Enhancing Medical Education: A Pathway to Nurturing Future Healthcare Professionals.

Introduction As medical knowledge, technology, and healthcare delivery continue to evolve, it is critical that upcoming healthcare workers possess the skills and information needed to ensure optimal patient care. Numerous studies indicate that students achieve better learning outcomes through active practice rather than solely relying on theoretical knowledge. The average human attention span is only 8.25 seconds, so an effective teaching program should employ various modes and techniques to ensure that students remain involved and interested. Aims and objectives The aim is to identify the primary areas where medical students need teaching and guidance and form the basis of a new teaching program to meet those needs. Materials and methods An anonymous online questionnaire, designed by the author was distributed to medical students who came for their clinical rotations at Basildon University Hospital, Mid and South Essex NHS Foundation Trust, United Kingdom, and that laid the foundations for introducing a new teaching program at the education department of the hospital in April 2023. The progress of the teaching program was evaluated by a second questionnaire-based survey conducted after six months, in October 2023. The teaching program we designed employed various modes and techniques including simulation, flip classroom, graded quizzes, and constructive feedback. The technique we used for giving feedback to students was the "star star wish" to encourage growth and further participation. The teaching program also made use of Lev Vygotsky's "Learning zone model" to ensure optimum learning. Results and discussion The program received immensely positive feedback from the students, and they felt that it catered perfectly to their requirements. Twenty-three students took part in this study and the results showed that 39% of the students felt adequately prepared for ward rounds in October 2023 in contrast to only 17% in April 2023. The mean score, on a scale of 1-10 on how comfortable the students felt in discussing patient care plans and management with the rest of the team rose from 2.78 in April 2023 to 4.26 in October 2023. When asked to score how confident the students felt in performing bedside examinations in wards, 26% scored 5 or above (on a scale of 1-10) in April 2023 as compared to 62% scoring 5 or above in October 2023. The students were then asked how confident they felt in using their theoretical knowledge in practical situations and the majority scored 2 or 3 (on a scale of 1-10) in April 2023 whereas in October, the majority scored 4 or above. Conclusions A significant number of medical students were satisfied with the teaching program and demanded more frequent sessions. The results of this study showed that in order to foster increased student engagement and effective participation, it is essential for teaching to incorporate diverse techniques and approaches.

Comparing the Efficacy of Individual Approaches and Team-Based Approaches in Solving Clinical Case Vignettes.

Background Clinical case vignettes are a widely adopted pedagogical approach in medical education. The cases may be presented to students with a closed response option for objectivity. While solving clinical cases has demonstrated its effectiveness in enhancing medical students' clinical reasoning, there is an ongoing debate regarding the most effective approach: individual problem-solving or team-based problem-solving. Objective To observe and compare the score obtained from individual clinical problem-solving approaches versus team-based clinical problem-solving approaches. Methods After obtaining consent, a total of 100 students were randomly selected for the study. The participants were divided into two groups: an individual approach group (IAG) (n=25) and a team-based approach group (TAG) comprising 25 groups of three students each. Both groups were presented with a set of 10 clinical problems, each requiring a closed-answer response of "yes", "no", or "don't know". The participants' responses were recorded and analyzed to evaluate their problem-solving efficacy. Results A total of 25 responses were obtained from 25 students from the IAG group and 25 responses from 25 groups from the TAG group. There was no difference between the score in IAG (7.44±1.12) and TAG (7.52 1.66) p-value=0.58. There was no difference between individual scores in 10 questions between IAG and TAG groups. Conclusion The study found no significant score differences between individual and team-based clinical case-solving groups. Hence, for the objective type of case-solving pattern used in this study, a team-based approach may not be necessary. Further research is needed to explore factors for such findings in future studies.

Impact of Multi-point Nursing Strategies Under a Clinical Problem-Solving Framework on Adverse Events Associated With Thyroid Nodule Resection.

The impact of multi-point nursing strategies drawing on a problem-solving clinical framework to examine adverse events associated with thyroid nodule resection was investigated. Patients (n = 98) who underwent thyroid nodule resection were divided into observation and control groups. Patients in the control group received conventional care, and patients in the observation group received a multi-point care strategy under a clinical problem-solving framework. The length of stay (p < .001), hospitalization cost (p < .001), nursing satisfaction scores (p < .001) of the observation group were longer or higher and statistically significant. The incidence of complications in the observation group (8.16%) was lower than that in the control group (22.45%). The incidence of adverse events in the observation group (2.04%) was lower than that in the control group (14.29%), and statistically significant (p < .05). The multi-point nursing strategy using a clinical problem-solving framework provided evidence that it shortened the length of stay, reduce hospitalization costs, improve psychological status, increase nursing satisfaction, and reduce complications and adverse events in patients undergoing thyroid nodule resection.

