Identifying developmental features in students’ clinical reasoning to inform teaching*

Pinnock, Ralph; Anakin, Megan; Lawrence, Julie; Chignell, Helen; Wilkinson, Tim

doi:10.1080/0142159x.2018.1463433

Cited by 19 publications

(18 citation statements)

References 29 publications

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“…A study showed that when every case is unfolded gradually (serial-cue), the students perform 72% worse than when every case is provided in a whole-case format (21). There was a similar result in another study (22). The reason behind the low performance in serial-cue approach is concluded as the high amount of cognitive load created by the difficulty of constructing a meaningful whole (23).…”

Section: Methods (The Theory Behind and The Roots Of Contextended Questions)mentioning

confidence: 89%

ContExtended Questions (CEQ) to Teach and Assess Clinical Reasoning: A New Variant of F-Type Testlets

Kıyak

Budakoğlu

Kula³

et al. 2021

Rev Esp Edu Med

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This study introduces ContExtended Questions (CEQ), which is a tool both to teach and assess clinical reasoning particularly in the preclinical years, and the web-based program to implement. CEQ consists of text-based case-based multiple-choice questions that provide patient data in a fixed and predetermined sequence. It enables the examinees to develop and reshape their illness scripts by using feedback after every question. Feedback operates to transform the examinee’s failure into a “productive failure”. The preliminary results of the randomized controlled experiment of teaching clinical reasoning to preclinical students through CEQ is quite satisfactory. In the medical education literature, this would be the first time that students, who have no or very limited clinical experience, developed their illness scripts just by taking formative multiple-choice tests. The approach would be named “test-only learning”. The complete results of the experiment and then more experiments in other contexts and domains are necessary to establish a more powerful assessment tool and software. Furthermore, by changing the content of the questions, it is possible to use CEQ in every period of medical education and health professions education.

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Section: Methods (The Theory Behind and The Roots Of Contextended Questions)mentioning

confidence: 89%

ContExtended Questions (CEQ) to Teach and Assess Clinical Reasoning: A New Variant of F-Type Testlets

Kıyak

Budakoğlu

Kula³

et al. 2021

Rev Esp Edu Med

View full text Add to dashboard Cite

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“…Previous researchers have focused on enhancing skills of students through simulation-based learning for care of a single case in the community (Akselbo et al., 2018; Babenko-Mould et al., 2015; Lebcir et al., 2017). For the novice learner, the beginning of the simulation experience should focus on a straightforward patient problem (Pinnock et al., 2019). However, PHNs support various community people in their practice.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Health Guidance Simulation in Community Settings for Public Health Nursing Students: A Preliminary Study

Yoshioka‐Maeda

Naruse

2021

SAGE Open Nursing

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Introduction Simulation-based learning is a relatively new concept in public health nursing education, and little is known about the efficacy of this approach for teaching of health guidance. Objective: The aim of this study was to evaluate the effectiveness of health guidance simulation in community settings for public health nursing students. Methods Using a pre/post-test design, 29 public health nursing students in their third year participated in a high-fidelity simulation program with standardized patients. We developed six scenarios on health guidance for three themes (mother and child, tuberculosis, and adult occupational health) and practice guidelines for the standardized patients to act and assist in understanding of the purpose of the course. Data were collected at baseline and after the simulation sessions through evaluation sheets that the students placed in a designated box on campus. Changes in the level of self-confidence of the students were evaluated based on the “practical skills required for public health nurses and achievement level at graduation” of the Ministry of Health, Labor and Welfare, and the skills in the minimum requirements for public health nurse education defined by the Japan Association of Public Health Nurse Educational Institutions. Results The total score for self-confidence and the mean self-confidence scores for health guidance skills for mother and child, tuberculosis, and adult occupational health nursing were significantly higher post-test compared to pre-test ( p < 0.001). Conclusion These results indicate that high-fidelity simulation focused on health guidance in community settings can bridge the gap between theoretical knowledge and practice of students.

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“…Feedback techniques can be modified to foster psychiatrists' clinical reasoning and bias detection, such as by giving feedback on every step of the forensic psychiatric analysis instead of the finished report only ( 31 , 83 ). This “serial-cue” approach (as opposed to “whole-case” approach) is appropriate, considering that psychiatrists have already formed illness and forensic scripts from their previous experience and they only need to refine them ( 84 ).…”

Section: Training For Clinical Reasoning and Mitigating Biasmentioning

confidence: 99%

Clinical Reasoning in Forensic Psychiatry: Concepts, Processes, and Pitfalls

et al. 2021

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Forensic psychiatrists are often sought by the court of law to provide professional opinion on specific legal matters that have a major impact on the evaluee and possibly society at large. The quality of that opinion and recommendations rely on the quality of the analysis from the assessment results conducted by the psychiatrist. However, the definition and scope of a forensic psychiatric analysis is not clear. While existing literature on forensic psychiatric analysis generally includes organizing information, identifying relevant details, and formulating a set of forensic psychiatric opinions as components, there is no explicit and unified definition of these terms and process. This lack of clarity and guidelines may hinder forensic psychiatry from achieving its goal of providing objective information to the court or other relevant parties. Forensic psychiatric analysis exhibits numerous parallels to clinical reasoning in other fields of medicine. Therefore, this review aims to elaborate forensic psychiatric analysis through the lens of clinical reasoning, which has been developed by incorporating advances in cognitive sciences. We describe forensic psychiatric analysis through three prominent clinical reasoning theories: hypothetico-deductive model, illness script theory, and dual process theory. We expand those theories to elucidate how forensic psychiatrists use clinical reasoning not only to diagnose mental disorders, but also to determine mental capacities as requested by law. Cognitive biases are also described as potential threat to the accuracy of the assessment and analysis. Additionally, situated cognition theory helps elucidate how contextual factors influence risk of errors. Understanding the processes involved in forensic psychiatric analysis and their pitfalls can assist forensic psychiatrists to be aware of and try to mitigate their bias. Debiasing strategies that have been implemented in other fields of medicine to mitigate errors in clinical reasoning can be adapted for forensic psychiatry. This may also shape the training program of general psychiatrists and forensic psychiatrists alike.

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Identifying developmental features in students’ clinical reasoning to inform teaching*

Abstract: Early in their training students are unable to analyze data during history taking. When they have started developing illness scripts, they are able to benefit from the "serial cue" approach of teaching clinical reasoning.

Cited by 19 publications

References 29 publications

ContExtended Questions (CEQ) to Teach and Assess Clinical Reasoning: A New Variant of F-Type Testlets

ContExtended Questions (CEQ) to Teach and Assess Clinical Reasoning: A New Variant of F-Type Testlets

Effectiveness of Health Guidance Simulation in Community Settings for Public Health Nursing Students: A Preliminary Study

Clinical Reasoning in Forensic Psychiatry: Concepts, Processes, and Pitfalls

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