The development of expertise in dermatology

Norman, Geoff

doi:10.1001/archderm.125.8.1063

Cited by 53 publications

(40 citation statements)

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“…The remediation plan was intentionally created using our understanding of the clinical reasoning process and prior work on the development of expertise. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]34,35 The steps provide a concrete way of teaching discrete skills needed to problem solve in medicine.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22] The ability to create and recall illness scripts, or mental models of disease, and compare and contrast these scripts results in better clinical reasoning. 23,24 Semantic qualifiers provide abstract, qualitative descriptions of a case's signs and symptoms that allow for generation of problem representation, and build in oppositions that allow for comparing and contrasting relevant diagnoses. An example of a sematic qualifier is as follows: for a 55-year-old African American male with an acute, episodic, monoarticular arthritis, the terms African American, male, acute, episodic and monoarticular all serve to categorize the presentation and are semantic qualifiers.…”

Section: Introductionmentioning

confidence: 99%

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Methods and Outcomes for the Remediation of Clinical Reasoning

Guerrasio

Aagaard

2014

J GEN INTERN MED

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INTRODUCTION:There is no widely accepted structured, evidence based strategy for the remediation of clinical reasoning skills. AIM: To assess the effectiveness of a standardized clinical reasoning remediation plan for medical learners at various stages of training. SETTING: Learners enrolled in the University of Colorado School of Medicine Remediation Program. PROGRAM DESCRIPTION: From 2006 to 2012, the learner remediation program received 151 referrals. Referrals were made by medical student clerkship directors, residency and fellowship program directors, and through self-referrals. Each learner's deficiencies were identified using a standardized assessment process; 53 were noted to have clinical reasoning deficits. The authors developed and implemented a ten-step clinical reasoning remediation plan for each of these individuals, whose subsequent performance was independently assessed by unbiased faculty and senior trainees. Participant demographics, faculty time invested, and learner outcomes were tracked. PROGRAM EVALUATION: Prevalence of clinical reasoning deficits did not differ by level of training of the remediating individual (p=0.49). Overall, the mean amount of faculty time required for remediation was 29.6 h (SD=29.3), with a median of 18 h (IQR 5-39) and a range of 2-100 h. Fiftyone of the 53 (96 %) passed the post remediation reassessment. Thirty-eight (72 %) learners either graduated from their original program or continue to practice in good standing. Four (8 %) additional residents who were placed on probation and five (9 %) who transferred to another program have since graduated. DISCUSSION: The ten-step remediation plan proved to be successful for the majority of learners struggling with clinical reasoning based on reassessment and limited subsequent educational outcomes. Next steps include implementing the program at other institutions to assess generalizability and tracking long-term outcomes on clinical care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Methods and Outcomes for the Remediation of Clinical Reasoning

Guerrasio

Aagaard

2014

J GEN INTERN MED

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“…This assumption is based on an "independent cues" model of expertise, whereby knowledge of the diagnostic features of cancerous lesions forms the basis of skilled performance in dermatology (Kellogg & Bourne, 1989). Research investigating the development of expertise in dermatology, however, has refuted this model of expertise (Norman, Rosenthal, Brooks, Allen & Muzzin, 1989). Norman, et al found that when a dermatologist inspected a suspicious skin lesion, it was usually judged as a whole without regard to individual features.…”

mentioning

confidence: 99%

“…In this respect, expertise in dermatology may be more closely allied with expertise in radiology and histology than with other medical disciplines (Norman, et al, 1989).…”

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confidence: 99%

Skill Acquisition in Skin Cancer Detection

et al. 2010

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Previous research has shown that the ability to detect potentially dangerous skin lesions is not improved by viewing a pamphlet describing the characteristic features of such lesions. A different approach to improving this skill was investigated in this study. 100 student recruits were tested to investigate the effect of practice at distinguishing between dangerous and nondangerous skin lesions. Around 30 minutes of such practice, viewing 360 pictures of skin lesions, provided a significant advantage in making decisions about a target set of dangerous and nondangerous lesions, compared to no practice or practice with a filler task. Viewing a skin cancer pamphlet for 5 min. at the beginning of the experiment made no difference to the speed or accuracy of decisions regarding the test lesions. The results are interpreted as evidence for a form of implicit learning of a skin cancer detection skill, a finding that is consistent with what is known of the nature of expertise in dermatologists. The results also point to the ineffectiveness of pamphlets to engender such expertise in the general public.

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“…Un beneficio adicional de este tipo de estrategia educativa es el producto colateral de proporcionar mejor información para el profesor clínico con relación a cuando los estudiantes puedan estar experimentando dificultades. Es bien conocido que los expertos tienen dificultades para predecir los errores que hacen otros 45 . Proporcionando a los estudiantes una oportunidad para descubrir errores idiosincrásicos capacita a los profesores clínicos para focalizar los esfuerzos de enseñanza en la dirección que sea más probable beneficiar a los estudiantes individuales.…”

Section: Implicaciones Para Los Profesores Clínicosunclassified

Lo que todo profesor necesita saber sobre el razonamiento clínico

Kevin

2005

Educ. méd.

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Contexto: Una de las tareas nucleares que se asignan a los profesores clínicos es capacitar a los estudiantes para escoger entre un grupo de características que presenta un paciente y asignar con precisión una etiqueta diagnóstica con el objetivo final de desarrollar una estrategia de tratamiento apropiada. Durante los últimos 30 años se ha debatido considerablemente en el seno de la literatura en Educación en Ciencias de la Salud, sobre el modelo que mejor describe cómo los clínicos expertos generan decisiones diagnósticas. Propósito: El propósito de este ensayo es proporcionar una revision bibliográfica de la investigación sobre razonamiento clínico. Los puntos fuertes y débiles de las diferentes aproximaciones del razonamiento clínico se examinarán usando una de las principales divergencias se da entre los modelos de estrategia de razonamiento analítico (p.ej., consciente / controlado) versus estrategias de razonamiento no analítico (p.ej., Context: One of the core tasks assigned to clinical teachers is to enable students to sort through a cluster of features presented by a patient and accurately assign a diagnostic label, with the development of an appropriate treatment strategy being the end goal. Over the last 30 years there has been considerable debate within the Health Sciences Education literature regarding the model that best describes how expert clinicians generate diagnostic decisions. Purpose: The purpose of this essay is to provide a review of the research literature on clinical reasoning for frontline clinical teachers. The strengths and weaknesses of different approaches to clinical reasoning will be examined using one of the core divides between various models (that of analytic (i.e., conscious/controlled) versus non-analytic (i.e., unconscious/automatic) reasoning strategies) as an orienting framework. Discussion: Recent work suggests that clinical teachers should stress the importance of both forms of reasoning, thereby enabling students to marshal Lo que todo profesor necesita saber sobre el razonamiento clínico* Correspondencia:

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The development of expertise in dermatology

Cited by 53 publications

References 0 publications

Methods and Outcomes for the Remediation of Clinical Reasoning

Methods and Outcomes for the Remediation of Clinical Reasoning

Skill Acquisition in Skin Cancer Detection

Lo que todo profesor necesita saber sobre el razonamiento clínico

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