scholarly journals Evaluating Evidence-Informed Clinical Reasoning Proficiency in Oral Practical Examinations

2014 ◽  
Vol 9 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Paul R. Geisler ◽  
Chris Hummel ◽  
Sarah Piebes
Keyword(s):  
Athletic Training ◽  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Clinical Performance ◽  
Clinical Decision ◽  
Athletic Injury ◽  
Evidence Based ◽  
Biomedical Knowledge ◽  
Relevant Evidence ◽  
Key Features

Clinical reasoning is the specific cognitive process used by health care practitioners to formulate accurate diagnoses for complex patient problems and to set up and carry out effective care. Athletic training students and practitioners need to develop and display effective clinical reasoning skills in the assessment of injury and illness as a first step towards evidence-based functional outcomes. In addition to the proper storage of and access to appropriate biomedical knowledge, an equally important component of effective clinical reasoning is the ability to select and interpret various conclusions from the mounting quantity of evidence-based medicine (EBM) sources. In assessing injury and illness, this competency is particularly reliant upon experience, skill execution, and available evidence pertaining to the diagnostic accuracy and utility of various special tests and physical examination procedures. In order to both develop and assess the ability of our students to integrate EBM into their clinical reasoning processes, we have designed exercises and evaluations that pertain to evidence-based clinical decision making during oral practical examinations in our assessment of athletic injury labs. These integrated oral practical examinations are designed to challenge our students' thinking and clinical performance by providing select key features of orthopaedic case pattern presentations and asking students to pick the most fitting diagnostic tests to fit that particular case. Students must not only match the appropriate special/functional tests, etc, to the case's key features, but also choose and explain how useful the chosen tests are for the differential diagnosis process, relative to the best diagnostic evidence. This manuscript will present a brief theoretical framework for our model and will discuss the process we use to evaluate our students' ability to properly select, perform, and explain various orthopaedic examination skills and the relevant evidence available. Specific examples of oral practical exam modules are also provided for elucidation.

Supporting the Development of Clinical Reasoning of Preprofessional Novices in Dysphagia Management

2019 ◽  
Vol 40 (03) ◽  
pp. 151-161 ◽  
Author(s):  
Sebastian Doeltgen ◽  
Stacie Attrill ◽  
Joanne Murray
Keyword(s):  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Management Practice ◽  
Clinical Decision ◽  
Assessment Process ◽  
Evidence Based ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Implicit Processing ◽  
Reasoning Skills

AbstractProficient clinical reasoning is a critical skill in high-quality, evidence-based management of swallowing impairment (dysphagia). Clinical reasoning in this area of practice is a cognitively complex process, as it requires synthesis of multiple sources of information that are generated during a thorough, evidence-based assessment process and which are moderated by the patient's individual situations, including their social and demographic circumstances, comorbidities, or other health concerns. A growing body of health and medical literature demonstrates that clinical reasoning skills develop with increasing exposure to clinical cases and that the approaches to clinical reasoning differ between novices and experts. It appears that it is not the amount of knowledge held, but the way it is used, that distinguishes a novice from an experienced clinician. In this article, we review the roles of explicit and implicit processing as well as illness scripts in clinical decision making across the continuum of medical expertise and discuss how they relate to the clinical management of swallowing impairment. We also reflect on how this literature may inform educational curricula that support SLP students in developing preclinical reasoning skills that facilitate their transition to early clinical practice. Specifically, we discuss the role of case-based curricula to assist students to develop a meta-cognitive awareness of the different approaches to clinical reasoning, their own capabilities and preferences, and how and when to apply these in dysphagia management practice.

Integrating Evidence-Based Practice in Athletic Training Though Online Learning

2018 ◽  
pp. 5810-5819
Author(s):  
Brittany A. Vorndran ◽  
Michelle Lee D'Abundo
Keyword(s):  
Decision Making ◽  
Online Learning ◽  
Continuing Education ◽  
Athletic Training ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Athletic Trainers ◽  
Clinical Decision ◽  
Evidence Based ◽  
Primary Method

Evidence-based practice (EBP) involves a health care professional using his or her own knowledge, the current research published, and the needs of the patient to make the best clinical decision. This has been a hot topic in many different branches of healthcare and recently athletic trainers have begun to embrace its importance. In December of 2015, athletic trainers (ATs) will need to have completed ten of their fifty continuing education units (CEUs) in EBP to maintain certification. While ATs recognize the significance of implementing EBP into clinical decision making, there are many barriers slowing the change. This chapter includes information about how EBP is currently being used by athletic training clinicians and educators, the barriers ATs perceive to using EBP, the importance of using EBP, and managing the transition needed to successfully adopt the use of EBP. Online learning will be reviewed as the primary method of diffusing EBP into the profession of Athletic Training.

