Clinical reasoning and simulation: facilitating hypothesis prioritization using simulated patients. Data from quantitative research
DOI:
https://doi.org/10.36834/cmej.73556Abstract
Background: Prioritizing diagnostic hypotheses can be difficult for novice medical students given their limited clinical exposure. Simulated clinical reasoning (CR) clinics allow students to practice focused histories with a simulated patient (SP). The delivery of clinical data by SPs can influence hypothesis generation.
Objective: This pilot study seeks to test whether the transmission of key elements through SP acting influences CR prioritization among medical students.
Method: The diagnostic hypotheses of two cohorts of students of the same academic level were compared following a virtual interview with an SP. The SPs in the experimental group were given a targeted script and briefing on key elements while the SPs in the control group were given a traditional script and briefing. The difference between the distributions of frequencies of the hypotheses of the two groups was determined using the chi-square calculation.
Results: The students in the experimental group prioritized expert-validated hypotheses more than those in the control group. The control group showed greater variability in their diagnostic choices.
Conclusion: Targeting the delivery of key elements by SPs could be a way to help novice medical students prioritize their diagnostic hypotheses. Simulated CR clinics therefore become a space for learning about CR in the absence of clinical exposure. The risk of inducing premature closure of clinical reasoning needs further research.
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References
Audétat M-C, Sader J, Coen M. Clinical reasoning and COVID 19 pandemic: current influencing factors Let us take a step back. Intern Emerg Med. 2021;16(4):1109-11.
https://doi.org/10.1007/s11739-020-02516-8
K D. Online clinical teaching: a simple model to improve students' communication and clinical reasoning skills on distance learning e-platform. MedEdPublish2020.
Giet D, Massart V, Gagnon R, Charlin B. Le test de concordance de script en 20 questions. Pédagogie médicale. 2013;14(1):39-48. https://doi.org/10.1051/pmed/2012026
Hoff L, Bestawros A, Kassis J, Charlin B. Le test de concordance de script comme outil d'enseignement et d'apprentissage : un projet-pilote pour les étudiants de première année de médecine. Pédagogie médicale. 2010;11(1):51-6. https://doi.org/10.1051/pmed/2010006
Audetat M-C, Laurin S, Sanche G. Aborder le raisonnement clinique du point de vue pédagogique II. Les difficultés de raisonnement clinique à l'étape du recueil initial des données et de la génération d'hypothèses. Pédagogie médicale. 2011;12(4):231-6. https://doi.org/10.1051/pmed/2011110
Tremblay M-L, Lafleur A, Leppink J, Dolmans DHJM. The simulated clinical environment: cognitive and emotional impact among undergraduates. Med teach. 2017;39(2):181-7. https://doi.org/10.1080/0142159X.2016.1246710
Groves M, Scott I, Alexander H. Assessing clinical reasoning: a method to monitor its development in a PBL curriculum. Med teach. 2002;24(5):507-15. https://doi.org/10.1080/01421590220145743
Harendza, S., Gärtner, J., Zelesniack, E., & Prediger, S. (2020). Evaluation of a telemedicine-based training for final-year medical students including simulated patient consultations, documentation, and case presentation. GMS J Med. Educ. 37(7), Doc94. https://doi.org/10.3205/zma001387
Nendaz M, Charlin B, Leblanc V, Bordage G. Le raisonnement clinique: données issues de la recherche et implications pour l'enseignement. Pédagogie médicale. 2005;6(4):235-54. https://doi.org/10.1051/pmed:2005028
Charlin B, Boshuizen HPA, Custers EJ, Feltovich PJ. Scripts and clinical reasoning. Med ed. 2007;41(12):1178-84. https://doi.org/10.1111/j.1365-2923.2007.02924.x
Gruppen LD, Palchik NS, Wolf FM, Laing TJ, Oh MS, Davis WK. Medical student use of history and physical information in diagnostic reasoning. Arthritis and rheumatism. 1993;6(2):64-70. https://doi.org/10.1002/art.1790060204
Renaud J-S, Ratté F, F. Thériault J, Roy AM, Côté L. Questions de planification clinique : un nouvel outil pour évaluer la capacité des étudiants en médecine à identifier les éléments-clés discriminants d'un diagnostic différentiel. Pédagogie médicale. 2016;17(1):65-75. https://doi.org/10.1051/pmed/2016024
Lafleur A, Cote L, Leppink J. Influences of OSCE design on students' diagnostic reasoning. Medical education. 2015;49(2):203-14. https://doi.org/10.1111/medu.12635. PMID: 25626751.
Visser CLF, Wouters A, Croiset G, Kusurkar RA. Scaffolding clinical reasoning of health care students: a qualitative exploration of clinicians' perceptions on an interprofessional obstetric ward. J Med Educ Curric Dev. 2020;7:2382120520907915- https://doi.org/10.1177/2382120520907915
Cristina B, Ianis C, Anne-Helene U, et al. Simulated patient and role play methodologies for communication skills and empathy training of undergraduate medical students. BMC med educ. 2020;20(1):1-491.
Burnier I, Bouchard-Lamothe D, Khouani Z. Patient simulé et patient standardisé : peut-on en finir avec le terme SPs ? Pédagogie médicale. 2020;20(3):147-9. https://doi.org/10.1051/pmed/2020015
Burnier I, Fotsing S, Bouchard-Lamothe D, Amrani S. Briefing des patients simulés en cinq étapes : effets perçus sur la préparation à la pratique simulée. Données d'un projet pilote. Pédagogie médicale. 2019;20(4):177-85. https://doi.org/10.1051/pmed/2020021
Grosjean S, Cherba M, Matte F, Gauthier-Beaupré A, Burnier I, Myles D. How simulated patients' 'showing practices' contribute to improving medical students’ 'sensory awareness' during teleconsultations: a multimodal interaction analysis. Conference of the International Association for Dialogue Analysis; Virtual event. 2021.
Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: the role of experience. Med ed. 2007;41(12):1140-5. https://doi.org/10.1111/j.1365-2923.2007.02914.x
Konopasky A, Artino AR, Battista A, et al. Understanding context specificity: the effect of contextual factors on clinical reasoning. Diagnosis (Berlin, Germany). 2020;7(3):257-64. https://doi.org/10.1515/dx-2020-0016
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