Clarifying the Theoretical Foundation for the Concept of Diagnosis and Its Relevance in Nursing: A Discussion Paper.

Disparities in Adequate Mental Health Care for Past-Year Major Depressive Episodes Among Caucasian and Hispanic Youths

Following efforts made in recent years to provide effective mental health treatments based on evidence-based guidelines, a working definition was developed in the literature detailing a minimum level of "adequate mental health care" for serious mental illness. However, little is known about racial or ethnic disparities in receipt of adequate mental health care for individuals affected with serious mental illness. The objective of this study was to examine disparities among Caucasian and Hispanic youths in receipt of adequate mental health care for past-year major depressive episodes. Data for this study were drawn from the 2005 National Survey on Drug Use and Health. The study sample was composed of 1,169 Caucasian youths and 316 Hispanic youths aged 12 to 17 with past-year major depressive episodes. The percentages of youths in the sample who received adequate mental health care for past-year major depressive episodes were estimated, and the correlates of receipt of adequate mental health care were examined. Thirty-four percent of the full sample received adequate mental health care for past-year major depressive episodes, but separate analyses indicated that adequate mental health care was received by a significantly higher proportion of Caucasian youths (36%) than Hispanic youths (27%). The odds of receiving adequate mental health care for past-year major depressive episodes for Caucasians were 1.55 times that of Hispanics (p=.01). Having Medicaid or coverage via the State Children's Health Insurance Program significantly increased the odds of receiving adequate mental care for past-year major depressive episodes for both Hispanics and Caucasians. As mental health problems of adolescents from diverse racial or ethnic backgrounds become more easily identified and a larger proportion of these groups is referred to mental health treatment services, it is important to examine the degree to which treatment should be tailored to engage and retain specific racial or ethnic groups so that they will receive the minimum of adequate mental health care.

Clinical thinking is not only the basis and premise of clinical reasoning and decision-making, but the necessary quality to cultivate reliable, responsible, and emotional excellent doctors. Virtual reality technology provides a real clinical learning environment for medical students, which can bridge the gap between medical theory and medical practice and save educational resources. Virtual reality is helpful to cultivate medical students' clinical thinking and prepare for their clinical practice. Through the deconstruction of clinical thinking, this paper determines the connotation and constituent elements of clinical thinking, puts forward the model framework for virtual reality technology to promote the development of medical students' clinical thinking, and explains the impact of virtual reality technology on the development of medical students' clinical thinking, clinical reasoning, and critical thinking from the aspects of virtual reality situation, teaching activities, and virtual reality characteristics.

Introduction This study aimed to investigate dental students' clinical reasoning and diagnostic thinking ability by key feature test and “diagnostic thinking inventory” questionnaire. Methods The present study was a descriptive cross-sectional study. The participants consisted of 61 senior dental students. Clinical reasoning and diagnostic thinking were assessed by key feature tests and the “diagnostic thinking inventory” “DTI” questionnaire, respectively. The “diagnostic thinking inventory” was developed by Bordage et al. in France and consisted of 41 questions on a 6-point Likert scale. The satisfaction of students was assessed through a 10-item questionnaire. Data were analyzed using SPSS 19 with descriptive tests (mean, SD, and percentage), student independent T-test, and Pearson correlation. The significance level was determined at p < 0.05. Results The mean scores of the key feature test were 56.55 ± 7.80. Diagnostic thinking scores of learners were reported in diagnostic thinking 136.47 ± 16.45, flexibility in thinking 72.22 ± 11.15, and structure of memory 64.24 ± 7.84. The difference in students' scores in flexibility in thinking was significantly higher among male students than female students. (p-value = 0.04). The students' satisfaction scores were 3.53 ± 0.52, which showed relative satisfaction. Conclusion The participants' clinical reasoning and diagnostic thinking skills were reported at a low level. This issue emphasizes the need for training to enhance diagnostic thinking and clinical reasoning in dental education. Formative evaluation and reform of the educational programs of this course should be considered.

