Student Clinical Reasoning Research Articles

Impact of Teaching Methods on Clinical Reasoning in Forensic Medicine: A Quasi-Experimental Study.

To compare the effectiveness of flipped classroom and video-assisted learning techniques with didactic lectures in promoting clinical reasoning skills in Forensic Medicine. Quasi-experimental study. Place and Duration of the Study: Department of Forensic Medicine, Dow International Medical College and Dow University of Health Sciences, Karachi, Pakistan, from May to October 2023. The study included 114 third-year medical students divided into three predefined tutorial groups. Over four weeks, within the Forensic Medicine respiratory module, each group was taught one topic per week using a distinct teaching strategy: Traditional lectures (TL) for the first group, flipped classroom (FC) method for the second group, and video-assisted teaching (VAT) for the third group. Students' learning achievements and clinical reasoning skills were assessed through a pre-test, post-test, and revision post-test. Pre-test scores showed no significant differences among the groups (p = 0.655). However, post-test scores differed significantly (F2:111 = 11.93, p <0.001). Tukiye's test indicated that the mean score for the FC group was significantly different from the TL group (p = 0.003) and the VAT group (p <0.001), but there was no significant difference between the TL and VAT groups (p = 0.422). The revision post-test indicated a significant decrease in mean scores across all groups, regardless of the instructional approach (p <0.001). The FC approach for teaching clinical reasoning in Forensic Medicine shows promising results, effectively improving student performance and learning experience. Flipped classroom, Video-assisted teaching, Clinical reasoning, Forensic Medicine teaching.

Assessment of Clinical Reasoning in Undergraduate Medical Education: A Pragmatic Approach to Programmatic Assessment.

Clinical reasoning, a complex construct integral to the practice of medicine, has been challenging to define, teach, and assess. Programmatic assessment purports to overcome validity limitations of judgments made from individual assessments through proportionality and triangulation processes. This study explored a pragmatic approach to the programmatic assessment of clinical reasoning. The study analyzed data from 2 student cohorts from the University of Utah School of Medicine (UUSOM) (n = 113 in cohort 1 and 119 in cohort 2) and 1 cohort from the University of Colorado School of Medicine (CUSOM) using assessment data that spanned from 2017 to 2021 (n = 199). The study methods included the following: (1) asking faculty judges to categorize student clinical reasoning skills, (2) selecting institution-specific assessment data conceptually aligned with clinical reasoning, (3) calculating correlations between assessment data and faculty judgments, and (4) developing regression models between assessment data and faculty judgments. Faculty judgments of student clinical reasoning skills were converted to a continuous variable of clinical reasoning struggles, with mean (SD) ratings of 2.93 (0.27) for the 232 UUSOM students and 2.96 (0.17) for the 199 CUSOM students. A total of 67 and 32 discrete assessment variables were included from the UUSOM and CUSOM, respectively. Pearson r correlations were moderate to strong between many individual and composite assessment variables and faculty judgments. Regression models demonstrated an overall adjusted R2 (standard error of the estimate) of 0.50 (0.19) for UUSOM cohort 1, 0.28 (0.15) for UUSOM cohort 2, and 0.30 (0.14) for CUSOM. This study represents an early pragmatic exploration of regression analysis as a potential tool for operationalizing the proportionality and triangulation principles of programmatic assessment. The study found that programmatic assessment may be a useful framework for longitudinal assessment of complicated constructs, such as clinical reasoning.

Integrating Formative and Summative Clinical Skills Examinations to Promote Learning for Early Medical Students: A Mixed Methods Study

