Clinical Critical Thinking Research Articles

Medicine in the 21st Century: How Not to Lose the Art of Healing?

In our time of advanced technologies, the Internet, and the enormous acceleration of all areas of humanitarian activity, medical scientists make outstanding discoveries and innovations that revolutionize diagnostic approaches and treatment options, improve patient care, and enrich the way to a healthier world. Is there still a place for the art of medicine in the era of innovations and artificial intelligence? Although modern technology in the field of medicine with computerization of every aspect (including electronic medical records, laboratory data entry, images, patients' monitoring systems, etc.), young physicians, while embracing that innovation, should be trained in the development of clinical thinking and the establishment of personalized connections to the patients. Young physicians should be taught to adopt the ability to see, hear, and feel a patient's problems, formulate optimal management, and be empathetic to the patient's emotions and suffering. Communication skills are a key to successful medical practice and a part of "the Introduction to Clinic" course in almost all medical schools, but a substantial lack of time in clinical settings creates new challenges for communication between medical students, clinical teachers, and patients in medical schools. In many areas around the world, including Ukraine, this problem has been aggravated by wars, epidemics, pandemics, and natural disasters. At the same time, developing clinical observational skills remains an integral part of medical education and the basis of medical art. The art of a careful physical exam should not be lost behind a computer screen. Dnipro State Medical University has traditions of integrating centuries-old world historical experiences of teaching the art of healing into the philosophical concept of forming the critical clinical thinking of medical students. Our medical school has incorporated "diagnosing the canvas" into its curriculum. A thematic gallery of diagnostic symptoms and signs from great artists of all times and peoples has been created, expanding the young physicians' educational horizons in clinical thinking, empathy, and mercy.

Cardiovascular disorders in a patient with Fabry disease: A serious prognostic factor

Fabry disease (FD) is an inherited rare metabolic disease caused by a mutation in the GLA gene, encoding the lysosomal enzyme alpha-galactosidase A. The disorder is a systemic disease that manifests as cerebrovascular and cardiac disease, chronic renal failure, skin lesions, peripheral neuropathy, and other abnormalities. Arrhythmias, cardiac conduction disorders, and sudden deaths in Fabry diseases represent the main prognostic factors and are usually hard to manage. We describe here the case of a 56-year-old woman followed for Fabry disease with conductive and rhythmic cardiac involvement. Our case illustrates the pivotal role of critical clinical thinking in the management of rare but treatable hereditary cardiomyopathy like Fabry disease.

Contribution of Academia Colleague as a Clinical Model to the Professional Development of Pre-Service Teachers

The current study aimed to investigate the contribution of Academia Colleague as a clinical model to the professional development of pre-service teachers. An interview consisting of 8 questions, a questionnaire consisting of 24 paragraphs, as well as a measurement of teaching tendencies, which consisted of 4 domains and 35 paragraphs, were the major instruments used in the study. The qualitative research method was employed to address, analyze, and interpret the concerned phenomenon (domain of the research) within its natural context. This was done in tandem with the descriptive analytical approach of a sample of 13 pre-service teachers who constituted the study community. Results of the study showed that the incorporation of the proposed clinical model contributed to the professional development of the participants and promoted numerous positive aspects, including active participation, collaborative learning, personal and collective responsibility, procedural research (applied research), clinical-critical thinking, and socio-emotional learning (SEL). The program also promoted positive tendencies towards the teaching profession at large. The results also showed no statistically significant relationship between the teaching tendencies and the participants’ grade point average (GPA).

Application of the CITE Mode of Ward Rounds in Teaching Critical Clinical Thinking

Application of the CITE Mode of Ward Rounds in Teaching Critical Clinical Thinking

Use of a Multimodal, Peer-to-Peer Learning Management System for Introduction of Critical Clinical Thinking to First-Year Veterinary Students.

Veterinary medical students need multiple thinking strategies, particularly critical thinking. We used a multimedia, peer review learning management system (CGScholar) to introduce a series of complex, realistic, case-based e-learning modules to help introduce critical thinking to 422 first-year veterinary students through instructor-designed clinical cases. Students developed and published on the CGScholar platform an analysis of a case and conducted anonymous peer reviews of each other's drafts. Instructors selected desirable characteristics of a student's activity to track and provide automatic feedback to students via an analytics dashboard and aster plot that allowed visualization of progress. The dashboard also enabled instructors to view the entire class's performance, highlighting students whose performance was lagging. Online interactions were supplemented by case-specific face-to-face workshop sessions. Our goal was to address the following questions: Does the addition of multimedia to a work (one's own or others') enhance people's ability to understand and convey the material? Does peer review (of one's own and others' work) lead to improvements in the writer's own work? Does the peer review process enhance the writer's understanding of what constitutes high-quality literature evidence? An anonymous student survey showed that experience was significantly more positive in the second and third year of implementation after inclusion of explicit guidance on the use of the rubric for peer review. Overall, 67% of students thought inclusion of multimedia enhanced their ability to communicate and 52% agreed multimedia enhanced their ability to understand their peers' analyses, but students were split on benefits to their understanding of high-quality literature.

Orthopaedic Resident Burnout Is Associated with Poor In-Training Examination Performance.

