Clinical reasoning and medical education: Scoping Review

This review aims at identifying research trends in medical education focused on clinical reasoning and argumentation for the resolution of specific problems in the area of medicine. A systematic literature review was performed comprising articles from 2015 to 2019 with the keywords; Clinical Reasoning and Medical Education. A total of 191 articles were initially found, of which 52 were analyzed as they were in accordance with the criteria designed for the study. Most studies had a qualitative design and, although they were focused on the teaching process, there was a fundamental recognition of the student in the design of strategies and methods. The theoretical and thematic categories most addressed were new trends in teaching strategies, resolution of medical practice problems, and the decrease in diagnostic error. This type of study allows the delimitation of fields of research, and clarifies the state of progress, approaches, and interests of researchers dedicated to this particular area. It is concluded that the investigation of teaching practices that lead to the promotion of argumentation in students has become a field of exploration, and introduces new perspectives in relation to the training process. This supports the need to integrate the method into teaching and learning processes of health sciences, as well as in the theoretical and methodological developments resulting from research on specific didactics.     

Utilidad de una herramienta informática para la adquisición de competencia en razonamiento clínico en logopedia

This study presents the results of a pilot experiment using a computer tool specifically designed to teach clinical diagnostics to students in Speech and Language Therapy. This computer-based tool, called Language Assessment Training System (LATS) focuses on resolving virtual clinical cases. The aim of the present study was to demonstrate the usefulness of LATS in acquiring clinical competences in diagnosing speech and language disorders. An experimental study was carried out to test this aim. A group of 60 participants took part in this experiment. These participants were 4^th year students of the Speech and Language Therapy course. They had a mean age of 25.2 (SD = 4.11) years. The study was conducted on the basis of an A-A design. The results were analysed and interpreted, and show that their skills have improved with the use of this tool.     

Reflexiones sobre la deshumanización de la educación médica: empatía,emociones y posibles recursos pedagógicos para la educación afectiva del estudiante de medicina

While medicine is going through a phase of increasing technical growth, it is also a time of increasing depersonalisation in the doctor-patient relationship. Empathy is a required element to build this relationship, and is a bridge between evidence-based medicine and patient centred clinical practice. Studies that have appraised empathy demonstrate its erosion during the undergraduate years. This fact has boosted the development of tools for assessing empathy, such as the Jefferson Scale of Physician Empathy, or the Interpersonal Reactivity Index adapted by Davis. However, the real challenge is how to promote strategies aimed at promoting empathy and to prevent its erosion. This, in short, requires strategies on how to educate student emotions and feelings that are intrinsically related to empathy. Educational tools for this purpose are emerging in the teaching scenario, represented by literature, music, poetry, narrative medicine, opera and, especially Cinematic Education. Academic and Medical Educators find it difficult to find effective answers for the current mandatory challenge of promoting empathy in the training of medical students.     

Acreditación y resultados de la educación médica en México

Objective

To determine whether the medical education programs recognised for their quality achieve better results in the National Medical Residency Examination.

Avances del Modelo Educativo para Desarrollar Actividades Profesionales Confiables (MEDAPROC)☆

The Educational Model to Develop Entrustable Professional Activities (MEDAPROC) arises as a response to the implementation of competency-based education. It is a multidisciplinary project based on interpretative epistemology, the constructivist paradigm, the transformations of the national health system, and the context of the current practice of medicine. Its purpose is to encourage the acquisition of essential knowledge, skills, and attitudes by the medical student. It integrates the international trend of the entrustable professional activities and converts them into entrustable professional activities (APROC). MEDAPROC proposes that the development of the APROC be promoted in an inverse manner, from the profile of the graduate to the beginning of the undergraduate studies. Therefore, it is involved in several phases of the learning and teaching process (planning, didactics, assessment, and feedback) through projects to implement didactic strategies and assessment resources, with the support of teacher training, educational research, and technology. Its aim is to improve medical and health sciences education, with the firm purpose of making a positive change in the health care quality from the educational environment.     