BackgroundMedical educators aim to train students with high-quality clinical skills through the promotion of self-regulated learning and the development of lifelong learning skills. Formative clinical skills examinations (FCSE) allow for real-time learner-centered feedback and coaching which are key in promoting the development of expertise in early learners. This study assessed the impact of the integration of FCSE with learner-centered, real-time feedback and coaching based on an “educational plan-do-study-act” (PDSA) cycle on early medical students’ experience and performance.MethodsA mixed methods study was designed to assess the integration of FCSE for first- and second-year medical students. FCSE consisted of linked stations: students gathered a history from a standardized patient (SP), performed a hypothesis-driven physical examination followed by real-time learner-centered feedback and coaching. Each student met with one faculty and one SP to reflect on their performance, identify areas for improvement, re-practice of skills, and identify a plan for ongoing practice improvement. Students were surveyed upon completion of formative and summative clinical skills examinations. Student communication and clinical reasoning performance were compared to historical controls.ResultsStudents reported that FSCE improved the learning environment and helped prepare them for subsequent summative clinical skills examinations. Students appreciated the opportunity for practice and real-time feedback and reported applying their take-home points on subsequent exams. Student longitudinal performance was not impacted by the transition to FSCE.ConclusionWhile labor-intensive, FCSE with real-time feedback and coaching are an effective means of promoting learning and should be considered for integration early in medical school curricula.

Use of a clinical reasoning scaffolding document improves student performance

ObjectiveClinical reasoning is an essential skill set for practicing pharmacists to possess. Given its complex nature, optimal pedagogies for teaching clinical reasoning are largely unknown. The use of scaffolding to expand a student's zone of proximal development and improve clinical reasoning performance was assessed in this study. MethodsThis prospective, observational cohort study of second professional year (P2) students compared performance of those who were exposed to a clinical reasoning scaffolding tool (CRST) to historic control P2 students (No CRST) on FARMR notes in alignment with the Pharmacists' Patient Care Process. Student performance was assessed using an entrustment-like scale for each of 5 sections (Findings, Assessment and goals, Recommendations, Monitoring, and Rationale) of the FARMR to link classroom and experiential education settings. ResultsIn total, 141 CRST students from 28 groups were compared to 77 No CRST students from 13 groups. CRST students performed significantly higher in Assessment and goals of therapy, Recommendations, Monitoring, Rationale sections but no difference in Findings. ConclusionsScaffolding has been utilized successfully in other health professions education. This study provides evidence of it successfully improving student pharmacist clinical reasoning skills, an essential ability for successful pharmacy practitioners.

Investigating pharmacy students clinical reasoning of antimicrobial stewardship cases using a qualitative, think-aloud methodology

Abstract Introduction Future healthcare workers’ education must include antimicrobial stewardship (AMS) clinical decision-making to achieve optimal clinical outcomes and to treat and prevent infection in a manner that minimises the effects of antimicrobial resistance (AMR) and is safe for patients. Clinical reasoning is an important cognitive process that is essential to evaluate and manage a patient’s medical problem.[1] This study aimed to evaluate the cognitive processes and clinical reasoning skills of pharmacy students when they review AMS cases, as well as identify any existing knowledge gaps in this area that need to be addressed. Methods This qualitative study used a case study approach, in which a sample (n=13) of Master of Pharmacy (MPharm) students in an Irish University were recruited to interpret three patient infection cases. Convenience sampling of MPharm students by email invitation was conducted and students took part voluntarily. Semi-structured interviews were conducted, recorded and transcribed verbatim. A think-aloud procedure with verbal protocol analysis was adopted to determine students’ decision-making processes and clinical reasoning.[2] Thematic analysis was used to analyse interview data. Results Interviews were conducted with 13 students (5 male, 8 female), all aged 22-27 years old. Overall, students interpreted and reasoned through the cases following a structured approach. Some students adopted different approaches to clinical decision-making and did not always follow all the steps outlined in the clinical reasoning cycle. Within the clinical decision-making process, common themes were identified, as outlined in Table 1. Some knowledge gaps were reported by students, including antibiotic prophylaxis, microorganisms, AMS measures, guideline use, soft tissue infection management, and IV-to-oral switch. Conclusion This study provides interesting findings on students’ interpretation and review of infection management and AMS principles which could inform the curriculum development of pharmacy education in AMR and AMS. Educators should consider introducing opportunities to develop clinical reasoning skills to support learning on AMS concepts, particularly in challenging areas such as microbiology, and interpretation and application of guidelines. A limitation of the study is that it was conducted with pharmacy students from one university programme. A strength of the study is the think-aloud methodology which provides in-depth detail on students clinical reasoning thought processes and skills.

Evaluating Clinical Reasoning in Undergraduate Medical Education: The Value of a Virtual Oral Assessment.

