Clinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings

Introduction There is a need for educational resources supporting the practice and assessment of the complex processes of clinical reasoning in the inpatient setting along a continuum of physician experience levels. Methods Using participatory design, we created a scenario-based simulation integrati...

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Autores principales:	Megan Ohmer, Steven J. Durning, Walter Kucera, Matthew Nealeigh, Sarah Ordway, Thomas Mellor, Jeffery Mikita, Anna Howle, Sarah Krajnik, Abigail Konopasky, Divya Ramani, Alexis Battista
Formato:	article
Lenguaje:	EN
Publicado:	Association of American Medical Colleges 2019
Materias:	Clinical Reasoning Simulation Standardized Patient Scenario-Based Simulation Think-Aloud Medical/Surgical Ward Medicine (General) R5-920 Education L
Acceso en línea:	https://doaj.org/article/f39c4a79e5574c74b8bd6ae97f63ca65
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spelling	oai:doaj.org-article:f39c4a79e5574c74b8bd6ae97f63ca652021-11-22T13:57:11ZClinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings10.15766/mep_2374-8265.108342374-8265https://doaj.org/article/f39c4a79e5574c74b8bd6ae97f63ca652019-09-01T00:00:00Zhttp://www.mededportal.org/doi/10.15766/mep_2374-8265.10834https://doaj.org/toc/2374-8265Introduction There is a need for educational resources supporting the practice and assessment of the complex processes of clinical reasoning in the inpatient setting along a continuum of physician experience levels. Methods Using participatory design, we created a scenario-based simulation integrating diagnostic ambiguity, contextual factors, and rising patient acuity to increase complexity. Resources include an open-ended written exercise and think-aloud reflection protocol to elicit diagnostic and management reasoning and reflection on that reasoning. Descriptive statistics were used to analyze the initial implementation evaluation results. Results Twenty physicians from multiple training stages and specialties (interns, residents, attendings, family physicians, internists, surgeons) underwent the simulated scenario. Participants engaged in clinical reasoning processes consistent with the design, considering a total of 19 differential diagnoses. Ten participants provided the correct leading diagnosis, tension pneumothorax, with an additional eight providing pneumothorax and all participants offering relevant supporting evidence. There was also good evidence of management reasoning, with all participants either performing an intervention or calling for assistance and reflecting on management plans in the think-aloud. The scenario was a reasonable approximation of clinical practice, with a mean authenticity rating of 4.15 out of 5. Finally, the scenario presented adequate challenge, with interns and residents rating it as only slightly more challenging (means of 7.83 and 7.17, respectively) than attendings (mean of 6.63 out of 10). Discussion Despite the challenges of scenario complexity, evaluation results indicate that this resource supports the observation and analysis of diagnostic and management reasoning of diverse specialties from interns through attendings.Megan OhmerSteven J. DurningWalter KuceraMatthew NealeighSarah OrdwayThomas MellorJeffery MikitaAnna HowleSarah KrajnikAbigail KonopaskyDivya RamaniAlexis BattistaAssociation of American Medical CollegesarticleClinical ReasoningSimulationStandardized PatientScenario-Based SimulationThink-AloudMedical/Surgical WardMedicine (General)R5-920EducationLENMedEdPORTAL, Vol 15 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Clinical Reasoning Simulation Standardized Patient Scenario-Based Simulation Think-Aloud Medical/Surgical Ward Medicine (General) R5-920 Education L
spellingShingle	Clinical Reasoning Simulation Standardized Patient Scenario-Based Simulation Think-Aloud Medical/Surgical Ward Medicine (General) R5-920 Education L Megan Ohmer Steven J. Durning Walter Kucera Matthew Nealeigh Sarah Ordway Thomas Mellor Jeffery Mikita Anna Howle Sarah Krajnik Abigail Konopasky Divya Ramani Alexis Battista Clinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings
description	Introduction There is a need for educational resources supporting the practice and assessment of the complex processes of clinical reasoning in the inpatient setting along a continuum of physician experience levels. Methods Using participatory design, we created a scenario-based simulation integrating diagnostic ambiguity, contextual factors, and rising patient acuity to increase complexity. Resources include an open-ended written exercise and think-aloud reflection protocol to elicit diagnostic and management reasoning and reflection on that reasoning. Descriptive statistics were used to analyze the initial implementation evaluation results. Results Twenty physicians from multiple training stages and specialties (interns, residents, attendings, family physicians, internists, surgeons) underwent the simulated scenario. Participants engaged in clinical reasoning processes consistent with the design, considering a total of 19 differential diagnoses. Ten participants provided the correct leading diagnosis, tension pneumothorax, with an additional eight providing pneumothorax and all participants offering relevant supporting evidence. There was also good evidence of management reasoning, with all participants either performing an intervention or calling for assistance and reflecting on management plans in the think-aloud. The scenario was a reasonable approximation of clinical practice, with a mean authenticity rating of 4.15 out of 5. Finally, the scenario presented adequate challenge, with interns and residents rating it as only slightly more challenging (means of 7.83 and 7.17, respectively) than attendings (mean of 6.63 out of 10). Discussion Despite the challenges of scenario complexity, evaluation results indicate that this resource supports the observation and analysis of diagnostic and management reasoning of diverse specialties from interns through attendings.
format	article
author	Megan Ohmer Steven J. Durning Walter Kucera Matthew Nealeigh Sarah Ordway Thomas Mellor Jeffery Mikita Anna Howle Sarah Krajnik Abigail Konopasky Divya Ramani Alexis Battista
author_facet	Megan Ohmer Steven J. Durning Walter Kucera Matthew Nealeigh Sarah Ordway Thomas Mellor Jeffery Mikita Anna Howle Sarah Krajnik Abigail Konopasky Divya Ramani Alexis Battista
author_sort	Megan Ohmer
title	Clinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings
title_short	Clinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings
title_full	Clinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings
title_fullStr	Clinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings
title_full_unstemmed	Clinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings
title_sort	clinical reasoning in the ward setting: a rapid response scenario for residents and attendings
publisher	Association of American Medical Colleges
publishDate	2019
url	https://doaj.org/article/f39c4a79e5574c74b8bd6ae97f63ca65
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Clinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings

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