Clinical Judgment Skills Research Articles

Creating a Simulation Experience to Promote Clinical Judgment

There is a need for high-quality simulation scenarios to promote nursing students’ clinical judgment skills. Yet, faculty possess different levels of experience with simulation. Skillful scenario development requires collaboration with simulation experts and adherence to best practices, but the process can be initiated by course faculty. This article presents development and application of a simulation experience to promote clinical judgment by a faculty member that lacked previous experience in writing simulation scenarios.

Critical thinking and nursing administration clinical judgment skills for baccalaureate nursing students at Damanhour University

Critical thinking and clinical judgment skills are one of the most important concepts in the field of education. Although many studies have been published on nursing students’ critical thinking and, clinical judgment skills some suggest that there is not enough evidence supporting the relationship between the content of nursing education programs and nursing students' critical thinking and, clinical judgment skills. This study aimed to assess critical thinking and nursing administration clinical judgment skills for baccalaureate nursing students at Damanhour University. Research design: A descriptive research design was used in this study. Setting: the study was carried out in the Faculty of Nursing at Damanhour University. Subject: All baccalaureate nursing students who had finished the course of nursing administration in the Faculty of Nursing at Damanhour University in the academic years 2018-2019 with the total number (n=240).Tools: A structured self-administer questionnaire included demographic data, California Critical Thinking Disposition Inventory scale, and clinical judgment skills. Result: the Nursing student had achieved clinical thinking with the highest mean scores. There was a statistically significant difference between critical thinking and clinical judgment according to sex and residence (p<0.1001**). Recommendation: Enhancement of the learning experiences in the development of clinical thinking and clinical judgment skills, attributes and knowledge of nursing students during their placement in the clinical learning environment.

A Tale of Two Rounds: Managing Conflict During the Worst of Times in Family-Centered Rounds.

> It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity. > > Charles Dickens1 Family-centered rounds (FCRs) provide a framework for structuring rounds to optimize care of the pediatric patient and provide family-centered care.2 However, the communication skills required to realize the benefits of FCRs are complex, and in practice, they can be easily derailed from their intended course. For instance, during a recent faculty-development session that included direct observations of bedside teaching, 2 rounding experiences stood in sharp contrast. In 1 situation, the intern expertly led the communication with the family, incorporated all team members into the rounds, and integrated teaching points on her physical examination findings for the medical students, all of which were made easier by a cooperative patient. As the 10-minute encounter concluded, the team and family were in consensus with the management plan and were in consensus that all concerns were addressed. The second experience was vastly different. The parents were already upset before rounds because a consulting service had visited earlier with recommendations that differed from those of the primary team, leading the family to question the primary team’s clinical judgment and communication skills. This seed of mistrust seemed to grow as the …

Graduate training in psychotherapy: The importance of ongoing clinical activity for the training faculty

AbstractBackgroundPsychotherapy training is designed to help graduate students develop confidence and competence in their clinical skills.ApproachThe present manuscript explores three dimensions of an Aristotelian doctrine of knowledge as related to skill in psychotherapy.FindingsFirst, a psychotherapist should be knowledgeable about the background information pertaining to psychological theories and current research in the field. Typically, background information is covered in graduate courses and updated through continuing education opportunities for the licensed psychologists. Second, psychotherapists develop competence in technical skills used in psychotherapy sessions. For graduate students, competence in technical skills can be developed through the direct provision of clinical services in supervised placements. For faculty members, technical skills can be maintained through their involvement in ongoing clinical activities. Third, psychotherapy instructors need expertise in practical wisdom to guide clinical judgment and ethical reasoning skills. Expertise develops through years of practice.ConclusionsGraduate students are expected to develop background knowledge and basic competence in clinical skills. Furthermore, faculty members who teach graduate courses on psychological assessment, psychiatric diagnosis and psychological treatments can be expected to attain a level of expertise. Psychotherapy training is improved when faculty instructors have ongoing clinical experience and practical wisdom. The present manuscript confronts the problem and proposes several possible solutions.

The effectiveness of critical thinking instructional strategies in health professions education: a systematic review

ABSTRACTThis review intends to reveal the current status of the instructional practices used to enhance Critical Thinking (CrT), Clinical Reasoning and Clinical Judgement (CJ) skills and dispositions in Health Sciences Higher Education programmes. After a three-step filtering process, 28 empirical studies on the effectiveness of the instructional strategies were analysed, following PICOS methodology. The analysis tackled the type of strategy, methods and outcomes, the research design, and assessment tools used. Diverse instructional designs, different in length, were used with variable success when compared with traditional lecturing. Several limitations were found, such as insufficient information regarding the intervention design and the alignment between learning outcomes and the assessment instruments. Due to the variability in sample sizes and research designs, it is difficult to conclude on the effectiveness of particular instructional strategies. Researchers ought to recognize the concerns herein discussed when designing, implementing and assessing future interventions.