Oral assessments are essential components of board certification in numerous fields, as they provide insight into problem-solving capacity and clinical reasoning. The development of clinical reasoning often begins in undergraduate medical education and remains a challenge to assess. We developed a pilot oral assessment to evaluate medical student oral presentations and systematically assess clinical reasoning. This was incorporated into a previously existing cumulative assessment at the conclusion of the third year of medical school, with the intent to demonstrate feasibility and future reliability of this exam format. This pilot oral assessment was developed using content taught during third year clerkships. A modified Assessment of Reasoning Tool (ART) was used as the evaluation metric. It was conducted virtually to include faculty members from multiple disciplines and accommodate schedules and space limitations. A total of 152 third year medical students completed the exam, with a total of 15 faculty examiners. 89% of medical students scored as complete in hypothesis directed history, 93% in problem representation, 86% in prioritized differential diagnoses, and 67% in effectively directing management. Most examiners felt an oral assessment is effective to determine a medical student's clinical reasoning ability. Virtual oral assessments of clinical reasoning can be incorporated in undergraduate medical education to identify students struggling with components of clinical reasoning, while also allowing maximum flexibility for the clinician educator workforce as examiners. Longitudinal use of these exams would be valuable to track the development of clinical reasoning across the medical school curriculum.

Impact of case-based learning approach in clinical microbiology on second-year students: A prospective observational study

Case-based learning (CBL) is an interactive student-centred exploration of real-life situations. It has been used in addition to didactic lectures (DL) in the medical curriculum for strengthening the students' critical thinking, clinical reasoning, and better understanding of the disease and its management. 100 students were divided into 2 groups. Group A was exposed to CBL first and didactic lectures later and Group B were exposed to didactic lectures and then to CBL, with pre and post tests conducted with questionnaire each time. 91% of the students were satisfied with the newer teaching learning method and 94% of the students felt the teaching method must be student centric. CBL revealed improvised learning among the students and enhanced their communication skills and long term memory, while with didactic lectures, the students seemed not too keen on applying and implementing the topics.

시뮬레이션 기반 수업이 간호대학생의 눈치, 의사소통능력, 임상추론역량에 미치는 효과

This study aimed to investigate the effects of simulation-Based Education on nursing students' nunchi, communication skills and clinical reasoning ability. For the study, an experimental study with a one group pre-post design was used. The participants were 48, 4-years nursing students from S University in G-city, and participated in the 'Simulation-Based Education' course for 12 weeks from August to October 2022. parid t-test using SPSS program. Result, Nunchi(t=3.29, p=.003), Communication skills(t=2.51, p=.018) and Clinical reasoning ability (t=-4.98, p&lt;.001) of nursing students significantly improved after application of simulation-based Education. In addition, the correlation between nunchi, communication skills, and clinical reasoning ability shows that clinical reasoning ability has a strong positive correlation with Nunchi(r=.644, p&lt;.001) and communication ability (r=.629, p&lt;.001). A relationship appeared. Additionally, the factor accounted for 41.9% of the variance in Clinical reasoning ability. Therefore, it is necessary to develop various clinical nursing scenarios of simulation-based training education to nursing subjects to improve clinical reasoning capabilities for nursing students'. It is believed that the period of education should be considered before clinical practice.

The influence of Gamification on medical students’ diagnostic decision making and awareness of medical cost: a mixed-method study

