| What is so difficult about managing clinical reasoning difficulties? | |
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MedLine Citation:
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PMID: 22239335 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Medical Education 2012: 46 : 216-227 Context Clinical reasoning is the cornerstone of medical competence. Difficulties in this area are often identified late in clinical training. Studies point to challenges faced by clinical educators in their dual roles as clinicians and educators. Little is known about the common, yet complex, issue of how they manage clinical reasoning difficulties. We therefore sought to: (i) describe the current state of affairs in various clinical teaching settings, and (ii) explore the factors that determine the behaviour of clinical educators in this respect. Methods Four focus groups were conducted with 26 clinical educators in general practice, internal medicine and emergency medicine in Belgium and Switzerland. Two researchers analysed the transcripts of the focus group discussions using Fishbein's integrative model of behaviour prediction in a theory-driven, immersion-crystallisation process. Experienced faculty members validated the findings. Results Across diverse settings, the process of identifying and remediating clinical reasoning difficulties was unstructured. Consistent with Fishbein's model, clinical educators' underlying beliefs determined their behaviour. They believed in the apprenticeship model of learning in the clinical environment, in which their educational role was limited to role-modelling and in which residents were responsible for assimilating skills. They were sceptical about the potential impact of remediation. A few more knowledgeable supervisors had a stronger sense of their educational role, but did not implement systematic procedures to manage clinical reasoning difficulties. Environmental constraints were symptomatic of a collective paradigm of residency as an apprenticeship, in which the focus is on clinical duties, rather than as an educational programme. Conclusions In order to improve the current state of affairs in the management of clinical reasoning difficulties, a collective paradigm shift is required to alter the perception of residency as an apprenticeship to one of residency as a structured educational programme. Faculty development programmes should be designed in an integrated way so that they not only develop clinical educators' skills, but also modify their beliefs. |
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Authors:
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Marie-Claude Audétat; Valérie Dory; Mathieu Nendaz; Dominique Vanpee; Dominique Pestiaux; Noelle Junod Perron; Bernard Charlin |
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Publication Detail:
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Type: JOURNAL ARTICLE |
Journal Detail:
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Title: Medical education Volume: 46 ISSN: 1365-2923 ISO Abbreviation: - Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-1-13 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7605655 Medline TA: Med Educ Country: - |
Other Details:
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Languages: ENG Pagination: 216-227 Citation Subset: - |
Copyright Information:
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© Blackwell Publishing Ltd 2012. |
Affiliation:
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Départment of Family and Emergency Medicine and CPASS (Centre de Pédagogie appliquée aux Sciences de la Santé), Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium Service de médecine interne générale et Unité de recherche et de développement en éducation médicale, Faculty of Medicine, University of Geneva, Geneva, Switzerland Centre académique de médecine générale, Université catholique de Louvain, Brussels, Belgium Division of primary care, Department of community medicine, primary care and emergencies, Geneva University Hospital, Geneva, Switzerland CPASS (Centre de Pédagogie Appl. aux Sciences de la Santé), Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada. |
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