Clinical Skills

Subdecks (1)

Cards (210)

  • Clinical reasoning
    A complex cognitive activity by which clinicians collect, process and interpret patient information in order to develop a diagnosis, therapeutic decisions and prognosis
  • Medical error

    A preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behaviour, infection, or other ailment
  • The estimated incidence of medical error 'is unacceptably high' at 10–15%
  • Reason for this lecture
    • To promote students performance and professional development in their OSCE exams related to history taking and clinical examination
    • To teach clinical reasoning early in the curriculum hoping to decrease incidence and consequences of medical errors in the future
  • Clinical Reasoning (CR)
    A parallel process which guides the student to understand the framework by which the clinician solves the clinical problem (thinking like a doctor)
  • Three dimensions to clinical reasoning
    • CR is a general skill like any other clinical skill
    • CR is also a function of memory or accumulated knowledge
    • CR utilises generalised mental representations such as: Semantic qualifiers, Problem representation, Illness scripts, Diagnostic schemas
  • Managing cognitive load

    • Exemplars - a person or thing serving as a typical example or appropriate model
  • Data Gathering
    1. Acquire Data: How to collect – standard format, Clarify and verify data
    2. Interpret and Organise: Create Problem List, Work out Semantic qualifiers, Chunk the data (Categorise it), Problem Statement/Representation
  • Hypothesis Testing
    1. Make Differential Diagnosis: Pattern Recognition, If no Pattern Recognised (mnemonics): Anatomical Sieve (Organ system), Surgical Sieve (Pathophysiological)
    2. Test Differential Diagnosis: Illness scripts, Diagnostic schema, Diagnostic criteria & Threshold testing
  • Dual Process Theory
    Explains how clinicians think when reasoning through a patient's case. Thinking is categorized in two systems: System 1 (Intuitive process) and System 2 (Analytical / Rational)
  • System 1 (Intuitive process)
    • Mostly at the subconscious level/ automatic, Pattern recognition, More developed and used by experienced practitioners, Takes years to develop, Difficult to put into words, Low scientific rigor, Heuristics, Plenty of cognitive biases
  • System 2 (Analytical / Rational)

    • Effort dependent, Hypothetico-deductive method, Requires knowledge, Easy to put into words, Repetitive use of System 2 leads to better understanding and development of System 1, Largely forms the basis of the medical education
  • Heuristic
    A mental shortcut that allows experienced doctors to solve problems and make judgments quickly and correctly in 80% of cases in 5 minutes
  • Three Main Sources of Our Cognitive Biases within System 1: Too much information, Too little information, Too much emphasis on speed
  • Critical thinking
    The ability of thinkers to take charge of their own thinking - metacognition. This requires sound criteria and standards for analyzing and assessing one's own thinking and routine use of those criteria and standards to improve its quality
  • Clinical Mnemonics for the Type 2 reasoning
    • Surgical sieve: MUNCHEBARS
    • Anatomical sieve: VITAMIN CDEF
  • Illness script
    A mental summary of a disease in the physician's mind
  • Diagnostic schema
    A systematic approach to a clinical problem by providing an organizing scaffold
  • Diagnostic criteria
    A guide consisting of set of signs, symptoms, and tests developed for use in routine diagnostic and clinical care
  • Threshold testing

    Testing the probability below which the diagnosis is so unlikely it is excluded without further testing
  • Components of Illness Script: Epidemiology, Pathophysiology, Time course, Prominent Symptoms and Signs, Diagnostics, Treatment
  • Benefits of Diagnostic Schema
    • Connecting diagnostic thinking to a logical framework
    • Avoiding false diagnoses
    • Triggering search for differentiating features
    • Helps teaching others how to reason
    • Creating Diagnostic Schema is beneficial to learning
  • History Scenario Example: Demographics, Presenting complaint, History of Presenting complaint, Associated problems, Past Medical History
  • History taking
    Helps teaching others how to reason
  • Schema
    An efficient way to teach others how to approach a clinical problem ("think aloud")
  • Creating Diagnostic Schema is beneficial to learning
  • Through deliberate practice, learners adapt and individualize their schema — tying these frameworks to prior clinical knowledge and experience, which keeps them robust and accessible and allowing a schema to "work" best for them
  • Demographics
    Mr Smith, 04/02/1986 (35 years), shop owner, married, two children, lives in flat in Johannesburg
  • Presenting complaint
    I felt sick yesterday, felt hot and then I suddenly got very loose stools
  • Severity
    I have to go around 7 times a day. I never measured temperature but I had chills
  • Consistency
    It is watery. There isn't any mucus or blood in it
  • What made it better
    I took some rehydration solution. I have also been vomiting a lot so I have not been able to keep anything down, so it made me only little better
  • Associated problems
    I have been feeling a dizzy and faint. I have slight pain in my belly but it isn't too bad
  • I cannot think of anything I ate that could be the cause
  • One of my friends also has similar problems
  • I have not had diarrhoea or constipation for many years now
  • Past Medical History
    One day admission one week ago for chest infection. No other significant past medical and surgical history
  • Drug History
    Antibiotics for recent chest infection
  • Allergies
    Allergic to penicillin
  • Family History
    Parents , 2 siblings and 2 children healthy