Medical teacher
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Comparative Study
Clinical reasoning: the relative contribution of identification, interpretation and hypothesis errors to misdiagnosis.
The aim of this study was to identify and describe the types of errors in clinical reasoning that contribute to poor diagnostic performance at different levels of medical training and experience. Three cohorts of subjects, second- and fourth- (final) year medical students and a group of general practitioners, completed a set of clinical reasoning problems. The responses of those whose scores fell below the 25th centile were analysed to establish the stage of the clinical reasoning process--identification of relevant information, interpretation or hypothesis generation--at which most errors occurred and whether this was dependent on problem difficulty and level of medical experience. ⋯ Furthermore, although hypothesis errors increased in line with problem difficulty, identification and interpretation errors decreased. A possible explanation is that as problem difficulty increases, subjects at all levels of expertise are less able to differentiate between relevant and irrelevant clinical features and so give equal consideration to all information contained within a case. It is concluded that the development of clinical reasoning in medical students throughout the course of their pre-clinical and clinical education may be enhanced by both an analysis of the clinical reasoning process and a specific focus on each of the stages at which errors commonly occur.
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As the healthcare system continues to change, healthcare professionals will need to assume an increasing number of administrative and management responsibilities. The goal of this article is to describe a two-day workshop on Executive Skills for Medical Faculty and the results of an evaluation conducted one year later. This workshop consisted of specific modules on analyzing time-management skills, determining goals and priorities, improving time-management strategies, assessing leadership styles and skills, and conducting effective meetings. ⋯ Both the immediate and delayed workshop evaluations indicated that the most useful sessions were those devoted to determining goals and priorities, time management and effective meetings. These results suggest that a two-day workshop can improve health care professionals' administrative and management skills in certain areas. A longer workshop and built-in 'follow-up' activities would enhance the potential for change.
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Guideline
AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician.
Two important features of contemporary medical education are recognized. The first is an emphasis on assessment as a tool to ensure quality in training programmes, to motivate students and to direct what they learn. The second is a move to outcome-based education where the learning outcomes are defined and decisions about the curriculum are based on these. ⋯ It is likely to be some form of written test, a performance test such as an OSCE in which the student's competence can be tested in a simulated situation, and a test of the student's behaviour over time in clinical practice, based on tutors' reports and students' portfolios. An assessment profile can be produced for each student which highlights the learning outcomes the student has achieved at the required standard and other outcomes where this is not the case. For educational as well as economic reasons, there should be collaboration across the continuum of education in test development as it relates to the assessment of learning outcomes and in the implementation of a competence-based approach to assessment.