SIDM's priority: Translating ideas into action

Julianne Nemes Walsh nemeswalsh at GMAIL.COM
Mon Nov 9 19:30:12 UTC 2015


Hello,

As an educator of nurses in advanced practice roles, critical thinking
skills are often assessed both in the clinical and classroom environment
utilizing either case studies or simulation texts with group discussions.

A study done by Cruz et al.,(2009) hypothesized that diagnostic accuracy
(nursing diagnoses) would be significantly higher in nurses who completed a
course focused on cognitive skills, including critical thinking.  This was
a prospective study (small N=39) and results of pre and post testing
revealed a significant difference on the accuracy of nursing diagnoses
(p<0.01).

I am wondering if identifying a specific area in the process of decision
making that educators begin to focus on strategies to improve critical
thinking.  Sibbald's study (2013) found that checklists utilized
during the *verification
phase* not the i*nterpretative phase *of diagnosis revealed marked
decreases in diagnostic errors when interpreting EKGs.  This forced
provider's to utilize their critical thinking skills first.

Sincerely,

Julianne Nemes Walsh, MS, PNP-BC


Cruz, D., Pimenta, C. & Lunney, M. (2009).  Improving critical thinking and
clinical reasoning with a continuing education course.  *The Journal of
Continuing Education in Nursing,* 40(3), 121-127.


Sibbald, M., Bruin, A., & van Merrienboer, J. (2013). Checklists improve
experts’ diagnostic decisions.  *Medical Education*, 47, 301-308.



On Thu, Nov 5, 2015 at 7:47 AM, Mayer, Thom <tmayer at best-practices.com>
wrote:

> Folks:
>
>
>
> In support of Pat’s excellent idea-and as symbol of how deep the problem
> is, I teach a large portion of the American College of Emergency Physicians
> (ACEP) Emergency Department Directors’ Academy course,, which addresses
> both physician and nurse leadership.  To date, we have had over 1,500
> physician and nurse leaders go through the course, part of which highlights
> the often disparate ways in which physicians and nurses are educated.
>
>
>
> 100% of the nurse leaders have told me that “critical thinking skills” are
> the single most important attribute in hiring emergency department nurses.
> And yet when I ask the physicians, less than 10 had any idea whatsoever
> what that term meant, simply because they are not exposed to that specific
> concept.  A decidedly unscientific sample, to be sure, but one which I fear
> would hold true in other specialties.
>
>
>
> Obviously, I think a Critical Thinking module is an excellent idea.
>
>
>
> Best,
>
>
>
> Thom
>
>
>
> Thom A. Mayer, MD, FACEP, FAAP
>
> Founder and CEO
>
> [image: BP]
>
>
>
>
>
>
>
> *From:* Pat Croskerry [mailto:croskerry at EASTLINK.CA]
> *Sent:* Wednesday, November 04, 2015 3:52 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] SIDM's priority: Translating ideas into action
>
>
>
> Mark: these all look worthwhile initiatives.
>
> I’d like to add a further one: given that a number of studies now point to
> a significant proportion of diagnostic failure being due to thinking
> failures, and given that meta-analytic studies demonstrate conclusively
> that by far the most effective way of improving reasoning and problem
> solving skills is through critical thinking interventions, I advocate for
> the introduction of critical thinking interventions at UGME and PGME.
> Others have already designated critical thinking as a meta-competency and
> some programs have embarked on this in separate initiatives. Others in the
> ethics domain have strongly proposed that this be done as an ‘ethical
> imperative’, and, given the unacceptably high estimates of preventable
> deaths from diagnostic failure it’s hard to argue with that.
>
> Rather than each inventing our own wheels, how about developing a generic
> Critical Thinking Module that would be available off the shelf that medical
> educators could use? The content could be approved by a consensus
> committee. This would be an inexpensive project with potentially high
> returns.
>
> Pat
>
>
>
> On 11/04/15 12:43 PM, *Mark Graber *<mark.graber at IMPROVEDIAGNOSIS.ORG>
> wrote:
>
> With the IOM report now officially out on the street, SIDM is now focused
> on how to change practice to improve diagnosis.  The "Coalition to Improve
> Diagnosis" will be our first priority; the Coalition steering committee has
> had several meetings already, and the next steps are for each organization
> to identify at least one action they can take, and for all the members to
> agree on a common action. The Coalition will also be growing very soon to
> include another set of key national organizations.
>
>
>
> We are also urging federal agencies to step up to the plate.  Founding
> Board member David Newman-Toker represented SIDM at a meeting yesterday of
> the AHRQ National Advisory Committee, and publicly thanked AHRQ for being a
> key supporter of our efforts through funding of our Diagnostic Error
> Conferences, the IOM report itself, and through the new R01 and R18 grant
> funding to study diagnostic error they have recently made available. We
> asked the NAC to support 3 initiatives deriving from the IOM report:  1)
> Developing a Common Format for organizations to report diagnostic errors to
> their Patient Safety Organizations; 2) Working with DOD, HHS, VA and others
> to develop the national research priorities for diagnosis, and to develop a
> public-private partnership to promote research; and 3) Providing dedicated
> funding for AHRQ to support research on diagnostic error in proportion to
> the harm associated with diagnostic error.
>
>
>
> Later this month I'll be addressing a group at the CDC to emphasize the
> actions we'd like to see them take: 1) Resurrect the clinical pathologist
> position by providing funding for this type of consultation; 2) Resuscitate
> autopsies at key designated centers as a way to learn about errors; 3) Help
> develop and use failsafe procedures for test reporting; and 4) Use second
> opinions in anatomic pathology.
>
>
>
> We'll provide updates on these activities as they come up, and would love
> to hear about initiatives that the listserv readership might also know
> about, or be involved with.
>
>
>
> *  Mark*
>
>
>
> Mark L Graber MD FACP
> President, SIDM  www.improvediagnosis.org
> 919 990-8497
>
>
> ------------------------------
>
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>
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>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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