Evaluation of the effectiveness of educational medical informatics tutorial on improving pharmacy students' knowledge and skills about the clinical problem-solving process.

Objective: To investigate the effectiveness of an online tutorial and its impact on improving knowledge and skills of pharmacy students in the clinical problem-solving process that is necessary to implement pharmaceutical care. Methods: This is a prospective interventional study conducted during the COVID-19 pandemic restrictions using four novel templates. The first two levels of Kirkpatrick's Model (Reaction and Learning) were used. Results: 129 participants completed all of the online training parts. The findings indicated a significant improvement in the students' knowledge and skills. The participants achieved higher score following the tutorial than the baseline, with a statistically significant difference (p < 0.001). There was a significant improvement in the number of detected treatment-related problems. The majority of students were satisfied with the overall training process and stated a high evaluation score out of 10 (mean = 7.93 ± 1.42, median = 8.00). Conclusion: The educational intervention achieved a substantial positive impact on decision-making skills of participating students and was considered effective in helping them attain basic skills such as teamwork, peer assessment, communication and critical evaluation. Healthcare providers must work together to ensure accurate medication use during care transitions. Pharmacists, as medication experts, play an important role in the implementation process. Pharmacy educators must prepare pharmacy student to use pharmaceutical care in their future practice.

Evaluation of the effectiveness of educational medical informatics tutorial on improving pharmacy students’ knowledge and skills about the clinical problem-solving process

Objective: To investigate the effectiveness of an online tutorial and its impact on improving knowledge and skills of pharmacy students in the clinical problem-solving process that is necessary to implement pharmaceutical care. Methods: This is a prospective interventional study conducted during the COVID-19 pandemic restrictions using four novel templates. The first two levels of Kirkpatrick’s Model (Reaction and Learning) were used. Results: 129 participants completed all of the online training parts. The findings indicated a significant improvement in the students’ knowledge and skills. The participants achieved higher score following the tutorial than the baseline, with a statistically significant difference (p < 0.001). There was a significant improvement in the number of detected treatment-related problems. The majority of students were satisfied with the overall training process and stated a high evaluation score out of 10 (mean = 7.93 ± 1.42, median = 8.00). Conclusion: The educational intervention achieved a substantial positive impact on decision-making skills of participating students and was considered effective in helping them attain basic skills such as teamwork, peer assessment, communication and critical evaluation. Healthcare providers must work together to ensure accurate medication use during care transitions. Pharmacists, as medication experts, play an important role in the implementation process. Pharmacy educators must prepare pharmacy student to use pharmaceutical care in their future practice. (AU)

Clinical Problem-Solving: Lower Extremity Weakness & Paresthesia in an Immunocompromised Patient With a Complex Cancer History.

We present a case of new onset bilateral lower extremity weakness, paresthesia, urinary retention and bowel incontinence in a 51-year-old man. He had a complicated history of acute myelogenous leukemia with known central nervous system (CNS) and leptomeningeal involvement status post allogenic stem cell transplant complicated by chronic graft versus host disease (GVHD). We review the differential diagnosis as the physical exam and diagnostic results evolved. We also provide a review of the relevant literature supporting our favored diagnosis, as well as other competing diagnoses in this complicated case. The ultimate differential diagnosis included viral myelitis, treatment-related myelopathies, and CNS GVHD. The case provides a sobering reminder that even with an appropriate diagnostic workup, some cases remain refractory to therapeutic efforts. It also underscores the importance of a sensitive neurologic exam, given the significant clinico-radiological delay, and reviews the complex differential diagnosis for myelopathy.

Team-based learning: design, facilitation and participation.

Team-based learning (TBL) provides an active, structured form of small group learning, that can be applied to large classes. Student accountability is achieved through the specific steps of TBL, including pre-class preparation, readiness assurance testing, problem-solving activities, and immediate feedback. Globally, a growing number of healthcare faculties have adopted TBL in a variety of combinations, across diverse settings and content areas. This paper provides a succinct overview of TBL and guidance for teachers towards successful design and implementation of TBL within health professional education. It also offers guidance for students participating in TBL. The paper is informed by both educational theory, and the extensive, seven year experience of the first and last authors in designing, implementing, facilitating and evaluating TBL at a large medical school.