Objective: To address the need for a more definitive approach to critical thinking during athletic training educational experiences by introducing the clinical reasoning model for critical thinking. Background: Educators are aware of the need to teach students how to think critically. The multiple domains of athletic training are comprehensive and complex. Thinking is the fundamental connection between didactic and experiential components. Therefore, clinical thinking must be viewed as a critical part of experiential education in athletic training. Description: Research from educational journals in medicine, physical therapy and athletic training, as well as relevant texts, were searched to investigate the theoretical and practical underpinnings of clinical thinking models. Definitions, applications, and the historical underpinnings of the clinical thinking processes in allied health were reviewed and presented to highlight the need for athletic training educators to better appreciate the thinking processes of students and practitioners. Practical suggestions for the implementation of clinical reasoning in athletic training are presented. Application: Athletic training requires clinically based decision-making and problem solving skills. Medical educators recognize differences between the thinking of novice and expert practitioners, and have investigated the nature of clinical cognition as part of their formal curriculum. As AT's professional scope and credibility expand, the process of teaching, fostering, and evaluating clinical reasoning is paramount for AT educators.

This article was migrated. The article was not marked as recommended. Objectives: In recent years, many medical universities in China have launched Problem-Based Learning (PBL) curriculum. It improves the autonomous learning ability, but also exposes some problems and shortcomings. For example, the low learning efficiency due to excessive freedom of atmosphere and insufficient guidance of tutor, the lack of clinical training due to case compiling and curriculum design, etc. To solve these problems, we conceive a new method Navigation-Based Learning (NBL) in this study. Methods: A standard learning group includes one tutor and ten students. The NBL cases containing two acts are generated by expanding and modifying real clinical records. The learning process comprises a series of steps: Introduction (10 min), Act Ⅰ (75 min), Act Ⅱ (75 min), Summary (20 min). The learning quality is further evaluated by an objective examination and a subjective questionnaire, followed by quantitative analyses with various statistical models. Results: The results of examination show that NBL achieves similar learning quality as PBL. Benefiting from enhanced guidance and compressed course time, NBL reaches a higher learning efficiency than PBL. The results of questionnaire show that the approval rating of NBL is 85.11%. Compared with PBL, the high support rate of NBL is attributed to the advantages of four aspects, including learning efficiency of unit time (HR=1.119, p=0.029), clarified learning orientation (HR=1.093, p=0.039), authentic simulation of clinical diagnosis and treatment scenarios (HR=1.139, p=0.033), clinical thinking and logical reasoning (HR=1.089, p=0.033). Conclusions: NBL has been proved to be an effective learning method in clinical thinking training for medical students. It achieves a balance between promoting efficiency and maintaining interest in medical learning.

Background: The ability to think clearly and critically is necessary to normal human conduct. Particular forms of reasoning characteristic of practitioners of medicine have been studied, but a principled pedagogical framework that also reflects clinical practice has not been delineated.Aims: The goals are: identify the principles that underlie the clinical thinking of physicians, develop a pedagogical framework, and design and implement curricular modules for medical students in the first year of their studies.Methods: The authors reviewed prior work on clinical thinking of physicians and medical students as well as reflective pieces by seasoned clinicians. They also examined modalities of logic and inference used by physicians and others. The designed modules were implemented at the Faculty of Medicine at McGill University and linked to training in attentive listening and clinical observation.Results: Five core features of a pedagogic framework on clinical thinking were developed and used to design and implement a series of teaching modules for first-year medical students.Conclusions: The core features, and the modules based upon them, can serve for further empirical work on clinical reasoning and lead to modules for advanced students as they progress in their acquisition of expertize.

Clinical reasoning concepts can be viewed as descriptions of mental operations or as a thinking frame--a structure to organize and support clinical thinking. This study examined an approach for teaching clinical reasoning as a thinking frame to occupational therapy students. A quasi-experimental, pretest-posttest design was used with a convenience sample of 10 undergraduate occupational therapy seniors. All participants (a) acquired the thinking frame of clinical reasoning concepts through explicit instruction and (b) practiced that thinking frame with an external aid--the Clinical Reasoning Case Study Format. The accuracy of participants' definitions of clinical reasoning concepts before and after this learning experience were examined to assess their acquisition of the thinking frame. The content of clinical reasoning case studies were examined to assess students' application of the thinking frame to clinical situations. Wilcoxon signed rank tests done on presemester and postsemester definitions ratings indicated that the latter were rated significantly higher than the former for (a) narrative reasoning (p = .008), (b) procedural reasoning (p = .005), (c) interactive reasoning (p = .006), (d) pragmatic reasoning (p = .008), and (e) conditional reasoning (p = .01). The content of participants' clinical reasoning case studies indicated that they were able to apply clinical reasoning concepts. The results suggest that using a clinical reasoning thinking frame to organize clinical observations is an effective way to help entry-level occupational therapy students learn and apply clinical reasoning concepts.

