1
|
Mok SF, Tan TMD, Seow CJ. Modified endocrinology script concordance test: evaluating the reliability and construct validity for assessing clinical reasoning. Singapore Med J 2023:384045. [PMID: 37675672 DOI: 10.4103/singaporemedj.smj-2021-230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Shao Feng Mok
- Department of Medicine, National University Hospital, Singapore
| | | | - Cherng Jye Seow
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
2
|
Zagaar M, Appelbaum N, Tchio D, Le A. Pharmacy students' perceptions of clinical reasoning development through a foundational thinking application framework. CURRENTS IN PHARMACY TEACHING & LEARNING 2023:S1877-1297(23)00147-8. [PMID: 37385896 DOI: 10.1016/j.cptl.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 05/16/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Pharmacy students must learn to integrate the foundational and clinical sciences to make therapeutic decisions. There is a need for a developmental framework and scaffolding tools to bridge foundational knowledge with clinical reasoning among novice learners in pharmacy education. Our purpose is to describe the development and student perceptions of a framework designed to integrate foundational knowledge and clinical reasoning in second-year pharmacy students. EDUCATIONAL ACTIVITY AND SETTING Using script theory as a conceptual model, a Foundational Thinking Application Framework (FTAF) was designed around a four-credit Pharmacotherapy of Nervous Systems Disorders course at the beginning of the second year of the doctor of pharmacy curriculum. The framework was implemented as two structured learning guides known as a unit plan and a pharmacologically based therapeutic evaluation. A total of 71 students in the course were asked to complete a 15-question online survey assessing perceptions towards specific components of the FTAF. FINDINGS Of 39 survey respondents, 37 (95%) described the unit plan as a useful organizer for the course. Thirty-five (80%) students agreed or strongly agreed that the unit plan helped organize instructional material for a given topic. Students (n = 32, 82%) preferred the pharmacologically based therapeutic evaluation format, with text comments highlighting that it provided good practice for clinical experiences and helped to organize critical thinking. SUMMARY Our study found that students had positive perceptions of FTAF's implementation within a pharmacotherapy course. Pharmacy education can benefit by adapting script-based strategies that have been successful in other health professions.
Collapse
Affiliation(s)
- Munder Zagaar
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States; Texas Southern University, College of Pharmacy and Health Sciences, 3100 Cleburne Street, Houston, TX 77004, United States.
| | - Nital Appelbaum
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States.
| | - Dorice Tchio
- Texas Southern University, College of Pharmacy and Health Sciences, 3100 Cleburne Street, Houston, TX 77004, United States
| | - Aaron Le
- Texas Southern University, College of Pharmacy and Health Sciences, 3100 Cleburne Street, Houston, TX 77004, United States
| |
Collapse
|
3
|
Newsom LC, Augustine J, Momary K. Development of a script concordance test to assess clinical reasoning in a pharmacy curriculum. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1135-1142. [PMID: 36154958 DOI: 10.1016/j.cptl.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Clinical reasoning is a vital skill for student pharmacists in the provision of patient-centered care, but these skills are often difficult to assess in the didactic curriculum. A script concordance test (SCT) is an innovative assessment method that can be used to assess clinical reasoning skills. The objective of this study was to develop and refine an SCT to assess clinical reasoning skills of third year student pharmacists (P3s). METHODS An SCT was written and administered to P3s. Pharmacy practice faculty members served as the expert group. The SCT was scored and Rasch analysis was performed. RESULTS The SCT included 20 case vignettes and 60 questions. Test reliability was 0.34 with mean square values for all items between 0.7 and 1.3. Forty-two questions had a difficulty score between 0 and - 1 logits, indicating there were multiple questions with similar difficulty levels. Two case vignettes and 43.3% of questions (n = 26) were revised to enhance clarity and decrease ambiguity. CONCLUSIONS The SCT is a tool to assess clinical reasoning in the didactic curriculum. Faculty can create the SCT and use statistical methods such as Rasch analysis to assess validity and reliability of the SCT.
Collapse
Affiliation(s)
- Lydia C Newsom
- Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341-4115, United States.
| | - Jill Augustine
- Department of Pharmacy Practice and the Department of Pharmaceutical Sciences, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341-4115, United States.
| | - Kathryn Momary
- Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341-4115, United States.
