Preparing medical students for clinical decision making: A pilot study exploring how students make decisions and the perceived impact of a clinical decision making teaching intervention

McGregor, Calum A; Paton, Catherine; Thomson, Calum; Chandratilake, Madawa; Scott, Hazel

doi:10.3109/0142159x.2012.670323

Cited by 45 publications

(36 citation statements)

References 23 publications

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“…24 Clinical decision-making education modules could include topics such as understanding meta-cognition and the Dual Processing Theory, understanding and appropriate use of various decision-making strategies (ranging from exhaustive to ruling out the worst case scenario to algorithmic), awareness of cognitive biases, and ensuring knowledge of cognitive error-avoiding strategies. 25,26 Similarly, continuing education opportunities for paramedics could include clinical decision-making. Case presentations are a common quality assurance practice in many EMS services and are suitable for adaptation to a "cognitive autopsy" style of case review, which includes a focus on the thinking strategies used and the internal and external factors that may have affected paramedic decisionmaking.…”

Section: Discussionmentioning

confidence: 99%

“…Les ambulanciers paramédicaux (n = 904), d'un âge médian de 36 ans (écart interquartile [EIQ] : 29-42), étaient pour la plupart des hommes (69,5%) et ils avaient une formation en soins préhospitaliers de base ou avancés (base = 55,5%; avancés = 32,5%). De leur côté, les étudiants en technique paramédicale (n = 268), d'un âge médian de 23 ans (EIQ : [21][22][23][24][25][26], étaient pour la plupart des hommes (63,1%) et ils avaient terminé leurs études secondaires (31,7%) ou avaient obtenu un diplôme de premier cycle (25,4%) avant leur formation en technique paramédicale. Dans les deux groupes, les répondants ont indiqué une préférence marquée pour le mode de pensée rationnelle comparativement au mode de pensée expérientielle, et se sont dits capables de l'utiliser.…”

Section: Résuméunclassified

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A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics

Jensen

Bienkowski

Travers

et al. 2016

CJEM

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Objective: Two major processes underlie human decisionmaking: experiential (intuitive) and rational (conscious) thinking. The predominant thinking process used by working paramedics and student paramedics to make clinical decisions is unknown. Methods: A survey was administered to ground ambulance paramedics and to primary care paramedic students. The survey included demographic questions and the Rational Experiential Inventory-40, a validated psychometric tool involving 40 questions. Twenty questions evaluated each thinking style: 10 assessed preference and 10 assessed ability to use that style. Responses were provided on a five-point Likert scale, with higher scores indicating higher affinity for the style in question. Analysis included both descriptive statistics and t tests to evaluate differences in thinking style. Results: The response rate was 88.4% (1172/1326). Paramedics (n = 904) had a median age of 36 years (IQR 29-42) and most were male (69.5%) and primary or advanced care paramedics (PCP = 55.5%; ACP = 32.5%). Paramedic students (n = 268) had a median age of 23 years (IQR 21-26), most were male (63.1%) and had completed high school (31.7%) or an undergraduate degree (25.4%) prior to paramedic training. Both groups scored their ability to use and favourability toward rational thinking significantly higher than experiential thinking. The mean score for rational thinking was 3.86/5 among paramedics and 3.97/5 among paramedic students (p < 0.001). The mean score for experiential thinking was 3.41/5 among paramedics and 3.35/5 among paramedic students (p = 0.06). Conclusion: Working paramedics and student paramedics prefer and perceive that they have the ability to use rational over experiential thinking. This information adds to our current knowledge on paramedic decision-making and is potentially important for developing continuing education and clinical support tools. RÉSUMÉObjectif: Deux grands processus sous-tendent les prises de décision chez l'homme : la pensée expérientielle (intuitive) et la pensée rationnelle (consciente). Toutefois, l'on ne sait pas à quel mode de pensée recourent principalement les ambulanciers paramédicaux et les étudiants en technique paramédi-cale dans leurs prises de décision d'ordre clinique. Méthode: Une enquête a été menée parmi des ambulanciers paramédicaux et des étudiants en soins préhospitaliers de base. Le questionnaire se composait d'une collecte de données démographiques ainsi que d'un outil psychométri-que validé de 40 questions, le Rational Experiential Inventory-40 (inventaire rationnel-expérientiel). Vingt questions portaient sur chacun des modes de pensée : dix sur le mode de prédilection et dix sur la capacité d'utiliser ce mode. Les réponses étaient cotées sur une échelle de Likert à 5 points, et les scores plus élevés indiquaient une préférence pour le mode en question. Une analyse s'appuyant sur des statistiques descriptives et des tests t a été réalisée afin de faire ressortir les différences entre les modes de pensée. Résultats: Le taux de rép...

