Clinical Reasoning. Clinical Reasoning in Differential Diagnosis Experts use 3 main methods or a combination:  Analytic or Hypothetico-deductive  Non-analytic.

Slides:

Advertisements

Similar presentations

Learning Principles of Get Real! Science Learners learn science by participating in the real, messy & relevant practices and language of science as a culture.

Advertisements

Instructional Decision Making

Objectives Explain the purpose of the RIME feedback method.

TeachMed Clinical reasoning learning with simulated patients Guy Bisson M.D., Faculté de médecine Froduald Kabanza Ph.D., Faculté des sciences, département.

Non-Linguistic Representation Web 2.0 Tools Helping students understand and represent knowledge non- linguistically is the most under-used instructional.

Clinical Decision Making Clinicians are prone to a wide range of cognitive errors and biases in clinical judgment situations.  Only by being aware of.

Errors in the diagnostic process Hierarchy of Qualities in Medicine Frequency of diagnostic Errors Judgment under Uncertainty: Heuristics and Biases The.

Marzano Training May 24, 2013.

© C. Kemke1Expert Systems Tasks COMP 4200: Expert Systems Dr. Christel Kemke Department of Computer Science University of Manitoba.

Diagnosing – Critical Activity HINF Medical Methodologies Session 7.

Principles of Teaching and Learning in Clinical Settings Professor Hossam Hamdy University of Sharjah.

Principles of Teaching and Learning in Clinical Settings Professor Hossam Hamdy University of Sharjah.

Clinical decision making Carl Thompson UK, Centre for Evidence Based Nursing Editor, Evidence Based Nursing

Teaching and assessing clinical reasoning “The medical whodunit” Subha Ramani, Warren Hershman, Rob Lowe FDDC seminar Department of Medicine BUSM / BMC.

 D Rubosky EDUC 533 – Spring  Creating an instructional foundation based on how individuals acquire knowledge and skills o Supplement lecture.

Science Inquiry Minds-on Hands-on.

Effective Questioning in the classroom

Sharie Kranz. Technology & Pedagogy “One of the enduring difficulties about technology and education is that a lot of people think about technology first.

COPYRIGHT WESTED, 2010 Calipers II: Using Simulations to Assess Complex Science Learning Diagnostic Assessments Panel DRK-12 PI Meeting - Dec 1–3, 2010.

The Art and Science of Clinical Reasoning: The Role of Experience in Clinical Expertise Geoff Norman, Ph.D. McMaster University.

Understanding and Preventing Cognitive Errors in Healthcare Marjorie Stiegler, M.D. Department of Anesthesiology University of North Carolina at Chapel.

McGraw-Hill/Irwin © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 2: Elements of the Instruction-Learning- Assessment Model.

© 2009 McGraw-Hill Higher Education. All rights reserved. C H A P T E R 9 Complex Cognitive Processes.

1-2-3 OF OBJECTIVE WRITING Dee Dee Herrmann School of Medicine and Health Sciences Lunch & Learn Series July 22, 2015.

PBL in the clinic Hong Kong 2004 Associate Professor Liz Farmer Co chair PBL Expert Advisory Group Flinders University.

BRIDGET C. O’BRIEN, PhD UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Educating Physicians: A focus on integration, inquiry, innovation and improvement.

Measuring What Matters: Technology & the Assessment of all Students Jim Pellegrino.

This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator.

Developing learner competency in the clinical environment GRACE Session 3 GRACE Program.

Expertise Novices and experts Expertise and perception Expertise and memory Expertise and judgment Expertise and domain-specificity.

Integrating Basic Science and Clinical Teaching Using Problem Based Learning Era Buck, PhD Office of Educational Development, UTMB José M. Barral, MD,

TEACH ON THE RUN! SESSION 3: HELPING LEARNERS THINK! DIAGNOSTIC REASONING Created by Dr. Leslie Ann Sadownik.

Transfer Like a Champ! By Michelle Brazeal. Transfer Training Why do we teach?

Clinical Reasoning and Problem Solving

Evidence-Based Medicine – Definitions and Applications 1 Component 2 / Unit 5 Health IT Workforce Curriculum Version 1.0 /Fall 2010.

1 Computer Group Engineering Department University of Science and Culture S. H. Davarpanah

Decision Making Chapter 7. Definition of Decision Making Characteristics of decision making: a. Selecting a choice from a number of options b. Some information.

Effective Teaching Strategies Day 2

Generic Tasks by Ihab M. Amer Graduate Student Computer Science Dept. AUC, Cairo, Egypt.

1© 2010 by Nelson Education Ltd. Chapter Five Training Design.

Problem-Solving Approach of Allied Health Learning Community.

1 DECISION MAKING Suppose your patient (from the Brazilian rainforest) has tested positive for a rare but serious disease. Treatment exists but is risky.