Person-centred clinical reasoning and evidence-based healthcare

2020 ◽  
Vol 8 (2) ◽  
pp. 215
Author(s):  
Roger Kerry ◽  
Matthew Low ◽  
Peter O'Sullivan
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Population Data ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Evidence Based Healthcare ◽  
Causal Theories

Purpose: Clinical practice, and in particular decision-making, are dependent on data and knowledge which are relevant to the context at hand. Numerous frameworks have existed which aim to facilitate best clinical decision-making for healthcare professionals and their patients, for example clinical reasoning and the evidence-based healthcare models. The purpose of this paper is to provide some reconciliation between apparently conflicting models of healthcare practice with regards to best practice.Methods: We provide a theoretical narrative account of clinical practice with regards to clinical reasoning and best decision-making. We problematise the practice frameworks of clinical reasoning and evidence base healthcare by suggesting they are conflicting and contradictory to each other. We frame the arguments available with philosophical views of causation, making the assumption that causation lies central to all aspects of knowledge. We use the narrative to expose causal theories behind different practice models and illustrate our account with a case study.Results: Clinical reasoning and evidence-based healthcare are characterised by different causal theories which do not readily align with each other. By reconceptualising causation as a dispositional phenomenon, reconciliation between individualised person-centred care and the population data which are the core interest of evidence-based healthcare, can be found, thus preserving the most valuable aspects of each practice framework.Conclusion: Reconceptualising causation in dispositionalist terms facilitates a more person-centred, multi-dimensional clinical reasoning process. This in-turn allows for the integration of data from prioritised methods of evidence-based healthcare into complex and context-sensitive individualised clinical situations.

Student paramedic decision-making: a critical exploration of a patient interaction

2021 ◽  
Vol 13 (2) ◽  
pp. 76-80
Author(s):  
Barry Costello ◽  
Simon Downs
Keyword(s):  
Decision Making ◽  
Clinical Reasoning ◽  
Health Professionals ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Lead Author ◽  
Evidence Based ◽  
Patient Encounter ◽  
The Past ◽  
Patient Interaction

Clinical decision-making is a multifaceted construct, requiring the practitioner to gather, interpret and evaluate data to select and implement an evidence-based choice of action. Clinical reasoning is a difficult skill for students to develop due in part to the inability to guarantee awareness or opportunity to develop within time spent in practice. While professional developments within the past few years have established a supportive preceptorship programme within NHS trusts for new paramedic registrants, enhancing activities to develop these crucial skills within a pre-registrant programme should be prioritised to enhance the abilities of students and subsequent new registrants. A better understanding of the reasoning processes used during clinical decision-making may help health professionals with less experience to develop their processes in their own clinical reasoning. To embed such awareness and enhanced practice, the lead author, a third-year student paramedic at the time of writing, presents a reflective consideration of a patient encounter using the hypothetico-deductive model to evaluate and critically explore his own reasoning and processing within a meaningful patient interaction.

Take a Page from Your Coach's Play Book: Teaching Technical and Tactical Skills in Athletic Training

2015 ◽  
Vol 10 (3) ◽  
pp. 244-248
Author(s):  
Jeremy R. Hawkins ◽  
Elizabeth B. Sharp ◽  
Skip M. Williams
Keyword(s):  
Decision Making ◽  
Athletic Training ◽  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Training Programs ◽  
Teaching Method ◽  
Technical Skills ◽  
Clinical Decision ◽  
Athletic Training Students ◽  
Good Decision

