The document discusses using virtual patients and small group discussions to promote reflective practice in medical education. It notes that diagnostic errors are common in medicine, with cognitive errors contributing to most. Educational approaches are proposed to increase expertise through deliberate practice and help learners apply reflective thinking. Specifically, the approach involved residents working through virtual patients where premature closure had occurred, followed by moderated group discussions of clinical reasoning. Evaluations found residents perceived the sessions as valuable for learning clinical reasoning. Future research could evaluate the impact on clinical reasoning skills and transfer to clinical settings.
Hogue, R.J. (2013, March). Short paper. Tablet Use Within Medicine. IADIS International Conference Mobile Learning 2013. Lisbon, Portugal.
Paper available at:
Hogue, R.J. (2013). Short paper. Tablet Use Within Medicine. IADIS International Conference Mobile Learning 2013. Lisbon, Portugal.
Clinical Questions types .
A Hierarchy of Preprocessed Evidence.
EBM definition and value.
Knowledge and Skills Necessary for Optimal Evidence-Based Practice.
Basic computer and internet knowledge for electronic searching of the literature
Hogue, R.J. (2013, March). Short paper. Tablet Use Within Medicine. IADIS International Conference Mobile Learning 2013. Lisbon, Portugal.
Paper available at:
Hogue, R.J. (2013). Short paper. Tablet Use Within Medicine. IADIS International Conference Mobile Learning 2013. Lisbon, Portugal.
Clinical Questions types .
A Hierarchy of Preprocessed Evidence.
EBM definition and value.
Knowledge and Skills Necessary for Optimal Evidence-Based Practice.
Basic computer and internet knowledge for electronic searching of the literature
Learn more about Hematologists' digital habits, tools they utilize in their practices and the top sources of information that guide key decisions. This infographic is brought to you by the #ConcentricAnalyticsTeam
April 18, 2018
Decision aids can be highly-effective tools to promote shared decision making and support patients in becoming engaged participants in their healthcare. Join us for the first-ever convening with leaders behind a Washington experiment in certifying decision aids, as state officials, health systems, and on-the-ground implementation experts share lessons learned and discuss policy recommendations for national or statewide approaches to decision aid certification.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/decision-aids-for-patients-with-serious-illness
April 18, 2018
Decision aids can be highly-effective tools to promote shared decision making and support patients in becoming engaged participants in their healthcare. Join us for the first-ever convening with leaders behind a Washington experiment in certifying decision aids, as state officials, health systems, and on-the-ground implementation experts share lessons learned and discuss policy recommendations for national or statewide approaches to decision aid certification.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/decision-aids-for-patients-with-serious-illness
This session on safety was presented to the International Council of Nurses audience in Durban, South Africa. This is just a sample of the entire session; for more information on safety in the workplace, contact sharonw@corelimited.com
a brief overview about how and why to practice evidence based medicine, its clinical application, what it is and what it is not? benefits and challenges
April 18, 2018
Decision aids can be highly-effective tools to promote shared decision making and support patients in becoming engaged participants in their healthcare. Join us for the first-ever convening with leaders behind a Washington experiment in certifying decision aids, as state officials, health systems, and on-the-ground implementation experts share lessons learned and discuss policy recommendations for national or statewide approaches to decision aid certification.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/decision-aids-for-patients-with-serious-illness
Learn more about Hematologists' digital habits, tools they utilize in their practices and the top sources of information that guide key decisions. This infographic is brought to you by the #ConcentricAnalyticsTeam
April 18, 2018
Decision aids can be highly-effective tools to promote shared decision making and support patients in becoming engaged participants in their healthcare. Join us for the first-ever convening with leaders behind a Washington experiment in certifying decision aids, as state officials, health systems, and on-the-ground implementation experts share lessons learned and discuss policy recommendations for national or statewide approaches to decision aid certification.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/decision-aids-for-patients-with-serious-illness
April 18, 2018
Decision aids can be highly-effective tools to promote shared decision making and support patients in becoming engaged participants in their healthcare. Join us for the first-ever convening with leaders behind a Washington experiment in certifying decision aids, as state officials, health systems, and on-the-ground implementation experts share lessons learned and discuss policy recommendations for national or statewide approaches to decision aid certification.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/decision-aids-for-patients-with-serious-illness
This session on safety was presented to the International Council of Nurses audience in Durban, South Africa. This is just a sample of the entire session; for more information on safety in the workplace, contact sharonw@corelimited.com
a brief overview about how and why to practice evidence based medicine, its clinical application, what it is and what it is not? benefits and challenges
April 18, 2018
Decision aids can be highly-effective tools to promote shared decision making and support patients in becoming engaged participants in their healthcare. Join us for the first-ever convening with leaders behind a Washington experiment in certifying decision aids, as state officials, health systems, and on-the-ground implementation experts share lessons learned and discuss policy recommendations for national or statewide approaches to decision aid certification.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/decision-aids-for-patients-with-serious-illness
My presentation on Android in my collegeSneha Lata
Hi everyone.....i am studying diploma in IT,i just love to know new technologies....