BackgroundThe gamification of learning increases student enjoyment, and motivation and engagement in learning tasks. This study investigated the effects of gamification using decision-making cards (DMCs) on diagnostic decision-making and cost using case scenarios.MethodThirty medical students in clinical clerkship participated and were randomly assigned to 14 small groups of 2–3 medical students each. Decision-making was gamified using DMCs with a clinical information heading and medical cost on the front, and clinical information details on the back. First, each team was provided with brief clinical information on case scenarios. Subsequently, DMCs depending on the case were distributed to each team, and team members chose cards one at a time until they reached a diagnosis of the case. The total medical cost was then scored based on the number and contents of cards drawn. Four case scenarios were conducted. The quantitative outcomes including confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical costs were measured before and after our gamification by self-evaluation using a 7-point Likert scale. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using DMCs.ResultConfidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical cost were significantly higher after the gamification. Furthermore, comparing the clinical case scenario tackled last with the one tackled first, the average medical cost of all cards drawn by students decreased significantly from 11,921 to 8,895 Japanese yen. In the content analysis, seven advantage categories of DMCs corresponding to clinical reasoning components were extracted (information gathering, hypothesis generation, problem representation, differential diagnosis, leading or working diagnosis, diagnostic justification, and management and treatment).ConclusionTeaching medical students clinical reasoning using DMCs can improve clinical decision-making confidence and learning motivation, and reduces medical cost in clinical case scenarios. In addition, it can help students to acquire practical knowledge, deepens their understanding of clinical reasoning, and identifies several important clinical reasoning skills including diagnostic decision-making and awareness of medical costs. Gamification using DMCs can be an effective teaching method for improving medical students’ diagnostic decision-making and reducing costs.

Excellence via Strategic Experiential Learning (ExSEL): A Continuous Improvement Project for Developing Clinical Reasoning and Management

BackgroundThis improvement project explored using virtual patient simulations to increase an AGANCP students’ confidence applying clinical decision-making skills. MethodsA statistical analysis compared students clinical reasoning, clinical. management, and confidence scores between clinical courses with differing pedagogies focused on case-based learning versus traditional didactics. ResultsStudents showed higher clinical reasoning scores with a virtual-patient case-base pedagogy, and higher clinical management scores using traditional didactics. Higher clinical confidence scores were more frequent within the case-based approach than the traditional pedagogy. ConclusionA well-structured educational strategy using virtual-patient cases showed effectiveness in gaining competence and confidence learning clinical decision-making.

Development and Contribution of a Serious Game to Improve Nursing Students' Clinical Reasoning in Acute Heart Failure: A Multimethod Study.

Clinical reasoning is essential for nurses and nursing students to recognize and intervene when hospitalized patients present acute heart failure. Serious games are digital educational interventions that could foster the development of clinical reasoning through an engaging and intrinsically motivating learning experience. However, elements from a playful approach (eg, rewards, narrative elements) are often absent or poorly integrated in existing serious games, which may limit their contribution to learning. Thus, we developed and studied the contribution of a novel serious game on nursing students' engagement, intrinsic motivation, and clinical reasoning in the context of acute heart failure. We adopted a multimethod design and randomized 28 participants to receive two serious game prototypes in a different sequence, one that fully integrated elements of a playful approach (SIGN@L-A) and one that offered only objectives, feedback, and a functional aesthetic (SIGN@L-B). Through self-reported questionnaires, participants reported higher levels of engagement and intrinsic motivation after using SIGN@L-A. However, negligible differences in clinical reasoning scores were found after using each serious game prototype. During interviews, participants reported on the contribution of design elements to their learning. Quantitative findings should be replicated in larger samples. Qualitative findings may guide the development of future serious games.

Peer Role-Play Simulation: A Valuable Alternative to Bedside Teaching During the COVID-19 Pandemic.

The COVID-19 pandemic dramatically affected every aspect of life worldwide. Contact restrictions and social distancing during the epidemic has led to the suspension of bedside teaching (BST) and shifting to online didactic teaching and other methods of active learning. We implemented peer role-play simulation (PRPS) during the pandemic to compensate for the suspended BST. This study aims to explore the effectiveness of PRPS in developing the students' verbal communication, empathy and clinical reasoning skills compared to BST. This is a cross-sectional observational study conducted in Jazan University faculty of medicine with the study sample including all medical students enrolled in 5th and 6th year during the academic year 2020-21. Data collection involved using a web-based validated questionnaire. Most of the students (84.1%) rated bedside teaching (BST) as extremely beneficial or beneficial in developing verbal communication skills compared to 73.3% for peer role-play simulation (PRPS). A similar pattern was found in empathy skills development with 84.1% for bedside compared to 72.2% for PRPS. The pattern is reversed with the development of clinical reasoning skills with 77.7% rating BST as beneficial or extremely beneficial compared to 81.2% for PRPS. Overall, peer role-play is generally a valuable and trustworthy method in the absence of bedside teaching for enhancing clinical reasoning skills of medical students during the COVID-19 pandemic from students' perspective. It is less efficient than bedside teaching in enhancing communication skills. It cannot wholly replace bedside teaching, although it can be used reliably for that purpose in exceptional circumstances when bedside teaching cannot be implemented.

