Clinical Reasoning Workshop: Lumbosacral Spine and Hip Disorders

Alex Moroz, Alex Moroz

Abstract

Introduction: Helping physicians-in-training develop effective clinical reasoning skills may facilitate progression to expertise, reduce diagnostic errors, and improve patient safety. Using our previous experience, we developed a workshop that reviews musculoskeletal lumbar spine and hip conditions. This workshop also uses deductive and inductive modes of clinical reasoning and provides opportunities for learners to practice toggling from one to another while reviewing.

Methods: Using exemplar musculoskeletal vignettes, this workshop allows residents to practice engaging and toggling between both modes of information processing. This workshop also includes pre- and posttests, small-group learning, and a small-group competition.

Results: The workshop was implemented with a group of 26 physical medicine and rehabilitation residents. Although residents did well on the pretest, the workshop improved their test performance. Residents liked the workshop and thought it improved their diagnostic ability.

Discussion: A workshop that included team- and case-based learning, key features assessment, script theory, and gamification was effective in engaging residents and resulted in high resident satisfaction and the perception of increased ability to tackle clinical problems. Learning from our experience with the previous workshop resulted in significant reduction in faculty time required, and increased the number of residents who were able to complete both pre- and posttests.

Keywords: Clinical Reasoning; Dual Processing Theory; Musculoskeletal.

Conflict of interest statement

None to report.

References

    1. Mamede S, van Gog T, Moura AS, et al. Reflection as a strategy to foster medical students' acquisition of diagnostic competence. Med Educ. 2012;46(5):464–472.
    1. Schmidt HG, Mamede S, van den Berge K, van Gog T, van Saase JL, Rikers RM. Exposure to media information about a disease can cause doctors to misdiagnose similar-looking clinical cases. Acad Med. 2014;89(2):285–291.
    1. Sibbald M, de Bruin ABH. Feasibility of self-reflection as a tool to balance clinical reasoning strategies. Adv Health Sci Educ Theory Pract. 2012;17(3):419–429.
    1. Kyriacou DN. Evidence-based medical decision making: deductive versus inductive logical thinking. Acad Emerg Med. 2004;11(6):670–671.
    1. Lubarsky S, Dory V, Audétat MC, Custers E, Charlin B. Using script theory to cultivate illness script formation and clinical reasoning in health professions education. Can Med Educ J. 2015;6(2):e61–e70.
    1. Weinstein A, Pinto-Powell R. Introductory clinical reasoning curriculum. MedEdPORTAL Publications. 2016;12:10370
    1. Norman GR, Monteiro SD, Sherbino J, Ilgen JS, Schmidt HG, Mamede S. The causes of errors in clinical reasoning: cognitive biases, knowledge deficits, and dual process thinking. Acad Med. 2016;92(1):23–30.
    1. Soares S, Wang H, Siddharthan T, Holt S. OSCE-based teaching of the musculoskeletal exam to internal medicine residents and medical students: neck and spine. MedEdPORTAL Publications. 2015;11:10120
    1. Moroz A. Clinical reasoning workshop: cervical spine and shoulder disorders. MedEdPORTAL Publications. 2017;13:10560
    1. Dolmans DHJM, Tigelaar D. Building bridges between theory and practice in medical education using a design-based research approach: AMEE Guide No. 60. Med Teach. 2012;34(1):1–10.
    1. Levin M, Cennimo D, Chen S, Lamba S. Teaching clinical reasoning to medical students: a case-based illness script worksheet approach. MedEdPORTAL Publications. 2016;12:10445
    1. Yardley S, Teunissen PW, Dornan T. Experiential learning: AMEE Guide No. 63. Med Teach. 2012;34(2):e102–e115.
    1. Bordage G, Lemieux M. Semantic structures and diagnostic thinking of experts and novices. Acad Med. 1991;66(9)(suppl):S70–S72.
    1. Hrynchak P, Takahashi SG, Nayer M. Key-feature questions for assessment of clinical reasoning: a literature review. Med Educ. 2014;48(9):870–883.
    1. Downing SM, Yudkowski R, eds. Assessment in Health Professions Education. New York, NY: Routledge; 2009.
    1. Kirkpatrick DL, Kirkpatrick JD. Evaluating Training Programs: The Four Levels. 3rd ed. San Francisco, CA: Berrett-Koehler Publishers; 2006.
    1. Fatmi M, Hartling L, Hillier T, Campbell S, Oswald AE. The effectiveness of team-based learning on learning outcomes in health professions education: BEME Guide No. 30. Med Teach. 2013;35(12):e1608–e1624.
    1. Thistlethwaite JE, Davies D, Ekeocha S, et al. The effectiveness of case-based learning in health professional education. a BEME systematic review: BEME Guide No. 23. Med Teach. 2012;34(6):e421–e444.
    1. Hamari J, Koivisto J, Sarsa H. Does gamification work?—A literature review of empirical studies on gamification. Paper presented at the 47th Hawaii International Conference on System Sciences; January 6–9, 2014; Waikoloa, HI.
    1. Rogoff B. Developing understanding of the idea of communities of learners. Mind, Cult, Activity. 1994;1(4):209–229.

Source: PubMed

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