Correction: Clinical reasoning education in the clerkship years: A cross-disciplinary national needs assessment.

[This corrects the article DOI: 10.1371/journal.pone.0273250.].

Clinical reasoning education in the clerkship years: A cross-disciplinary national needs assessment.

BACKGROUND: Improving clinical reasoning education has been identified as an important strategy to reduce diagnostic error-an important cause of adverse patient outcomes. Clinical reasoning is fundamental to each specialty, yet the extent to which explicit instruction in clinical reasoning occurs across specialties in the clerkship years remains unclear. METHOD: The Alliance for Clinical Education (ACE) Clinical Reasoning Workgroup and the Directors of Clinical Skills Courses (DOCS) Clinical Reasoning Workgroup collaborated to develop a clinical reasoning needs assessment survey. The survey questionnaire covered seven common clinical reasoning topics including illness scripts, semantic qualifiers, cognitive biases and dual process theory. Questionnaires were delivered electronically through ACE member organizations, which are primarily composed of clerkship leaders across multiple specialties. Data was collected between March of 2019 and May of 2020. RESULTS: Questionnaires were completed by 305 respondents across the six organizations. For each of the seven clinical reasoning topics, the majority of clerkship leaders (range 77.4% to 96.8%) rated them as either moderately important or extremely important to cover during the clerkship curriculum. Despite this perceived importance, these topics were not consistently covered in respondents' clerkships (range 29.4% to 76.4%) and sometimes not covered anywhere in the clinical curriculum (range 5.1% to 22.9%). CONCLUSIONS: Clerkship educators across a range of clinical specialties view clinical reasoning instruction as important, however little curricular time is allocated to formally teach the various strategies. Faculty development and restructuring of curricular time may help address this potential gap.

Progress on a New Kind of Progress Test: Assessing Medical Students' Clinical Skills.

PROBLEM: Progress testing of medical knowledge has advantages over traditional medical school examination strategies. However, little is known about its use in assessing medical students' clinical skills or their integration of clinical skills with necessary science knowledge. The authors previously reported on the feasibility of the Progress Clinical Skills Examination (PCSE), piloted with a group of early learners. This subsequent pilot test studied the exam's validity to determine whether the PCSE is sensitive to the growth in students' clinical skills across the four years of medical school. APPROACH: In 2014, 38 medical student volunteers (years 1-4) in the traditional 2 + 2 curriculum at Michigan State University College of Human Medicine participated in the eight-station PCSE. Faculty and standardized patients assessed students' clinical skills, and faculty assessed students' responses to postencounter necessary science questions. Students performed pretest self-assessment across multiple measures and completed a posttest evaluation of their PCSE experience. OUTCOMES: Student performance generally increased by year in medical school for communication, history-taking, and physical examination skills. Necessary science knowledge increased substantially from first-year to second-year students, with less change thereafter. Students felt the PCSE was a fair test of their clinical skills and provided an opportunity to demonstrate their understanding of the related necessary science. NEXT STEPS: The authors have been piloting a wider pool of cases. In 2016, they adopted the PCSE as part of the summative assessment strategy for the medical school's new integrated four-year curriculum. Continued assessment of student performance trajectories is planned.

An evaluation of the effects of a breastfeeding support program on health outcomes.

OBJECTIVE: To estimate the causal effect of a Michigan peer counselor (PC) breastfeeding support program for low-income women on infant health outcomes. DATA SOURCES: Program referral forms, program forms (enrollment, birth, and exit data), and state administrative data from the Women Infants and Children program, Medicaid, and Vital Records. STUDY DESIGN: Quasi-random enrollment due to the excess demand for PC breastfeeding support services allowed us to compare the infants of women who requested services and were enrolled in the program (the treatment group, N = 274) to the infants of women who requested services and were not enrolled (the control group, N = 572). Data were analyzed using regression. PRINCIPAL FINDINGS: The PC program increased the fraction breastfeeding at birth by 19.3 percent and breastfeeding duration by 2.84 weeks. Program participation also reduced the fraction of infants with gastrointestinal disorders by a statistically significant 7.9 percent. The program, if anything, increased the overall health care utilization. CONCLUSIONS: This Michigan PC breastfeeding support program resulted in improvements in breastfeeding and infant health outcomes as measured by the diagnosis of ailments while increasing health care utilization.

A quasi-experimental evaluation of a breastfeeding support program for low income women in Michigan.

We examined the effectiveness of a peer counseling breastfeeding support program for low income women in Michigan who participate in WIC. Because there was more demand for services than could be met by the program, many women who requested services were not subsequently contacted by a peer counselor. We used a quasi-experimental methodology that utilized this excess demand for services to estimate the causal effect of the support program on several breastfeeding outcomes. We relied on data derived from administrative and survey-based sources. After providing affirmative evidence that our key assumption is consistent with the data, we estimated that the program caused the breastfeeding initiation to increase by about 27 percentage points and the mean duration of breastfeeding to increase by more than 3 weeks. The support program we evaluated was very effective at increasing breastfeeding among low income women who participate in WIC, a population that nationally breastfeeds at rates well below the national average and below what is recommended by public health professionals. Given the substantial evidence that breastfeeding is beneficial for both the child and mother, the peer counseling breastfeeding support program should be subjected to a cost/benefit analysis and evaluated at other locales.