Diagnostic Competence Research Articles

A clinical reasoning curriculum for medical students: an interim analysis

Diagnostic error is a critical patient safety issue that can be addressed in part through teaching clinical reasoning. Medical schools with clinical reasoning curricula tend to emphasize general reasoning concepts (e.g., differential diagnosis generation). Few published curricula go beyond teaching the steps in the diagnostic process to address how students should structure their knowledge to optimize diagnostic performance in future clinical encounters or to discuss elements outside of individual cognition that are essential to diagnosis. In 2016, the University of California, San Francisco School of Medicine launched a clinical reasoning curriculum that simultaneously emphasizes reasoning concepts and intentional knowledge construction; the roles of patients, families, interprofessional colleagues; and communication in diagnosis. The curriculum features a longitudinal thread beginning in first year, with an immersive three week diagnostic reasoning (DR) course in the second year. Students evaluated the DR course. Additionally, we conducted an audit of the multiyear clinical reasoning curriculum using the Society to Improve Diagnosis in Medicine-Macy Foundation interprofessional diagnostic education competencies. Students rated DR highly (range 4.13-4.18/5 between 2018 and 2020) and reported high self-efficacy with applying clinical reasoning concepts and communicating reasoning to supervisors. A course audit demonstrated a disproportionate emphasis on individual (cognitive) competencies with inadequate attention to systems and team factors in diagnosis. Our clinical reasoning curriculum led to high student self-efficacy. However, we stressed cognitive aspects of reasoning with limited instruction on teams and systems. Diagnosis education should expand beyond the cognitive- and physician-centric focus of most published reasoning courses.

A call to action: next steps to advance diagnosis education in the health professions

Improving diagnosis-related education in the health professions has great potential to improve the quality and safety of diagnosis in practice. Twelve key diagnostic competencies have been delineated through a previous initiative. The objective of this project was to identify the next steps necessary for these to be incorporated broadly in education and training across the health professions. We focused on medicine, nursing, and pharmacy as examples. A literature review was conducted to survey the state of diagnosis education in these fields, and a consensus group was convened to specify next steps, using formal approaches to rank suggestions. The literature review confirmed initial but insufficient progress towards addressing diagnosis-related education. By consensus, we identified the next steps necessary to advance diagnosis education, and five required elements relevant to every profession: 1) Developing a shared, common language for diagnosis, 2) developing the necessary content, 3) developing assessment tools, 4) promoting faculty development, and 5) spreading awareness of the need to improve education in regard to diagnosis. The primary stakeholders, representing education, certification, accreditation, and licensure, in each profession must now take action in their own areas to encourage, promote, and enable improved diagnosis, and move these recommendations forward.

Perspectives on Assembling Coronavirus Spikes on Fiber Optics to Reveal Broadly Recognizing Antibodies and Generate a Universal Coronavirus Detector

In time of COVID-19 biological detection technologies are of crucial relevance. We propose here the use of state of the art optical fiber biosensors to address two aspects of the fight against SARS-CoV-2 and other pandemic human coronaviruses (HCoVs). Fiber optic biosensors functionalized with HCoV spikes could be used to discover broadly neutralizing antibodies (bnAbs) effective against known HCoVs (SARS-CoV, MERS-CoV and SARS-CoV-2) and likely future ones. In turn, identified bnAbs, once immobilized onto fiber optic biosensors, should be capable to detect HCoVs as diagnostic and environmental sensing devices. The therapeutic and preventative value of bnAbs is immense as they can be used for passive immunization and for the educated development of a universal vaccine (active immunization). Hence, HCoV bnAbs represent an extremely important resource for future preparedness against coronavirus-borne pandemics. Furthermore, the assembly of bnAb-based biosensors constitutes an innovative approach to counteract public health threats, as it bears diagnostic competence additional to environmental detection of a range of pandemic strains. This concept can be extended to different pandemic viruses, as well as bio-warfare threats that entail existing, emerging and extinct viruses (e.g., the smallpox-causing Variola virus). We report here the forefront fiber optic biosensor technology that could be implemented to achieve these aims.