| |
Collapse
|
4
|
Patel R. General practice trainees’ learning experiences of formative think-aloud script concordance testing. EDUCATION FOR PRIMARY CARE 2022; 33:229-236. [DOI: 10.1080/14739879.2022.2057240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rajan Patel
- Academic Clinic Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford Medical Sciences Division, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, United Kingdom
| |
Collapse
|
5
|
Janke KK, Bechtol RA, Dy-Boarman EA, Nelson M. Capturing employer's perceptions of key variables in exceptional new practitioners' success by using a modified Delphi process. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:397-406. [PMID: 35483804 DOI: 10.1016/j.cptl.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 02/03/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The primary aim was to determine the key variables in a new practitioner's success from the perspective of pharmacy employers. A secondary aim was to describe the use of a modified Delphi process to collect quality information from external constituents. METHODS A historical review of the literature was conducted to ensure the inquiry extended existing thinking and to aid the development of questions. An asynchronous, online two-round modified Delphi process was used to gather input and develop consensus. The findings were verified by crosswalking with the Habits of Mind. Additionally, the strategies for inviting panelists, practitioner response rates, and the amount and quality of the data collected were examined. RESULTS The historical review yielded 25 articles that were categorized by disciplines studied, methods used, and characteristics found. Fourteen seasoned employers participated. Nine themes describing the behaviors and practices of exceptional new practitioners were identified. These themes were categorized into three groups: Change-Leader, Self-Manager, or Relationship-Builder. Additionally, all the themes mapped to multiple Habits of Mind. As a method for constituent input, the Delphi process yielded employer response rates per school ranging from 10% to 67% and produced five single-spaced pages of text (2124 words) for analysis. CONCLUSIONS These descriptions of behaviors and practices of exceptional new practitioners build upon existing literature and provide additional guidance for professional development curricula. Additionally, an asynchronous, online Delphi panel can be a useful method to glean important insights from experienced pharmacy employers.
Collapse
Affiliation(s)
- Kristin K Janke
- Wulling Center for Innovation & Scholarship in Pharmacy Education, Pharmaceutical Care & Health Systems, University of Minnesota College of Pharmacy, 308 SE Harvard Street, Minneapolis, MN 55455, United States.
| | - Robert A Bechtol
- School of Pharmacy, Cedarville University, 251 N. Main Street, Cedarville, OH 45314, United States.
| | - Eliza A Dy-Boarman
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
| | - Michael Nelson
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
| |
Collapse
|
6
|
Frankart LM, Matulewicz AT, Crane WBP, Patterson J, Bond R, Donohoe KL. A classroom-based patient case activity as a potential formative indicator of pre-advanced pharmacy practice experience readiness. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:514-520. [PMID: 35483819 DOI: 10.1016/j.cptl.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 01/20/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND PURPOSE Pharmacy programs must assess student readiness for advanced pharmacy practice experiences (APPEs). This study evaluated: (1) if a relationship exists between student performance on a classroom-based patient case activity (Rx Review) and (2) performance on direct patient care and perceptions of the transferability of Rx Reviews to the APPE setting. EDUCATIONAL ACTIVITY AND SETTING Rx Reviews are timed, independent, prospective reviews of a patient's medical record intended to simulate pre-rounding activities common in acute and ambulatory care settings. Students complete 12 Rx Reviews across a skills laboratory course sequence. Rx Review scores were compared to performance on acute care and ambulatory care APPEs for students in the Class of 2019 using descriptive statistics for student scores and bivariate logistic regression for the association between Rx Review scores and performance outcomes on patient care APPEs. Student perceptions of the Rx Reviews were assessed through a survey. Descriptive statistics and qualitative responses were used to analyze responses to the multiple-choice survey questions and open-ended question, respectively. FINDINGS One hundred twenty-two students participated in the study. A relationship was found between students' Rx Review scores and performance in certain direct patient care APPEs, with students performing in the bottom 50% on Rx Reviews being more likely to perform poorly on those APPEs. Over 93% of students identified Rx Reviews as at least somewhat helpful in preparing them for APPEs. SUMMARY This study indicated that a classroom-based patient case activity could be used as a formative measure of APPE readiness.
Collapse
Affiliation(s)
- Laura M Frankart
- Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., P.O. Box 980581, Richmond, VA 23298, United States.
| | - Abigale T Matulewicz
- Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., P.O. Box 980581, Richmond, VA 23298, United States.
| | - Wylie B P Crane
- Community Pharmacy Resident, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., P.O. Box 980581, Richmond, VA 23298, United States.
| | - Julie Patterson
- Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., P.O. Box 980581, Richmond, VA 23298, United States.
| | - Rucha Bond
- Associate Dean of Experiential Education, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., P.O. Box 980581, Richmond, VA 23298, United States.
| | - Krista L Donohoe
- Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., P.O. Box 980581, Richmond, VA 23298, United States.
| |
Collapse
|
7
|
Brentnall J, Thackray D, Judd B. Evaluating the Clinical Reasoning of Student Health Professionals in Placement and Simulation Settings: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020936. [PMID: 35055758 PMCID: PMC8775520 DOI: 10.3390/ijerph19020936] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Clinical reasoning is essential to the effective practice of autonomous health professionals and is, therefore, an essential capability to develop as students. This review aimed to systematically identify the tools available to health professional educators to evaluate students' attainment of clinical reasoning capabilities in clinical placement and simulation settings. (2) Methods: A systemic review of seven databases was undertaken. Peer-reviewed, English-language publications reporting studies that developed or tested relevant tools were included. Searches included multiple terms related to clinical reasoning and health disciplines. Data regarding each tool's conceptual basis and evaluated constructs were systematically extracted and analysed. (3) Results: Most of the 61 included papers evaluated students in medical and nursing disciplines, and over half reported on the Script Concordance Test or Lasater Clinical Judgement Rubric. A number of conceptual frameworks were referenced, though many papers did not reference any framework. (4) Conclusions: Overall, key outcomes highlighted an emphasis on diagnostic reasoning, as opposed to management reasoning. Tools were predominantly aligned with individual health disciplines and with limited cross-referencing within the field. Future research into clinical reasoning evaluation tools should build on and refer to existing approaches and consider contributions across professional disciplinary divides.