Context The ability to demonstrate sound clinical reasoning is needed for a practicing athletic trainer. However, instruction on how to make a correct clinical decision may be deficient in many athletic training programs. Objective To provide an overview of how to teach technical and tactical skills, using both a tradition and a nontraditional approach, and to apply this teaching method to athletic training education. Background The teaching of technical skills involves four steps: (1) introduction, (2) demonstration and explanation, (3) practice, and (4) error correction. The teaching of tactical skills takes technical skills a step further by putting them into action. To teach a tactical skill, coaches (1) identify the decision to be made, (2) determine knowledge needed to make a good decision, (3) identify cues that should or should not be attended to, and help to ensure the cues are interpreted correctly, (4) determine appropriate tactical options, and (5) design an opportunity to practice reading the situation and choosing appropriate tactics. Applying this approach to athletic training, students may be better prepared to make good decisions when placed in a situation to do so. Description This paper discusses how applying a methodology for teaching technical and tactical skills will help athletic training students to become better at clinical decision making. It also provides an application example that can be adapted to other situations aiding in the implementation of this approach. Clinical Advantage(s) This approach can be applied to numerous situations and scenarios, preparing athletic training students to be better clinicians through proper clinical reasoning and decision making. Conclusion(s) The ability to reason clinically is a foundational skill that needs to be taught in athletic training programs. Teaching technical and tactical skills is a viable method to help athletic training students develop this skill.

Integrating Evidence-Based Practice in Athletic Training Though Online Learning

2019 ◽  
pp. 316-326
Author(s):  
Brittany A. Vorndran ◽  
Michelle Lee D'Abundo
Keyword(s):  
Decision Making ◽  
Online Learning ◽  
Continuing Education ◽  
Athletic Training ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Athletic Trainers ◽  
Clinical Decision ◽  
Evidence Based ◽  
Primary Method

Evidence-based practice (EBP) involves a healthcare professional using his or her own knowledge, the current research published, and the needs of the patient to make the best clinical decision. This has been a hot topic in many different branches of healthcare and recently athletic trainers have begun to embrace its importance. In December of 2015, athletic trainers (ATs) will need to have completed 10 of their 50 continuing education units (CEUs) in EBP to maintain certification. While ATs recognize the significance of implementing EBP into clinical decision making, there are many barriers slowing the change. This chapter includes information about how EBP is currently being used by athletic training clinicians and educators, the barriers ATs perceive to using EBP, the importance of using EBP, and managing the transition needed to successfully adopt the use of EBP. Online learning will be reviewed as the primary method of diffusing EBP into the profession of athletic training.

Integrating Evidence-Based Practice in Athletic Training

2017 ◽  
pp. 1368-1378
Author(s):  
Brittany A. Vorndran ◽  
Michelle Lee D'Abundo
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Continuing Education ◽  
Athletic Training ◽  
Health Care Professional ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Athletic Trainers ◽  
Clinical Decision ◽  
Evidence Based

Evidence-based practice (EBP) involves a health care professional using his or her own knowledge, the current research published, and the needs of the patient to make the best clinical decision. This has been a hot topic in many different branches of healthcare and recently athletic trainers have begun to embrace its importance. In December of 2015, athletic trainers (ATs) will need to have completed ten of their fifty continuing education units (CEUs) in EBP to maintain certification. While ATs recognize the significance of implementing EBP into clinical decision making, there are many barriers slowing the change. This chapter includes information about how EBP is currently being used by athletic training clinicians and educators, the barriers ATs perceive to using EBP, the importance of using EBP, and managing the transition needed to successfully adopt the use of EBP.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

HEALTH TECHNOLOGY ASSESSMENT AND CLINICAL DECISION MAKING:

1999 ◽  
Vol 15 (3) ◽  
pp. 585-592 ◽  
Author(s):  
Alicia Granados
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Technology Assessment ◽  
Case Studies ◽  
Technology Assessment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Technology ◽  
Evidence Based ◽  
Systematic Process

This paper examines the rationality of the concepts underlying evidence—based medicineand health technology assessment (HTA), which are part of a new current aimed at promoting the use of the results of scientific studies for decision making in health care. It describes the different approaches and purposes of this worldwide movement, in relation to clinical decision making, through a summarized set of specific HTA case studies from Catalonia, Spain. The examples illustrate how the systematic process of HTA can help in several types of uncertainties related to clinical decision making.

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