Developing and validating a scriptwriting task in the context of student difficulties with fraction multiplication and division

ABSTRACT Teaching simulations such as scriptwriting tasks offer a novel way to support pre-service teachers in gaining diagnostic competencies and in guiding students to work through difficulties. We first report on the theory-driven development of a scriptwriting task, specifically the theoretically-founded language- and accompanying content-related challenges concerning fraction multiplication and division that were embedded in the task. In a validation study, nine experts in mathematics education and/or academic language development participated in an expert rating of the scriptwriting task, assessing the intended embedded student difficulties. As a further means of examining content validity, a second study was conducted in which 32 completed dialogues from the scriptwriting tasks from pre-service primary mathematics teachers were compared to the results of the expert rating. Findings of the validation study highlighted that the experts recognised the intended embedded content. Correspondingly, the results of the second study revealed that the pre-service teachers also identified the intended content.

Declared and Real Level of Digital Skills of Future Teaching Staff

Digital competence is undoubtedly one of the key skills that teaching staff should possess. Currently, there are many theoretical frameworks and ways to measure skills and knowledge related to the use of information and communication technologies (ICT). This article is an attempt to show the real and declared level of digital skills among future teaching staff. The research was conducted in Poland among 128 students of pedagogical faculties (first-year undergraduate studies). The research used a triangulation of research methods and techniques: diagnostic survey and competency tests related to the use of word processors and spreadsheets, and the level of knowledge about the use of ICT. Competency tests were in accordance with the European Computer Skills Certificate (ECDL) standard. The collected data showed the following: (1) more than half of the students rate their own skills in the use of word processors and spreadsheets, and their overall theoretical knowledge as high or very high; (2) in the case of the real assessment of digital competence, only less than 20% reached the passing threshold in the areas of word processors and theoretical knowledge, with only 1.6% passing in the area of spreadsheets; (3) the declared and actual levels of digital competence were moderately related in the surveyed group; (4) attitudes towards new media, self-assessment of digital skills, and previous learning experience in handling ICT are not predictive factors for ECDL test results.

A Scoping Review of Medical Laboratory Science and Simulation: Promoting a Path Forward with Best Practices.

In medical laboratory science, there is a need to enhance the clinical learning curriculum beyond laboratory skill and diagnostic interpretation competency. Incorporating simulation presents an opportunity to train and produce medical laboratory scientists with the skills to communicate and work effectively in an interprofessional healthcare team. A scoping review was performed to (i) understand the landscape of research literature on medical laboratory science and simulation and (ii) provide a path for future research directions. The International Nursing Association for Clinical Simulation and Learning Standards of Best Practice: Simulation were used as a guiding framework for literature that described simulation activities. Out of 439 articles from multiple databases, 32 were eligible for inclusion into this review. Of the 14 articles that described a simulation activity, only 3 described or partially described each component of the best practice criteria for simulation. Articles that did not describe the design and implementation of simulation (n = 18) consisted of 7 opinion-based papers, 4 narrative reviews, 5 case reports, and 2 empirical papers. Despite increases in medical laboratory science with simulation, there is a need for more detailed empirical studies, more studies with an interprofessional context, and more methodological rigor.

Barriers and facilitators to the access to specialized female genital cutting healthcare services: Experiences of Somali and Sudanese women in Norway.