Collapse
Affiliation(s)
- Jennie Brentnall
- Work Integrated Learning, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Correspondence:
| | - Debbie Thackray
- Physiotherapy, School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK;
| | - Belinda Judd
- Work Integrated Learning, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| |
Collapse
|
8
|
Vital S, Wulfman C, Girard F, Tamimi F, Charlin B, Ducret M. Script concordance tests: A call for action in dental education. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2021; 25:705-710. [PMID: 33486880 DOI: 10.1111/eje.12649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/23/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
The Script Concordance Test (SCT) is an educational tool that aims to assess the ability to interpret medical information under conditions of uncertainty. It is widely used and validated in health education, but almost unknown in dentistry. Based on authentic clinical problem-solving situations, it allows to assess clinical reasoning that experienced health workers develop over the years. A specific scoring system, dedicated to SCT, considers the variability of responses of practitioners in the same clinical situations. Finally, the scores generated by SCT reflect the respondents' ability to interpret clinical data compared to experienced clinicians. This article aims to familiarise the dental educators' community with SCT construction, optimisation and its possible applications.
Collapse
Affiliation(s)
- Sibylle Vital
- UFR Odontologie, UR 2496, Université de Paris, Paris, France
- Hôpital Louis Mourier, Service de Médecine Bucco-Dentaire, DMU ESPRIT, AP-HP, Colombes, France
| | - Claudine Wulfman
- Université de Paris, URB2I, UR 4462, F-92049, Montrouge, Université Sorbonne Paris Nord, F- 93000, Bobigny, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Médecine Bucco-Dentaire, F-94010, Créteil, France
| | - Félix Girard
- Faculty of Dentistry, Université de Montréal, Montréal, QC, Canada
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- College of Dental Medicine, Qatar University, Doha, Qatar
| | - Bernard Charlin
- Faculté de médecine, Université de Montréal, Montréal, QC, Canada
- Centre de pédagogie appliquée aux sciences de la santé (CPASS), Université de Montréal, Montréal, QC, Canada
| | - Maxime Ducret
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
| |
Collapse
|
9
|
Bryant GA, Dy-Boarman EA, Herring MS, Witry MJ. Use of a script concordance test to evaluate the impact of a targeted educational strategy on clinical reasoning in advanced pharmacy practice experiential students. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:1024-1031. [PMID: 34294243 DOI: 10.1016/j.cptl.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/27/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE It is unclear how clinical reasoning is impacted by a single advanced pharmacy practice experience (APPE) and how preceptors can further develop these skills. EDUCATIONAL ACTIVITY AND SETTING Students completing an APPE within four sites were invited to participate. To assess clinical reasoning skills, students completed a 30 item script concordance test (SCT) during week 1 and week 5 of a rotation. Students were divided into control and intervention groups. The intervention group participated in a clinical reasoning discussion, during which students presented a case and led a discussion on how to reason through treatment options. FINDINGS Change in mean SCT scores between week 1 and week 5 were 0.84 (2.8%) and 1.23 (4.1%) in the control (n = 15) and intervention groups (n = 28), respectively. There was no significant change in scores in the control group (P = .07, CI -0.34, 2.01). The change in scores was statistically significant in the intervention group (P = .02, CI 0.23, 2.23). An independent samples t-test comparing the SCT score change for the control and intervention group showed no significant difference (P = .62, CI -1.18, 1.96). SUMMARY This study demonstrated the feasibility of implementing a SCT in experiential education. SCT scores did not significantly improve beyond the standard APPE in response to the focused educational intervention, but investigators found that the discussion facilitated rich conversations about patient cases and was valuable for assessing a student's thinking pattern.
Collapse
Affiliation(s)
- Ginelle A Bryant
- Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Avenue, Des Moines, IA 50311-4505, United States.
| | - Eliza A Dy-Boarman
- Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Avenue, Des Moines, IA 50311-4505, United States.
| | - Morgan S Herring
- Department of Pharmacy Practice and Science, Division of Applied Clinical Sciences, University of Iowa College of Pharmacy, 180 South Grand Avenue, Iowa City, Iowa 52242, United States.
| | - Matthew J Witry
- Department of Pharmacy Practice and Science, Division of Health Services Research, University of Iowa College of Pharmacy, 180 South Grand Avenue 342 CPB, Iowa City, Iowa 52242, United States.
| |
Collapse
|