Teaching Clinical Reasoning as a Thinking Frame

Neistadt, Maureen E.

doi:10.5014/ajot.52.3.221

Cited by 38 publications

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“…6 Clinical reasoning is a cognitive and procedural process that has 3 core dimensions: knowledge, cognition, and metacognition. 3 Cognition is the use of higher-level thinking skills, whereas metacognition is a form of reflective selfawareness in which a student is instructed to think about thinking.…”

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“…3 Metacognition, which is the act of connecting knowledge and cognition, is a much more elusive facet of reasoning. The development and assessment of clinical reasoning skills have become focuses of education programs in several disciplines, including medicine, 4,7,8 nursing, 9,10 occupational therapy, 6,11,12 and physical therapy. 13 However, few researchers have investigated clinical reasoning during the athletic training clinical education process.…”

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confidence: 99%

“…Several clinical reasoning techniques, including case studies, 6 journaling, 9 problem-based learning, 12 peer coaching, 13 and role play, 8 have been used to evaluate the expression of clinical reasoning in allied health and medical students. However, each technique has limitations.…”

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A Learner-Centered Technique and Clinical Reasoning, Reflection, and Case Presentation Attributes in Athletic Training Students

Heinerichs

Vela

Drouin

2013

Journal of Athletic Training

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Context: Providing opportunities to develop clinical decision-making skills, including clinical reasoning, is an important aspect of clinical education. The learner-centered technique of summarizing the history and findings, narrowing the differential, analyzing the differential, probing the instructor about uncertainties, plan management, and selecting an issue for selfdirected study (SNAPPS) is used in medicine to express clinical reasoning.Objective: To investigate the effects of SNAPPS on the clinical reasoning, reflection, and 4 case presentation attributes (length, conciseness, case summary, and expression of clinical reasoning) in athletic training students.Design: Randomized controlled clinical trial. Setting: Three undergraduate programs accredited by the Commission on Accreditation of Athletic Training Education.Patients or Other Participants: We randomly assigned 38 athletic training students (17 men, 21 women; age ¼ 21.53 6 1.18 years, grade point average ¼ 3.25 6 0.31) who had completed at least 1 year of clinical education and all orthopaedic evaluation coursework to the SNAPPS group or the usual and customary group using a stratification scheme.Intervention(s): The SNAPPS group completed four 45-minute clinical reasoning and case presentation learning modules led by an investigator to learn the SNAPPS technique, whereas the usual and customary group received no formal instruction. Both groups audio recorded all injury evaluations performed over a 2-week period.Main Outcome Measures: Participants completed the Diagnostic Thinking Inventory and Reflection in Learning Scale twice. Case presentations were analyzed for 4 attributes: length, conciseness, case summary, and expression of clinical reasoning.Results: Case presentations were longer (t 18.806 ¼ À5.862, P , .001) but were more concise (t 32 ¼ 11.297, P , .001) for the SNAPPS group than for the usual and customary group. The SNAPPS group performed better on both the case summary subscale (t 32 ¼ 2.857, P ¼ .007) and the clinical reasoning subscale (t 25.773 ¼À14.162, P , .001) than the other group. We found a time effect for Diagnostic Thinking Inventory scores (F 1,34 ¼ 6.230, P ¼ .02) but observed no group effects (F 1,34 ¼ 0.698, P ¼ .41) or time-by-group interaction (F 1,34 ¼ 1.050, P ¼ .31). The Reflection in Learning Scale scores analysis revealed no group-by-time interaction (F 1,34 ¼ 1.470, P ¼ .23) and no group (F 1,34 ¼ 3.751, P ¼ .06) or time (F 1,34 ¼ 0.835, P ¼ .37) effects.Conclusions: The SNAPPS is an effective and feasible clinical education technique for case presentations. This learnercentered technique provides the opportunity for the expression of clinical reasoning skills.Key Words: learning styles, metacognition, clinical education Key PointsThe expression of clinical reasoning and uncertainties is possible in the athletic training environment with the learner-centered technique of summarizing the history and findings, narrowing the differential, analyzing the differential, probing the instructor about uncertainties, plan ...