i have made this presentation first time on the day of Seminar presentation in my college...... i had put my efforts for doing my best......but still there may be some mistakes....just wanna share this one...hope you will like this.....thank you.. :)
The Salient Features of "The Constitution of India".
This PPTX file is better viewed in Microsoft PowerPoint 2010 or above.
Office 2007 ver is not capable for viewing animations properly.
We love all the Android devices out there, every year Google build Nexus devices to show off the latest and greatest, directly from the people who built Android. Google has introduced the latest Nexus treats, both running Marshmallow, sweetened by amazing apps and sandwiched by some cutting-edge hardware. Google unveils two Nexus phones, a Pixel tablet, and new Chromecast 2.0, on September 29 Event. Here we have summaries it.
In the world of Android application development it’s going to set the revolution for all SmartPhones. Here are some keynotes on Google September Event 2015.
With the explosion of the maker movement, schools are beginning to embrace creativity. However, what does this mean for assessment? Should we assess the creative process? Should we assess the finished product? Does assessing creativity actually make kids more risk-averse? In this workshop we explore what it means to assess both the creative process and the creative product without leading to risk aversion.
Professor Cindy Farquhar
Cochrane Menstrual Disorders & Subfertility Group
NZ Cochrane Branch of the Australasian Cochrane Centre
New Zealand Guidelines Group
National Women’s Health
University of Auckland
Most clinicians neither have enough time nor are trained to pick the best information from the enormous literature available. By practicing Evidence Based Medicine, they can give better patient care. EBM is the integration of the best research evidence with clinical expertise and patient values to make clinical decisions
Overview of Evidence-basedPractice and the Research Pro.docxLacieKlineeb
Overview of Evidence-based
Practice and the Research Process
What is EVIDENCE BASED PRACTICE?
A systematic review of critical appraisal and synthesis of the most relevant research.
Clinical Expertise
Patient Preferences and Values
Initiatives to Advance EBP
To Err is Human: Institute of Medicine (IOM): Building a Safer Health System
Initiatives driving the movement
IOM’s goal: By 2020, 90% health care will be evidence-based
US Preventive Services Task Force (sponsored by AHRQ): analyzing evidence and publishing guidelines (Guide to Preventive Clinical Services)
Magnet Recognition Program (ANA): mandate nursing research and use of EBP
Goal of EBP
OPTIMUM PATIENT OUTCOMES
Once you begin to look for
evidence-based projects,
you’ll start to see them everywhere!
SOURCES OF EVIDENCE
Research Findings
Agency quality monitoring data
Data from national databases
Expert opinions
Scientific principles
Research prOCESS
Conducting Research:
Steps of the Research Process
1. Identify issue or question
2. Formulate research question
3. Review the literature
If further research is needed:
4. Determine theoretical framework
5. Design the study
6. Select the sample
7. Collect data
8. Analyze data
9. Interpret results
If indicated, change practice!