Clinical reasoning in undergraduate paramedicine: utilisation of a script concordance test

IntroductionClinical reasoning is a complex cognitive and metacognitive process paramount to patient care in paramedic practice. While universally recognised as an essential component of practice, clinical reasoning has been historically difficult to assess in health care professions. Is the Script Concordance Test (SCT) an achievable and reliable option to test clinical reasoning in undergraduate paramedic students?MethodsThis was a single institution observational cohort study designed to use the SCT to measure clinical reasoning in paramedic students. Clinical vignettes were constructed across a range of concepts with varying shades of clinical ambiguity. A reference panel mean scores of the test were compared to that of students. Test responses were graded with the aggregate scoring method with scores awarded for both partially and fully correct responses.ResultsEighty-three student paramedic participants (mean age: 21.8 (3.5) years, 54 (65%) female, 27 (33%) male and 2 (2%) non-binary) completed the SCT. The difference between the reference group mean score of 80 (5) and student mean of score of 65.6 (8.4) was statistically significant (p < 0.001).DiscussionClinical reasoning skills are not easily acquired as they are a culmination of education, experience and the ability to apply this in the context to a specific patient. The SCT has shown to be reliable and effective in measuring clinical reasoning in undergraduate paramedics as it has in other health professions such as nursing and medicine. More investigation is required to establish effective pedogeological techniques to optimise clinical reasoning in student and novice paramedics who are devoid of experience.

High-Fidelity Simulation’s Impact on Clinical Reasoning and Patient Safety: A Scoping Review

<h3>Background</h3> Simulation-based learning is a recognized teaching approach in nursing education. However, research on the interplay of simulation and clinical reasoning development is limited. It is assumed that the opportunity to develop skills and clinical reasoning through simulation will contribute to patient safety. <h3>Purpose</h3> This scoping review aims to summarize the literature on the impact of high-fidelity simulation (HFS) on students' clinical reasoning and patients' safety in undergraduate nursing education and to use that information to provide recommendations to nursing educators. <h3>Methods</h3> A scoping review of the literature published between 2011 and 2022 was conducted following the guidelines of the Joanna Briggs Institute Manual for Evidence Synthesis and a methodological framework for scoping studies. <h3>Results</h3> Of 155 studies identified, 21 were included in the final review. Based on these studies, HFS may affect patient safety by stimulating clinical reasoning in a safe environment for undergraduate nursing students. Exposure to HFS improves students' readiness and alleviates "transition shock" and anticipatory anxiety in the clinical setting. HFS cannot replace but may be used in conjunction with real-life nursing practice to support the development of clinical reasoning in students. <h3>Conclusion</h3> Simulation promotes active learning as students engage in lifelike scenarios. Repetitive practice of nursing skills in simulation contributes to students' dexterity, leading to improved safety, clinical performance, and translation of theory to practice. In addition, prebriefing and debriefing sessions after the HFS activity provide opportunities for exploration of factors influencing patient safety.

Teaching delirium to undergraduate medical students: Exploring the effects of a cross-professional group objective structured clinical examination compared to standard education.

To compare a cross-professional facilitated delirium group objective structured clinical examination (GOSCE) educational intervention with standard delirium education for medical students during clinical placement, and explore the differences in the examiner's written feedback between the two groups. A non-randomised clustered controlled designed study at a single metropolitan university across several campuses in Sydney, Australia. A convenience sample of third-year medical students was recruited. Students' knowledge, communication, and clinical reasoning skills were assessed using a delirium case mock OSCE at the end of the academic year. The OSCE marks and the examiner's feedback for the intervention and control group were compared. The intervention group (n=41) had a higher total mean OSCE mark compared to the control group (n=29) (36.5, SD 2.9 vs. 33.7, SD 2.9, p < 0.001). Content analysis of the examiner's feedback showed the intervention group had a greater understanding of the need for forward planning and future cognitive assessments, and the roles of the interdisciplinary team in delirium care. The innovative cross-professional facilitated delirium GOSCE education was effective in increasing delirium knowledge, communication, and clinical reasoning skills compared to conventional education for medical students during clinical placement. Further studies are needed to investigate how this is translated into practice.

