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While watching the video to the left, pay close attention to what the students have to say about how their clinical experiences prepare them to be a competent future professional.
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Experience is without a doubt, one of the most important elements of clinical education. However, it is naive for clinical preceptors to assume that all pre-determined, or even well-designed, learning experiences are automatically educative and positive experiences. Despite good intention, educational experiences may not always end up true and meaningful to students. For years, educators and students alike have admitted that a certain degree of mis-education occurs when educators fail to teach students how to think like professionals.
To ensure that experiences are truly educative toward the goal of competency, clinical preceptors must address students' ability to think like experts. It is essential that clinical preceptors go beyond educating students on how to do athletic training, and focus on teaching students how to reason and think like an expert.
In medical education, when differentiating between novice and expert thinking processes, two primary methods of clinical reasoning come into play.
1. hypothetico-deductive reasoning
2. case pattern recognition
To ensure that experiences are truly educative toward the goal of competency, clinical preceptors must address students' ability to think like experts. It is essential that clinical preceptors go beyond educating students on how to do athletic training, and focus on teaching students how to reason and think like an expert.
In medical education, when differentiating between novice and expert thinking processes, two primary methods of clinical reasoning come into play.
1. hypothetico-deductive reasoning
2. case pattern recognition
Hypothetico-deductive reasoning
With hypothetico-deductive reasoning, possible hypotheses are proposed followed by an attempt to prove or disprove each of the hypotheses using clinical "experiments" to come to a problem solution. Novice athletic trainers typically utilize hypothetico-deductive reasoning as a starting point. This approach to collecting data for the support or elimination of competing hypotheses can be a very lengthy, misguided, and unorganized process in the clinical environment. The more unnecessary information that is gathered, the more chaotic that the evaluative process becomes. Inexperienced students often become frustrated and easily overwhelmed with the challenge of identifying a diagnosis and might resort to withdrawing from the situation out of their fear of coming to the wrong conclusion.
However, with time and experience this process becomes quicker and more efficient. As students and young professionals reach higher levels of expertise, they develop fewer hypotheses and come to more accurate resolutions. |
The image above provides a visual representation of hypothetico-deductive reasoning. First a hypothesis or multiple hypotheses are formulated inductively. Information about the situation is then collected through tests and hypotheses can be either supported or eliminated deductively. The goal is to end up with a single conclusive solution.
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Case Pattern Recognition
In the visual above, you can see how patient presentation is initially either recognized or not recognized. If key features are identified the evaluation process is streamlined to produce a quicker diagnosis. Even if the pattern is not recognized at first, the evaluation could lead to key feature recognition that in turn could still speed up the process when compared to the slower and more thorough process of hypothetico-deductive reasoning.
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Expert athletic trainers process information based upon an extensive knowledge base that they have constructed through years of contextual experiences. Quite the opposite of novices, experts use their intuition to guide decision making processes. In other words, while novices naturally gravitate to hypothetico-deductive reasoning, experts rely more heavily on case pattern recognition.
Case pattern recognition is another term for expert clinical reasoning, whereby experts utilize any number of mental short-cuts or heuristics based upon prior experiences to work more efficiently than individuals with less experience. The expert athletic trainer is capable of recognizing the key features of a familiar case (i.e., signs and symptoms) with ease and identifying these features with a specific pattern for an illness or injury. Eventually, pattern recognition becomes unconsciously automatic for experts. |
Modeling Expert Thinking
Though individuals with less expertise should be taught case pattern recognition strategies, these individuals should not be taught to rely solely on this strategy for all decisions. Novice and advanced beginners will utilize hypothetico-deductive reasoning at first because completing comprehensive evaluations will enable them to perform every test, repeating all the rules that they have been taught and leaving nothing behind. Therefore, during the earlier levels of proficiency, clinical preceptors should recommend and focus on teaching students how to improve hypothetico-deductive reasoning skills. Clinical preceptors might model how to formulate fewer plausible hypotheses to be tested in a more organized and concise manner by verbalizing a scenario out loud.
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As these individuals gain more contextual experiences and become better at the use of hyptothetico-deductive reasoning, clinical preceptors should begin to encourage students to organize their thoughts and create case patterns by focusing on reoccurring key features of similar cases. Of the two types of clinical reasoning, case pattern recognition is the more difficult method to teach and to learn. It is only as students and young clinicians continue to accumulate clinical experiences that they become able to organize experiences with key features into recognizable case patterns. Clinical preceptors might be able to speed this process up by modeling how to recognize and organize key features of specific illnesses or injuries.
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In the table above you can see the different characteristics, advantages, and disadvantages for each of the two clinical reasoning strategies.
The most important thing to remember as a clinical preceptor is that your role is to promote student expertise development in ways that reflect expert clinical thinking and reasoning, instead of just rote memorization. It is also important to recognize that novice students might become easily overwhelmed by an expert athletic trainer's thought processes. In order to breach the communication barrier, skilled clinical preceptors will need to make a conscious effort to slow down their own thought process so that they may clearly verbalize and explain clinical reasoning strategies. Again development of expertise is a process that requires deliberate practice and situational experiences. It is not something that can simply be developed over night. It is going to take students and young professionals some several years before they will begin to think like an expert. It is also going to challenge clinical preceptors in a new way, but it is absolutely necessary for the development of our profession's future.
Click below to download and print this final document for your clinical preceptor toolbox. It can be used to assess students' and young clinicians' clinical thinking and reasoning processes to identify where they fall on the Novice to Expert continuum.
Click below to download and print this final document for your clinical preceptor toolbox. It can be used to assess students' and young clinicians' clinical thinking and reasoning processes to identify where they fall on the Novice to Expert continuum.
geisler_annd_lazenby_-_differential_diagnosis_schematic_exercise.pdf | |
File Size: | 55 kb |
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