Workplace Based Assessment in Obstetrics and Gynecology Clerkship to Detect Learning Gaps

ABSTRACT Background An outcome-based curriculum helps to communicate expectations of performance to students and clinical teachers. The Mini Clinical Evaluation Exercise (mini-CEX) is a useful tool for workplace-based formative assessment. The objective of this study was to use workplace-based assessment and student feedback to evaluate an Obstetrics and Gynecology (Ob&amp;Gyn) clerkship curriculum. Methods A cross-sectional study was conducted with faculty members and medical students in an Ob&amp;Gyn clerkship. The Mini-CEX was introduced into the clerkship assessment system, together with multiple choice question (MCQ) tests. This tool evaluates the history collection, physical examination, clinical judgment, professionalism and humanism, and also gives an overall score at the end of the test. At the end of the rotation, questionnaires were used to collect the students’ perceptions about their skills acquisition during the program. The results of the Mini-CEX, the MCQ test, and questionnaire responses were compared, to determine the extent to which learning objectives were achieved. Results three faculty members assessed 84 medical students using the mini-CEX during the four-month clerkship. The scores for the physical examination and clinical judgment skills were lower, compared to those of the interviewing skills. Based on the students’ feedback, ratings for physical examination and counseling preparation were rated as “inadequate”, especially for the topic breaking bad news. The bivariate correlation between the mini-CEX skills and MCQ test scores showed a positive relationship (r = 0.27). Although they assess different skills on the Muller pyramid, there appears to be a relationship between “Knowing” and “Doing”. These findings will help curriculum managers to identify important gaps in the rotation design and delivery. Based on these results, training in the skills workshop during the first month of the rotation was initiated, in addition to previous simulated training during the third year of medical course. Conclusions The introduction of the mini-CEX offers critical information to identify and refine important curriculum elements in the clinical years. Based on this, physical examination and communications skills training were initiated in the skills workshop.

Advances in the management of acute cholecystitis.

The diagnosis and management of acute cholecystitis (AC) continues to evolve. Among the most common surgically treated conditions in the USA, appropriate diagnosis and management of AC require astute clinical judgment and operative skill. Useful diagnostic and grading systems have been developed, most notably the Tokyo guidelines, but some recent clinical validation studies have questioned their generalizability to the US population. The timing of surgical intervention is another area that requires further investigation. US surgeons traditionally pursue laparoscopic cholecystectomy (LC) for AC patients with symptoms onset <72 hours, but for patients with symptoms over 72 hours, surgeons often elect to treat the patients with antibiotics and delay LC for 4‐6 weeks to permit the inflammation to subside. This practice has recently been called into question, as there are data suggesting that LC even for AC patients with over 72 hours of symptoms confers decreased morbidity, shorter length of stay, and reduced overall healthcare costs. Finally, the role of percutaneous cholecystostomy (PC) needs to be better defined. Traditional role of PC is a temporizing measure for patients who are poor surgical candidates. However, there are data suggesting that in AC patients with organ failure, PC patients suffered higher mortality and readmission rates when compared with a propensity‐matched LC cohort. Beyond diagnosis, the surgical management of AC can be remarkably challenging. All surgeons need to be familiar with best‐practice surgical techniques, adjunct intra‐operative imaging, and bail‐out options when performing LC.

End of Paediatric Posting Assessment of Medical Interns at a Teaching hospital from Coastal Karnataka

Introduction: Internship is very a critical period of a medical undergraduate education during which student evolves into a doctor. The objectives of this study were to assess the interns at the end of their paediatric postings.&#x0D; Materials and Methods. Interns knowledge and skills were assessed at the end of their postings in the must know areas. Assessment was conducted by the trained faculty and interns were given the orientation about it. Method of assessment included OSCE, simulation based using standardized patients and computer-based model driven simulators. Feedback was given to the students immediately at the end of their exam&#x0D; Results: Total 202 interns participated in the exam over the period of two years. New-borns assessment was done more frequently (22.7%) and interpretation of investigations was less frequently assessed (7.9%). Rest of other stations was assessed almost at the equal proportion. Highest score was observed in vaccines section (7.5) and lowest score was seen in procedures assessment (5.5).&#x0D; Conclusion. Interns were found to be weaker in procedural, communication and clinical scenario judgement skills which will help us in planning future training of the Interns.