Exploring perceptions and barriers in developing critical thinking and clinical reasoning of nursing students: A qualitative study.

AIM: The aims of this study were to explore year two nursing students' perceptions toward critical thinking and clinical reasoning and to identify the barriers faced by the students in developing critical thinking and clinical reasoning. BACKGROUND: Critical thinking and clinical reasoning are core competencies emphasized in nursing practices. Nursing students are required to develop and practice these skills throughout their nursing programs to graduate as competent nurses. However, recent studies still report a lack of critical thinking and clinical reasoning in nursing students and fresh graduates. Hence, it is important to recognize the perceptions of nursing students and the barriers that they face in developing critical thinking and clinical reasoning skills. METHODS: An exploratory descriptive qualitative study design was adopted. Twenty nursing students were recruited from a university in Singapore. Individual face-to-face interviews, using semi-structured questions and an interview guide, were conducted in the academic year 2018/2019. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze the data. RESULTS: Seven themes were emerged, namely: 1) essentials for nursing practices, 2) linking theory to practice, 3) individual thought process, 4) stimulating strategies, 5) classroom environment, 6) clinical environment, and 7) students' attributes. Nursing students perceived critical thinking and clinical reasoning as essential for nursing practices and described these skills as linking theory to practice. Strategies such as simulation, case studies, real clinical experiences, and guidance from clinical instructors/preceptors were found to stimulate critical thinking and clinical reasoning for the students. Barriers to developing critical thinking included classroom environments, such teaching methods and student-to-tutor ratios, ward environments/cultures, and students' attributes/attitudes toward learning. CONCLUSION: The findings provided areas for improvement in the current nursing education and practices to better support nursing students in developing critical thinking and clinical reasoning skills.

Clinical problem solving and social determinants of health: a descriptive study using unannounced standardized patients to directly observe how resident physicians respond to social determinants of health.

Objectives While the need to address patients' social determinants of health (SDoH) is widely recognized, less is known about physicians' actual clinical problem-solving when it comes to SDoH. Do physicians include SDoH in their assessment strategy? Are SDoH incorporated into their diagnostic thinking and if so, do they document as part of their clinical reasoning? And do physicians directly address SDoH in their "solution" (treatment plan)? Methods We used Unannounced Standardized Patients (USPs) to assess internal medicine residents' clinical problem solving in response to a patient with asthma exacerbation and concern that her moldy apartment is contributing to symptoms - a case designed to represent a clear and direct link between a social determinant and patient health. Residents' clinical practices were assessed through a post-visit checklist and systematic chart review. Patterns of clinical problem solving were identified and then explored, in depth, through review of USP comments and history of present illness (HPI) and treatment plan documentation. Results Residents fell into three groups when it came to clinical problem-solving around a housing trigger for asthma: those who failed to ask about housing and therefore did not uncover mold as a potential trigger (neglectors ­ 21%; 14/68); those who asked about housing in negative ways that prevented disclosure and response (negative elicitors ­ 23%, 16/68); and those who elicited and explored the mold issue (full elicitors ­ 56%; 38/68) [corrected]. Of the full elicitors 53% took no further action, 26% only documented the mold; and 21% provided resources/referral. In-depth review of USP comments/explanations and residents' notes (HPI, treatment plan) revealed possible influences on clinical problem solving. Failure to ask about housing was associated with both contextual factors (rushed visit) and interpersonal skills (not fully engaging with patient) and with possible differences in attention ("known" vs. unknown/new triggers, usual symptoms vs. changes, not attending to relocation, etc.,). Use of close-ended questions often made it difficult for the patient to share mold concerns. Negative responses to sharing of housing information led to missing mold entirely or to the patient not realizing that the physician agreed with her concerns about mold. Residents who fully elicited the mold situation but did not take action seemed to either lack knowledge or feel that action on SDoH was outside their realm of responsibility. Those that took direct action to help the patient address mold appeared to be motivated by an enhanced sense of urgency. Conclusions Findings provide unique insight into residents' problem solving processes including external influences (e.g., time, distractions), the role of core communication and interpersonal skills (eliciting information, creating opportunities for patients to voice concerns, sharing clinical thinking with patients), how traditional cognitive biases operate in practice (premature closure, tunneling, and ascertainment bias), and the ways in which beliefs about expectancies and scope of practice may color clinical problem-solving strategies for addressing SDoH.