Objectives: As a fundamental element of medical practice, clinical reasoning should be cultivated in courses of study in human medicine. To date, however, no conclusive evidence has been offered as to what forms of teaching and learning are most effective in achieving this goal. The Diagnostic Thinking Inventory (DTI) was developed as a means of measuring knowledge-unrelated components of clinical reasoning. The present pilot study examines the adequacy of this instrument in measuring differences in the clinical reasoning of students in varying stages of education in three curricula of medical studies. Methods: The Diagnostic Thinking Inventory (DTI) comprises 41 items in two subscales (“Flexibility in Thinking” and “Structure of Knowledge in Memory”). Each item contains a statement or finding concerning clinical reasoning in the form of a stem under which a 6-point scale presents opposing conclusions. The subjects are asked to assess their clinical thinking within this range. The German-language version of the DTI was completed by 247 student volunteers from three schools and varying clinical semesters. In a quasi-experimental design, 219 subjects from traditional and model courses of study in the German state of North Rhine-Westphalia took part. Specifically, these were 5th, 6th and 8th semester students from the model course of study at Witten/Herdecke University (W/HU), from the model (7th and 9th semester) and traditional (7th semester) courses of study at the Ruhr University Bochum (RUB) and from the model course of study (9th semester) at the University of Cologne (UoC). The data retrieved were quantitatively assessed.Results: The reliability of the questionnaire in its entirety was good (Cronbach’s alpha between 0.71 and 0.83); the reliability of the subscales ranged between 0.49 and 0.75. The different groups were compared using the Mann-Whitney test, revealing significant differences among semester cohorts within a school as well as between students from similar academic years in different schools. Among the participants from the model course of study at the W/HU, scores increased from the 5th to the 6th semester and from the 5th to the 9th semester. Among individual cohorts at RUB, no differences could be established between model and traditional courses of study or between 7th and 9th semester students in model courses of study. Comparing all participating highest semester students, the 8th semester participants from the W/HU achieved the highest scores – significantly higher than those of 9th semester RUB students or 9th semester UoC students. Scores from the RUB 9th semester participants were significantly higher than those of the 9th semester UoC participants.Discussion: The German-language version of the DTI measures self-assessed differences in diagnostic reasoning among students from various semesters and different model and traditional courses of study with satisfactory reliability. The results can be used for discussion in the context of diverse curricula. The DTI is therefore appropriate for further research that can then be correlated with the different teaching method characteristics and outcomes of various curricula.

Introduction and background: Today’s complex healthcare environment requires skilled clinical decision making. Yet, this skill in novice and student nurses is documented as linear, based on limited knowledge and experience, and often focused on single problems. Concurrently, an ongoing shortage of nurse educators has resulted in many clinical instructors and preceptors being relatively novice as educators.Methods: Teaching and assessing critical thinking and clinical reasoning is challenging in the context of clinical practice education, especially for novice clinical instructors and preceptors. Critical thinking and clinical reasoning tools are presented as a useful pedagogical approach for teaching and assessing critical thinking, clinical reasoning and clinical decision-making both with students as well as with novice educators and preceptors.Conclusions: By utilizing theoretically-based clinical thinking tools to guide learners through critical thinking, clinical reasoning and decision-making processes, both learners and novice educators benefit.

The article is devoted to the analysis of the clinical reasoning of specialists in the field of physical rehabilitation, in particular, specialists in physical therapy and occupational therapy. Despite numerous studies, the topic of "formation of clinical thinking" remains insufficiently studied and has its own peculiarities in the field of physical therapy.&#x0D; The key features influencing clinical reasoning in physical rehabilitation are revealed. They include the use of movement as one of the main means of diagnosis, rehabilitation, evaluation of effectiveness, as well as the goals of rehabilitation interventions; focus on patient activity and participation (according to the International Classification of Functioning, ICF); patient mobility; interactivity and multidisciplinarity. The autonomy extend in professional activity has a significant impact on the formation of clinical reasoning of specialists.&#x0D; Conceptually, clinical reasoning in physical rehabilitation may be defined as the combination and interaction of cognitive, affective and psychomotor skills. At the same time, effective clinical reasoning is narrative, adaptive and collaborative, contextual and it utilizes a biopsychosocial approach to the patient.

