Objective. To determine the quality of published rheumatology-focused continuing professional development (CPD) for primary care clinicians (PCCs) for improving the care of patients with rheumatic diseases.Methods. The authors conducted a systematic review of CPD focused on rheumatology topics for PCCs. A librarian systematically searched PubMed, Embase, Web of Science, ERIC, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Sinico. Studies were limited to those conducted in North America after 1993. An extraction form that included the Medical Education Research Study Quality Instrument and the Kirkpatrick levels of learning outcomes was created through an iterative process and applied to the included articles.Results. In total, 725 articles were retrieved, of which 9 were included. Results showed that CPD was directed more at noninflammatory arthritis than inflammatory arthritis. Autoimmune diseases were underrepresented; 4 studies discussed rheumatoid arthritis, and 1 study examined rheumatologic topics broadly. Newer research tended to include multimodal approaches that combined didactic and active learning strategies, showing an evolution toward more active learning. Although online learning is increasingly popular, interventions were predominantly face-to-face, with only a single example of e-learning. Studies were predominantly of moderate quality.Conclusion. Published studies of rheumatology-focused CPD are moving toward more interactive teaching modalities and are typically conducted in person, although virtual options for rheumatology-focused CPD should be explored to improve access to CPD. Autoimmune disease is an uncommon topic in CPD and represents an area for future expansion. Efficacy was difficult to assess given that most of the studies assessed for learner satisfaction, knowledge acquisition, or behavior change, whereas only 1 study focused on patient outcomes.
A change in the contraception curriculum led to improved residents' skills in etonogestrel placement, and attitudes regarding the applicability of training in contraception to internal medicine, but did not significantly improve confidence in contraceptive counseling. These results suggest that internal medicine residencies should focus on teaching contraception to improve the attitudes in future internists who will need to address contraception in the military population. Future studies could include assessing physician preparedness for addressing contraception during general medical officer tours.
Introduction An objective of undergraduate medical education is to teach students how to think like physicians through a process called clinical reasoning. Currently, clerkship directors often feel that students enter their clinical years with a marginal comprehension of clinical reasoning concepts; instruction in this area could be improved. Although there have been previous educational studies assessing curricular interventions to improve the instruction of clinical reasoning, it is not yet known what happens at an individual level between an instructor and a small group of students in the teaching of clinical reasoning. This research will identify how clinical reasoning is being taught in a longitudinal clinical reasoning course. Methods The Introduction to Clinical Reasoning course is a 15-month-long case-based course held in the preclinical curriculum of the USU. Individual sessions involve small-group learning with approximately seven students per group. Throughout the academic year of 2018-2019, 10 of these sessions were videotaped and transcribed. All participants provided informed consent. A thematic analysis was performed using a constant comparative approach. Transcripts were analyzed until thematic sufficiency was reached. Results Over 300 pages of text were analyzed; new themes ceased to be identified after the eighth session. Topics included obstetrics, general pediatric issues, jaundice, and chest pain; these sessions were taught either by attendings, fellows, or fourth-year medical students with attending supervision. The thematic analysis revealed themes associated with clinical reasoning processes, themes associated with knowledge organization, and a theme associated with clinical reasoning in the military. The clinical reasoning process themes included problem list construction and refinement, differential diagnosis, naming and defending a leading diagnosis, and clinical reasoning heuristics. The knowledge organization themes included illness script development and refinement and semantic competence. The final theme was military relevant care. Conclusions In individual teaching sessions, preceptors emphasized problem lists, differential diagnoses, and leading diagnoses in a course designed to strengthen diagnostic reasoning in preclerkship medical students. The use of illness scripts was more often implicitly used rather than explicitly stated, and students used these sessions to use and apply new vocabularies related to a clinical presentation. Instruction in clinical reasoning could be improved by encouraging faculty to provide further context to their thinking, by encouraging the comparing and contrasting of illness scripts, and by using a shared vocabulary for clinical reasoning. Limitations of this study include that it was done in the context of a clinical reasoning course and that it was done at a military medical school, which may limit generalizability. Future studies could determine if faculty development could improve the frequency of references to the clinical reasoning processes that could improve student readiness for clerkship.
Purpose Clinical reasoning is the process of observing, collecting, analyzing, and interpreting patient information to arrive at a diagnosis and management plan. Although clinical reasoning is foundational in undergraduate medical education (UME), the current literature lacks a clear picture of the clinical reasoning curriculum in preclinical phase of UME. This scoping review explores the mechanisms of clinical reasoning education in preclinical UME. Method A scoping review was performed in accordance with the Arksey and O’Malley framework methodology for scoping reviews and is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews. Results The initial database search identified 3,062 articles. Of these, 241 articles were selected for a full-text review. Twenty-one articles, each reporting a single clinical reasoning curriculum, were selected for inclusion. Six of the reports included a definition of clinical reasoning, and 7 explicitly reported the theory underlying the curriculum. Reports varied in the identification of clinical reasoning content domains and teaching strategies. Only 4 curricula reported assessment validity evidence. Conclusions Based on this scoping review, we recommend 5 key principles for educators to consider when reporting clinical reasoning curricula in preclinical UME: (1) explicitly define clinical reasoning within the report, (2) report clinical reasoning theory(ies) used in the development of the curriculum, (3) clearly identify which clinical reasoning domains are addressed in the curriculum, (4) report validity evidence for assessments when available, and (5) describe how the reported curriculum fits into the larger clinical reasoning education at the institution.
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