A Proposed Theoretical Framework for Clinical Judgment in EMS

Gugiu, Mihaiela Ristei; McKenna, Kim D.; Platt, Thomas E.; Panchal, Ashish R.

doi:10.1080/10903127.2022.2048756

Cited by 8 publications

(10 citation statements)

References 32 publications

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“…Understanding the complex construct of clinical judgment is an important step to enhance EMS initial and continuing education, clinician assessment, and the development of clinical tools to support decision-making. 4 In this study, after deriving the tasks and KSAs for communication, leadership and clinical judgment, we identi ed no difference between the Task-KSA matrices for AEMT and paramedic certi cation levels recognizing that these higher order constructs are similar for any ALS care. Furthermore, a comparison of the Task-KSA matrices for both leadership and communication with clinical judgment demonstrated a large amount of commonality supporting the hypothesis that the higher order construct of clinical judgment subsumes both leadership and communication.…”

Section: Discussionmentioning

confidence: 72%

Understanding Higher-order Constructs of Leadership and Communication in EMS Clinical Judgment

Gugiu,

Cotto,

Burgess

et al. 2024

Preprint

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BACKGROUND: For emergency medical services (EMS) clinicians, clinical judgment is a higher-order construct that encompasses the initial thought process (clinical reasoning) that assists clinicians in reaching conclusions (clinical decision making). Current theoretical frameworks of clinical judgment contain other higher order constructs (e.g., leadership, communication) which may play a significant role in delivery of care. It is unknown whether this definition of clinical judgment does include additional higher order constructs of leadership and communication. The goal of this evaluation was to determine whether leadership and communication overlap and are subsumed under the larger construct of clinical judgment. METHODS: Focus groups of experts in prehospital paramedic and advanced emergency medical technician levels of certification were recruited to generate tasks and their associated knowledge, skills, and abilities (KSAs) in for the domains of clinical judgment, communication, and leadership. These tasks and KSAs were then evaluated for commonality between the domains to evaluate whether communication and leadership are incorporated within clinical judgment. RESULTS: Task-KSA matrices were generated by focus groups for each domain and evaluated by certification level. There were no differences by certification level in the tasks-KSA matrices for the domains. A total of 77 tasks were identified, comprised of 392 KSAs across three domains (9 sub-domains). An analysis of commonality of tasks between the domains of communication and leadership with clinical judgment demonstrated that 61% of communication tasks were similar to the identified clinical judgment tasks. Similarly, in leadership, clinical judgment had a total of 79% commonality overall. CONCLUSION: Clinical judgment was found to be a higher order construct that overlaps with and incorporates the domains of leadership and communication in the theoretical framework of EMS clinical judgment. This study provides validity evidence for the proposed clinical judgment theoretical framework. Future work should focus on pilot evaluations in simulated settings for building additional construct validity.

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Section: Discussionmentioning

confidence: 72%

Understanding Higher-order Constructs of Leadership and Communication in EMS Clinical Judgment

Gugiu,

Cotto,

Burgess

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

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“…Emergency medical services (EMS) clinicians encounter a variety of seriously ill or injured patients on a consistent basis 1 . The specific nature and circumstances around each patient's needs are unpredictable and wide ranging 1 . Simulation is an integral part of initial and continuing paramedic education, and supports paramedic students in their training to safely diagnose and treat a wide variety of patients.…”

Section: Introductionmentioning

confidence: 99%

“…Clinical reasoning has been defined as the "thought process a clinician uses to evaluate a problem." 1 Simulation continues to show evidence of being one of the most effective ways to teach clinical reasoning and has…”

Section: Introductionmentioning

confidence: 99%

“…EMS clinicians are required to make quick observations of dynamic environments, perform thorough patient assessments, establish a diagnosis, and create an evidence‐based treatment plan in a matter of minutes which requires impeccable clinical reasoning ability. Clinical reasoning has been defined as the “thought process a clinician uses to evaluate a problem.” 1 Simulation continues to show evidence of being one of the most effective ways to teach clinical reasoning and has shown to be as effective as lecture‐based education 2–10 . The evidence presented in these and other studies led the National League of Nurses in 2003 to endorse the use of simulations to improve the critical thinking and self‐reflection abilities of nursing students in preparation for complex clinical environments 3 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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SMARTSIM A multicenter prospective randomized trial of 3D virtual reality versus traditional patient simulation

Donathan,

LaLumia,

Foat

et al. 2023

JACEP Open

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ObjectiveSimulations are an integral part of paramedic education. Technological advancements have introduced three‐dimensional virtual reality patient simulations (3DVRS), offering a low‐cost, accessible alternative. This study compares the impact of 3DVRS and traditional simulation on paramedic students.MethodsStudents selected from a convenience sample of 11 cohorts in 10 accredited programs distributed across the United States were allocated to 2 groups using a stratified random sampling. One group received simulations via 3DVRS, the second used traditional in‐person simulation. Students were exposed to 6 scenarios over 2 h from the National Association of Emergency Medical Technicians (NAEMT) Advanced Medical Life Support (AMLS) program. Altered mental status scenarios were selected a priori by the research team containing approximately 30 potential differential diagnoses. A 50‐item posttest was administered using validated cognitive items provided by Fisdap.ResultsA multicenter prospective randomized trial of 174 paramedic students was undertaken from April until August of 2022. The traditional simulation group was comprised of 88 students and the 3DVRS group had 86 students. A Mann–Whitney U test (U = 4064.5, n1 = 88, n2 = 86, p = 0.396) detected no statistical difference between two distributions or median exam score (70%), the range of values and interquartile range (IQR) for both groups: TS IQR = 64–75 (range, 32–82); 3DVRS IQR = 64–76 (range, 34–86).ConclusionNo difference in exam scores using 3DVRS versus traditional simulation was detected. Paramedic programs may have an effective new option when incorporating simulation with 3DVRS, potentially reducing financial and real‐estate resources required with in‐person simulations. Larger studies are needed to truly evaluate the impact and usability of virtual reality on paramedic education.

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Older patients’ perceptions of the Swedish ambulance service: A qualitative exploratory study

Rantala¹,

Sterner²,

Frank³

et al. 2023

Australasian Emergency Care

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A Proposed Theoretical Framework for Clinical Judgment in EMS

Cited by 8 publications

References 32 publications

Understanding Higher-order Constructs of Leadership and Communication in EMS Clinical Judgment

Understanding Higher-order Constructs of Leadership and Communication in EMS Clinical Judgment

SMARTSIM A multicenter prospective randomized trial of 3D virtual reality versus traditional patient simulation

Older patients’ perceptions of the Swedish ambulance service: A qualitative exploratory study

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A Proposed Theoretical Framework for Clinical Judgment in EMS

Cited by 8 publications

References 32 publications

Understanding Higher-order Constructs of Leadership and Communication in EMS Clinical Judgment

Understanding Higher-order Constructs of Leadership and Communication in EMS Clinical Judgment

*SMARTSIM* A multicenter prospective randomized trial of 3D virtual reality versus traditional patient simulation

Older patients’ perceptions of the Swedish ambulance service: A qualitative exploratory study

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Product

Resources

About

SMARTSIM A multicenter prospective randomized trial of 3D virtual reality versus traditional patient simulation