"Clinical reasoning" refers to all the thought processes that physicians use to make a diagnosis and determine a treatment and care plan. Artificial intelligence (AI) will enhance, improve, and accelerate human clinical diagnostic thinking, but it is unlikely to replace it. Its application in medicine has the potential to drastically reduce medical diagnostic errors and give doctors more time to care for their patients. Here, we provide an overview of some of the key elements of clinical diagnostic reasoning and the potential impacts of AI on clinical reasoning.

BackgroundCardiovascular diseases present a significant challenge in clinical practice due to their sudden onset and rapid progression. The management of these conditions necessitates cardiologists to possess strong clinical reasoning and individual competencies. The internship phase is crucial for medical students to transition from theory to practical application, with an emphasis on developing clinical thinking and skills. Despite the critical need for education on cardiovascular diseases, there is a noticeable gap in research regarding the utilization of artificial intelligence in clinical simulation teaching.ObjectiveThis study aims to evaluate the effect and influence of AI-empowered scenario-based simulation teaching mode in the teaching of cardiovascular diseases.MethodsThe study utilized a quasi-experimental research design and mixed-methods. The control group comprised 32 students using traditional teaching mode, while the experimental group included 34 students who were instructed on cardiovascular diseases using the AI-empowered scenario-based simulation teaching mode. Data collection included post-class tests, “Mini-CEX” assessments, Clinical critical thinking scale from both groups, and satisfaction surveys from experimental group. Qualitative data were gathered through semi-structured interviews.ResultsResearch shows that compared with traditional teaching models, AI-empowered scenario-based simulation teaching mode significantly improve students’ performance in many aspects. The theoretical knowledge scores(P < 0.001), clinical operation skills(P = 0.0416) and clinical critical thinking abilities of students(P < 0.001) in the experimental group were significantly improved. The satisfaction survey showed that students in the experimental group were more satisfied with the teaching scene(P = 0.008), Individual participation(P = 0.006) and teaching content(P = 0.009). There is no significant difference in course discussion, group cooperation and teaching style of teachers(P > 0.05). Additionally, the qualitative data from the interviews highlighted three themes: (1) Positive new learning experience, (2) Improved clinical critical thinking skills, and (3) Valuable suggestions and concerns for further improvement.ConclusionThe AI-empowered scenario simulation teaching Mode plays an important role in the improvement of clinical thinking and skills of medical undergraduates. This study believes that the AI-empowered scenario simulation teaching mode is an effective and feasible teaching model, which is worthy of promotion in other courses.

Background: Clinical reasoning, comprising the processes of clinical thinking, which form the basis of medical decisions, constitutes a central competence in the clinical routine on which diagnostic and therapeutic steps are based. In medical curricula in Germany, clinical reasoning is currently taught explicitly only to a small extend. Therefore, the aim of this project was to develop and implement a clinical reasoning course in the final year of undergraduate medical training.Project description: A clinical reasoning course with six learning units and 18 learning objectives was developed, which was taught by two to four instructors on the basis of 32 paper cases from the clinical practice of the instructors. In the years 2011 to 2013, the course of eight weeks with two hours per week was taught seven times. Before the first and after the last seminar, the participating students filled out a self-assessment questionnaire with a 6-point Likert scale regarding eight different clinical reasoning skills. At the same times, they received a patient case with the assignment to prepare a case presentation and differential diagnoses.Results: From 128 participating students altogether, 42 complete data sets were available. After the course, participants assessed themselves significantly better than before the course in all eight clinical reasoning skills, for example in “Summarizing and presentation of a paper case” or in the “Skill to enumerate differential diagnoses” (p<0.05). The greatest increase occurred in the skill to recognize typical cognitive errors in medicine and to identify risk situations for their occurrence (pre: 2.98±0.92 and retro-pre: 2.64±1.01, respectively, versus post: 4.38±0.88). Based on the ratio of number of words used per keywords used the problem presentation of the paper case was significantly more focused after the course (p=0.011). A significant increase in the number of gathered differential diagnoses was not detected after the course.Conclusion: The newly developed and established Clinical Reasoning Course leads to a gain in the desired skills from the students’ self-assessment perspective and to a more structured case presentation. To establish better options to exercise clinical reasoning, a longitudinal implementation in the medical curriculum seems to be desirable. Faculty training would be useful to implement the concept as standardized as possible.

IntroductionClinical reasoning, a major competency for all health professionals, has been defined and studied ‘within’ each profession. We do not know if content, process and outcomes are comparable ‘between’ physician...