Diagnostic Competence Research Articles

Sociocultural learning in emergency medicine: a holistic examination of competence.

Objectives In the medical community of practice, the resident is situated in systems of professional and cultural activities. How diagnostic competence manifests in their sociocultural context is examined through situativity and systems theories. A holistic model is proposed that could examine diagnostic competence across micro (individual), meso (activity), and macro (cultural) systems. Methods Two short scenarios are presented resulting from observations of emergency medicine residents and their supervising physicians. These scenarios are analyzed using a trans-theoretical model of situativity and systems theories to understand how diagnostic competence manifests in practice (activity system). Results Assessment of diagnostic competence in a sociocultural context may require assessment of responses to contextual factors that seem immaterial to clinical reasoning. This information may signal that the resident also has the skills to identify appropriate information channels within an activity system and can accurately collect and prioritize clinical information within those channels. Therefore, the formal assessment of competent clinical reasoning performance, as a situated practice, may benefit from delineating how much of the context of an activity system is required to be competently managed and synthesized across the competency milestones. Conclusions The examination of diagnostic competence as a sociocultural practice can provide a unique and holistic examination of clinical reasoning performance and assessment.

ABILITY TO DIAGNOSE AS A PROFESSIONAL COMPETENCE OF A PEDAGOGUE-PSYCHOLOGIST IN THE TASKS OF COGNITIVE EFFECTIVENESS OF LEARNING SUPPORT1

Цель. Целью работы было: определить уровень исследованности способности к диагностике как профессиональной компетенции педагога-психолога в различных профессиональных задачах, особенно в задачах обеспечения когнитивной эффективности обучения, показать необходимость научных исследований в обозначенной области, показать необходимость формирования диагностической компетенции педагогов-психологов в рамках университетского образования.Материалы и методы. Исследования и анализ источников проводилось по ключевым словам «диагностическая компетенция», «диагностическая способность как компетенция», «компетентностный подход»; были проанализированы стандарты высшего профессионального образования, принятые сегодня в России в сфере подготовки по направлениям «Психолого-педагогическое образование» и «Психология» для уровней «Бакалавр» и «Магистр».Результаты. Диагностическая способность однозначно является базовой профессиональной компетенцией педагога-психолога. Однако, пока еще нет точного понимания и согласия по поводу того, что именно работающий в школе специалист-психолог должен знать и уметь в отношении этой компетенции, особенно в сфере обеспечения когнитивной эффективности обучения. В статье также обсуждаются вопросы профессиональной диагностической компетенции в рамках компетентностного подхода в образовании, недостаточность исследованности и представленности диагностической компетенции в стандартах высшего профессионального образования, отношения мышления и понимания к диагностике, диагностика для обеспечения когнитивной эффективности обучения.Выводы. Сделаны выводы о том, что эффективная реализация компетентностного подхода не будет возможной без специальных исследований, нацеленных на изучение содержания, возможностей и методологии формирования профессиональных диагностических компетенций. Рассмотрение диагностики в аспектах понимания и диагностического мышления может помочь также показать необходимость профессиональных компетенций, формирование и развитие которых является задачей современного образования. Формирование диагностической компетенции сегодня находится в фокусе внимания современных ученых, однако эффективной методологии для формирования диагностических способностей пока нет.

Remote Evaluation of Short Videos Captured by Static Telecytological Applications for Obtaining Expert Opinions

Over the last decade, cytopathology laboratories wishing to achieve an automated and seamless workflow process, to diminish turnaround times and to improve their diagnostic accuracy have successfully adopted information technologies and automation. New types of cameras and microscopes, connected to computers, have made possible image capture and transmission (telecytology). New innovative information technologies, including e-health and telemedical applications, constitute a valuable tool for interlaboratory collaboration and quality improvement. New applications are expected to enhance the opportunities for improvement in the field of cytological data management and sharing. In this article, we emphasize on the possible use of short videos captured by static telecytology applications in a modern cytopathology laboratory wishing to establish an effective interlaboratory comparison system and obtain expert opinions in diagnostically challenging cases from distant consultants with well recognized diagnostic competence and experience in the field of thyroid cytology.

