Academic medicine : journal of the Association of American Medical Colleges
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Multicenter Study
Identifying and overcoming the barriers to bedside rounds: a multicenter qualitative study.
The use of bedside rounds in teaching hospitals has declined, despite recommendations from educational leaders to promote this effective teaching strategy. The authors sought to identify reasons for the decrease in bedside rounds, actual barriers to bedside rounds, methods to overcome trainee apprehensions, and proposed strategies to educate faculty. ⋯ Bedside teachers encountered primarily systems- and time-related barriers and overcame resident apprehensions by creating a learner-oriented environment. Strategies used by experienced bedside teachers can be used for faculty development aimed at promoting bedside rounds.
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The rapidly evolving medical education landscape requires restructuring the approach to teaching and learning across the continuum of medical education. The deliberate practice strategies used to coach learners in disciplines beyond medicine can also be used to train medical learners. However, these deliberate practice strategies are not explicitly taught in most medical schools or residencies. ⋯ Design of a multisource evaluation tool based on the coaching competencies will enable more rigorous study of the Doctor Coach framework and training programs and provide a richer feedback mechanism for participants. The framework will also facilitate the faculty development needed to implement the milestones and entrustable professional activities in medical education.
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Diagnostic errors are thought to arise from cognitive biases associated with System 1 reasoning, which is rapid and unconscious. The primary hypothesis of this study was that the instruction to be slow and thorough will have no advantage in diagnostic accuracy over the instruction to proceed rapidly. ⋯ The study demonstrates that simply encouraging slowing down and increasing attention to analytical thinking is insufficient to increase diagnostic accuracy.
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Two reports in this issue address the important topic of clinical decision making. Dual process theory has emerged as the dominant model for understanding the complex processes that underlie human decision making. This theory distinguishes between the reflexive, autonomous processes that characterize intuitive decision making and the deliberate reasoning of an analytical approach. ⋯ Reductionist approaches that attempt to isolate dependent variables may create such artificial experimental conditions that both external and ecological validity are sacrificed. Clinical decision making is a complex process with many independent (and interdependent) variables that need to be separated out in a discrete fashion and then reflected on in real time to preserve the fidelity of clinical practice. With these caveats in mind, the authors believe that research in this area should promote a better understanding of clinical practice and teaching by focusing less on the deficiencies of intuitive and analytical systems and more on their adaptive strengths.