Clinical reasoning skills are very important in primary care. Currently we use chart-stimulated recall, directly observed consultation skills, videotaped consultation and small group discussions to teach our postgraduates in family medicine. However, I would like to know other effective ways to teach clinical reasoning skills in the outpatient setting, particularly for postgraduates.
I'm not sure if there is a "best way" to go about it. An outpatient setting makes it difficult for the patient and the consultant to provide time for demonstrating clinical reasoning. And if the OPD is in a developing country with huge crowds, there is not enough time for assessing the patient itself!
In outpatient settings where there are rooms/ halls available for student sessions, the postgraduate may be the physician who initially assesses the patient and the given case may be then discussed from the beginning to the logical end, with the consultant offering step-by-step guidance throughout -i.e., similar to a bedside session, but in the OPD(which i personally feel is the best).
A simulated case study (Paper case)may also be offered to students, although the "feel" of directly interacting with the patient is missing.
In departments with long queues, the postgraduate resident who sees the patient first, may discuss(in brief) with the consultant/faculty and gets advised(briefly) the clinical reasoning behind the faculty's assessment of the patients. but then, other students miss out on the discussion
One of the assets of our faculty is that some classes are given with specially trained actors. This is especially helpful in clinical reasoning skill related to personality disorders. It is one of these classes that everyone has fears for starting the class, but at the end we all want more.
We use simulated patients who have been trained for certain scenarios for our clinical exams in Family Medicine. However, we do not use them for training regularly apart from role play situations in communication skills.
I have read that there are approaches such as SNAPPS or thinking aloud for consultations. I wonder whether anyone can share such methods in postgraduate training.
In Canada (BC) for post-grad (residents) we mostly use real patients in clinical settings. As a teacher I think some of the key elements are:
- practice: they have to see volume to get the range and so they can try out new approaches.
- rapid feedback: going over aspects as soon as possible (i.e. during the case review and right after) allows the memories to link to the feedback and changes to be applied. We are starting to use Field Notes for this. Field Notes are short ~1/4 page feedback forms that target one aspect of the encounter.
- observation / review. This is harder for us to do in our setting but observation and video review is very good for people to see what they are doing.
- role rehearsal and simulated cases: we use these in a limited way in post-grad, mostly focused on teaching / practicing behavioural medicine skills (breaking bad news, managing a difficulty encounter) and in exam prep.
Brainstorming is based on the pathogens resources in the Chinese medicine:
External Factors: The wind, coldness, dampness, dryness, summer heat, and fire.
Internal factors: Abnormal emotions. Any abnormal emotion eventually caused heart problems.
Non-external and non-internal factors: Accidents, animals' bits, etc.
https://universaltcm.com/cold-foods-drinks-caused-problems-chart-rev-1/
https://universaltcm.com/tcm-concept-chart/
https://universaltcm.com/avoid-emotional-disturbances-to-a-pregnant-woman/
https://universaltcm.com/stress-caused-problems-chart-3/
https://universaltcm.com/education-information-in-tcm/high-blood-pressure-causes-and-tcm-treatments-2/
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