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Investigación en Educación Médica

2024, Number 49

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Inv Ed Med 2024; 13 (49)

Online workshop about clinical reasoning and cognitive dispositions to respond for medical residents

Rodríguez Piña FR, Gutiérrez-Cirlos C, García-Minjares M, Sánchez-Mendiola M

Language: Spanish
References: 38
Page: 100-119
PDF size: 453.37 Kb.


ABSTRACT

Introduction: Errors occur frequently in medicine, mainly due to cognitive biases. There are many biases or “cog- nitive dispositions to respond" (CDR) that influence the diagnostic process, and there is a need for interventions to improve knowledge and skills about it in residency education.
Objective: To develop an online workshop about clinical reasoning and CDR and test it in residents.
Method: Kern’s model for curriculum development and Kolb’s experiential learning model were used for workshop design. Croskerry’s conceptual framework was used for course contents. A one-group pre-post study was performed in Internal Medicine residents at the National Autonomous University of Mexico (UNAM) Faculty of Medicine. Outcomes: knowledge, self-reported skills, and satisfaction. Instruments: pre and post-test multiplechoice question exams to measure knowledge; course opinion survey; retrospective pre-post questionnaire to assess skills. Psychometric analysis was done using classical measurement theory. Pre-post comparisons were done with paired Student’s t-test.
Results: The workshop had three two-hour synchronic sessions via Zoom, over a three-week period, with asynchronic activities for case preparation in Canvas. 22 Internal medicine residents took the workshop (13 M/9 F), average age 27.5 years. Pre-test exam average score was 12.8 (51.2% correct), post-test 14.6 (58.4% correct), p = 0.038. The retrospective pre-post questionnaire had substantial positive increases in all areas (p ‹ 0.001). The satisfaction questionnaire showed positive responses. Small groups analyzed real-life clinical cases, identifying cognitive biases, their impact on the patients’ clinical course and proposed strategies to mitigate CDR.
Conclusions: An online educational intervention for residents about clinical reasoning, cognitive biases and strategies to cope with CDR, was developed and implemented. The workshop showed an increase in knowledge and self-reported skills and was satisfactory for the residents. The research design cannot exclude several validity threats, so studies in other populations, with larger sample size and control groups, using more robust research designs are needed.


REFERENCES

  1. Norman GR, Eva KW. Diagnostic error and clinical reasoning.Med Educ. 2010;44(1):94-100. DOI: 10.1111/j.1365-2923.2009.03507.x

  2. Leape LL, Brennan TA, Laird N, et al. The nature of adverseevents in hospitalized patients. Results of the HarvardMedical Practice Study II. N Engl J Med. 1991;324(6):377-384. doi:10.1056/NEJM199102073240605

  3. Makary MA, Daniel M. Medical error-the third leadingcause of death in the US. BMJ. 2016; 353(3):1-5. doi:10.1136/bmj.i2139

  4. Clark BW, Derakhshan A, Desai SV. Diagnostic Errors andthe Bedside Clinical Examination. Med Clin North Am.2018;102(3):453-464. doi:10.1016/j.mcna.2017.12.007

  5. Graber ML, Franklin N, Gordon R. Diagnostic error in internalmedicine. Arch Intern Med. 2005;165(13):1493-1499.doi:10.1001/archinte.165.13.1493

  6. Balogh EP, Miller BT, Ball JR, Committee on Diagnostic Errorin Health Care; Board on Health Care Services; Instituteof Medicine; Improving Diagnosis in Health Care. Washington(DC): National Academies Press (US); December 29,2015. https://doi.org/10.17226/21794

  7. Croskerry P, Singhal G, Mamede S. Cognitive debiasing 1:origins of bias and theory of debiasing. BMJ Qual Saf. 2013;22Suppl 2(Suppl 2):58-64. doi:10.1136/bmjqs-2012-001712

  8. Campbell SG, Croskerry P, Bond WF. Profiles in patientsafety: A “perfect storm” in the emergency department.Acad Emerg Med. 2007;14(8):743-749. doi:10.1197/j.aem.2007.04.011

  9. O’Sullivan ED, Schofield SJ. Cognitive bias in clinicalmedicine. J R Coll Physicians Edinb. 2018;48(3):225-232.doi:10.4997/JRCPE.2018.306

  10. Mahuina C, Dania L, Fabián F, Alejandro A. El razonamientoclínico en la era de la medicina digital. Informáticabiomédica II. 1.ª ed. Ciudad de México, México: EditorialMédica Panamericana; 2020 p. 153.

  11. Croskerry P, Singhal G, Mamede S. Cognitive debiasing 2: impedimentsto and strategies for change. BMJ Qual Saf. 2013;22Suppl 2(Suppl 2):65-72. doi:10.1136/bmjqs-2012-001713

  12. Sánchez-Mendiola M, Lifhshitz-Guinzberg A, Vilar-PuigP, Martínez-González A, Varela-Ruiz ME, Weichers EG.Educación médica. Teoría y práctica. 1a ed. Ciudad de México,México. UNAM Elsevier; 2015, p.p 460.

  13. Schaye V, Janjigian M, Hauck K, et al. A workshop to trainmedicine faculty to teach clinical reasoning. Diagnosis (Berl).2019;6(2):109-113. doi:10.1515/dx-2018-0059

  14. Wilson TD, Brekke N. Mental contamination and mentalcorrection: unwanted influences on judgments and evaluations.Psychol Bull. 1994;116(1):117-142. doi:10.1037/0033-2909.116.1.117

  15. Meruane PS, Castro MC. Métodos de investigación social. 1ªEd. Ediciones Universidad Católica del Norte, AntofagastaChile, 2008, p.p 270.