Step ONE: Identify issue
Step Two: formulate Research Question
Conducting Research: Formulating the research question
Research Questions (quantitative):
Identify the target population
State an intervention or treatment (independent variable)
List the variables to be measured/outcomes (dependent variables)
Sample Research Question
Do pediatric patients who are given a
reward when they cooperate during
nursing procedures tend to be more
cooperative during those procedures
than unrewarded peers?
12
Sample Research Question
What are the relationships among spiritual well-being, sleep quality, and health status in HIV-infected men and women?
13
Conducting Research: Formulating the research question
Research Question:
What are the effects of weekly quizzes on the grades of nursing students?
What is the target audience?
What is the independent variable?
What is the dependent variable?
Conducting Research: Formulating the research question
Research Question:
Do nursing students who participate in study groups earn higher grades on final exams?
What is the target audience?
What is the independent variable?
What is the dependent variable?
Conducting Research: Formulating the research question
Research Question:
Is there a difference in patient satisfaction scores between patients who have had nursing students care for them and patients who have not had nursing students assigned to them?
What is the target audience?
What is the independent variable?
What is the dependent variable?
Avoid “Yes” or “No” Question Formats
.
EBM Is the ability to access, asses and apply the best evidence from systematic research information to daily clinical problems after integrating them with the physician's experience and patient's value.
Why bother with evidence-based practice?PaulGlasziou
An introduction to evidence-based medicine (EBM) with short section in history and why EBM? Then a brief overview of the 4 steps of EBM.
These slides have been used for starting a 1-day workshops in EBM
What does “patient centricity” really mean and how is it actually done? This was the driving question of the DayOne Experts Meeting in Basel, co-hosted by Arcondis.
final project (nursing major) najah universitymahdyvika
The knowledge of nursing toward the role of them in End of life care in Intensive care units and oncology units in Nablus hospitals- Cross sectional study.
The development of a Patient Safety Programme for Primary Care is being informed by the learning from two ongoing primary care safety projects. This session highlights the approaches used, the early findings and describes how to sustain and spread the success of this work.
1. Faculty of Health, Medicine and Life Sciences
School of Health Professions Education
Prof. dr. Albert Scherpbier
The combination of virtual patients and small
group discussions to promote reflective practice
Bas de Leng, PhD
ICVP London, 26 April 2010
3. Faculty of Health, Medicine and Life Sciences
7
19
28
46
Factors
No fault
Only system
Only cognitive
Both system and
cognitve
Medical errors
Diagnostic errors: 5-15% of medical diagnosis
Taxonomy of diagnostic error (Graber,2005):
– No-fault errors
– System-related errors
– Cognitive errors
Cognitive errors contribute
to 75% of all diagnostic errrors
‘Premature closure’ most
common cognitive error
4. Faculty of Health, Medicine and Life Sciences
Education to prevent cognitive errors
Relationships between reliability and effort of diagnostic
decision making (Graber, 2009)
Effort
Accuracy
Low High
Less
More
Deductive
reasoning
Expert
thinking
Monitoring,
reflection
Expert
thinking
Pre-expert
reasoning:
heuristics
ideas for educational approaches
5. Faculty of Health, Medicine and Life Sciences
Increase expertise
Deliberate practice with coaching and feedback by
more accomplished professionals (Ericsson, 2003)
Access to a large numbers of patients with similar
symptoms for which the correct diagnosis is
validated
Virtual patients can supplement real patient
encounters
6. Faculty of Health, Medicine and Life Sciences
Learn to apply reflective thinking
Learning to:
Recognize and understand the most likely
diagnostic pitfalls (Croskerry, 2003)
Use a checklist for the diagnostic process including
‘reflection’.
