SIDM's priority: Translating ideas into action

robert bell rmsbell200 at YAHOO.COM
Mon Nov 9 20:39:58 UTC 2015


Great,

Let’s expand this kind of work and get something completed that is evidence based!

Then get the coalition to recommend/endorse.

Where does the litigation dragon fit into all of this - will its powerful breath burn to cinders any effort to move forward and make recommendations?

Then the question becomes, what can we do to tame the dragon of research hindrance?

Rob Bell, M.D.


> On Nov 9, 2015, at 12:30 PM, Julianne Nemes Walsh <nemeswalsh at GMAIL.COM> wrote:
> 
> 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 interpretative 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 <mailto: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
> 
> <image001.png>
> 
>  
> 
>  
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>  
> 
> From: Pat Croskerry [mailto:croskerry at EASTLINK.CA <mailto:croskerry at EASTLINK.CA>] 
> Sent: Wednesday, November 04, 2015 3:52 PM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto: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 <mailto: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 <http://www.improvediagnosis.org/>
> 919 990-8497 <tel:919%20990-8497>
> 
>  
> 
> 
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> 
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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:
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> 

Robert M. Bell, M.D., Ph.C.
P.O. Box 3668
West Sedona, AZ  86340-3668
USA
Tel: Fax: 928 203-4517









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


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