Monitoring progression of clinical reasoning skills during health sciences education using the case method - a qualitative observational study

Clinical Reasoning Curricula in Health Professions Education: A Scoping Review

OBJECTIVES

This scoping review aimed to explore and synthesize current literature to advance the understanding of how to design clinical reasoning (CR) curricula for students in health professions education.

METHODS

Arksey and O'Malley's 6-stage framework was applied. Peer-reviewed articles were searched in PubMed, Web of Science, CINAHL, and manual searches, resulting in the identification of 2932 studies.

RESULTS

Twenty-six articles were included on CR in medical, nursing, physical therapy, occupational therapy, midwifery, dentistry, and speech language therapy education. The results describe: features of CR curriculum design; CR theories, models, and frameworks that inform curricula; and teaching content, methods, and assessments that inform CR curricula.

CONCLUSIONS

Several CR theories, teaching, and assessment methods are integrated into CR curricula, reflecting the multidimensionality of CR among professions. Specific CR elements are addressed in several curricula; however, no all-encompassing CR curriculum design has been identified. These findings offer useful insights for educators into how CR can be taught and assessed, but they also suggest the need for further guidance on educational strategies and assessments while learners progress through an educational program.

Development of an electronic learning progression dashboard to monitor student clinical experiences

INTRODUCTION

Clinical experience tracking mechanisms for students at dental schools provide patient assignment, student experience, and learning progression feedback. The purpose of this study was to evaluate dental students' clinical experiences following the implementation of a learning progression dashboard (LPD).

METHODS

After developing and deploying an electronic LPD using PHP, secondary data analysis on dental students' clinical experiences from 2017-2019 was conducted. Student experience differences were compared between the year before continuous use of the LPD and the first year using it. LPD data contained the required clinical procedures dentistry students must perform across all disciplines and the number of planned, in progress, and completed tasks each student has accomplished. Using two time points, the students' experiences were compared. Univariate statistics and independent t-tests were conducted in R for detecting the differences in the number and categories of codes.

RESULTS

The number and category of codes showed significant differences between the academic year 2017-2018 and 2018-2019 for both third- and fourth-year dental students after one and two terms. Overall, students recorded a 26% greater number of treatment codes and experienced a 26% greater number of code categories compared to the previous year.

CONCLUSION

Applying information management methods such as dashboards can better inform educators on student clinical experiences and improve clinical learning outcomes for students.

Case-based learning: Modern teaching tool meant for present curriculum: A behavioral analysis from faculties' perspective

BACKGROUND

Case-based learning (CBL) is an established bidirectional active learning approach where students learn concepts by solving cases or problems under the guidance of a facilitator. In the present study, the awareness and acceptance level of faculties to implement this method of teaching were assessed by behavioral analysis.

MATERIALS AND METHODS

This cross-sectional study was done through two workshops organized at NDRI Karnal on December 16 and 17, 2019, and BHU Varanasi on March 1, 2020. Fifty-four faculties from different applied sciences participated. The participants were given an insight into this teaching tool through didactic lecture and hands-on training session about implementation of this method. Pre and post- session responses were compared through a set of questionnaires and the behavioral change was analyzed by using SPSS version 22. P ≤ 0.05 was considered as statistically significant.

RESULTS

Only 31.5% faculties were aware of the active learning methods though 83% agreed that active learning is better than conventional teaching. 96% agreed that CBL is a better way to develop concepts and nearly 81% agreed that more learning could be done with lesser efforts. The clinical decision-making improve significantly. Pre and post-session mean scores of effectiveness of CBL as a teaching tool were 2.44 ± 0.63 and 2.72 ± 0.53, respectively.

CONCLUSION

CBL originally is a mode of imparting knowledge in a student-centric bimodal learning. Acceptance to the mode is increasing among faculties despite of many deterrents.

The Use of Clinical Reasoning Skills in the Setting of Uncertainty: A Case of Trial Femoral Head Migration

Clinical skills and medical knowledge enable physicians to overcome the uncertainty of emergent and rare clinical scenarios. Recently, a growing emphasis on evidence-based medicine (EBM) has flooded medical curricula of universities across the globe with guideline-based material, and while it has given teachers and students new tools to improve medical education, clinical reasoning must be reaffirmed in its capacity to provide physicians with the ability to solve unexpected clinical scenarios. Anatomical education in medical school should have two main objectives: to acquire anatomical knowledge and to develop the skill of applying that knowledge in clinical scenarios. The authors present a clinical scenario in which an unexpected and rare complication occurred during a routine elective hip replacement surgery. The general surgeon presiding over the case, also an anatomy professor, solved the problem using clinical reasoning and anatomical knowledge. It was a clear example of how clinical reasoning is key in approaching unprecedented, rare, or unknown complications. The intention of this scenario is to remind colleagues and medical schools that, although EBM is the standard, educators must uphold sound clinical reasoning to best prepare health care providers for their careers.