Dentists' Perceptions of Their Peer Learning Experiences in Dental School and Effects on Practice.

Peer-assisted learning (PAL) has been found in medical, nursing, and dental education research to aid in preparing students to develop clinical judgment, leadership, and teamwork skills. This study sought to extend that research by assessing the effect of PAL on dentists in practice. The aim of this study was to ask practicing dentists who were clinically trained with PAL in dental school for their perceptions of the effects and value of that training for their patient care, team relations, and professional development. In addition, participants were asked for recommendations to improve pairing and the matching process. An electronic survey was sent in October 2017 to all 667 dentists who graduated from Midwestern University College of Dental Medicine-Arizona from 2012 to 2017, all of whom had been trained in a PAL-general practice model. A total 107 alumni responded, for a 16% overall response rate; the response rate averaged 16.7% for each class. The majority (83.6%) of responding dentists recommended peer learning in clinical dental education. Survey participants attributed their clinical judgment (72.3%) and teamwork (80.9%) skills to peer pairing in dental school. Among the respondents, 89.8% had taken leadership roles and were training team members, and 75.7% reported enjoying teaching others. Of the 65% who commented on peer pairing enhancements, 15% recommended rotation of peers for greater learning experiences, and 24% advised personality assessments for future pair matching. These results suggested that participating in PAL had helped prepare these alumni for practice.

Educators’ Perceptions of Clinical Judgment Skill Competencies in Rehabilitation Counseling

Purpose:To address a significant gap in the clinical judgment competency research by adding new knowledge of important clinical judgment skill competencies in rehabilitation counseling.Method:This Internet-based survey design is a follow-up inquiry to Austin and Leahy’s (2015) instrument validation study; this same sample of rehabilitation counselor educators (n= 126) rated the importance and student preparedness in using clinical judgment skill competencies (i.e., scientific attitude, cultural bias, cognitive complexity, memory bias, confirmatory bias, negative bias, evidence-based practice [EBP]).Results:Clinical judgment skills were perceived to be highly important. Students were rated as least prepared in scientific attitude and evidence-based practice. Ten skills of high importance/limited student preparation across four clinical judgment skill areas were identified.Conclusions:This study’s findings provide initial empirical support of important clinical judgment skill competencies for effective rehabilitation counseling practice. Identified student preparation gaps may be used to help prioritize potential clinical training needs for rehabilitation counseling programs to prepare students in the use of clinical judgment skill competencies that address cultural bias, cognitive complexity, confirmatory bias, and evidence-based practice. Most importantly, data generated from this study can be used when preparing students to effectively address their biases and improve their clinical judgments when applying EBP.

Development of clinical judgment model to guide nursing interns

Every day and every moment, nurses have to deal with a wide variety of patient’s issues and problems, with multiple difficulties and conflicts. Nurse’s judgment considers the core component of healthcare activities. This judgment directs her/his achievement and choices, not for her/him only, but for other healthcare professionals. Thus, nurses have to be competent observers and decision makers with reasoning and sound regarding their intervention and practice. Clinical judgment skills are essential aptitudes in nursing practice, predominantly, in nursing internship intermediary period, in which, a graduate nurse faced several predicaments and obstacles in such transitory experience from academic work to real labor. The present study aimed to develop a clinical judgment model to guide nursing interns in their nursing practice and assess its effectiveness on nursing interns’ clinical judgment knowledge and skills. The study passed through Quasi-experimental pretest-posttest research design. A stratified random sampling approach was used to recruit 50 nursing interns as an experimental group out of 305. The collection of data was carried out in the following hospitals of nurses’ intern’s training: Damanhur Medical National Institute, El Raee El Saleh, El Farok and Kafer El Dawar Hospitals, in Damanhur, Egypt. The Clinical Judgment Evaluation Sheet (CJES) was employed to collect necessary data. It included two parts: the Clinical Judgment Knowledge Test that was developed by Fathi &amp; Aly in 2018, beside the Lasater Clinical Judgment Rubric (LCJR) that was developed by Kathie Lasater et al., in 2009. Results before using the developed model demonstrated that there were observed lacking in knowledge and skills about clinical judgment in nursing practice among experimental group. Then improvements were noticed after using the developed clinical judgment model. These results confirm that the use of an educational and self-learning reference such as the developed clinical judgment model is a successful tool for Egyptian nursing interns in nursing practice. Conclusion and recommendations: There is an understandable deficiency of nursing interns’ clinical judgment knowledge and skills in nursing practice. But, after using the developed clinical judgment model with them as a self-learning reference, it was confirmed that it is a helpful approach to develop and improve clinical judgment knowledge and skills of nursing interns. Creativity in using instructional aides and self-learning approaches is an essential ability that is important among nurse educators and preceptors who direct nursing intern’s performance. For further sturdies, replicate the study using the developed model with different subjects in nursing practice or develop new instructive models about creative, reflective, discovery, and decision-making models among nursing interns.