BackgroundGirls and women subjected to female genital cutting (FGC) risk experiencing obstetrical, gynecological, sexual, and psychological health problems. Therefore, Norway has established low-threshold specialized healthcare services where girls and women with FGC-related health problems can directly seek medical attention. Nevertheless, we lack data about access to these services, especially for non-maternity-related purposes. In this article, we explore experiences of seeking medical attention for health problems that are potentially FGC-related, aiming to identify factors that hinder or facilitate access to FGC-specialized services.MethodsWe conducted a qualitative study in three Norwegian cities employing semi-structured repeat interviews with 26 girls and women subjected to FGC, participant observation, and three validation focus group discussions with 17 additional participants. We thematically analyzed the data and approached access as a dynamic process of interactions between individuals and the healthcare system that lasts from an initial perception of need until reception of healthcare appropriate to that need.FindingsWe identified several barriers to healthcare, including 1) uncertainty about FGC as a cause of experienced health problems, 2) unfamiliarity with FGC-specialized services, 3) lack of assessment by general practitioners of FGC as a potential cause of health problems, and 4) negative interactions with healthcare providers. In contrast, factors facilitating healthcare included: 1) receiving information on FGC-related health problems and FGC-specialized services from a non-profit immigrant organization, 2) referral to gynecologists with good knowledge of FGC, and 3) positive interactions with healthcare providers.ConclusionAssessing whether FGC is the cause for experienced health problems requires diagnostic competency and should not be left entirely to the patients. We recommend that Norwegian policymakers acknowledge the central role of GPs in the clinical management of patients with FGC-related health problems and provide them with comprehensive training on FGC.

Diagnostic evaluation of qRT-PCR-based kit and dPCR-based kit for COVID-19.

BackgroundCoronavirus disease of 2019 (COVID-19) is well known as a fatal disease, first discovered at Wuhan in China, ranging from mild to death, such as shortness of breath and fever. Early diagnosis of COVID-19 is a crucial point in preventing global prevalence.ObjectiveWe aimed to evaluate the diagnostic competency and efficiency with the Allplex™ 2019-nCoV Assay kit and the Dr. PCR 20 K COVID-19 Detection kit, designed based on the qRT-PCR and dPCR technologies, respectively.MethodsA total of 30 negative and 20 COVID-19 positive specimens were assigned to the diagnostic test by using different COVID-19 diagnosis kits. Diagnostic accuracy was measured by statistical testing with sensitivity, specificity, and co-efficiency calculations.ResultsComparing both diagnostic kits, we confirmed that the diagnostic results of 30 negative and 20 positive cases were the same pre-diagnostic results. The diagnostic statistics test results were perfectly matched with value (1). Cohen’s Kappa coefficient was demonstrated that the given kits in two different ways were “almost perfect” with value (1). In evaluating the detection capability, the dilutional linearity experiments substantiate that the Dr. PCR 20 K COVID-19 Detection kit could detect SARS-CoV-2 viral load at a concentration ten times lower than that of the Allplex™ 2019-nCoV Assay kit.ConclusionsIn this study, we propose that the dPCR diagnosis using LOAA dPCR could be a powerful method for COVID-19 point-of-care tests requiring immediate diagnosis in a limited time and space through the advantages of relatively low sample concentration and small equipment size compared to conventional qRT-PCR.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13258-021-01162-4.

Building Preservice Teachers’ Diagnostic Competence: An Exploratory Study in the Domain of Fractions

In this study, we explored elementary preservice teachers’ (PSTs’) competence to make diagnostic inferences about students’ levels of understanding of fractions and their approaches to developing appropriate tiered assessment items. Although recent studies have investigated beginning teachers’ diagnostic competency, teachers’ ability to design and evaluate diagnostic assessment items has remained largely underexplored. Fifty-seven PSTs, who enrolled in a mathematics methods course at a midwestern university in the U.S., participated in developing and attempting to differentiate diagnostic assessment items considering individual students’ varied levels of understanding. An inductive content analysis approach was used in identifying general patterns of PSTs’ approaches and strategies in designing and revising tiered assessment items. Our findings revealed the following: (a) the PSTs were well versed in students’ cognitive difficulties; (b) when modifying the core questions to be more or less difficult, the PSTs predominantly used strategies related to procedural fluency of the questions; and (c) some strategies PSTs used to modify questions did not necessarily yield the intended level of difficulty. Further, we discussed the challenges and opportunities teacher education programs face in teaching PSTs how to effectively design tiered assessment items.