Digital Tools to Enhance Clinical Reasoning.

Physicians can improve their diagnostic acumen by adopting a simulation-based approach to analyzing published cases. The tight coupling of clinical problems and their solutions affords physicians the opportunity to efficiently upgrade their illness scripts (structured knowledge of a specific disease) and schemas (structured frameworks for common problems). The more times clinicians practice accessing and applying those knowledge structures through published cases, the greater the odds that they will have an enhanced approach to similar patient-cases in the future. This article highlights digital resources that increase the number of cases a clinician experiences and learns from.

Point-of-care Head and Neck Sonography for Clinical Problem-solving: Impact of One-day Training Sessions on Medical Student Education.

Introduction The curriculum for medical student education is continuously evolving to emphasize knowledge acquisition with critical problem-solving skills. Medical schools have started to implement curricula to teach point-of-care ultrasound skills. To our knowledge, the expansion into head and neck sonography for medical student education is novel and has never been studied. Our objective was to determine the feasibility of implementing point-of-care head and neck sonography and critical problem-solving instruction for medical student education. Methods This was a cross-sectional study enrolling third-year medical students with minimal prior ultrasound experience. A one-day educational curriculum focusing on the use of head and neck ultrasound for clinical problem-solving was integrated into one of the week-long intersessions. The components of point-of-care ultrasound workshop included asynchronous learning, one-hour didactic lecture, followed by a pre-test assessment, then a one-day hands-on workshop, and finally a post-test assessment administered at the end of the training session. Results A total of 123 subjects participated in this study. Ninety-one percent completed the questionnaire prior to the workshop and 83% completed the post-test questionnaire. The level of comfort with using an ultrasound system significantly increased from 31% to 92%. Additionally, the comfort level in interpreting ultrasound images also significantly increased from 21% to 84%. Eighty-nine percent (95% CI, 86%-97%) had an interest in learning ultrasound and would enroll in an optional ultrasound curriculum if given the opportunity. Knowledge of specific ultrasound applications also increased from 60% (after asynchronous learning and lectures) to 95% (after additional hands-on sonographic training). Conclusion At our institution, we successfully integrated point-of-care head and neck sonography and critical problem-solving instruction for medical student education.

Monitoring progression of clinical reasoning skills during health sciences education using the case method - a qualitative observational study.

BACKGROUND: Outcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students' progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method. METHODS: In this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions - problem-solving process, disciplinary knowledge, character of discussion and communication - was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed. RESULTS: The results revealed the students' transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone. CONCLUSIONS: Our observations revealed progression in several aspects of students' clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.

Vivencias de los pasantes de enfermería, en la resolución de problemas clínicos / Experiences of unregistered nursing graduates while solving clinical problems / Vivências dos estagiários de enfermagem, na resolução de problemas clínicos

Objetivo: Comprender las vivencias de los pasantes de enfermería, en la resolución de problemas clínicos, a través de su descripción e interpretación. Métodos: Estudio cualitativo, descriptivo e interpretativo, tradición fenomenológica, método fenomenológico, técnica: Entrevista semiestructurada a profundidad a 8 pasantes de enfermería asignadas a un Hospital de Sinaloa, México; instrumento: Guía de entrevista, selección de participantes: Intencional hasta saturación teórica, carta de consentimiento informado y protección de la intimidad y confidencialidad, con base en el Código de Ética de las y los enfermeros de México y Declaración de Helsinki. Análisis de contenido tipo temático de acuerdo a Souza Minayo, del que emergieron 4 categorías. Resultados: Del análisis se seleccionó la categoría "Resolver problemas, un arte profesional", con las subcategorías: a) Incertidumbre y ambigüedad en la identificación y resolución del problema; b) Percepción del problema como caso único; c) Presencia de conflicto de valores en la resolución del problema, y d) Saber práctico, aprender al observar, reflexionar y hacer. Conclusiones: Al inicio del servicio social, los pasantes de enfermería muestran dificultad no solo para identificar y solucionar problemas clínicos, sino para comprender el significado de resolver problemas desde su conceptualización. Sin embargo, a punto de concluir su servicio social, empieza a emerger en ellos el arte de la enfermería, puesto que ya son capaces de identificar y dar solución a situaciones de cuidados que se presentan en los pacientes.