Resident burnout-the state of exhaustion, maladaptive detachment, and low sense of accomplishment-is a widely documented phenomenon that affects between 27% and 75% of residents in the United States. To our knowledge, no previous study has examined the relationship between resident burnout and performance on the Orthopaedic In-Training Examination (OITE). The current investigation sought to evaluate whether an association exists between indices of orthopaedic surgery resident burnout as assessed by the Maslach Burnout Inventory (MBI) and performance on the OITE. In a cross-sectional study of the orthopaedic surgery residents at a single large academic institution, the MBI was completed by all trainees in May 2016. The results of the 2016 OITE were documented for each resident, including the percentage of correctly answered questions and OITE percentile ranking. To control for individual test-taking skills, United States Medical Licensing Examination (USMLE) Step-1 and Step-2 scores also were documented for each resident. The relationship between the MBI subscale scores and OITE performance was evaluated. The analysis included 100% of the 62 orthopaedic surgery residents in training at our institution. Sixteen (25.8%) of the residents experienced at least moderate emotional exhaustion, while 32 (51.6%) of the residents experienced at least moderate depersonalization and 8 (12.9%) of the residents experienced a moderate sense of impaired personal accomplishment. Postgraduate year (PGY)-2 residents had the highest emotional exhaustion and depersonalization scores compared with residents in other years of training. Each of the 3 MBI indices of burnout was associated with worse OITE performance when controlling for general test-taking ability. In this study of orthopaedic surgery residents at a large academic training program, burnout was present among residents in all PGYs of training; it was most prevalent during the second year of training. Increased levels of the 3 components of burnout were associated with worse performance on the OITE. While there is a lack of consensus in the existing literature, this study provides additional evidence that burnout is negatively associated with 1 aspect of overall resident performance. Orthopaedic surgery residency training is challenging; residents are tasked to acquire a considerable amount of knowledge, develop complex surgical skills, and hone critical clinical thinking in a relatively short period of time. Identifying modifiable contributors to resident burnout and the development of strategies to promote resident wellness during training are important as we strive toward developing the next generation of capable, competent, and well-balanced orthopaedic surgeons.

Дистанційні технології у післядипломній освіті – альтернатива назустріч реформі

The purpose of the work is to analyze the practical, theoretical and methodical bases of training students for the distant form in the context of reforming the health care system in modern Ukraine. Distance learning as a component of the European Higher Education Area (EHEA) requires a qualitative transformation of the learning environment for learners and other learners in order to achieve their autonomy and ability to critical clinical thinking based on a productive approach that is essential for the formation of professional readiness specialists. By joining the Bologna process, Ukraine has embarked on a global reform of its higher education system, which should raise the status of holders of national diplomas on higher education in the European labor market. To achieve the best results in this direction, based on classical teaching methods, it is necessary to develop new ones – based on the Internet technologies of the XXI century, which are already successfully applied in a number of leading universities of Ukraine. The distance learning form is also called «life-long education» because most of the learners are adults. Have higher education, but because of the need to improve their skills or expand the scope of many, there is a need to quickly and qualitatively acquire new knowledge and skills. Due to the fact that distance technologies in the system of post-graduate education provide the status of listeners as important, democratic, active participants in their own potential, the importance of their internal motivation to improve personal and professional qualities is substantially increased. Internal motivation becomes the basis for the implementation of the professional profile of continuing education of doctors with the aim of correcting their personality-value, professional qualities. Conclusions Because of the need for advanced training or expansion of the field, many need to quickly and qualitatively acquire new knowledge and acquire professional skills. The distance learning form is very popular among the audience because of its economic performance and educational efficiency. The social function of professional mobility is a fundamental factor in ensuring the effectiveness of educational and cognitive activities of health professionals. Key words: distance learning; professional improvement; reforming; health care.

Encouraging Critical Clinical Thinking (CCT) Skills in First-Year Veterinary Students.

First-year didactic course instructors at the University of Illinois College of Veterinary Medicine leverage earlier clinical rotation experiences with weekly "Clinical Correlations" exercises to provide early exposure to critical clinical thinking (CCT). This study evaluated the efficacy of individual and paired group exercises on CCT development. Before and after instruction, the Cornell Critical Thinking Test (Level Z) (CCTTZ) was administered. Based on the hypothesis that students with higher scores would coach lower-scoring colleagues during group exercises, heterogeneous groups with similar mean scores were established for the year. Students completed 14 individual and paired group exercises over 6 months. Exercises were designed to increase in complexity and decline in scaffolding. Seven of the exercises were cases using the Applied Learning Platform (ALP) at http://www.whenknowingmatters.com . Student analyses were scored according to a six-category critical-thinking rubric using a 5-point scale. Consistent with our hypothesis, individual and group rubric scores increased significantly, plateauing near the end of the year. Contrary to our hypothesis, mean overall CCTTZ scores did not change, but there was a small statistically significant increase in the ability to assess the validity of an argument. Student attitudes were mixed. Positive comments focused on reinforcement of prior didactic instruction, while negative comments focused on preparation time needed to conduct research on clinical concepts, and on a lack of explicit evaluation by summative examinations. Nonetheless, end-of-year GPAs correlated linearly with cumulative individual rubric scores. In summary, the value of early curriculum CCT training was confirmed when discipline-specific criteria were applied.

The Effectiveness of Short-Term International Clinical Practicum Experiences on Communication Sciences and Disorders Graduate Students' Cultural Development and Critical Clinical Thinking Skills

This paper examined what effect short-term international clinical practicum experiences had on Howard University (HU) Communication Sciences and Disorders (CSD) graduate students' clinical skills. The CSD graduate student participants reflected on their attitudes and perception of the short-term international clinical practicum experience conducted during the winter and summer sessions of 2013, 2014, and 2017. Transcribed video diary reflections, focus group reflections, and survey responses captured the views, pedagogical knowledge, and skills and perceptions of 13 CSD first-year graduate students. The findings revealed five themes related to perceptions, cultural awareness, clinical development, and pedagogical knowledge. Findings of the study also revealed that providing CSD graduate students with the opportunity to participate in short-term international clinical practicums increased their clinical skills, cultural and self-awareness, and changed some perceptions they may have had about other cultures. This paper also reflects on the recommended incorporation of clinical supervision for short-term international clinical practicum programs, and key factors critical to the development and successful implementation of such a program.