Script Concordance Tests for Formative Clinical Reasoning and Problem-Solving Assessment in General Pediatrics.

IntroductionScript Concordance Tests (SCTs) are short clinical vignettes with proposed diagnoses, diagnostic studies, treatments, and management options for patient care scenarios. The SCTs included in this resource were incorporated into a required pediatric clerkship to facilitate formative student feedback and additional opportunities for precepting faculty to provide midclerkship feedback. Pediatric cases were specifically selected due to the scarcity of medical student experience with common pediatric clinical presentations.MethodsWe developed eight themed SCTs comprising 72 individual test items focused on common topics in general pediatrics. Items were administered to a convenience sample of third-year medical students during their required pediatric clerkship between fall 2016 and spring 2020. To evaluate the SCTs, we conducted item analyses, as well as comparing student performance to summative assessments.ResultsThe mean aggregate percentage score across all SCTs was .84 (SD = .08). Student SCT performance was related to USMLE Step 2 Clinical Knowledge scores, clerkship grades, and NBME Pediatrics Shelf Exam scores.DiscussionThese SCTs facilitated feedback to medical students in the clinical learning environment. Their current form provides a means of exploring student clinical reasoning and problem-solving and can be used at a single point or to measure longitudinally. When paired with structured subject- and competency-specific midclerkship student evaluation, SCTs helped facilitate timely feedback to students via immediate explanations of each question. SCTs can assist students in recognizing and reflecting on potential knowledge gaps.

Can Simulation be a Learning and Assessment Tool for Collaborative Learning in the Preclinical Years?

Collaborative learning cases (CLC) is a new model of teaching and learning in healthcare education based on patient problems. Basic medical sciences and clinical sciences are integrated in case‐based scenarios simulating with real‐life situations1. The most common problem in the medical curriculum is that medical students have poor understanding of clinical conditions due to the inability to apply basic concepts to clinical practice. This is largely due to some curricula having a didactic teaching pedagogy with a teacher‐centric and discipline‐specific format along with content overload. The imperative was to develop teaching‐learning formats based on collaborative learning, breaking away from the traditional didactic large group lecture sessions. This would promote self‐directed, student‐centred learning, which would lead to deeper learning, the acquisition of meaningful content and consequently, ideal educational outcomes2. Furthermore, these learning methods would promote and develop domain‐independent skills such as collaboration, respect, leadership, communication and research skills, professionalism/ ethical behaviours, and lifelong learning skills.CLCs also serve as the capstone to align the lectures, tutorials, simulations, and practical sessions. Prior to a CLC session, students take the pre‐reading and pre‐quiz (Fig. 1), and the in‐class activities are facilitated by trained tutors (Fig. 2). During the CLC, a simulated patient (SP) and videos are shared in a sequential manner to facilitate discussion and strengthen student clinical reasoning skills. Evaluation of the CLCs are conducted through surveys involving students, tutors and SPs who observe the interaction between them and the students. These feedbacks are valuable and are frequently used as formative and summative assessment.Thus, CLCs can help students to better understand the relevance of basic medical sciences by integrating it with clinical sciences, encourage deeper learning, promote collaboration and lifelong learning. In this symposium, we will discuss the rationale and process of developing CLCs as well as the strengths and limitations. Further, we will explore these ideas in more details and engage in a collegial discussion that will broaden our perspective on collaborative learning.ReferencesThistlethwaite JE, Davies D, Ekeocha S, Kidd JM, MacDougall C, Matthews P, Clay D. The Effectiveness of Case‐Based Learning in Health Professional Education. A BEME Systematic Review: BEME Guide No. 23. Medical Teacher. 2012; 34(6),e421‐e444.Samarasekera DD, Nayak D, Yeo SP, Gwee, MCE. Teaching for effective learning in higher education: Focusing on learning and moving from a “based learning” mind‐set. Asian Journal of the Scholarship of Teaching and Learning. 2014;4(2): 113‐123.