7. Faculty of Health, Medicine and Life Sciences
Clinical reasoning sessions
Ingredients:
Virtual patients based on real cases in which ‘premature
closure’ had occurred
Procedure to induce reflective diagnostic reasoning
(Mamede, 2008)
8. Faculty of Health, Medicine and Life Sciences
Clinical reasoning sessions
Procedure:
All residents simultaneously worked out the same virtual
patient
And the end of the work-up they had a moderated
discussion on their clinical reasoning
The logged actions and their notes were starting points for
the discussion
9. Faculty of Health, Medicine and Life Sciences
Evaluation of perceptions
Two student questionnaires:
1. Experiences with the use virtual patients. With 12 statements on:
Authenticity
Professional approach
Coaching
Learning effect
Overall judgment
1. Experiences with the integration of virtual patients. With 20 statements
on:
Teaching presence
Cognitive presence
Social presence
Learning effect
Overall judgment
10. Faculty of Health, Medicine and Life Sciences
Conclusion
Residents perceived a session combining individual virtual
patient workup with small group discussions as a
valuable learning activity for clinical reasoning.
The clinical supervisor found the presented teaching
approach feasible for the medical specialist training at the
workplace.
11. Faculty of Health, Medicine and Life Sciences
Future research
Evaluation of clinical reasoning sessions with VPs on 3rd
and
4th
level of Kirkpatrick:
Do they learn clinical reasoning and reflective practice
from this activity?
Do the learning outcomes transfer to clinics and wards?
Editor's Notes
No fault: deception, missed appointment, atypical disease presentation
Sytem related: communication of test results, expertise unavailable, no or to long procedures, technical failure of equipment.
Cognitive: faulty data gathering, faulty synthesis of information available (verification) , inadequate knowledge or skills is infrequent cause.
So cognitive factors contributed in about 75% of the cases of diagnostic error
Training of communication and team skills. In healthcare there are frequent shift changes. Handoffs from one provider to another are critical moments.
Premature closure is the failure to continue considering reasonable alternatives after an initial diagnosis is reached. With ‘premature closure’ a diagnosis is established early on in the diagnostic process and all subsequent diagnostic efforts (or even thinking) stops.
Novices use knowledge of the basic and clinical sciences for deductive reasoning to solve clinical problems. This costs a lot of effort and is highly error prone.
Expert with extensive knowledge base and experience often apply pattern recognition and solve clinical problems with little effort and high accuracy.
In their grows to the expert level clinicians will use a combination of both and the intermediate levels of effort and accuracy.
Educational by training to reflect, keeping a comprehensive approach and considering alternatives and recognizing the shortcomings of heuristics. And with this checking approach catch errors.
Extensive experience alone is not enough. Extensive practice combined with formative feedback (Ericsson 2008)
They must continuously counteract the tendency towards automaticity and deliberately construct training situations to exceed their current level of performance.
Access to large numbers of patients with similar symptoms for which the correct diagnosis is validated and with immediate expert feedback.
Large library with indexed virtual patients:
Selection of specific cases;
Deliberate sequencing of cases to ensure an ideal case mix;
Revisiting cases from different perspectives.
1) After the investigations they were asked to write down the first diagnosis that came to their mind and after this to go back to the patient record and list findings that:
Supported their diagnosis
Opposed their diagnosis
Would be expected if their diagnosis was true but which were not encountered
2) Subsequently they were asked to list alternative diagnoses and to answer the same 3 questions for each of these
3) Finally they we asked to rank their diagnoses based on the personal analysis
Aggregation tool for logged actions
Students’ questionnaires developed in the e-vip project
1) To evaluate their experiences with virtual patients. It contains twelve 5-point Likert Scale statements on the issues:
Authenticity
Professional approach
Coaching
Learning effect
Overall judgment
b) Students’ questionnaire to evaluate their experiences their experiences with the integration of virtual patients. It contains twenty 5-point Likert Scale statements on the issues:
Teaching presence
Cognitive presence
Social presence
Learning effect
Overall judgment