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Teaching Problem Solving Skills

Teaching Problem Solving Skills. Doris Young Professor of General Practice University of Melbourne. What are the ingredients of a 5 star doctor?. Astute Diagnostician Up to date knowledge Good communicator Preventive health Appropriate use of health resources. Diagnostician.

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Teaching Problem Solving Skills

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  1. Teaching Problem Solving Skills Doris Young Professor of General Practice University of Melbourne

  2. What are the ingredients of a 5 star doctor? • Astute Diagnostician • Up to date knowledge • Good communicator • Preventive health • Appropriate use of health resources

  3. Diagnostician • Rapport with patient • Active listening • Identify problems • Selective PE • Appropriate investigations • Rational prescribing “HOW CAN I HELP…….?”

  4. Diagnostic methods • Inductive method (traditional) full medical social history, presenting problems, review of systems checklist, then full physical examination, differential diagnoses, battery of tests (medical students or novice clinicians) • Hypothetical-deductive method (current) used by most practising experienced clinicians

  5. Hypothetical deductive method • A cycle loop of clinical reasoning • initial hypotheses • further questioning and physical examination to confirm (not confirm) our hypotheses? • modify our hypotheses based on further history and PE and tests etc…. • We rarely do a complete history and PE using a checklist except in workplace/ medical insurance examination

  6. Teaching students problem solving skills In The GP clinic

  7. Murtagh’s diagnostic criteria • Probability diagnosis • Epidemiological diagnosis • What serious illness that must not be missed? • Exclude common masquerades Anaemia, diabetes, depression, thyroid, musculo-skeletal,drugs • Why is the patient here today?

  8. Modeling Problem solving • Thinking out loud about the patient • Reviewing diagnostic hunches and consider the pros and cons of each • Providing rationale for a diagnostic or treatment decision

  9. Choose appropriate cases for novice learners 50 year old man with headache 35 year old woman presents with tiredness (Murtagh) 4 year old with cough 80 year old with chest pain 18 year old with shortness of breath 10 year old with fever

  10. Case study 1 20 year old student presents with 2 days of sore throat • What are your initial hypotheses?justify? • What further history would you need ? Why? • What are your hypotheses now? Why? • What relevant physical examination would to do to support, not support your hypotheses? Why? • Give me a problem list • What investigations would you order? • What treatment would you provide?

  11. Questions which help students to solve problems • What do you think is going on with the patient? • What other information do you think is needed? • Why do you think the patient has been non-compliant? • What were the major finding that led you to the conclusion? • What else do you consider?

  12. Do’s • Do involve them • Do encourage them • Do keep them busy • Do challenge them • Do make their placement a positive experience

  13. Don’ts • Don’t make them a wall flower • Don’t bore them • Don’t humiliate them • Don’t complain to them about family practice • Don’t expect them all to love family practice

  14. ‘I hear and I forget. I see and I remember. I do and I understand.’ (confucius)

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