Observable phenomena that reveal medical students' clinical reasoning ability during expert assessment of their history taking: a qualitative study

Haring, Catharina Maria; Cools, B.M.; Gurp, P.J.M. van; Meer, J.W.M. van der; Postma, Cornelis T.

doi:10.1186/s12909-017-0983-3

“…The employed records of nursing process in assessing the development of clinical reasoning before and after the exposure in a high-reliability post-operative model practice thus resulted to fostered quality patient care[16]. The barometers of clinical reasoning include control, recognition and response to significant information, specified symptoms, utilizing questions pointing to pathophysiological rationale, asking questions in chronological direction, focusing on pact with patients, making summary, and understanding body semantic[17]. Prior seeing the effects of clinical reasoning, it is important that it starts at the level of undergraduate activities for its development.…”

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confidence: 99%

Practice Rationale Care Model: The Art and Science of Clinical Reasoning, Decision Making and Judgment in the Nursing Process

Guerrero¹

2019

OJN

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Nurses must be enlightened that clinical reasoning, clinical decision making, and clinical judgement are the key elements in providing safe patient care. It must be incorporated and applied all throughout the nursing process. The impact of patients' positive outcomes relies on how nurses are effective in clinical reasoning and put into action once clinical decision making occurs. Thus, nurses with poor clinical reasoning skills frequently fail to see and notice patient worsening condition, and misguided decision making arises that leads to ineffective patient care and adding patients suffering. Clinical judgment on the other hand denotes on the outcome after the cycle of clinical reasoning. Within this context, nurses apply reflection about their actions from the clinical decision making they made. The process of applying knowledge, skills and expertise in the clinical field through clinical reasoning is the work of art in the nursing profession in promoting patient safety in the course of delivering routine nursing interventions. Nurses must be guided with their sound clinical reasoning to have an optimistic outcome and prevent iatrogenic harm to patients. Nurses must be equipped with knowledge, skills, attitude and values but most importantly prepared to face the bigger picture of responsibility to care for every patient in the clinical field.

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“…Validity for both instruments was measured as follows: (10) Content validity; For both instruments content validity was measured in two previous studies (6,8). Internal structure; analysis of internal consistency and Generalizability study to explore factors of variance.…”

Section: Measurementsmentioning

confidence: 99%

“…Our first step in the creation of such a tool was the definition of the phenomena that reveal the clinical-reasoning process of the student. (8) The main indicators of clinical reasoning ability abstracted from students' behavior that we identified were: taking control, recognizing and responding to relevant information, specifying symptoms, asking specific questions pointing to pathophysiological thinking, placing questions in a logical order, checking agreement with patients, summarizing and body language.…”

Section: Introductionmentioning

confidence: 99%

Validity, reliability and feasibility of a new observation rating tool and a post encounter rating tool for the assessment of clinical reasoning skills of medical students during their internal medicine clerkship. A pilot study.

Haring

¹

,

Klaarwater

²

,

Bouwmans

³

et al. 2020

Preprint

0

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Background Systematic assessment of clinical reasoning skills of medical students in clinical practice is very difficult. This is partly caused by the lack of understanding of the fundamental mechanisms underlying the process of clinical reasoning. Methods We previously developed an observation tool to assess the clinical reasoning skills of medical students during clinical practice. This observation tool consists of an 11-item observation rating form (ORT). In the present study we verified the validity, reliability and feasibility of this tool and of an already existing post-encounter rating tool (PERT) in clinical practice among medical students during the internal medicine clerkshipResults Six raters each assessed the same 15 student-patient encounters. The internal consistency (Cronbach’s alfa) for the (ORT) was 0.87 (0.71-0.84) and the 5-item (PERT) was 0.81 (0.71-0.87). The intraclass-correlation coefficient for single measurements was poor for both the ORT; 0.32 (p<0.001) as well as the PERT; 0.36 (p<0.001). The Generalizability study (G-study) and decision study (D-study) showed that 6 raters are required to achieve a G-coefficient of > 0.7 for the ORT and 7 raters for the PERT. The largest sources of variance are the interaction between raters and students. There was a consistent correlation between the ORT and PERT of 0.53 (p=0.04)Conclusions The ORT and PERT are both feasible, valid and reliable instruments to assess students’ clinical reasoning skills in clinical practice.

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“…Our rst step in the creation of such a tool was the de nition of the phenomena that reveal the clinical-reasoning process of the student. (8) The main indicators of clinical reasoning ability abstracted from students' behavior that we identi ed were: taking control, recognizing and responding to relevant information, specifying symptoms, asking speci c questions pointing to pathophysiological thinking, placing questions in a logical order, checking agreement with patients, summarizing and body language.…”

Section: Introductionmentioning

confidence: 99%

Validity, reliability and feasibility of a new observation rating tool and a post encounter rating tool for the assessment of clinical reasoning skills of medical students during their internal medicine clerkship. A pilot study.

Haring

¹

,

Klaarwater

²

,

Bouwmans

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background Systematic assessment of clinical reasoning skills of medical students in clinical practice is very difficult. This is partly caused by the lack of understanding of the fundamental mechanisms underlying the process of clinical reasoning. Methods We previously developed an observation tool to assess the clinical reasoning skills of medical students during clinical practice. This observation tool consists of an 11-item observation rating form (ORT). In the present study we verified the validity, reliability and feasibility of this tool and of an already existing post-encounter rating tool (PERT) in clinical practice among medical students during the internal medicine clerkshipResults Six raters each assessed the same 15 student-patient encounters. The internal consistency (Cronbach’s alfa) for the (ORT) was 0.87 (0.71-0.84) and the 5-item (PERT) was 0.81 (0.71-0.87). The intraclass-correlation coefficient for single measurements was poor for both the ORT; 0.32 (p<0.001) as well as the PERT; 0.36 (p<0.001). The Generalizability study (G-study) and decision study (D-study) showed that 6 raters are required to achieve a G-coefficient of > 0.7 for the ORT and 7 raters for the PERT. The largest sources of variance are the interaction between raters and students. There was a consistent correlation between the ORT and PERT of 0.53 (p=0.04)Conclusions The ORT and PERT are both feasible, valid and reliable instruments to assess students’ clinical reasoning skills in clinical practice.

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Observable phenomena that reveal medical students' clinical reasoning ability during expert assessment of their history taking: a qualitative study

Cited by 18 publications

References 16 publications

Practice Rationale Care Model: The Art and Science of Clinical Reasoning, Decision Making and Judgment in the Nursing Process

Practice Rationale Care Model: The Art and Science of Clinical Reasoning, Decision Making and Judgment in the Nursing Process

Validity, reliability and feasibility of a new observation rating tool and a post encounter rating tool for the assessment of clinical reasoning skills of medical students during their internal medicine clerkship. A pilot study.

Validity, reliability and feasibility of a new observation rating tool and a post encounter rating tool for the assessment of clinical reasoning skills of medical students during their internal medicine clerkship. A pilot study.

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