460 likes | 1.17k Vues
Clinical Reasoning. For First Year Medical Students. Hypothesis-Driven History-Taking Project. Goals. Provide the context & rationale for HDHT project Situate the HDHT project within clinical education Explain learning objectives of the Module Show module Explain SP exercise assessment
E N D
Clinical Reasoning For First Year Medical Students Hypothesis-Driven History-Taking Project
Goals Provide the context & rationale for HDHT project Situate the HDHT project within clinical education Explain learning objectives of the Module Show module Explain SP exercise assessment How to access? When available? SP exercise?
Clinical Reasoning “Expert clinicians begin to generate hypotheses regarding the suspected illness very quickly while gathering cues and information from the patient.” Pattern recognition
Clinical Reasoning “This hypothesis driven approach is a means of coping with the open-ended problem presented by a patient.” There could be several explanations…Let me get some more information from you… I’m not sleeping very well…
Clinical Reasoning ‘The function of early hypotheses, therefore, is to limit the size of the space that must be searched for solutions to the problem.’ ‘Some way of progressively constraining the size of the search space must be found or else a clinical workup could never end in the time that is actually available’
Clinical Reasoning Hypotheses transform an open problem into one with several hypothetical solutions… The goal of the interview and physical examination is to carry out a comparative evaluation of these competing ‘diagnoses’. Differential Diagnosis
“This hypothesis driven approach = means of coping with the open-ended problem presented by a patient.” Creates a Tension ! Also a Problem…
Hypothesis Driven Approach Patient Centered Approach
Patient Centered Astute Diagnostician
Clinical Reasoning Unfortunately, “Clinical educators insist that students carry out a history: • Following a formulaicpath • Suspending, until the end, speculation on the illness in question.”
HPI • Cardinal Questions • Problem? • Quality? • Duration, time course? • Intensity? • Aggravating? • Alleviating? • Radiation? • Associated Symptoms?
Unfortunately.. “Clinical educators insist that students carry out a history and a review of systems by following a prescribed path suspending, until the end, all formulations of the illness in question.” • Patient: “What are you thinking?” • Physician: “Oh, I haven’t started thinking yet. First I gather all the information and then I think about it.”
Clinical Reasoning “We detriment our students in the traditional training approach by teaching a scheme that is not actually the one we expect them to utilize a scant year or two later.”
Clinical Reasoning What clinicians would actually admit that such is their method of reasoning!
History Taking HPI Hypothesis Driven History Module: Introduce Process Case Profiles - illness scripts Cardinal Questions: Problem Location Severity Aggravating Alleviating Radiating Assoc Sxs Cardinal Questions Pertinent +/- Year 1 Year 2 Year 3 Year 4 Normal Pathology Patient Contact Develop Skills
Hypothesis Driven History Taking Project Objectives • Enhance diagnostic abilities • Introduce pattern recognition • Maintain Patient-Centeredness ______________________________________________________________________ Learning Module SP Exercise Quiz
Hypothesis Driven History Taking Project Module • Web module: • Clinical Reasoning - epistemology • Diagnostic scripts & pattern • Self-Assessment Questions/Answers
HDHT Timeline of Activities for Project Module Open for Study February 17, 2010 To Access Module: To be given out at lecture Feb 16th SP Encounter & Quiz March 23, 2010 (Entire Class) Module’s Web link address