A case study about the use of the prospective strategy in the scenarization of a pedagogical workshop

IntroductionPedagogical workshop planning is challenging especially when we aim to promote a reflective practice of the tutees. This practice has been widely discussed in the literature without a real consensus. Some authors reported oral exercises or anecdotes, other described writings or even storytelling. The aim of the authors was to describe the different steps performed by the tutors and to assess the tutees’ satisfaction.Material and methodsThis was a pilot study dealing with the use of the prospective strategy principles in order to plan a pedagogical workshop. Included participants were early academic teacher trainees.ResultsThe authors illustrated how they planned a pedagogical workshop using the prospective strategy and highlighted the satisfaction of the tutees.ConclusionProspective strategy is mainly used in economic field in order to change the future of the companies by acting on different intervening factors. Associating prospective strategy to pedagogical principles hasn’t been reported in the medical literature and seems to be available in order to induce reflective practice.     

Validez de constructo y confiabilidad del ROTA-Q para la evaluación de la calidad académica de las rotaciones clínicas en estudiantes de medicina

Introduction

The availability of instruments for the evaluation of academic quality of clinical clerkships for undergraduates in Spanish language is limited. The aim of this study was to determine the construct validity and the internal consistency an instrument designed for this purpose.

The usefulness of TV medical dramas for teaching clinical pharmacology: A content analysis of House,M.D.

IntroductionTelevision medical dramas enjoy great popularity among the general public and university students. These dramas have been used to illustrate important aspects of medical training (doctor–patient relationships, professionalism, ethical conflicts), but their usefulness for discussing the use of drugs in medical care remains unexplored. We analyzed pharmacological issues in House, M.D. to determine their potential usefulness in teaching clinical pharmacology.Material and methodsTwo investigators, blind to each other's responses, reviewed each of the 22 episodes of the first season of House, M.D., recording the main and secondary topics dealt with as well as the drugs portrayed and rating the episode's interest for teaching clinical pharmacology (High/Medium/Low). Discordant ratings were settled by a third (or fourth, if necessary) investigator.ResultsMost episodes included information on drugs; in six, pharmacologic issues were the main topics. The episodes dealt with 115 drugs, mainly anti-infective (16.5%), cardiovascular (12.2%), CNS-acting (12.2%), and analgesic or anti-inflammatory (12.2%) drugs. Five episodes were considered very useful for teaching clinical pharmacology.DiscussionThe episodes of the first season of House, M.D. contained frequent references to drug treatment and pharmacological issues; in a few episodes, the main topic was related with clinical pharmacology. Before medical dramas are recommended as a regular teaching tool, their pedagogical efficacy should be tested empirically.     

Undergraduate medical students. Simulation-based activity to conduct the informed consent process for health research studies

IntroductionTraining through medical simulation allows for continuous learning under controlled conditions. Simulation-based training activities can be used simultaneously with other educational strategies to strengthen the attitudinal skills needed to develop an informed consent process in the context of health research.ObjectiveTo facilitate learning in undergraduate medicine students, and to evaluate their competences to carry out an informed consent process in a scenario that resembles reality.Materials and methodsIn this semi-longitudinal study, a simulation-based activity was conducted with 136 medical students of the fourth (Group A) and fifth year (Group B) of the Marist University of Mérida, in southern Mexico.ResultsThe mean score for both groups was 72.48 ± 1.05 (95% CI = 70.4–74.5); 86.2 ± 0.96 (95% CI = 84.2–88.0); and 77.7 ± 0.72 (95% CI = 76.3–79.1), in the pre-test, the simulation and the post-test, respectively. The students of group A self-evaluated their performance with 3.93/5.00, and those of Group B, 4.04/5.00.DiscussionThis study showed that Group A students did not score lower on simulation-based activity when compared to students in Group B, suggesting that before the fifth year of undergraduate medical education, students could properly develop an informed consent-process for health research if they receive early education about medical ethics and research bioethics. Issues related to bioethics in human health research can be included as soon as medical students initiate research methodology courses.     

The role of virtual interactive simulators in medical education: Exploring their integration as an assessment methodology in clinical years

IntroductionAssessment takes a fundamental role in medical education. In Portugal, the main assessment method used is multiple-choice questions (MCQ). The virtual interactive patients (VIP) as an assessment method can be indicated for the development of clinical reasoning for medical students of the clinical years. This study compared the use of MCQ and VIP as assessment methodologies in medical students.MethodsA randomized crossover study carried out, which 35 Portuguese medical students from clinical years evaluated by MCQ and VIP in four medical specialties. In each specialty, students randomized into two groups. One group started being evaluated by MCQ and finished with VIP, the other vice-versa. After the evaluation, students asked to complete a satisfaction questionnaire.ResultsThe final score was higher with the VIP than MCQ method (MCQ: 67.40 ± 8.96 vs. VIP: 73.34 ± 10.8; p < 0.01) with significant differences higher in Clinical History and Physical Examination. The satisfaction quiz showed although both methodologies are adequate and satisfactory, but VIP method allows to improve knowledge.ConclusionVIP is more accurate for clinical reasoning, accepted by medical students and should be integrated into the pre-graduate medical curriculum with other methodologies already used. The COVID-19 pandemic allowed a digital transformation of medical education and VIP will have a crucial role as a knowledge and evaluation method.     