Effects of reflection on clinical decision-making of intensive care unit nurses

BackgroundNurses are one of the most influential factors in overcoming the main challenges faced by health systems throughout the world. Every health system should, hence, empower nurses in clinical judgment and decision-making skills. ObjectiveThis study evaluated the effects of implementing Tanner's reflection method on clinical decision-making of nurses working in an intensive care unit (ICU). DesignThis study used an experimental, pretest, posttest design. SettingThe setting was the intensive care unit of Amin Hospital Isfahan, Iran. ParticipantsThe convenience sample included 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). MethodsThis clinical trial was performed on 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). The nurses were selected by census sampling and randomly allocated to either the case or the control group. Data were collected using a questionnaire containing demographic characteristics and the clinical decision-making scale developed by Laurie and Salantera (NDMI-14). The questionnaire was completed before and one week after the intervention. The data were analyzed using SPSS 21.0. ResultsThe two groups were not significantly different in terms of the level and mean scores of clinical decision-making before the intervention (P = 0.786). Based on the results of independent t-test, the mean score of clinical decision-making one week after the intervention was significantly higher in the case group than in the control group (P = 0.009; t = −2.69). The results of Mann Whitney test showed that one week after the intervention, the nurses' level of clinical decision-making in the case group rose to the next level (P = 0.001). ConclusionReflection could improve the clinical decision-making of ICU nurses. It is, thus, recommended to incorporate this method into the nursing curriculum and care practices.•Clinical decision-making is a fundamental concept in the field of nursing which affects the course of patient care and recovery•The validity of important clinical decisions depends on proper and thoughtful judgment•Reflection helps individuals use the critical analysis of their performance and integrate their thoughts and actions when facing different situations•The results of this study showed that the implementation of Tanner's reflection could significantly increase the mean score and level of clinical decision-making in ICU nurses

Creating synergy in critical care competency assessment

Creating synergy in critical care competency assessment

Implementation of a Learner-Centered Educational Program for Developing Hands-On Critical Care Knowledge and Clinical Judgment Skills for the PACU Nurse

Implementation of a Learner-Centered Educational Program for Developing Hands-On Critical Care Knowledge and Clinical Judgment Skills for the PACU Nurse

A framework to support preceptors’ evaluation and development of new nurses’ clinical judgment

In today’s complex, fast-paced world of hospital nursing, new graduate nurses do not have well-developed clinical judgment skills. Nurse preceptors are charged with bridging the gap between new graduates’ learning in school and their autonomous practice as RNs. In one large, urban medical center in the U.S., a clinical judgment model and rubric were used as a framework for a new evaluation and orientation process. Preceptors of new graduate nurses who had used the former and new processes described their experiences using the framework. The findings indicated that having a structured framework provided objective ways to evaluate and help develop new graduate nurses’ clinical judgment. It is hypothesized that academic clinical supervisors may find such a framework useful to prepare students for transition to practice.

Tertiary Pharmaceutical Care Services Between Facts and Realities

Pharmacy practice is dynamic, evolving and requires high level of drug knowledge in clinical judgment, decision making and advanced skills in actively and systematically identifying and resolving patients pharmacotherapy problems for desired outcomes to be achieved in patient care. This study organized literatures and identified the evidence based and ever increasing roles of pharmacists in tertiary pharmaceutical care. Literature search was conducted in Embase, Medline and Cochrane for evidence based studies describing pharmacist’s tertiary pharmaceutical care. Studies were selected based on their relivance to the subject, existing theories and models, and were summarized based on qualitative level. Results indicated that clinical pharmacist led pharmaceutical care improved clinical, economic, and humanistic outcomes in tertiary care settings. Pharmacists’ roles have evolved from a product to cost effective patient oriented services.

