Martine Chamberland

The influence of medical students’ self‐explanations on diagnostic performance

Medical Education 2011: 45: 688–695

Students' self-explanations while solving unfamiliar cases: the role of biomedical knowledge

General guidelines for teaching clinical reasoning have received much attention, despite a paucity of instructional approaches with demonstrated effectiveness. As suggested in a recent experimental study, self‐explanation while solving clinical cases may be an effective strategy to foster reasoning in clinical clerks dealing with less familiar cases. However, the mechanisms that mediate this benefit have not been specifically investigated. The aim of this study was to explore the types of knowledge used by students when solving familiar and less familiar clinical cases with self‐explanation.

Self‐explanation in learning clinical reasoning: the added value of examples and prompts

Recent studies suggest that self‐explanation (SE) while diagnosing cases fosters the development of clinical reasoning in medical students; however, the conditions that optimise the impact of SE remain unknown. The example‐based learning framework justifies an exploration of students’ use of their own SEs combined with the study of examples. This study aimed to assess the impact on medical students’ diagnostic performance of: (i) combining students’ SEs with their listening to examples of residents’ SEs, and (ii) the addition of prompts (specific questions) while working with examples.

Expectations, Observations, and the Cognitive Processes That Bind Them: Expert Assessment of Examinee Performance.

Performance-based assessment (PBA) is a valued assessment approach in medical education, be it in a clerkship, residency, or practice context. Raters are intrinsic to PBA and the increased use of PBA has lead to an increased interest in rater cognition. Although several researchers have tackled factors that may influence the variability in rater judgment, the critical examination of rater observation of performance and the translation of that data into judgements are being investigated. The purpose of this study was to qualitatively investigate the cognitive processes of raters, and to create a framework that conceptualizes those processes when raters assess a complex performance. We conducted semi-structured interviews with 11 faculty members (nominated as excellent assessors) from a Department of Medicine to investigate how raters observe, interpret, and translate performance into judgments. The transcribed verbal protocols were analyzed using Constructivist Grounded Theory in order to develop a theoretical model of raters’ assessment processes. Several themes emerged from the data and were grouped according to three macro-level themes describing how the raters balance two sources of data [(1) external sources of information and (2) internal/personal sources of information] by relying on specific cognitive processes to assess an examinee performance. The results from our study demonstrate that assessment is a difficult cognitive task that involves nuance using specific cognitive processes to weigh external and internal data against each other. Our data clearly draws attention to the constant struggle between objectivity and subjectivity that is observed in assessment as illustrated by the importance given to nuancing the examinee’s observed performance.

The role of the assessor: exploring the clinical supervisor's skill set

Clinical supervisors have several different responsibilities. Although their responsibilities as an assessor are important, little is known about what skill set should be acquired for this role and how to foster their development. Documenting assessor skills to study their acquisition and development is critical.

Incipient neuroleptic malignant syndrome with quetiapine/paroxetine combination treatment: atypical presentation and early, successful rechallenge with olanzapine

A 26-year-old caucasian male developed incipient neuroleptic malignant syndrome (NMS) during the course of paranoid schizophrenia with catatonic signs at admission, while on quetiapine/paroxetine combination treatment. The clinical presentation was “atypical”, but increased creatine kinase levels and positive myoglobinemia were highly suggestive of the diagnosis. Of note, the patient was successfully rechallenged with olanzapine. The implications of the drug regimen and of the catatonic presentation are discussed.

Optometrists' clinical reasoning made explicit: a qualitative study.

Purpose Because the clinical reasoning processes engaged in by practicing optometrists have not previous been investigated, until now, there has been no way of knowing whether models of clinical reasoning from other health professions can be transposed to optometry. The purpose of this study has therefore been twofold: making explicit the clinical reasoning processes of optometrists at both the “competent” and “expert” levels and comparing these processes to highlight the characteristics of clinical reasoning expertise. Methods Four competent-level optometrists and four expert-level optometrists participated in this qualitative study. Each optometrist performed a complete optometric examination on a preselected patient. Each of these examinations was recorded on a DVD video and followed by a feedback session, also captured on a DVD video. The feedback session was conducted using techniques inspired by a form of interview called the “explicitation interview,” aiming to describe optometrists’ mental actions and the time sequence of these actions throughout the examination. Results The results indicate that optometrists’ clinical reasoning is patient centered and includes both analytical and nonanalytical modes of reasoning. When compared with a competent-level optometrist, an expert-level optometrist is more patient centered, formulates an earlier mental representation of the patient’s clinical situation (including diagnosis formulation), plans examinations more thoroughly, is able to analyze and reflect during cognitively demanding tasks, and draws up his or her care management plan throughout the entire examination. Conclusions The verbalization of optometrists’ clinical reasoning processes represents a first step toward a better understanding of this competency. The impact of this research on optometric education is discussed. The results open doors to further research in the field, for example, toward defining the stages of clinical reasoning development among optometry students and professionals.

Back to basics: keeping students cognitively active between the classroom and the examination

After a didactic session, a student comes to you for advice on deepening his understanding of the material presented because he hopes you can help him to retain this knowledge better over the next months. You have invested all of your educational knowledge in developing the session, adding interactive aspects, making links to clinical cases and providing a selection of relevant references for additional reading. As requested by your unit director, you have also designed appropriate examination questions that will be part of a more general assessment to be delivered at the end of the unit in 2 months time. Thus, you are not sure what more you can do and how you can help. After all, you have done your part, and students have to do theirs. If this scenario looks familiar, take heart! There is interesting news!