[EXTERNAL] Re: [IMPROVEDX] Training on clinical reasoning in US med schools

Wally Smith wally.smith at VCUHEALTH.ORG
Thu Aug 31 21:45:22 UTC 2017


In my experience, having taught this stuff throughout various stages of medical school, late in the third year or early in the fourth year is the peak interest.  By then, they’ve been disavowed of the notion that testing and interpretation are simple, always right, and that diagnoses are always easy to make.  That scares them as they consider bearing the responsibility of becoming an intern.

Smith

From: "Grubenhoff, Joe" <Joe.Grubenhoff at CHILDRENSCOLORADO.ORG>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Grubenhoff, Joe" <Joe.Grubenhoff at CHILDRENSCOLORADO.ORG>
Date: Thursday, August 31, 2017 at 5:14 PM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [EXTERNAL] Re: [IMPROVEDX] Training on clinical reasoning in US med schools

I have had a similar experience with 4th year students destined for pediatrics residency here at CU.

It begs the question as to whether certain topics SHOULD  be displaced for this fundamental skill training?

Joseph A. Grubenhoff, MD, MSCS
Associate Professor of Pediatrics
Section of Emergency Medicine
University of Colorado
Joe.grubenhoff at childrenscolorado.org<mailto:Joe.grubenhoff at childrenscolorado.org>
________________________________
From: John Brush <jebrush at ME.COM>
Sent: Thursday, August 31, 2017 8:10:12 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Training on clinical reasoning in US med schools

I gave a lecture to the second year class at Eastern Virginia Medical School 2 weeks ago on “The Logic of Medicine.” I talked about the systematic thinking, cognitive psychology, and probability theory that can provide the underpinning for medical decision-making. It was on “how" to think through medical problem-solving. It was a bit philosophical about the “why” and the “ought,” but I had enough examples to make it realistic and not too philosophical. It had the feel of a TED talk. The class was riveted.
I received enormously positive feedback. The students crave this type of exposure to an overall philosophical approach that gives them a basic “mission statement” for practice. After the talk, 2 class members who are the officers in the local Evidence-based Medicine Club asked me to give a talk at their next meeting. They have asked the course director to include more of this type of thing in their course offerings.
Students have an appetite for this type of explicit instruction if they get a little taste of it. It displaces other topics, however, so getting it into the curriculum is a challenge - but possible.
John

John E. Brush, Jr., M.D., FACC
Professor of Medicine
Eastern Virginia Medical School
Sentara Cardiology Specialists
844 Kempsville Road, Suite 204
Norfolk, VA 23502
757-261-0700
Cell: 757-477-1990
jebrush at me.com<mailto:jebrush at me.com>



On Aug 31, 2017, at 6:58 AM, Jason Maude <jason.maude at ISABELHEALTHCARE.COM<mailto:jason.maude at isabelhealthcare.com>> wrote:

Many congratulations to Joe Renic and his colleagues for this study which is brilliant but left me both horrified and speechless.

It does a real service by shining a light on this huge gap in national medical education. We all accept that clinical reasoning is a fundamental part of being a good doctor so how can we have arrived at a situation where even poor or fair students only receive a total of 6.4 hours of dedicated instruction on this topic?

Isn’t this a bit like pilots only getting a tiny amount of their overall training on take-offs?!

Regards
Jason

Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890
www.isabelhealthcare.com<http://www.isabelhealthcare.com/>



From: Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG<mailto:Mark.Graber at improvediagnosis.org>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at list.improvediagnosis.org>>, Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG<mailto:Mark.Graber at improvediagnosis.org>>
Date: Tuesday, 29 August 2017 at 14:38
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at list.improvediagnosis.org>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at list.improvediagnosis.org>>
Subject: [IMPROVEDX] Training on clinical reasoning in US med schools

Congratulations to Joe Rencic and colleagues for this important article on teaching clinical reasoning in US med schools.  A survey of clerkship directors with a high response rate found that less than half of schools have a formal curriculum on clinical reasoning, and that 80% were dissatisfied with student reasoning competency at the end of the clerkship.

This is an area where SIDM is highly engaged and trying to improve the current state of affairs.  Most of the authors of this paper are members of SIDM and the SIDM Education Committee.  There are many excellent resources for educators on the SIDM website, in particular the items in the Clinical Reasoning Toolkit<http://www.improvediagnosis.org/page/ClinicalReasoning>.


Mark L Graber, MD FACP
President, SIDM
Senior Fellow, RTI International
Professor Emeritus, Stony Brook University, NY
<image001.png>

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