Clinical Evaluation: Concepts and Processes Copyright 2008 by The Health Alliance of MidAmerica LLC.

Connecting the Characteristics Margaret Heritage UCLA/ CRESST Attributes of Other Characteristics of Effective Instruction and Assessment for Learning.

Time Efficient Clinical Teaching

ED 557 August 6, The brain seeks patterns, connections, & relationships between & among prior & new learning. (Gregory & Chatman,2001) The ability.

Blended Learning Shortlisted for...

ED 557 August 6, Amount of homework should increase as students get older. Minimal parent involvement. Identify purpose of homework Provide.

The Teacher- Child Interaction Linking Developmentally Appropriate Practices to the Characteristics of Effective Instruction.

Complex Cognitive Processes

The Key to Teaching for Performance. “The more you teach without finding out who understands the information and who doesn’t, the greater the likelihood.

PRECEPTOR PEARLS II Sonoma State University Family Nurse Practitioner Program Dr. Wendy Smith and Dr. Mary Ellen Wilkosz Part II Tools and Practice.

Myers’ Psychology for AP* David G. Myers *AP is a trademark registered and/or owned by the College Board, which was not involved in the production of,

Introduction to Math Methods Math Standards. Why can math be fun? Math can be fun because… it can have so much variety in topics. many different ways.

UDL & DIFFERENTIATION Cynthia Eason EDU 673 Instruction, Strategy for Differentiated Teaching & Learning.

Reflection Win May.

Evidence-based Medicine

Problem-Based Learning

The One Minute Preceptor

The Role of Expectancy & Self-Efficacy Beliefs

REASONING WITH UNCERTANITY

FACULTY OF MEDICINE MALANG ISLAMIC UNIVERSITY

Chapter 7 The Hierarchy of Evidence

Component 11: Configuring EHRs

Consultant’s Day, November 11th 2017

Differentiation in the Classroom

Kevin W. Eva Department of Medicine

Perceiving Other Persons and the World Around Us

Presentation transcript:

Clinical Reasoning

Clinical Reasoning in Differential Diagnosis Experts use 3 main methods or a combination:  Analytic or Hypothetico-deductive  Non-analytic or Pattern recognition  Pathognomonic signs and symptoms

Analytic Process Presenting ClinicalDiagnosticPosterior FeaturesHypothesesProbability A Dx1 Pr (Dx1) B Dx2 Pr (Dx2) C Dx3 Pr (Dx3) Elstein, 1978

Non-analytic Process PresentingFilter Clinical through prior Diagnostic Featuresepisodes Hypotheses Pr (Dx1) Pr (Dx2) Pr (Dx3) A C D B A,B,D,F B,D,G,R C,F,G,H

Combined Model of Clinical Reasoning Both analytic and non-analytic processes combined Eva et al.,2002 Patient Presents Case Representation Hypotheses Tested Non-analytic Analytic Interactive

Implications for Clinical Teachers  Teach around examples Few, complex examples - suboptimal Provide many examples Represent range of presentations of specific conditions

Implications for Clinical Teachers  Practice with cases should mimic eventual use of knowledge Working through textbook cases is NOT enough Mixed practice with multiple categories mixed together

Implications for Clinical Teachers  Do NOT rely on students to make comparisons across problems spontaneously Allow students to identify similarities in underlying concepts of distinct problems Relate principles in new examples with those in past examples Provide learners with an opportunity to reveal idiosyncratic mistakes

Implications for Clinical Teachers Encourage learners to use both analytical rule knowledge and experiential knowledge

Cognitive sciences- based training  Research study 2 different methods for training 2nd year medical students Traditional classroom based lecture Cognitive sciences-based approach (KBIT) Papa et al. 2007

Cognitive sciences- based training  Similarities Common problem Identified differentials for problem Introduced each case via use of prototype and case example

Cognitive sciences- based training  Differences KBIT group - 4 example cases per disease FS group - 1 case example per disease KBIT group - actively required to apply knowledge base towards diagnosis of practice cases (35) FS group cases, with no control over students’ active engagement in the cases

Cognitive sciences- based training  Differences KBIT - immediate online formative and contrastive feedback tailored to each student FS - not possible to deliver tailored feedback

Cognitive sciences- based training  Results KBIT group diagnosed correctly more test cases than FS group 74.2% vs 59.9% (P < 0.001; effect size = 1.42)

Cognitive Biases  Representativeness heuristic - overestimating similarity between people and events  Availability heuristic - too much weight to easily available info  Overconfidence  Confirmatory bias - bias toward positive and confirming evidence  Illusory correlation - perceiving two events as causally related when there is none  Putting initial probability at too extreme a figure and not adjusting for subsequent info Klein, 2005.

Summary  Expertise is not a matter of acquiring a general, all-inclusive reasoning strategy  No one kind of knowledge counts more than any other  Expertise in medicine derives from both formal and experiential knowledge Norman, 2007