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Section: Discussionmentioning

confidence: 99%

Section: Résuméunclassified

A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics

Jensen

Bienkowski

Travers

et al. 2016

CJEM

View full text Add to dashboard Cite

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“…Despite recognizing the importance of the clinical decision-making process, it is complex to determine how dentists make treatment-related decisions 22 because a number of professional and patient-related factors come into play, which might influence the therapeutic choice 16 . Likewise, orthodontic treatment may be influenced both by the social and cultural environment 23 .…”

Section: Therapeutic Decisions In Orthodonticsmentioning

confidence: 99%

“…To do that, treatment selection must include clinical reasoning, which has been described as an essential pillar in the education of health professionals. It is also a significant aspect of medical and dentistry skills 22 . However, the factors that influence this process go beyond clinical or scientific considerations.…”

Section: Therapeutic Decisions In Orthodonticsmentioning

confidence: 99%

Factores que influyen las decisiones terapéuticas en Ortodoncia: Revisión de la literatura. Decisiones terapéuticas en Ortodoncia

Matthews

Cartes‐Velásquez

2017

Odontoestomatología

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Abstract:There is an immense variety of orthodontic techniques. Each of them has specific uses and indications from which to select the most appropriate options for each clinical situation. The aim of this article is to review the recent literature on the factors that influence or explain the therapeutic decisions made in dentistry with a focus on orthodontics. It has been found that the education received, individual preferences and the mastery of different techniques, features and personal values, as well as the clinical and economic situation of the patient, the health system and the dentist-patient relationship take on a major role in the treatment selected. Ethical and social principles, such as behavioral theories, are applicable to these professional aspects. It is important to understand the decision-making process and the selection of treatments because of the impact they have on patient care and satisfaction, on reaching the therapeutic objectives, on how public health services work, and on the quality of services. There are currently few studies that focus on the process of clinical decision-making. Therefore, it is necessary to expand the scope of research, including qualitative research, in order to better understand decision-making.

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“…While medical students graduate with much knowledge, their critical thinking and decision-making skills are underdeveloped. 1 Thus, it is important to assess these developing skills over time in all areas of practice to ensure that graduates are competent.…”

Section: Introductionmentioning

confidence: 99%

Assessing and Documenting the Cognitive Performance of Family Medicine Residents Practicing Outpatient Medicine

Shaughnessy¹,

Chang²,

Sparks³

et al. 2014

Journal of Graduate Medical Education

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Background Development of cognitive skills for competent medical practice is a goal of residency education. Cognitive skills must be developed for many different clinical situations. Innovation We developed the Resident Cognitive Skills Documentation (CogDoc) as a method for capturing faculty members' real-time assessment of residents' cognitive performance while they precepted them in a family medicine office. The tool captures 3 dimensions of cognitive skills: medical knowledge, understanding, and its application. This article describes CogDoc development, our experience with its use, and its reliability and feasibility. Methods After development and pilot-testing, we introduced the CogDoc at a single training site, collecting all completed forms for 14 months to determine completion rate, competence development over time, consistency among preceptors, and resident use of the data. Results Thirty-eight faculty members completed 5021 CogDoc forms, documenting 29% of all patient visits by 33 residents. Competency was documented in all entrustable professional activities. Competence was statistically different among residents of different years of training for all 3 dimensions and progressively increased within all residency classes over time. Reliability scores were high: 0.9204 for the medical knowledge domain, 0.9405 for understanding, and 0.9414 for application. Almost every resident reported accessing the individual forms or summaries documenting their performance. Conclusions The CogDoc approach allows for ongoing assessment and documentation of resident competence, and, when compiled over time, depicts a comprehensive assessment of residents' cognitive development and ability to make decisions in ambulatory medicine. This approach meets criteria for an acceptable tool for assessing cognitive skills.

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Preparing medical students for clinical decision making: A pilot study exploring how students make decisions and the perceived impact of a clinical decision making teaching intervention

Cited by 45 publications

References 23 publications

A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics

A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics

Factores que influyen las decisiones terapéuticas en Ortodoncia: Revisión de la literatura. Decisiones terapéuticas en Ortodoncia

Assessing and Documenting the Cognitive Performance of Family Medicine Residents Practicing Outpatient Medicine

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