ABSTRACT
The standardized resident training is an important step for training high-level professionals in clinical medicine and it is an important part of medical education after graduation. The training of residents' clinical thinking and clinical judgement should be emphasized in all resident training programs. Some resident programs in China still focus on the teaching of important knowledge that are originated from the medical colleges. Therefore,it is urgent for faculty to adopt new teaching methods aiming at the training of clinical thinking and clinical judgement. The paper introduces a mode for teaching clinical thinking and clinical judgement in the resident training programs. The goal is to improve the level of resident physicians in clinical diagnosis and treatment in China.
ABSTRACT
Objetivo: Conocer las experiencias de estudiantes de último año de enfermería en el trabajo con mapas conceptuales de cuidado y su contribución al desarrollo de juicio clínico. Método: Estudio de caso de abordaje cualitativo. Estudiantes de enfermería construyeron un mapa conceptual de cuidado, con el software CMap Tools® , basándose en un caso clínico propuesto. Posteriormente, previo consentimiento informado, 11 estudiantes participaron en 2 grupos focales para compartir su experiencia. Se realizó un análisis temático de la información y creación de categorías emergentes. Resultados: Los participantes refieren que los mapas conceptuales permiten alcanzar un juicio clínico a partir del desarrollo de sus 4 fases: darse cuenta, interpretar, responder y reflexionar sobre el cuidado de sus pacientes. Como desventajas, hubo dificultades para trabajar con el software. Conclusiones: La actividad de construcción del mapa conceptual fue valorada positivamente por los estudiantes, pese a que el uso del software les ocasionó algunas dificultades.
Objective: To know the experiences of nursing senior students using care conceptual maps, and the contribution of this pedagogy to the development of their clinical judgement. Method: This is a qualitatively approached case study in which nursing students generated a care conceptual map using the Map Tools® software. After the corresponding informed consents,11 students participated in 2 focus groups in order to share their experiences. A thematic analysis was carried out, and diverse emerging categories were distinguished. Results: Participants refer that the conceptual map allowed them to develop a clinical judgement through four stages: to become aware, to interpret, to respond, and to reflect on the corresponding care. Some students stated having had some difficulties with the software. Conclusions: The activity of creating a conceptual map was positively valued by the students.
Objetivo: Conhecer as experiências de estudantes de último ano de enfermagem no trabalho com mapas conceituais de cuidado e sua contribuição ao desenvolvimento de julgamento clínico. Método: Estudo de caso de abordagem qualitativa. Estudantes de enfermagem construíram um mapa conceitual de cuidado, com o software CMap Tools® , baseados em um caso clínico proposto. Posteriormente, prévio consentimento informado, 11 estudantes participaram em 2 grupos focais para compartilhar sua experiência. Realizou-se uma análise temática da informação e criação de categorias emergentes. Resultados: Os participantes referem que os mapas conceituais permitem atingir um julgamento clínico, a partir do desenvolvimento de suas quatro fases: Dar-se conta, interpretar, responder e refletir sobre o cuidado de seus pacientes. Como desvantagens, houve dificuldades para trabalhar com o software. Conclusões: A atividade de construção do mapa conceitual foi valorada positivamente pelos estudantes, apesar de que o uso de software ocasionou-lhes algumas dificuldades.
Subject(s)
Humans , Male , Female , Students, Nursing , Case Reports , Clinical ReasoningABSTRACT
Introduction: Differences in systolic blood pressure reading between arms are common but could signal trouble if the discrepancy is significant. Early detection of aortic dissection could invariably determine patient’s survivability. Hence, a high index of suspicion with prompt diagnostic imaging is vital for accurate diagnosis. Case Presentation: A previously healthy 35-year-old lady was referred from district hospital for hypertensive cardiomyopathy complicated by acute pulmonary oedema. After being admitted to the Intensive Care Unit, the mean arterial pressure on the left arm was noted to be significant higher. On physical examination, both lower limbs were dusky in appearance because of poor perfusion. Investigations: Computed Tomography Angiography showed extensive arch and abdominal aorta dissection extending to the proximal common carotid artery. There was distal abdominal aorta thrombosis with partial left renal infarction. Echocardiogram showed global hypokinesia, presence of intimal flap, aortic regurgitation and mild pericardial effusion. Supine chest X-ray showed apparent cardiomegaly. Treatment: Repair of the ascending aortic dissection and suspension of the aortic valve by the cardiothoracic team on Day 2 of admission. The vascular team did bilateral high above knee amputation on Day 9 of admission. Outcome: Patient passed away on Day 10 of admission. Discussion: With the absence of classical features of aortic dissection, establishing the diagnosis can be challenging and requires both good clinical judgment and prompt radiological imaging, such that early treatment can be initiated. Conclusion: A high index of suspicion and good clinical judgment is needed in cases of significant blood pressure discrepancy between arms.
Subject(s)
Blood PressureABSTRACT
There is a popular perception that clinical judgement and evidence-based medicine are at loggerheads with each other. We examine the concepts of evidence and judgment as applied to clinical practice, and attempt to understand the reasons behind this imaginary divide.