A research-practice cooperation to support elementary school teachers’ diagnostic competencies based on a working theory of talent development in STEM

ABSTRACT We present a teacher professionalization project for promoting elementary school teachers’ diagnostic competencies in recognizing their students’ potential in STEM subjects. Teacher professionalization is fostered through the teachers’ personal involvement in the development of subject-specific diagnostic materials as well as through continuing training on the fundamental knowledge needed to detect and support gifted students. On the basis of the Talent Development in Achievement Domains (TAD) framework, we reached a common working theory of talent and its development in mathematics and science for elementary school-aged students based on the available scientific evidence and approved by teachers. We share a multidimensional, dynamic view of talent development that includes abilities, personality traits, and skills. We describe how our working theory and diagnostic materials can foster teachers’ diagnostic competencies as well as talent discovery and promotion in order to foster students’ development of creative productivity in STEM fields.

Experience-Based Competency Training in Child and Adolescent Psychotherapy

Abstract. Background: Compared to adult psychotherapy training, there is little knowledge about the use of standardized actor-patients (SPs) for the development of professional competencies for younger patient populations. Objective: We assessed the effectiveness of two university-based training programs for diagnostic as well as intervention skills in child and adolescent psychotherapy. Methods: Psychology students took part in two courses on the development of diagnostic competencies ( N = 59) and on intervention skills ( N = 51). We applied active and experience-based learning strategies, including exercises on self-awareness, mindfulness, peer role-play, and the use of SPs. Competence gain as well as a general evaluation of the seminars were assessed by self-report. Results: For both seminars, self-reported competence increased significantly with a large effect. The retrospective evaluation of learning success and acceptance ratings of the didactic formats were high. Conclusions: Experience-based trainings that include SPs are a feasible option for child and adolescent psychotherapy. The findings are discussed from a conceptual as well as a practical perspective.

DIAGNOSTIC COMPETENCE OF THE SPECIAL EDUCATION TEACHER IN SLOVAKIA

The paper focuses on the analysis of the diagnostic competence of a special education teacher, which is a key element of the application of special pedagogical measures at the primary level of education. In primary school, a special education teacher carries out a special pedagogical intervention aimed at identifying specific manifestations in the process of educating pupils with the aim of their prevention and / or elimination. Intervention applies to students with special educational needs as well as intact students. Diagnostic competence is required to apply the correct precautions. Therefore, in our contribution we pay special attention to the specifics of the diagnostic competence of a special education teacher at the primary level of education in the Slovak Republic.

A DELPHI STUDY TO DETERMINE THE KEY QUALITIES CONSULTANT HISTOPATHOLOGISTS USE TO DETERMINE DIAGNOSTIC COMPETENCY IN TRAINEES

<h3>Background</h3> There has been no clear description of what constitutes "diagnostic competence" in histopathology. We have published qualitative interview data exploring this concept that were used to devise a framework describing how consultants identify diagnostic competence in trainees. <h3>Objective</h3> A Delphi study was conducted to triangulate and determine the relative importance of the key qualities of trainees derived from the qualitative interviews. <h3>Methods</h3> Twelve participants were purposively chosen to form an expert panel of relevant stakeholders within the United Kingdom. Participants were asked to score and rank the items presented to them. <h3>Results</h3> A total of 22 out of 27 of the key qualities of trainees reached "consensus in," suggesting that participants were able to agree that the majority of the items identified in the qualitative interviews were important to diagnostic competence. Five qualities reached "no consensus" and none reached "consensus out." Participants did not suggest any additional qualities. Participants particularly valued qualities of reflection and professionalism and trainees who understood the process of reaching a diagnosis and how their pathological report could impact patient care. This culminated in entrusting work to trainees. <h3>Conclusions</h3> This study has triangulated findings from qualitative interviews and shows that consultants value a wide variety of qualities when determining trainees' diagnostic competence. The judgment is complex and should be assessed longitudinally. Consultants can then assess consistency of both approach to diagnosis and trainee behavior. Curricula should focus on what trainees do in the workplace rather than demonstration of individual competencies.