Diagnosis of thoracic aortic diseases. Part 1. Role of echocardiography in dianosis of chronic atherosclerotic lesions and aneurysms

Current review focuses on the diagnostic aspects of chronic aortic diseases, including atherosclerotic lesions and aneurysms. The diagnostic competence of echocardiography (both transthoracic and transesophageal) is considered; echocardiographic criteria for making tactical decisions are given, including indications for surgical treatment; the main parameters for dynamic assessment are determined.

Diagnosis of thoracic aortic diseases. Part 2. Visualization methods in acute aortic syndromes and traumatic injuries

Current review article focuses on the diagnostic aspects of acute aortic syndromes and traumatic injuries. In each case, the etiology of the disease, diagnostic competence of echocardiography (both transthoracic and transesophageal) are considered as the first line diagnostic mean; also diagnostic possibilities of other methods are discussed (such as CT scan, magnetic resonance imaging).

The importance of teacher’s diagnostic competences for students’ development

The article focuses on the issue of teacher’s diagnostic competence. In order to emphasize the importance of the issue and to encourage scientifi c discussion, the value of the contemporary teacher’s pedagogical competences was pointed out, among which diagnostic competence was highlighted. Then the importance of diagnostic competence in working with the student and the consequences of its lack, which is the student’s marginalization, were determined. The conclusions indicate the implications for educational practice.

Artificial Intelligence in Modern Medicine - The Evolving Necessity of the Present and Role in Transforming the Future of Medical Care.

The dexterity of computer systems to resemble and mimic human intelligence is artificial intelligence. Artificial intelligence has reformed the diagnostic and therapeutic precision and competence in various fields of medicine. Artificial intelligence appears to play a bright role in medical diagnosis. Computer systems using artificial intelligence help in the assessment of medical images and enormous data. This research aims to identify how artificial intelligence-based technology is reforming the art of medicine. Artificial intelligence empowers providers in improving efficiency and overall healthcare. Newer machine learning techniques lead the automatic diagnostic systems. Areas of medicine such as medical imaging, automated clinical decision-making support have made significant advances with respect to artificial intelligence technology. With improved diagnosis and prognosis, artificial intelligence possesses the capability to revolutionize various fields of medicine. Artificial intelligence has its own limitations and cannot replace a bedside clinician. In the evolving modern medical digital world, physicians need to support artificial intelligence rather than fear it replacing trained physicians for improved healthcare.

Designing authentic simulations in ROSE and EBUS for undergraduate laboratory medicine students

IntroductionSimulation-based education (SBE) has successfully been implemented in several healthcare professions, more so in the fields of medicine and nursing. Laboratory medicine courses prepare medical scientists for employment in pathology...

Simuladores para el mejoramiento de las competencias de pensamiento estratégico en la Administración

Objetivo: Fortalecer las competencias de análisis prospectivo y diagnóstico empresarial a través de herramientas de aprendizaje inmersivo desarrolladas por la Institución Universitaria Politécnico Grancolombiano, en los estudiantes de la modalidad virtual. Método: El laboratorio de experiencias de aprendizaje inmersivo desarrolló una metodología fundamentada en el referente ADDIER (Analysis, Desing, Development, Implementation, Evaluation, Research) con la que se hizo el diseño e implementación de dos ambientes inmersivos. A través de una encuesta, se presenta la percepción de los estudiantes sobre el impacto de estas herramientas en su proceso formativo. Resultados: Los estudiantes expresaron un alto nivel de satisfacción asociado a la eficiencia y eficacia de su proceso formativo, derivado del uso de los ambientes inmersivos. Específicamente, se reportaron valoraciones positivas en ahorro de tiempo, minimización de errores, mejora en la calidad de los análisis empresariales y retroalimentación del tutor. Discusión y Conclusiones: Un rasgo innovador de esta propuesta es que permite que se trabaje con base en experiencias reales y no en datos simulados. También se concluye que el éxito de esta experiencia se debe al trabajo de los tutores, en el sentido de su apertura y dedicación para la introducción de herramientas innovadoras en los cursos de educación virtual.

