85% of students passed the exam. Communication assessment showed poorer results than those reported in the literature. Conclusions: Among Chilean medical students, the assessment of clinical outcomes in a collaborative way, through a valid and reliable exam, is feasible. A consensus on how to teach and assess clinical reasoning across the medical curriculum is required. The assessment of students' communication skills requires further development.

show abstract

“…En un intento por combatir este problema de salud pública, diversas instituciones internacionales han desarrollado guías para la orientación del equipo de salud desde la sospecha hasta el manejo específi- miento dual es el que está guiando las decisiones en los diferentes momentos de la simulación. 10 Además es posible analizar los elementos cognitivos y no cognitivos que influencian las acciones de los estudiantes, generando errores en la toma de decisiones. 10,11 Por otro lado, entender las brechas cognitivas a las que se enfrentan los estudiantes cuando las intervenciones teóricamente correctas no tienen el resultado esperado es otra dimensión susceptible de analizar.…”

Section: Introductionunclassified

“…10 Además es posible analizar los elementos cognitivos y no cognitivos que influencian las acciones de los estudiantes, generando errores en la toma de decisiones. 10,11 Por otro lado, entender las brechas cognitivas a las que se enfrentan los estudiantes cuando las intervenciones teóricamente correctas no tienen el resultado esperado es otra dimensión susceptible de analizar. 11…”

Section: Introductionunclassified

Escenario de sepsis refractaria e insuficiencia suprarrenal, para promover razonamiento clínico en estudiantes de medicina

Labarca-Solar¹,

Reyes-Morales²,

Valenzuela-Bodenburg³

et al. 2019

Revista Latinoamericana De Simulación Clínica

View full text Add to dashboard Cite

show abstract

Diagnosis and management of clinical reasoning difficulties: Part II. Clinical reasoning difficulties: Management and remediation strategies

Cited by 37 publications

References 22 publications

Checklist of cognitive contributions to diagnostic errors: A tool for clinician-educators

Checklist of cognitive contributions to diagnostic errors: A tool for clinician-educators

Diseño e implementación de OSCE para evaluar competencias de egreso en estudiantes de medicina en un consorcio de universidades chilenas

Escenario de sepsis refractaria e insuficiencia suprarrenal, para promover razonamiento clínico en estudiantes de medicina

Contact Info

Product

Resources

About