Samoświadomość nauczycieli wczesnej edukacji w kontekście diagnozowania dyskalkulii rozwojowej

The article concerns the self-awareness of diagnostic competence of early childhood education teachers in the field of identifying students' risk of facing specific difficulties in learning mathematics. Modern times impose on the teacher increasingly complex tasks, requiring new professional competence, which includes incorporating new teaching methods, methodological considerations, and new professional performance quality. That, in turn, raises the questions concerning the state of preparation of early childhood education teachers to recognize and meet the developmental and educational needs of the student resulting from specific difficulties in learning mathematics as well as the competencies they need and should develop. The overriding goal of the author's research was to find answers to these questions using the diagnostic survey method with the survey technique conducted among 112 early childhood education teachers. In this article, only one aspect of the research is presented, which refers to teachers' self-awareness of the discussed competences. Based on the conducted study, we can conclude that the examined teachers of early education feel prepared to conduct pedagogical activities aimed at recognizing in their students the risk of developing specific difficulties in learning mathematics.

PROBLEMS OF PROFESSIONAL TRAINING OF INFORMATICS FUTURE TEACHERS IN THE CONDITIONS OF DIGITALIZATION OF EDUCATION

The article is devoted to the formation of diagnostic competence of future teacherspsychologists. Some aspects of the prerequisites for the formation of diagnostic competence are considered. Diagnostic competence is characterized as a new environment of human life and a factor of social change. The concepts related to diagnostic competence are analyzed on the basis of the analysis of scientific research of foreign, Russian and domestic scientists. Of particular importance in the education system is the issue of studying the experience of implementing the diagnostic competence of future educational psychologists . The article analyzes the main theoretical approaches in scientific research on the issues of diagnostic competence of future educational psychologists in the context of cultural and national values. An excursion into the history of the problems of diagnostic competence of future educational psychologists was conducted . Based on the analysis of scientific studies of Russian and domestic scientists, it was decided to determine the main methodological approaches to the diagnostic competence of future educational psychologists. When considering this issue, it is necessary to pay special attention to the historical, cultural and spiritual values of the ethnic group, along with modern socio-cultural realities. There is an urgent need for an interdisciplinary study of the problems of diagnostic competence of future educational psychologists

Adding guidance to deliberate reflection improves medical student's diagnostic accuracy.

Diagnostic competence in students is a major medical education goal. Adding instructional guidelines to prompt deliberate reflection fosters medical students' diagnostic proficiency. This study investigates the effects of this teaching strategy on diagnostic accuracy in solving clinical cases of different complexity levels by novice and senior students. Eighty third-year and 62 sixth-year medical students participated in this three-phase experimental study. First, participants were randomly assigned to one of three experimental conditions (free reflection, cued reflection and worked example) to diagnose 12 clinical text-based cases, following different levels of deliberate reflection. In an immediate test and a delayed test, the participants diagnosed varied sets of 12 cases, six involving the same diseases (four routine and two rare). The main outcomes were the diagnostic accuracy scores achieved for the cases assessed by repeated measures of analysis of variance for each category. There was a significant primary effect of experimental condition (P<.001), year of training (P<.001) and study phase (P<.001) on the diagnostic accuracy achieved. The use of deliberate reflection in addition to instructional guidelines resulted in improved results in the immediate test for all cases evaluated (P<.001), regardless of participants' seniority. In the delayed test, this benefit was maintained for simple cases (P<.001). For complex cases, the benefit was maintained only for senior students (P<.001). The cued reflection and worked example groups did not differ in performance (P>.05), but both groups surpassed the free reflection group (P<.001), regardless of the students' learning stage and case complexity.

