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Context and clinical reasoning: Understanding the medical student perspective

INTRODUCTION: Studies have shown that a physician’s clinical reasoning performance can be influenced by contextual factors. We explored how the clinical reasoning performance of medical students was impacted by contextual factors in order to expand upon previous findings in resident and board certif...

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Autores principales: McBee, Elexis, Ratcliffe, Temple, Schuwirth, Lambert, O’Neill, Daniel, Meyer, Holly, Madden, Shelby J., Durning, Steven J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bohn Stafleu van Loghum 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086813/
https://www.ncbi.nlm.nih.gov/pubmed/29704167
http://dx.doi.org/10.1007/s40037-018-0417-x
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author McBee, Elexis
Ratcliffe, Temple
Schuwirth, Lambert
O’Neill, Daniel
Meyer, Holly
Madden, Shelby J.
Durning, Steven J.
author_facet McBee, Elexis
Ratcliffe, Temple
Schuwirth, Lambert
O’Neill, Daniel
Meyer, Holly
Madden, Shelby J.
Durning, Steven J.
author_sort McBee, Elexis
collection PubMed
description INTRODUCTION: Studies have shown that a physician’s clinical reasoning performance can be influenced by contextual factors. We explored how the clinical reasoning performance of medical students was impacted by contextual factors in order to expand upon previous findings in resident and board certified physicians. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of medical students in order to describe what impact the presence of contextual factors has on their reasoning performance. METHODS: Seventeen medical student participants viewed three video recordings of clinical encounters portraying straightforward diagnostic cases in internal medicine with explicit contextual factors inserted. Participants completed a computerized post-encounter form as well as a think-aloud protocol. Three authors analyzed verbatim transcripts from the think-aloud protocols using a constant comparative approach. After iterative coding, utterances were analyzed and grouped into categories and themes. RESULTS: Six categories and ten associated themes emerged, which demonstrated overlap with findings from previous studies in resident and attending physicians. Four overlapping categories included emotional disturbances, behavioural inferences about the patient, doctor-patient relationship, and difficulty with closure. Two new categories emerged to include anchoring and misinterpretation of data. DISCUSSION: The presence of contextual factors appeared to impact clinical reasoning performance in medical students. The data suggest that a contextual factor can be innate to the clinical scenario, consistent with situated cognition theory. These findings build upon our understanding of clinical reasoning performance from both a theoretical and practical perspective.
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spelling pubmed-60868132018-08-23 Context and clinical reasoning: Understanding the medical student perspective McBee, Elexis Ratcliffe, Temple Schuwirth, Lambert O’Neill, Daniel Meyer, Holly Madden, Shelby J. Durning, Steven J. Perspect Med Educ Original Article INTRODUCTION: Studies have shown that a physician’s clinical reasoning performance can be influenced by contextual factors. We explored how the clinical reasoning performance of medical students was impacted by contextual factors in order to expand upon previous findings in resident and board certified physicians. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of medical students in order to describe what impact the presence of contextual factors has on their reasoning performance. METHODS: Seventeen medical student participants viewed three video recordings of clinical encounters portraying straightforward diagnostic cases in internal medicine with explicit contextual factors inserted. Participants completed a computerized post-encounter form as well as a think-aloud protocol. Three authors analyzed verbatim transcripts from the think-aloud protocols using a constant comparative approach. After iterative coding, utterances were analyzed and grouped into categories and themes. RESULTS: Six categories and ten associated themes emerged, which demonstrated overlap with findings from previous studies in resident and attending physicians. Four overlapping categories included emotional disturbances, behavioural inferences about the patient, doctor-patient relationship, and difficulty with closure. Two new categories emerged to include anchoring and misinterpretation of data. DISCUSSION: The presence of contextual factors appeared to impact clinical reasoning performance in medical students. The data suggest that a contextual factor can be innate to the clinical scenario, consistent with situated cognition theory. These findings build upon our understanding of clinical reasoning performance from both a theoretical and practical perspective. Bohn Stafleu van Loghum 2018-04-27 2018-08 /pmc/articles/PMC6086813/ /pubmed/29704167 http://dx.doi.org/10.1007/s40037-018-0417-x Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
McBee, Elexis
Ratcliffe, Temple
Schuwirth, Lambert
O’Neill, Daniel
Meyer, Holly
Madden, Shelby J.
Durning, Steven J.
Context and clinical reasoning: Understanding the medical student perspective
title Context and clinical reasoning: Understanding the medical student perspective
title_full Context and clinical reasoning: Understanding the medical student perspective
title_fullStr Context and clinical reasoning: Understanding the medical student perspective
title_full_unstemmed Context and clinical reasoning: Understanding the medical student perspective
title_short Context and clinical reasoning: Understanding the medical student perspective
title_sort context and clinical reasoning: understanding the medical student perspective
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086813/
https://www.ncbi.nlm.nih.gov/pubmed/29704167
http://dx.doi.org/10.1007/s40037-018-0417-x
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