Analyzing prospective mathematics teachers\u2019 diagnostic processes in a simulated environment

Diagnostic competences are an essential facet of teacher competence. Many studies have investigated the quality of teachers’ judgments of students’ competences. However, little is known about the processes that lead to these judgments and about the ways to promote these processes in the early phase of teacher training. The aim of the research project on which we report in this paper was to develop a simulated computer-based environment that allows assessing and promoting the diagnostic processes of prospective teachers. In the simulated environment, ‘virtual third-graders’ solve mathematical problems. Participants are asked to diagnose the students’ competence levels according to a theoretical model, which has been empirically validated. Participants can repeatedly select mathematical problems of varying difficulty levels, assign them to a virtual student, and then receive the student’s written solution. In this paper, we present the conceptualization of the simulated environment. We also report on the results of a pilot study with 91 prospective primary school mathematics teachers to analyze whether the environment allows an assessment of individual differences in diagnostic processes. The majority of participants rated the environment as authentic and as one in which they could become immersed. Overall, participants were fairly accurate in their diagnoses concerning the student’s competence level. However, log data and participants’ written notes indicated that there was large variability in their diagnostic processes. Participants varied greatly in the number of mathematical problems they assigned to a student during their diagnostic process, and in how strongly the difficulty of these problems deviated from the student’s true competence level. Overall, the data suggest that the simulated environment has the potential to assess diagnostic processes in a valid way. We discuss open questions and issues for further development.

Comparing the Ultrasonography Diagnostic Value with Standard Radiography in Detecting Nasal Fractures

Background: Nasal bone fractures are the most typical kind of facial injuries. In recent years, ultrasonography has been suggested as an alternative method for detecting maxillofacial fractures. It can eliminate the risk of radiation exposure, especially in children and pregnant women. The objective of present study was to compare the diagnostic competency of conventional radiography with ultrasonography in the diagnosis of nasal injuries specially, fractures. Method: In prospective research, 331 patients with a history of midfacial trauma were enrolled. Following clinical examination, radiographs were obtained in lateral and occipitomental views. Ultrasonography was performed by an experienced sonologist, blinded to clinical findings in right and left lateral sides in addition to nasal dorsum. Images were analyzed by an experienced radiologist. Sensitivity, specificity and predictive values of radiology and US were determined by comparing their results with findings of the clinical examination as the gold standard. Results: In assessment of nasal fractures the sensitivity and specificity of ultrasonography were 97.79% and 97.66%, respectively; while for radiography these two factors were 81.21% and 86.66%, respectively. Based on the Chi-square test, ultrasonography was notably greater to radiography in diagnosing nasal fractures (P<0.001). Conclusion: Compared with radiography, ultrasonography had a higher sensitivity and specifity in detecting nasal fractures and seems to be an adequate method for the diagnosis of nasal fractures.

STUDENTS’ MUTUAL DIAGNOSIS AS EFFECTIVE PRACTICE OF ACTIVE APPROACH IN PROCESS OF TEACHING FOREIGN LANGUAGE AT UNIVERSITY

In the last decade, the problems of pedagogic diagnostics, monitoring, self-monitoring and self-diagnosis have become the focus of academic research. Diagnostic competence is considered to be an important component of the modern professional standard for a pedagogue. The article is devoted to the currently central problem of modern pedagogy and methodology, i.e. the development of students’ diagnostic thinking. The article presents the analysis of the views of Russian and foreign researchers on the importance of pedagogic diagnostics in the educational process. It is underlined that the organisation of the cognitive activity by a pedagogue involves the transformation of the function of training and education into the function of educational assistance. The authors of the article expand on the concept of mutual diagnosis of students, characterizing its components and listing the skills formed during the educational process. The article summarizes the authors’ practical experience, proposes an algorithm for working with diagnostic maps in foreign language classes and analyses a set of measures to test the skills of oral and written foreign language speech. According to the researchers’ point of view, when forming diagnostic competence, a number of framework conditions must be observed and certain algorithms, followed. The authors of the article emphasise the special educational value of mutual diagnosis, which implies not only evaluating progress in performance, but also predicting cognitive problems. This technique can be applied to other disciplines of the educational programme.

