How Do Contexts Affect Physicians' Clinical Reasoning? A Narrative Review

Effectiveness of ethics case based on blended learning approaches on medical students' learning: A quasi-experimental study

BACKGROUND

The use of active teaching methods in ethics education, instead of being merely teacher centred, can lead students to problem-solving in a practical way. Therefore, this study was conducted with the aim of comprehensive medical ethics education based on educational approaches and the effect of this approach on students' learning and moral reasoning skills.

MATERIALS AND METHODS

This quasi-experimental intervention study was performed on seventy physiopathology medical students who had taken the medical ethics course. The students' educational program included teaching theoretical concept of medical ethics, discussing ethical cases and clinical reasoning in class, and then discussing in forum environment and individual assignments in the learning management system (LMS) system and completing the portfolio. Student evaluation was associated students' knowledge, attitu de, and moral reasoning skills and learning. A comprehensive program including forum participation, individual assignments in LMS, theory and objective structured clinical examination (OSCE) tests, and portfolio completion was used to evaluation of students. The students' learning was compared to students of the previous year, which was conducted through a traditional teacher-centered method. Data analysis was conducted using IBM® SPSS® Statistics 21 at two levels of descriptive statistics and analytic statistics.

RESULTS

The results showed that there was a significant difference between the mean learning of students compared with traditional class (P < 0.05). Furthermore, comparison of students' practical scores through the OSCE test showed its impact on changing students' knowledge, attitude, and performance in moral reasoning.

CONCLUSION

According to research findings, it seems that the mentioned model is one of the important and new issues as a suitable method of teaching medical ethics. Furthermore, it can be suitable model in other medical courses. The more research in multicentral may be need to assess other effects on students' learning indicators.

The development of clinical thinking in trainee physicians: the educator perspective

BACKGROUND

An important element of effective clinical practice is the way physicians think when they encounter a clinical situation, with a significant number of trainee physicians challenged by translating their learning into professional practice in the clinical setting. This research explores the perceptions of educators about how trainee physicians develop their clinical thinking in clinical settings. It considers what educators and their colleagues did to help, as well as the nature of the context in which they worked.

METHOD

A qualitative approach was used in this study with in depth interviews carried out with educators as key informants. Rich data derived from 15 interview transcripts were analysed thematically in a rigorous and iterative process.

RESULTS

Three broad and overlapping themes were identified: working in an educationally minded culture; proximity of the educator to the trainee physician; and trajectory of the trainee physician. The departments in which these educators worked emphasised the importance for the education of trainee physicians. All members of the team were responsible for education of the team, and all members, particularly senior nurses, were able to give feedback upon the trainee physicians' progress. Educators described working side by side with their trainee physician and frequently being in close proximity to them which means that the educator was both easily accessible and spent more time with their trainee physicians. They described a trajectory of the trainee physicians through the placement with close monitoring and informal assessment throughout.

CONCLUSION

Recommendations are made as to how trainee physicians can be supported to develop their clinical thinking. Educators and managers can analyse their own and their department's practice and select the recommendations relevant to their local circumstances in order to make change. This study adds the educator perspective to a body of literature about the importance of context and supportive learning environments. As such the discussion is applicable to the education of other health professionals.