Aprendizaje del razonamiento clínico por reconocimiento de patrón, en seminarios de casos clínicos prototipos, por estudiantes de tercer año de medicina

L, Gustavo Montaldo; L, Pedro Herskovic

doi:10.4067/s0034-98872013000700001

Cited by 12 publications

(12 citation statements)

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“…La categoría relacionada con el componente lineal concuerda con lo descrito por Montaldo y Herskovic 16 , quienes utilizan el reconocimiento de patrones de enfermedades o Illness Script (IS). En él, el método clínico, o "proceso del diagnóstico", incluye los pasos ordenados que se aplica en la búsqueda del diagnóstico mediante obtención de la información necesaria (síntomas, signos y otros datos); generación de las hipótesis diagnósticas presuntivas; comprobación de dichas hipótesis y, finalmente, emisión del diagnóstico definitivo de certeza e indicación del tratamiento.…”

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“…Así, lejos de ser una habilidad reproductiva, el razonamiento clínico involucra procesos mentales complejos, en ocasiones controversiales, pues involucra plantear y replantear diversas hipótesis, hasta lograr comprobarlas 18 , siendo el componente cíclico lo que permite reconocer el hallazgo inesperado necesario para las reformular hipótesis y redireccionar la activación de los compilados de conocimiento hasta lograr aceptar un patrón de enfermedad dado 19 . Tal como lo mencionan Montaldo y Herskovic 16 , el razonamiento clínico constituye el principal método de interacción clínica con el paciente, y supone conocimiento, reflexión y acción.…”

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Instrumento para el desarrollo del razonamiento clínico

et al. 2018

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Development of an instrument to assess clinical reasoningBackground: Teaching clinical reasoning is a challenge in medical education. Aim: To design a clinical reasoning assessment instrument. Material and Methods: Structured interviews were carried out to six physicians with at least five years experience. The Grounded Theory method was used to determine the relevant categories of the clinical reasoning process and the modified Delphi expert judgment method to validate the categories, the definition of observable behaviors and the format of the instrument. Results: The relevant reasoning categories were the reason for consultation, medical history, physical examination, additional tests, diagnosis, therapeutic options and reasoning reassessment capacity. Expert judgment assessed at a level of "strongly agree" and "agree" the sufficiency, clarity and pertinence of all categories, related observable behaviors and instrument format. The internal Kappa consistency yielded an index of 0.92. Conclusions: The resulting instrument was constructed with the following axes derived from the main categories and subcategories: reason for consultation, history, physical examination, additional tests, diagnosis, therapeutic options and reassessment capacity.

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Instrumento para el desarrollo del razonamiento clínico

et al. 2018

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“…Desde las teorías del aprendizaje, estas estrategias también pueden asociarse a un enfoque vinculado con el aprendizaje significativo y el involucramiento 13,14 , que considera un fuerte componente emocional en el proceso, integrando pensamiento, emociones y acción 13 . Desde el punto de vista de las competencias clínicas que se esperan ir formando en este período, estas aproximaciones al aprendizaje no sólo colaborarían en el desarrollo de competencias como son saber realizar la entrevista clínica y el examen físico sino también podrían ser útiles para el aprendizaje del razonamiento clínico [15][16][17][18][19] .…”

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Evaluación de aproximaciones al aprendizaje clínico a través de CEACLIN: Resultados en estudiantes de medicina en una universidad chilena

et al. 2018

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Evaluación de aproximaciones al aprendizaje clínico a través de CEACLIN: Resultados en estudiantes de medicina en una universidad chilena mariBel calDerón 1,a , Denisse zúñiga 2,b , isaBel leiva 2,3 oslanDo PaDilla 4,c , marcela Bitrán 2,d,e Clinical learning strategies among medical students Background: Throughout medical education, students are gradually incorporated into authentic clinical practice scenarios. Aim: To describe the use of clinical learning strategies by Chilean students and compare them according to sex and year of training. Material and Methods: The Clinical Learning Strategies Questionnaire (CEACLIN) was applied to 336 students from the 4 th to 6 th year of medicine at a Chilean university. Results: The most frequently reported strategies were related to the search for autonomy, reliable environments for learning, observation of others and attention to emotions. The less frequent was the handling of academic burden. Gender accounted for significant differences in eight of the 11 strategies identified by CEACLIN, while years of training accounted for five of the 11. The cluster analysis identified two groups: the first group comprised nine CEACLIN strategies, with a slightly higher proportion of women and 5 th and 6 th year students. The second group consisted mainly of men in the 4 th year. Conclusions: Reported strategies include a set of actions oriented to the development of autonomy and confidence through the search for valid information and learning from and with others. These findings are associated with sex and year of training.

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“…This is consistent with the current literature, since it has been described that the most important part of the teaching of clinical reasoning emphasizes the mental process by which thinking is organized, rather than on the result alone. 1,11 Regarding the context, in both instances they refer to it as a case or clinical scenario, when facing a patient. The way in which contextual factors impact the clinical reasoning performance of medical students has been studied.…”

Section: Clinical Reasoningmentioning

confidence: 99%

Changes in clinical reasoning and cognitive error after a intensive online course: A Qualitative study in medical students

Bezanilla

Bernstein

lveda

et al. 2020

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Introduction: Clinical reasoning is a crucial competence for medical practice and also a complex task that is susceptible to cognitive errors. It is usually taught based on whole clinical cases, from a practical rather than from a conceptual perspective. Addressing the need to improve clinical reasoning teaching into undergraduate medical curricula, it was hypothesized that medical students could benefit from a practice and theoretical approach to the clinical reasoning process. Methods: A four week online course, based on simulation and groupal reflective practice was developed, to promote metacognition between the participants. The course was delivered to 8 sixth year medical students as an elective module. A questionnaire consistent of four open-ended questions was designed to explore knowledge about clinical reasoning and cognitive errors, and was applied at the beginning and at the end of the course. A qualitative analysis was conducted with Berelson content analysis method. Results: After the course the students changed their understanding about clinical reasoning, considering it more like a process and identifying the dual nature described in modern theories of clinical decision making. Also they changed their knowledge about cognitive errors, attributing them not only to lack of knowledge, and understanding that they can actively practice some strategies to reduce cognitive bias. Discussion: This study confirmed that undergraduate students change in a positive way their concept of clinical reasoning and their knowledge about this cognitive process and cognitive errors that occur on it after a course that includes simulation and reflection.

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Aprendizaje del razonamiento clínico por reconocimiento de patrón, en seminarios de casos clínicos prototipos, por estudiantes de tercer año de medicina

Abstract: Teaching of clinical reasoning to medical students using prototypical clinical cases (Rev Med Chile 2013; 141: 823-830).

Cited by 12 publications

References 11 publications

Instrumento para el desarrollo del razonamiento clínico

Instrumento para el desarrollo del razonamiento clínico

Evaluación de aproximaciones al aprendizaje clínico a través de CEACLIN: Resultados en estudiantes de medicina en una universidad chilena

Changes in clinical reasoning and cognitive error after a intensive online course: A Qualitative study in medical students

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