Objective: Through their own description and interpretation to understand the experiences of unregistered nursing graduates while solving clinical problems. Methods: This is a qualitative, descriptive and interpretative study. With a phenomenological tradition and method, this study uses in-depth structured interviews on eight unregistered nursing graduates assigned to a hospital in Sinaloa, Mexico. The main instrument is the interview guide. The selection of participants was intentional until theoretical saturation was reached. Based on the Nurses Ethics Code of Mexico, and also on the Helsinki Declaration, participants were given informed consent documentation as well as protection of their intimacy and confidentiality. From a thematic type content analysis which was aligned with Souza Minayo guidelines, four categories emerged. Results: From the category "Problem solving, a professional art" four sub-categories were proposed: (a) uncertainty and ambiguity while identifying and solving a problem; (b) perception of the problem as a unique case; (c) presence of conflict of values during the resolution of the problem; and (d) practical knowledge-learning while watching, realizing and doing. Conclusions: At the beginning of their social service, unregistered nursing graduates show difficulties, not only to identify and solve clinical problems, but also to understand the meaning of solving the problems based on their own conceptualization. However, as they near the end of their social services, the art of nursing gradually emerges from them as they manifest better performances at identifying and solving the diverse care situations of their patients.

Objetivo: Compreender as vivências dos estagiários de enfermagem, na resolução de problemas clínicos, a través de sua descrição e interpretação. Métodos: Estudo qualitativo, descritivo e interpretativo, tradição fenomenológica, método fenomenológico, técnica: entrevista semiestruturada a profundidade a oito estagiários de enfermagem assignados a um Hospital de Sinaloa, México, instrumento: Guia de entrevista, seleção de participantes: intencional até saturação teórica, carta de carta de consentimento informado e proteção da intimidade e confidencialidade, com base no Código de Ética das e dos enfermeiros do México e a Declaração de Helsinki. Análise de conteúdo tipo temático de acordo a Souza Minayo, da qual emergiram as quatro categorias. Resultados: Da análise selecionou-se a categoria "Resolver problemas, uma arte profissional", com as subcategorias: a) Incerteza e ambiguidade na identificação e resolução do problema, b) Percepção do problema como caso único, c) Presença de conflito de valores na resolução do problema, e d) Saber prático, aprender observando, refletir e fazer. Conclusões: No início do estágio, os estagiários de enfermagem mostram dificuldade não só para identificar e solucionar problemas clínicos, senão para compreender o significado de resolver problemas desde sua conceptualização. Porém, quase por concluir seu estágio, começa a emergir neles a arte da enfermagem, visto que já são capazes de identificar e dar solução a situações de cuidados que se apresentam nos pacientes.

System 3 diagnostic process: the lateral approach.

The process of obtaining diagnosis is described as a dual-process model, including the intuitive process, and the analytical process. The similarity between the two systems is that they both infer a diagnosis from patient-derived information. Here we present another process by which to elicit the diagnosis: asking direct questions of the patient themselves, such as "What do you think is the cause?" or "What do you suspect is wrong?" This simple method would enable us to elicit pivotal information for diagnosis. Asking patients direct questions allows them to think about the cause of their own problem and suggest their own diagnosis. This method of reasoning is completely different from the two above-mentioned systems and may represent a third approach. We highlight this third process as an important strategy, thereby using this third effective method of inquiry to facilitate quick and effective diagnosis in conjunction with former two systems.

Introduction of Problem-Based Preclerkship Clinical Training in Internal Medicine / 医学教育

To increase the safety and effectiveness of clinical clerkships, we have developed a 4-week preclinical training program, “Problem-Based Clinical Training, ” based on the concept of problem-based learning with the aim of encouraging life-long self-directed learning. The first week is a preparation period for clinical practice in which students are trained in problem-solving skills, basic-practice skills, and clinical reasoning. The second and third weeks are a practical training period in which students learn how be in charge of a patient's care. The fourth week was a problem-solving period without practical training in which students learned to solve problems. The students were encouraged to record daily “problem notes” describing problems and “problem solving notes” summarizing problems solved. To emphasize lessons learned, the students also presented and discussed problems. Evidence-based medicine was used as a tool for problem solving. Furthermore, medical record training based on the problem-oriented system using evaluations by other students encouraged self-development to improve clinical practice and the medical record. This curriculum should be effective for mastering the skills of self-directed learning and for motivating for advancement due to consideration of contributable proposals for the patients.