Teaching and learning in medicine
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Professional identity, or how a doctor thinks of himself or herself as a doctor, is considered to be as critical to medical education as the acquisition of skills and knowledge relevant to patient care. ⋯ Medical education needs to be responsive to changes in professional identity being generated from factors within medical student experiences and within contemporary society.
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Multicenter Study
The value of bedside rounds: a multicenter qualitative study.
Bedside rounds have decreased on teaching services, raising concern about trainees' clinical skills and patient-physician relationships. ⋯ Bedside teachers identify potential benefits of bedside rounds, many of which align with national calls to change our approach to medical education. The practice of bedside rounds enables activities essential to high-quality patient care and education.
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Recently, clinical diagnostic reasoning has been characterized by "dual processing" models, which postulate a fast, unconscious (System 1) component and a slow, logical, analytical (System 2) component. However, there are a number of variants of this basic model, which may lead to conflicting claims. This paper critically reviews current theories and evidence about the nature of clinical diagnostic reasoning. ⋯ Consequently, from this model, the best strategy for reducing errors is to make students aware of the biases and to encourage them to rely more on System 2. However, an accumulation of evidence suggests that (a) strategies directed at increasing analytical (System 2) processing, by slowing down, reducing distractions, paying conscious attention, and (b) strategies directed at making students aware of the effect of cognitive biases, have no impact on error rates. Conversely, strategies based on increasing application of relevant knowledge appear to have some success and are consistent with basic research on concept formation.
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Work-based assessment (WBA) is the assessment of trainees and physicians across the educational continuum of day-to-day competencies and practices in authentic, clinical environments. What distinguishes WBA from other assessment modalities is that it enables the evaluation of performance in context. ⋯ Although a systematic review is beyond the purview of this perspective, we highlight specific methods and needed shifts to WBA that (a) consider patient outcomes, (b) use nonphysician assessors, and (c) assess the care provided to populations of patients. We briefly describe strategies for the effective implementation of WBA and identify outstanding research questions related to its use.