Knowledge is not enough to solve the problems – The role of diagnostic knowledge in clinical reasoning activities

Kiesewetter, Jan; Ebersbach, René; Tsalas, Nike; Holzer, Matthias; Schmidmaier, Ralf; Fischer, Martin R.

doi:10.1186/s12909-016-0821-z

Cited by 28 publications

(29 citation statements)

References 24 publications

(25 reference statements)

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“…We have previously shown that additional knowledge beyond a solid factual knowledge base is not correlated with increased diagnostic competence [ 15 ]. This is in line with results that revealed that the application of different kinds of knowledge is not correlated with the diagnostic performance [ 16 ].…”

Section: Introductionsupporting

confidence: 91%

Diagnostic errors by medical students: results of a prospective qualitative study

et al. 2017

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BackgroundDiagnostic errors occur frequently in daily clinical practice and put patients’ safety at risk. There is an urgent need to improve education on clinical reasoning to reduce diagnostic errors. However, little is known about diagnostic errors of medical students. In this study, the nature of the causes of diagnostic errors made by medical students was analyzed.MethodsIn June 2016, 88 medical students worked on eight cases with the chief complaint dyspnea in a laboratory setting using an electronic learning platform, in summary 704 processed cases. The diagnostic steps of the students were tracked and analyzed. Furthermore, after each case the participants stated their presumed diagnosis and explained why they came to their diagnostic conclusion. The content of these explanations was analyzed qualitatively.ResultsBased on the diagnostic data gathering process and the students’ explanations, eight different causes could be identified of which the lack of diagnostic skills (24%) and inadequate knowledge base (16%) were the most common. Other causes that often contributed to a diagnostic error were faulty context generation (15%) and premature closure (10%). The causes of misdiagnosis varied per case.ConclusionsInadequate skills/knowledge and faulty context generation are the major problems in students’ clinical reasoning process. These findings are valuable for improving medical education and thus reducing the frequency of diagnostic errors in students’ later everyday clinical practice.

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Section: Introductionsupporting

confidence: 91%

Diagnostic errors by medical students: results of a prospective qualitative study

et al. 2017

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“…Clinical reasoning is an iterative process . It may take place rapidly and with little metacognitive guidance input, but this may increase the clinical reasoning error rate (Croskerry, 2003b;Graber, 2003;Kiesewetter et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Metacognitive awareness and the link with undergraduate examination performance and clinical reasoning

Welch¹,

Young²,

Johnson³

et al. 2018

MedEdPublish

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Theory: Metacognitive awareness is a component of self-regulated learning and helps us to understand and control our thinking and learning. Thinking about thinking is also an important aspect of the clinical reasoning process for medical practitioners.Hypotheses: This pilot study researched the link between metacognitive awareness and undergraduate examination performance. The Metacognitive Awareness Inventory (MAI) is a validated 52 item survey instrument for measuring metacognitive awareness. It has eight sub-scales grouped into two domains: Knowledge of Cognition and Regulation of Cognition. It was hypothesised that MAI scores would increase between first and fifth-year undergraduate medicine students and secondly that MAI scores would correlate with undergraduate examinations results.Method: Medical students at James Cook University, Australia were invited to complete the MAI and consented to give access to their examination scores. Results:The results of this pilot study found that metacognitive awareness was not significantly different between first and fifth-year undergraduates in this sample. For first-year medical undergraduates there were correlations between the Knowledge of Cognition domain and their end of year examination results, but not with the Regulation of Cognition domain. For fifth-year students there were correlations between both the Knowledge and Regulation of Cognition domains and their end of year examination results. Conclusion:This study identified that metacognitive awareness is not significantly different between first and fifthyear medical students. This may cause concern given that the study identified the importance of both MAI domains in undergraduate medical examinations. This study should be repeated on a larger scale and may confirm that raising metacognitive awareness levels among students is desirable. Increasing metacognitive awareness may raise Welch P, Young L, Johnson P, Lindsay D MedEdPublish

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“…However, diagnosing is a complex skill with estimates of the number of diagnostic errors ranging in the millions . Kiesewetter et al . categorize diagnostic knowledge in (1) conceptual knowledge or what information (e.g., “Antibiotics can cause red urine as well,” p. 3), (2) procedural knowledge consisting of strategical knowledge or how information (e.g., “One could make an ultrasound scan in order to identify free fluid,” p. 3) and conditional knowledge or why information (e.g., “Chronic kidney failure – due to this, the RAAS is activated causing the hypertension.…”

Section: Clinical Reasoning In Medicinementioning

confidence: 99%

The role of electronic health records in clinical reasoning

Berndt

Fischer²

2018

Annals of the New York Academy of Sciences

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Electronic health records (eHRs) play an increasingly important role in documentation and exchange of information in multi-and interdisciplinary patient care. Although eHRs are associated with mixed evidence in terms of effectiveness, they are undeniably the health record form of the future. This poses several learning opportunities and challenges for medical education. This review aims to connect the concept of eHRs to key competencies of physicians and elaborates current learning science perspectives on diagnostic and clinical reasoning based on a theoretical framework of scientific reasoning and argumentation. It concludes with an integrative vision of the use of eHRs, and the special role of the patient, for teaching and learning in medicine.

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Knowledge is not enough to solve the problems – The role of diagnostic knowledge in clinical reasoning activities

Cited by 28 publications

References 24 publications

Diagnostic errors by medical students: results of a prospective qualitative study

Diagnostic errors by medical students: results of a prospective qualitative study

Metacognitive awareness and the link with undergraduate examination performance and clinical reasoning

The role of electronic health records in clinical reasoning

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