Convergent Validity of a Novel Clinical Reasoning Tool in Clerkship Medical Students: Pilot Study.

Medical student educators have limited tools for standardized clinical reasoning assessment. The clinical reasoning task (CRT) checklist has been shown to identify specific tasks in the diagnostic process among residents and faculty. Authors assessed a novel student think aloud protocol strategy, the CRT, compared with the validated clinical data interpretation (CDI) test in six third-year medical students. The CRT was scored by two independent reviewers (kappa = 0.88). CRT and CDI scores were strongly positively correlated (r = 0.768, p = 0.074, df = 4). CRT provides both a global assessment of clinical reasoning and specific clinical reasoning deficits.

Clinical Reasoning and Knowledge Organization: Bridging the Gap Between Medical Education and Neurocognitive Science.

PURPOSE: The purpose of this pilot study was 2-fold. The first was to investigate the conceptual relationship between previously validated methodologies. The second was to establish a linkage between medical education research and current neurocognitive science that accounts for knowledge organization during the clinical reasoning process. METHODS: Transcripts of Think Aloud interviews conducted after an objective structured clinical examination (n = 12) were coded and analyzed into 3 clinical reasoning competencies (semantic, diagnostic, and knowledge network organization). Correlational analyses were conducted to establish relationships between the 2 methodologies. Analyses of variance examined group differences. RESULTS: Significant correlations with large effect sizes were found between semantic, diagnostic, and knowledge network organization variables. Analysis of variance results approach significant difference in the knowledge network organization between weak versus strong diagnosticians. CONCLUSIONS: Knowledge network organization measurement can be used to discern differences in clinical reasoning and may offer explanations for the variation in health professionals' diagnostic performance.

Low-glycemic index carbohydrates: an effective behavioral change for glycemic control and weight management in patients with type 1 and 2 diabetes.

PURPOSE: This retrospective study evaluated the incorporation of low-glycemic index (GI) carbohydrates into daily meal planning as an effective behavioral lifestyle change to improve glycemic control and weight management in patients with type 1 and 2 diabetes. METHODS: Twenty-one subjects participated in this study. All office visits and interview sessions took place in a 2-physician private medical practice setting in Wayne, New Jersey. Patients' pre- and postcounseling HbA1c and body mass index (BMI) values and their antidiabetic medication dosages were recorded. Audiotaped interviews were conducted using the 10-question Glycemic Index Foods Quiz (GIFQ) and the 29-question Interview Questionnaire (IQ). The GI values of pre- and postcounseling meals were calculated. Assessment was based on triangulating the subjects' adherence to the low-GI carbohydrate behavioral change and the primary outcome measures: HbA1c and BMI. RESULTS: Low-GI medical nutrition therapy (LGI-MNT) counseling reduced HbA1c by 19% (mean drop of 1.5 U) and decreased BMI by 8% (mean loss of 17 pounds). This was accomplished by the participants independently lowering the GI values of their meals by 25% (mean reduction of 15 points). Results were achieved over a time frame of 3 to 36 months from the initial LGI-MNT counseling session. CONCLUSIONS: Daily incorporation of low-GI carbohydrates in meal planning can be an effective diabetes self-management strategy for glycemic control and weight management. The documented responses to the subjects' conceptual and practical knowledge of the GI confirm their acceptance of this approach as a permanent behavioral lifestyle change and not a "diet." The positive results of this study attest to what worked for these subjects, inviting diabetes educators to consider offering low-GI dietary advice to their diabetes patients.