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A Learner-Centered Technique and Clinical Reasoning, Reflection, and Case Presentation Attributes in Athletic Training Students

Heinerichs

Vela

Drouin

2013

Journal of Athletic Training

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“…27 The decision tools provided in this workshop may help to influence thought processes by providing a structure to frame and categorize complex aspects of a clinical situation to guide clinical practice. 28 This is similar to the concept of scaffolding, a metaphor for providing learning support, such as clinical algorithms, during teaching as one provides a physical scaffold around a building under construction, and which addresses the learning of concepts and metacognitive skills. 29,30 Several studies have described the use of instructional scaffolds as structured approaches to facilitate learning.…”

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confidence: 99%

Education to Improve Dementia Care:

Lee

Weston

Hillier

2018

Fam Med

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BACKGROUND AND OBJECTIVES: Dementia often goes undiagnosed. A workshop was developed to provide primary care clinicians with a structured clinical reasoning approach to dementia diagnosis and brain map tool to differentiate type of dementia. The purpose of this study was to examine the impact of this approach on self-perceived changes in knowledge, confidence, and ability to assess and manage memory problems and on self-reported application of learning to clinical practice. METHODS:Participants of 20 workshops (N=392) were invited to complete a reaction survey and of these, participants of 12 consecutive workshops (N=242) were invited to complete a 3-month follow-up survey to assess application of new learning to clinical practice and challenges experienced in doing so. RESULTS:In total, 355 reaction and 108 follow-up surveys were completed. Mean ratings of usefulness reflected that participants considered the clinical reasoning approach and brain map very useful to learning and knowledge transfer. At follow-up, the majority of respondents reported they were more confident (79%) and better able to assess (79%) persons with cognitive impairment and more confident (88%) and better able to manage (86%) persons with cognitive impairment. A number of practice changes and challenges were identified. CONCLUSIONS:These results add to a growing literature on strategies to improve dementia care with effective continuing medical education. A structured clinical reasoning approach to cognitive impairment is effective in improving confidence and ability to assess and manage patients with cognitive impairment, although participants continue to experience challenges in managing this complex condition.

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“…Developing competent clinical reasoning skills among students is complicated by a rapidly changing clinical environment that focused on cost containment, funding, and complex health care technology (Neistadt, 1998) and by need for students to learn routine and standard clinical skills during fieldwork (Cohn, 1989). The demand for high quality care has led occupational therapy clinical supervisors to insist that both students and new staff have clinical reasoning skills in addition to technical skills (Cortellini-Benamy, 1990).…”

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Clinical Reasoning and Reflective Practice: Implications of Fieldwork Activities

Sladyk

Sheckley

2001

Occupational Therapy In Health Care

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Objectives. Theories and research suggest that learning clinical reasoning skills requires students to be reflective in their practice. To explain this proposition, five research questions were developed to examine the effect of: (a) the fieldwork experience on clinical reasoning skills, (b) degree of participation in different clinical reasoning activities on clinical reasoning skills, and (c) the total number of clinical reasoning activities in which students participated related to clinical reasoning. Method. Data (n = 70) were collected using a researcher-developed case analysis test, the Adaptive Style Inventory, and a questionnaire. Paired t tests, ANCOVA, and multiple regressions were used to analyze the data from the research questions. Results. Fieldwork does improve clinical reasoning skills (large effect size). Participation in activities thought to develop clinical reasoning skills was mixed. Conclusion. The results support the improvement of fieldwork as a mode of developing clinical reasoning skills in occupational therapy students.

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Teaching Clinical Reasoning as a Thinking Frame

Abstract: The results suggest that using a clinical reasoning thinking frame to organize clinical observations is an effective way to help entry-level occupational therapy students learn and apply clinical reasoning concepts.

Cited by 38 publications

References 5 publications

A Learner-Centered Technique and Clinical Reasoning, Reflection, and Case Presentation Attributes in Athletic Training Students

A Learner-Centered Technique and Clinical Reasoning, Reflection, and Case Presentation Attributes in Athletic Training Students

Education to Improve Dementia Care:

Clinical Reasoning and Reflective Practice: Implications of Fieldwork Activities

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