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KENDRIYA VIDAYALA TIBRI

CANTT GURDASPUR

HEALTH AND MEDICINE

SUBMITTED TO :- MEENAKSHI MEHTA

Faculty of Health, Medicine and Life Sciences

Risks of life…

Risks of life… Faculty of Health, Medicine and Life Sciences

Faculty of Health, Medicine and Life Sciences

Medical errors

  • Diagnostic errors: 5-15% of medical diagnosis

  • Taxonomy of diagnostic error (Graber,2005):

No-fault errors

System-related errors

Cognitive errors

  • Cognitive errors contribute to 75% of all diagnostic errrors

  • ‘Premature closure’ most

common cognitive error

Both system and cognitve Only cognitive Only system No fault Factors 46 28 19 7
Both system and
cognitve
Only cognitive
Only system
No fault
Factors
46
28
19
7

Faculty of Health, Medicine and Life Sciences

Education to prevent cognitive errors

Relationships between reliability and effort of diagnostic decision making (Graber, 2009)

More

ideas for educational approaches

Effort

Deductive Monitoring, reasoning reflection Pre-expert reasoning: heuristics Expert Expert thinking thinking Less Low High
Deductive
Monitoring,
reasoning
reflection
Pre-expert
reasoning:
heuristics
Expert
Expert
thinking
thinking
Less
Low
High

Accuracy

Faculty of Health, Medicine and Life Sciences

Increase expertise

  • Deliberate practice with coaching and feedback by more accomplished professionals (Ericsson, 2003)

  • Access to a large numbers of patients with similar symptoms for which the correct diagnosis is validated

  • Virtual patients can supplement real patient encounters

Increase expertise  Deliberate practice with coaching and feedback by more accomplished professionals (Ericsson, 2003) 

Faculty of Health, Medicine and Life Sciences

Learn to apply reflective thinking

Learning to:

  • Recognize and understand the most likely

diagnostic pitfalls (Croskerry, 2003)

  • Use a checklist for the diagnostic process including

‘reflection’.

Faculty of Health, Medicine and Life Sciences

Clinical reasoning sessions

Ingredients:

  • Virtual patients based on real cases in which ‘premature closure’ had occurred

  • Procedure to induce reflective diagnostic reasoning (Mamede, 2008)

Clinical reasoning sessions Ingredients:  Virtual patients based on real cases in which ‘premature closure’ had
Clinical reasoning sessions Ingredients:  Virtual patients based on real cases in which ‘premature closure’ had

Faculty of Health, Medicine and Life Sciences

Clinical reasoning sessions

Procedure:

  • All residents simultaneously worked out the same virtual patient

  • And the end of the work-up they had a moderated discussion on their clinical reasoning

  • The logged actions and their notes were starting points for the discussion

Clinical reasoning sessions Procedure:  All residents simultaneously worked out the same virtual patient  And

Faculty of Health, Medicine and Life Sciences

Evaluation of perceptions

Two student questionnaires:

  • 1. Experiences with the use virtual patients. With 12 statements on:

    • Authenticity

    • Professional approach

    • Coaching

    • Learning effect

    • Overall judgment

  • 2. Experiences with the integration of virtual patients. With 20 statements on:

    • Teaching presence

    • Cognitive presence

    • Social presence

    • Learning effect

    • Overall judgment

Faculty of Health, Medicine and Life Sciences

Conclusion

  • Residents perceived a session combining individual virtual patient workup with small group discussions as a valuable learning activity for clinical reasoning.

  • The clinical supervisor found the presented teaching approach feasible for the medical specialist training at the workplace.

Faculty of Health, Medicine and Life Sciences

Future research

Evaluation of clinical reasoning sessions with VPs on 3 rd and 4 th level of Kirkpatrick:

  • Do they learn clinical reasoning and reflective practice from this activity?

  • Do the learning outcomes transfer to clinics and wards?

Faculty of Health, Medicine and Life Sciences

THANK YOU

MADE BY :- SIMRAN

Faculty of Health, Medicine and Life Sciences