  16. Thomas PA, Kern DE, Hughes MT, Chen BY. Curriculumdevelopment for medical education: A six-step approach.Johns Hopkins University Press. 4th Ed, 2022, p.p 361https://books.google.com.mx/books?id=9yB0EAAAQBAJ

  17. Chen BY, Kern DE, Kearns RM, Thomas PA, Hughes MT,Tackett S. From Modules to MOOCs: Application of theSix-Step Approach to Online Curriculum Developmentfor Medical Education. Acad Med. 2019;94(5):678-685.doi:10.1097/ACM.0000000000002580

  18. Brooks-Harris JE, Stock-Ward SR. Workshops: Designingand facilitating experiential learning. Sage Publications;

  19. 1999. DOI: https://doi.org/10.4135/978145220486419. Kolb DA. Experiential learning: Experience as the sourceof learning and development. FT Press; 2nd Ed, 2014, p.p416. http://www.learningfromexperience.com/images/uploads/process-of-experiential-learning.pdf

  20. Croskerry P, Cosby K, Graber ML, Singh H. Diagnosis: Interpretingthe Shadows. CRC Press; 1st Ed, 2017, London,England, p.p 386. https://doi.org/10.1201/9781315116334

  21. Kirkley J. Distributed Learning. Encyclopedia of the Sciencesof Learning. En: Seel NM, editor. Boston, MA: SpringerUS; 2012. p. 1020-1. https://www.academia.edu/43580546/Encyclopedia_of_the_Sciences_of_Learning

  22. Haladyna TM, Downing SM, Rodriguez MC. A Review ofMultiple-Choice Item-Writing Guidelines for ClassroomAssessment. Appl Meas Ed. 2002;15(3):309-33. https://doi.org/10.1207/S15324818AME1503_5

  23. Teaching and Assessing Critical Thinking - ContinuingProfessional Development & Medical Education - DalhousieUniversity [Internet]. [citado oct 16 2024]. https://medicine.dal.ca/departments/core-units/cpd/faculty-development/programs/TACT.html

  24. Bhanji F, Gottesman R, de Grave W, Steinert Y, Winer LR.The retrospective pre-post: a practical method to evaluatelearning from an educational program. Acad Emerg Med.2012;19(2):189-194. doi:10.1111/j.1553-2712.2011.01270.x

  25. Mishra P, Singh U, Pandey CM, Mishra P, Pandey G. Applicationof student’s t-test, analysis of variance, and covariance.Ann Card Anaesth. 2019;22(4):407-411. doi:10.4103/aca.ACA_94_19

  26. Hill LG, Betz DL. Revisiting the Retrospective Pretest. Am J Ev.2005;26(4):501-517. https://doi.org/10.1177/1098214005281356

  27. Lambe KA, O’Reilly G, Kelly BD, Curristan S. Dual-processcognitive interventions to enhance diagnostic reasoning:a systematic review. BMJ Qual Saf. 2016;25(10):808-820.doi:10.1136/bmjqs-2015-004417

  28. Trowbridge RL, Olson APJ. Becoming a teacher of clinicalreasoning. Diagnosis (Berl). 2018;5(1):11-14. doi:10.1515/dx-2018-0004

  29. Kassirer JP. Teaching clinical reasoning: case-based andcoached. Acad Med. 2010;85(7):1118-1124. doi:10.1097/acm.0b013e3181d5dd0d

  30. Sánchez-Mendiola M, Martínez-Franco AI, Rosales-VegaA, et al. Development and implementation of a biomedicalinformatics course for medical students: challenges of alarge-scale blended-learning program. J Am Med InformAssoc. 2013;20(2):381-387. doi:10.1136/amiajnl-2011-000796

  31. Bertaux A, Alameda B, Tataw J, Kenfak A. Effet tunnelen contexte d’épidémie [Cognitive bias in the contextof epidemic]. Rev Med Suisse. 2020;16(718):2392-2396.https://bit.ly/475Oc4P

  32. Driessen E, van Tartwijk J, Dornan T. The self critical doctor:helping students become more reflective. BMJ. 2008;

  33. 336(7648):827-830. doi:10.1136/bmj.39503.608032.AD33. Reilly JB, Ogdie AR, Von Feldt JM, Myers JS. Teaching abouthow doctors think: a longitudinal curriculum in cognitivebias and diagnostic error for residents. BMJ Qual Saf.2013;22(12):1044-1050. doi:10.1136/bmjqs-2013-001987

  34. DiMaria CN, Lee B, Fischer R, Eiger G. Cognitive Biasin the COVID-19 Pandemic. Cureus. 2020;12(7):10-20.doi:10.7759/cureus.9019

  35. Smith BW, Slack MB. The effect of cognitive debiasing trainingamong family medicine residents. Diagnosis (Berl). 2015;2(2):117-121. doi:10.1515/dx-2015-0007

  36. Richards JB, Hayes MM, Schwartzstein RM. Teaching ClinicalReasoning and Critical Thinking: From Cognitive Theoryto Practical Application. Chest. 2020;158(4):1617-1628.doi:10.1016/j.chest.2020.05.525

  37. Pelaccia T, Messman AM, Kline JA. Misdiagnosis and failureto diagnose in emergency care: Causes and empathyas a solution. Patient Educ Couns. 2020;103(8):1650-1656.doi:10.1016/j.pec.2020.02.039

  38. Browne AM, Deutsch ES, Corwin K, Davis DH, Teets JM,Apkon M. An IDEA: Safety Training to Improve CriticalThinking by Individuals and Teams. Am J Med Qual. 2019;34(6):569-576. doi:10.1177/1062860618820687




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