KENDRIYA VIDAYALA TIBRI CANTT GURDASPUR

HEALTH AND MEDICINE

SUBMITTED TO :- MEENAKSHI MEHTA

Faculty of Health, Medicine and Life Sciences

Risks of life

Faculty of Health, Medicine and Life Sciences

Medical errors
Diagnostic errors: 5-15% of medical diagnosis Taxonomy of diagnostic error (Graber,2005): No-fault errors System-related errors Cognitive errors 7 19 Cognitive errors contribute 46 to 75% of all diagnostic errrors Premature closure most 28 common cognitive error

Factors
No fault
Only system

Only cognitive
Both system and cognitve

Faculty of Health, Medicine and Life Sciences

Education to prevent cognitive errors

Relationships between reliability and effort of diagnostic decision making (Graber, 2009) ideas for educational approaches
More Deductive reasoning Monitoring, reflection

Effort

Pre-expert reasoning: heuristics

Expert thinking

Less Low High

Accuracy Faculty of Health, Medicine and Life Sciences

Increase expertise
Deliberate practice with coaching and feedback by more accomplished professionals (Ericsson, 2003) Access to a large numbers of patients with similar symptoms for which the correct diagnosis is validated Virtual patients can supplement real patient encounters

Faculty of Health, Medicine and Life Sciences

Learn to apply reflective thinking

Learning to: Recognize and understand the most likely diagnostic pitfalls (Croskerry, 2003) Use a checklist for the diagnostic process including reflection.

Faculty of Health, Medicine and Life Sciences

Clinical reasoning sessions

Ingredients: Virtual patients based on real cases in which premature closure had occurred Procedure to induce reflective diagnostic reasoning (Mamede, 2008)

Faculty of Health, Medicine and Life Sciences

Clinical reasoning sessions

Procedure: All residents simultaneously worked out the same virtual patient And the end of the work-up they had a moderated discussion on their clinical reasoning The logged actions and their notes were starting points for the discussion

Faculty of Health, Medicine and Life Sciences

Evaluation of perceptions
Two student questionnaires:
1. Experiences with the use virtual patients. With 12 statements on:
Authenticity Professional approach Coaching Learning effect Overall judgment

2.

Experiences with the integration of virtual patients. With 20 statements on:

Teaching presence Cognitive presence Social presence Learning effect Overall judgment

Faculty of Health, Medicine and Life Sciences

Conclusion
Residents perceived a session combining individual virtual patient workup with small group discussions as a valuable learning activity for clinical reasoning. The clinical supervisor found the presented teaching approach feasible for the medical specialist training at the workplace.

Faculty of Health, Medicine and Life Sciences

Future research
Evaluation of clinical reasoning sessions with VPs on 3rd and 4th level of Kirkpatrick: Do they learn clinical reasoning and reflective practice from this activity? Do the learning outcomes transfer to clinics and wards?

Faculty of Health, Medicine and Life Sciences

THANK YOU
MADE BY :- SIMRAN

Faculty of Health, Medicine and Life Sciences