The science of communication, the art of medicine

We have all heard people talk (or write) about the art and science of medicine. Sometimes we mean that there’s a certain art or craft to clinical medicine, the application of science to real people in real situations. Sometimes we are referring to the unpredictable human side of medicine, the relationships and rapport building essential to clinical and professional practice. Whether we refer to clinical judgment or communication skills, what we imply is that in science we “know” but in art we are “winging it.” Definitions of science include words such as facts, principles, laws, truth, knowledge, and systematic, while definitions of art include creative skill, imagination, appreciation, and beauty. In Roze des Ordons et al. (this issue, 2016) we read that a misplaced and inappropriate word might leave a more lasting and painful scar than a surgeon’s sloppy scalpel, or as they put it, “… unhelpful communication can cause iatrogenic suffering, with a lasting impact upon patients and families and residual uncertainty and emotional distress amongst trainees, [thus] difficult discussions should be considered as seriously as an invasive procedure.” Our interactions with patients can have lasting and profound consequences so we should not be “winging it.” We need to move the art and craft of communications to a higher level where principles and laws of human behaviour and complex interactions are systematically learned and skillfully applied.

Strategies of Simulation Training for Improving Nursing Practice Skills in Korea

The purpose of this study is to propose critical thinking clinical judgment skills and strategies to improve academic achievement which are required for understanding in integral manner and further applying the nursing activities necessary for patient care by running a simulation exercise focused on the cases of the difficult patients, which the nursing students could scarcely encounter directly in their actual clinical practices.

Impact of concept mapping on the development of clinical judgment skills in nursing students

Helping nursing students learn to use sound clinical judgment has become a primary goal of nursing programs. Concept mapping has been shown to promote meaningful learning and critical thinking. The purpose of this study was to explore how junior baccalaureate nursing students perceive the effect of a concept mapping educational strategy on the development of clinical judgment skills. Concept mapping was taught using an adaptation of Gerdeman, Lux, and Jacko's (2013) Clinical Judgment Self-Evaluation Rubric (CJSR) that uses simplified wording. One hundred six students developed concept maps and completed a CJSR rubric to evaluate their concept maps each week during their clinical experience in a medical–surgical nursing course. The CJSRs were reviewed and evaluated by the clinical instructors. Students also completed a clinical evaluation tool at the end of the course. First, students did a self-evaluation, and then, the clinical instructor evaluated them. A descriptive data analysis was performed after the course was completed. The findings revealed that the use of concept mapping provided an interactive way to foster the growth of clinical judgment skills in nursing students.

Attending Surgeons as Teachers

PURPOSE: This study was designed to evaluate faculty characteristics that are valued most by residents. The study addressed personal and professional aspects of surgical faculty that residents consider important when evaluating their best teachers, with particular focus on male versus female respondents. METHODS: A twenty-nine question survey was distributed to all plastic surgery residents and fellows. Survey results were recorded anonymously and analyzed collectively, and according to gender, age, program type, and career plans. RESULTS: 148 survey responses were obtained. 66% of respondents were male, and 33% female. 86% were from integrated programs. 60% were PGY level 1–4, while 40% were senior residents or fellows. 74% of respondents prefer teaching faculty to be flexible based on resident input and intraoperative events when planning for a surgical case. While 82% prefer informal didactic teaching, with a clear separation of teacher from student, 72% prefer interaction outside of teaching sessions or cases to be casual with some career focus. Overall, females prefer a more casual teaching environment, but desire a greater patient-focused approach in the operating room versus resident-benefit. Male residents and those planning to enter private practice, on the other hand, favor an operative approach focused more on resident benefit. The most important skills residents want to learn from teachers are: clinical judgment, operative technique, and clinical diagnostic skills. Abilities in grant and manuscript writing, basic laboratory skills, and bedside manner were of less value. Reputation, research background, and national connections are the most highly valued professional characteristics, while practice type, years in practice, and gender are of less importance. Approachability and teaching style ranked highly among residents as important personal qualities in a teacher, and females found approachability a more valuable characteristic than did males. CONCLUSIONS: From the resident perspective, the best faculty educator is someone who is approachable, delivers case-oriented lectures and initiates didactics outside of required core conferences. This faculty member also actively participates in all program activities and conferences, has significant national connections with a national reputation, and possesses outstanding operative skills. Residents, particularly males and those planning a career in private practice, prefer that cases be performed with an emphasis on resident benefit.