Practice-oriented training of prospective teachers-speech therapists to work with stuttering preschoolers

The article focuses on the matters of studying the diagnostic competencies of prospective speech therapists, their readiness to apply the knowledge acquired in the process of corrective work with stuttering children, as well as the arrangement of the teaching internships for students. The necessity to develop these competencies of prospective speech therapists has to do with the formation of their professional competencies required by the Federal State Educational Standard of Higher Education.

The Diagnostic Competence of Glial Fibrillary Acidic Protein in Mild Traumatic Brain Injury and Its Prognostic Value in Patient Recovery.

To show whether the glial fibrillary acidic protein (GFAP) levels are significantly higher in the serum of patients with mild traumatic brain injury or not. The level of serum GFAP was measured in 176 patients suffering from brain trauma. The ability of GFAP in predicting the presence of intracranial lesions and the need for neurosurgical intervention was analyzed using the area under the receiver (AUC) operating characteristic (ROC). By passing three months from mild TBI, the Post-Concussion Symptoms Questionnaire (PCSQ) as well as the physical and mental evaluations were performed using the SF-36 questionnaire. Of 176 patients included, 79.5% had no complications and symptoms by passing three months from traumatic brain injury. The AUC for GFAP was 72.6%, which revealed a good accuracy in predicting the need for neurosurgical intervention. GFAP, as a predictive factor in people with mild TBI diagnosis who need neurosurgical operation, expressed a favorable diagnostic effect.

Analysis of students’ mathematical errors as a means to promote future primary school teachers’ diagnostic competence

The conceptualization of teachers’ professional competencies has evolved in the last decades. The specification of the types of knowledge that teachers require, the inclusion of affective and motivational aspects and the acknowledgments of the processes that connect these dispositions to the behavior of teachers in the classroom are considered especially important. In particular, teachers’ diagnostic competence has been regarded as crucial for successful teaching because it allows teachers to understand students’ thinking and make a corresponding plan to promote learning. Errors have been recognized as a valuable source of information about students’ thinking and therefore, teachers’ diagnostic competence in error situation is the focus of this study. This article shares the design of a university course and the theoretical basis aimed at developing pre-service primary school teachers’ diagnostic competence in error situations within their initial teacher education programs. Its implementation in Chilean universities suggests a valuable opportunity for future teachers to learn and discuss about mathematics and its teaching and learning.

Virtual patients with cardiovascular pathology: technology for postgraduate medical education

Aim. To develop an information basis for the formation and implementation of multimedia models for the diagnosis and treatment of depersonalized cases of cardiovascular diseases (virtual patients). Material and methods. The materials of the study were completed case histories and multimedia results of investigation of fifty patients who underwent hospital treatment. After an expert assessment of the completed clinical case, it was posted on the server. To provide remote access to content, web development technologies were used. Results. An information model of the medical process in text and multimedia formats has been formed. The virtual patient interface has been implemented in the form of marks appearing as new patient information is received, affecting the decision making. The structure of text and multimedia information on marks of various types is given. The implemented version of virtual patient technology provides web access to the demonstration of depersonalized medical process. Conclusion. During the project progress, a repository of virtual patients is created as a multimedia model for the diagnosis and treatment of cardiovascular pathology provided by web access. The repository will be used to enhance the diagnostic and treatment competencies of doctors through the demonstration and detailed analysis of completed disease cases. Virtual patients can become methodological basis for postgraduate education of doctors in the continuing medical education system.

Facilitating Diagnostic Competences in Simulations in Higher Education A Framework and a Research Agenda

Diagnosis is a prerequisite for successful professional problem-solving: A physician identifies an appropriate treatment based on a diagnosis of the patient’s disease, and a teacher selects an appropriate learning task based on an assessment of the student’s prior knowledge. Education in academic professions such as medicine or teaching is often focuses on the acquisition of conceptual knowledge from lectures and books; opportunities for students to engage in practical diagnostic situations are typically rare. However, applying such conceptual knowledge in diagnostic activities is regarded as necessary for developing diagnostic competences. In this article, we focus on simulations in which students can actively engage in practicing diagnostic activities concerning cases from professional practice. We review and link research perspectives on diagnostic competences, their components and their development. This is partly done by exploring the commonalities and differences in research on diagnostic competences in medicine and teaching. Then, we present approaches to simulation, followed by different types of instructional support in such simulations. In particular, we focus on different forms of scaffolding during problem-solving, and on the possibly complementary roles of expository forms of instruction in these kinds of environments. Building on the perspectives reviewed, we propose a framework for fostering diagnostic competences in simulations in higher education and outline an interdisciplinary research approach concerning the instructional design of such simulations.