Development of a Learning Environment to Enhance Preservice Physics Teachers’ Diagnostic Competence in Terms of Students’ Conceptions

Teachers’ diagnostic competence is fundamental for supporting students’ individual learning processes and must be fostered in teacher education. Following a design-based research approach, a learning environment is developed focusing on preservice physics teachers’ diagnostic competence in diagnosing students’ conceptions. A core element of the learning environment are video vignettes of high school students solving tasks on mechanics. The learning arrangement was implemented in a bachelor’s level physics didactics course. We aimed to identify supportive and obstructive elements for the preservice teachers’ learning processes when training with the video vignettes to inform the redesign of the learning environment. The working phases centred around the training video vignettes were videotaped and data of four groups of preservice teachers was analysed with thick description. We reconstructed preservice teachers’ intentions of action to gather a deeper understanding of supportive and obstructive elements. Among other findings, results show that preservice teachers’ gaps in content knowledge highly influence the training situation.

Moderators of dimensional comparison effects: A comprehensive replication study putting prior findings on five moderators to the test and going beyond.

Dimensional comparisons, where students compare their achievements in different subjects, have a significant impact on the formation of students’ subject-specific self-concepts. This research examines the influence of five moderators that have been shown in previous research to affect the strength of dimensional comparison effects: (1) the intraindividual difference between students’ math and verbal achievements, (2) the absolute level of students’ math and verbal achievements, (3) students’ belief in the negative interdependence of math and verbal abilities, (4) students’ perception of the dissimilarity of math and verbal subjects, and (5) students’ perceptions of their math and verbal subject teachers’ diagnostic competence. We examined the effects of all moderators within a sample of 1,424 students in Germany by conducting latent moderated structural equation modeling within the framework of the internal/external frame of reference model. Only two moderators showed significant influences on the strength of the dimensional comparison effects: The dimensional comparison effects on students’ math and German self-concepts were stronger, the more students believed in the negative interdependence of math and verbal abilities, and the more dissimilar they perceived the subjects math and German to be. These moderating effects also persisted if we integrated both moderators into one model simultaneously. Our findings have important implications for self-concept research and dimensional comparison theory, as well as for educational interventions aiming to foster and regulate students’ self-concepts. Moreover, they illustrate the importance of replication studies in educational psychology. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Assessment of Diagnostic Competences With Standardized Patients Versus Virtual Patients: Experimental Study in the Context of History Taking.

BackgroundStandardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research.ObjectiveThe aim of this study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy.MethodsWe conducted an experimental study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this study used equivalence testing to investigate the absence of meaningful effects.ResultsPerceived authenticity (1-tailed t81=11.12; P<.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (r=0.05) and neither equivalent (P=.09) nor statistically significant (P=.32). Cognitive load was equivalent in both assessment methods (t82=2.81; P=.003). Intrinsic cognitive load (1-tailed r=−0.30; P=.003) and extraneous load (1-tailed r=−0.29; P=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed r=0.38; P<.001); this finding did not hold for SPs (1-tailed r=0.05; P=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed t85=2.49; P=.01).ConclusionsThe results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students’ grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods.

수학적 모델링 과제의 실행과 수정을 통한 현직 교사의 수학적 모델링 교수 역량 신장 사례 분석

The purpose of this study is to investigate how teachers demonstrate ‘mathematical modeling teaching competencies’ (MMTCs) by implementing and modifying mathematical modeling tasks, as well as to suggest how teacher education should support teachers for teaching mathematical modeling. A teacher with three years of teaching experience participated in this study. Data sources include transcripts, student worksheets, interviews and the researcher’s field notes. The findings indicate that the participant edited tasks to improve the realism and complexity of mathematical modeling tasks. The edits included simplifying and specifying; the participant also decomposed tasks into multiple subtasks. Through iterative implementations and modifications, the participant improved his MMTCs in four dimensions -- diagnostic, theoretical, task, and instructional dimensions were promoted in relays and cyclically. The implementation and modification of the task contributed to connecting theoretical knowledge and practical competencies to mathematical modeling. The study recommends the following areas of need in order to develop teachers’ MMTCs: combining theoretical and practical experiences, improving teachers’ diagnostic competencies, and creating teacher-researcher communities.