Movimiento de alumnos ayudantes: experiencia de una institución cubana

The teaching-support student movement arose out of the necessity to cover the lack of teachers caused by the massive exodus of professionals at the beginning of the Cuban Revolution. Five decades later it is still alive and continuously perfects and adjusts itself according to the dynamic social requirements of the country. This article intends to describe the experience acquired at the University Hospital “Arnaldo Milián Castro” based on the work of teaching-support students in the period from 2011 to 2016, emphasising its achievements and challenges in the fulfilment of its main objectives in Cuban higher medical education such as: to support the development of the instructional and educational process, to address the professional orientation towards specialities deficient in professionals and to quickly acquire skills for teaching, research, and those related to specialities.     

Point of care ultrasound knowledge among resident doctors in Madrid's university hospitals. Influence of the induction in emergency departments with point of care ultrasound practice

BackgroundPoint of care ultrasound study (POCUS) is a relatively new technique in Spanish Emergency Departments (EDs). Nonetheless, its use is increasing, and the number of emergency doctors and the number of papers published in our country has skyrocketed in last decade. Despite this fact, there is still no evidence of how POCUS is taught in our medical schools.ObjectiveTo ascertain the level of knowledge about POCUS in first year resident doctors of three hospitals in Madrid, and one year after having worked in ED with POCUS practice.Methods and study designThe study looked at demographic aspects, POCUS knowledge, and opinions about its usefulness in the ED, prior to and after working in ED with routine use of POCUS.ResultsOf the 265 questionnaires, 197 were first-year residents (Group 1) and 68 second-year residents (Group 2). Another 55 senior medical students completed the questionnaire (Group 3). The majority of Groups 1 and 3 stated to have a very low POCUS level. Almost three-quarters (73%) of Group 2 stated having an intermediate or high level, and 26% even declared having full knowledge. More than half of the students agreed that POCUS was a useful tool in ED.ConclusionsThere is a low level of knowledge about POCUS among first-year residents. After working in POCUS qualified EDs, these resident doctors state both the importance and their higher level of knowledge of POCUS.     

High-fidelity simulation in pathophysiology courses with medical students

Introduction

Simulations make it possible to acquire various skills in a risk-free environment. The objective of this study was to assess medical student? performance in a simulation-enriched learning scenario in renal disease.

Fisiopatología y semiología clínica. ¿Dónde estamos y hacia dónde deberíamos dirigirnos?

The teaching methodology of many subjects must be rethought. In an environment where physicians have a lot of immediate access information in different formats, the memorization of concepts exposed in classical lectures followed by a multiple-choice test is clearly obsolete. The process of learning should be based on an active work by the student based on the resolution of situations that simulate what in the future will be found in the daily clinical work. In this context and aware of the enormous difficulty of a change of this depth, the interest of rehearsing new teaching experiences such as the one discussed in this same issue of Educación Médica is discussed. Only a more active participation of the students in their learning, in which the teachers become companions rather than protagonists, can guarantee the training that we want the doctors of the XXI century to achieve.     

Gradientes de idoneidad para impulsar la mejora continua de campos clínicos utilizados en programas de Especialidades Médicas en México

Objective

To develop a method for the evaluation of clinical sites through the perspective of medical residents.

La evaluación de residentes en las Unidades Docentes de Atención Familiar y Comunitaria de Madrid: ¿qué opinan los residentes y sus tutores?

Introduction

Assessment of residents is a complex process, for which the evaluation tools hardly ever produce certainty about the competence level. Residents’ teaching units have the responsibility of proposing the award of specialist degrees in health sciences, therefore they make a continuous effort to improve the process within the new regulatory framework in Spain. The opinion of tutors and residents were determined in order to address changes in the evaluation model of Primary Care teaching units in Madrid, Spain.