Guessing right - whether and how medical students give incorrect reasons for their correct diagnoses.

Background: Clinical reasoning is one of the central competencies in everyday clinical practice. Diagnostic competence is often measured based on diagnostic accuracy. It is implicitly assumed that a correct diagnosis is based on a proper diagnostic process, although this has never been empirically tested. The frequency and nature of errors in students’ diagnostic processes in correctly solved cases was analyzed in this study.Method: 148 medical students processed 15 virtual patient cases in internal medicine. After each case, they were asked to state their final diagnosis and justify it. These explanations were qualitatively analyzed and assigned to one of the following three categories: correct explanation, incorrect explanation and diagnosis guessed right.Results: The correct diagnosis was made 1,135 times out of 2,080 diagnostic processes. The analysis of the associated diagnostic explanations showed that 92% (1,042) reasoning processes were correct, 7% (80) were incorrect, and 1% (13) of the diagnoses were guessed right. Causes of incorrect diagnostic processes were primarily a lack of pathophysiological knowledge (50%) and a lack of diagnostic skills (30%).Conclusion: Generally, if the diagnosis is correct, the diagnostic process is also correct. The rate of guessed diagnoses is quite low at 1%. Nevertheless, about every 14th correct diagnosis is based on a false diagnostic explanation and thus, a wrong diagnostic process. To assess the diagnostic competence, both the diagnosis result and the diagnostic process should be recorded.

The Role of Lipidomics in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a complex neurodevelopmental syndrome commonly diagnosed in early childhood; it is usually characterized by impairment in reciprocal communication and speech, repetitive behaviors, and social withdrawal with loss in communication skills. Its development may be affected by a variety of environmental and genetic factors. Trained physicians diagnose and evaluate the severity of ASD based on clinical evaluations of observed behaviors. As such, this approach is inevitably dependent on the expertise and subjective assessment of those administering the clinical evaluations. There is a need to identify objective biological markers associated with diagnosis or clinical severity of the disorder. Several important issues and concerns exist regarding the diagnostic competence of the many abnormal plasma metabolites produced in the different biochemical pathways evaluated in individuals with ASD. The search for high-performing bio-analytes to diagnose and follow-up ASD development is still a major target in medicine. Dysregulation in the oxidative stress response and proinflammatory processes are major etiological causes of ASD pathogenesis. Furthermore, dicarboxylic acid metabolites, cholesterol-related metabolites, phospholipid-related metabolites, and lipid transporters and mediators are impaired in different pathological conditions that have a role in the ASD etiology. A mechanism may exist by which pro-oxidant environmental stressors and abnormal metabolites regulate clinical manifestations and development of ASD.

Investigating the Role of Cognitive Feedback in Practice-Oriented Learning for Clinical Diagnostics

Reflection plays an important role in medical students’ ability to develop diagnostic competence through practice with clinical cases. However, it is not easy for students to develop expert-like performance through self-reflection alone; conversely, seeking feedback from experts constantly in practice is impractical. This study investigates the design and effects of computer-based cognitive feedback in practice-oriented learning in an online system. The system allows learners to work with simulated cases and self-review and reflect on their diagnostic processes that the system captures visually. Moreover, the system provides learners with feedback about the gap between their performance and expert performance on a set of key components of the diagnostic task, i.e., selecting clinical examinations, making intermediate judgements, and reaching diagnostic conclusions. The findings show that cognitive feedback on task performance can reduce learners’ anxiety and frustration while working with complex tasks. Moreover, by providing feedback on learners’ performance on a set of key components of the task, the proposed approach has shown promising effects on improving learners’ diagnostic performance. Compared with its effects on learners’ diagnostic conclusions, the approach is more effective in enhancing learners’ performance when selecting clinical examinations and making intermediate judgements, both of which may improve learners’ understanding of the mechanism underlying the diagnostic process.