Assessment Strategies Used by Nurse Educators To Evaluate Critical Thinking, Clinical Judgment or Clinical Reasoning In Undergraduate Nursing Students In Clinical Settings: A Scoping Review of The Literature.

Nursing students in Canada are typically enrolled in a four-year bachelor degree program that provides students with the necessary skills and knowledge to enter a highly demanding and challenging workforce. Strong critical thinking, clinical reasoning, and clinical judgment skills are essential skills for safe nursing practice. Therefore, educational institutes and their mentors are mandated to teach and assess these skills. In addition, nursing programs operate under an apprenticeship model, which entails the fulfillment of practical experience during which students are expected to develop and refine their skills in critical thinking, clinical reasoning, and clinical judgment. The purpose of this scoping review of the literature is to assess the available evidence of how higher-level thinking, including critical thinking, clinical reasoning, and clinical judgment are evaluated in undergraduate nursing students in clinical settings. The inclusion criteria consisted of quantitative research articles published in the last 10 years. Search databases accessed included CINAHL Plus (EBSCO), Medline, and PubMed. Seven articles that fit the inclusion criteria became the focus of this scoping review. Four tools to evaluate higher-thinking processes in clinical settings were located and scrutinized: Lasater Clinical Judgment Rubric (LCJR), Script Concordance Testing, and Yoon's Critical Thinking Disposition Instrument. Relevance to practice: The scoping review will provide direction and contextualize future studies that focus on the appraisal of nursing students' critical thinking, clinical reasoning, and clinical judgment in clinical settings.

Are They Watching: Pedagogical Influence of Role Modeling on Student Competence, Confidence, and Clinical Reasoning

Background: This article examines the effects of role modeling used as an educational scaffold in simulation. Students requested an exemplar of what was expected before entering the simulation scenario. Three expert nurses were filmed managing a deteriorating patient scenario with these videos then used in pre-briefing with undergraduate nursing students. Method: Action research is employed with undergraduate nursing students (n = 161) who acted as co-researchers in that they are asked for changes in simulation which will improve their learning in the areas of knowledge acquisition, skill development, critical thinking, and communication. Three action research cycles were employed with feedback from each cycle informing the next. Results: The use of an expert role modeling video as a prebriefing educational scaffold strengthened professional competence, clinical reasoning and judgment, and professional confidence. Furthermore, designing roles within the simulation allowed students to gain competence in managing one small piece of the overall situation. Conclusion: This research highlights the effectiveness of pre-briefing video clips in enhancing student learning with undergraduate nurses. These abilities are essential in order to provide safe and competent care, and to encourage professional identity/development in undergraduate nurses.

Design, Implementation and Evaluation of Clinical Pharmacology Simulation Training Method for Nursing Students of Tehran School of Nursing and Midwifery

Introduction: Educating students in a safe environment such as simulated centers can be effective in providing educational services and preparation for clinical work. Accordingly, the present study was conducted with the aim of designing, implementing and evaluating clinical pharmacology simulation training method for nursing students. Methods: This study was performed in 2019-2021 in three main phases of design, implementation and evaluation of Pharmaceutical Skills Center in Clinical Skills Center of Tehran School of Nursing and Midwifery. First, the design phase was accomplished by preparing the space and the desired drugs. Due to the prevalence of Covid-19 disease, part of the implementation and evaluation phase was carried out in the virtual context. Before and after the internship, students' knowledge, skills, satisfaction and clinical reasoning were measured using relevant questionnaires and analyzed using descriptive and analytical statistics. Result: The mean scores of the three variables in terms of pharmacology knowledge, drug calculation skills and clinical reasoning of pharmacology of nursing students before and after the internship were examined. The results demonstrated that all three means were significantly improved compared to that of before the intervention (P &lt;0.001 and P = 0.001). The mean of total students' satisfaction with pharmacology internship course turned out to be 30.57 (3.2), which indicated the relative satisfaction with the training course. Conclusion: In general, the results of the study indicated an improvement at the level of pharmacological knowledge, clinical reasoning of pharmacology and a significant improvement in pharmacological skills. Despite the limitations of Covid 19, this training method seems to augment the performance of nursing students in pharmacology.