Nolt Valerie, Cain Jeff, Wermeling Daniel
University of Kentucky College of Pharmacy, 789 S Limestone, Lexington, KY 40536, United States.
Curr Pharm Teach Learn. 2018 Aug;10(8):1113-1123. doi: 10.1016/j.cptl.2018.05.012. Epub 2018 Jun 12.
Teaching students therapeutic knowledge is not the same as teaching them how to reason through clinical problems. It was determined a new approach was necessary to close the gap between classroom learning and clinical application.
A stand-alone clinical reasoning course was developed to enhance students' ability to think about and solve clinical problems. This course involved a variety of active-learning strategies based upon literature regarding clinical reasoning.
The objective of this study was to determine if a clinical reasoning course influenced student perceptions on evolution of their thinking and learning strategies and ways to improve. Thematic analysis of midpoint student reflections (n = 133) revealed eight different themes of how students perceived evolution of their thinking. Top themes were approaching a problem (n = 76), evaluating information (n = 62), and efficiency (n = 44). Thematic analysis of final student reflections (n = 138) included two categories: thinking and improvement. Reflections related to evolvement of thinking revealed five themes, the top three of which were approaching a problem (n = 89), holistic (n = 55), and efficiency (n = 46). Reflections of improvement revealed four themes, the top two of which were continue applying (n = 74) and communication (n = 23).
The themes indicate that students began to understand clinical reasoning as a set of skills necessary to become an effective practitioner.
A novel course designed to develop clinical reasoning skills can help students evolve their perception of thinking and learning strategies and engage them in a process for the application of knowledge to patient care.
教授学生治疗知识与教授他们如何通过临床问题进行推理并不相同。已确定需要一种新方法来弥合课堂学习与临床应用之间的差距。
开发了一门独立的临床推理课程，以提高学生思考和解决临床问题的能力。本课程采用了基于临床推理文献的多种主动学习策略。
本研究的目的是确定临床推理课程是否会影响学生对其思维和学习策略演变以及改进方法的认知。对学生中期反思（n = 133）的主题分析揭示了学生对其思维演变的八种不同认知主题。主要主题包括解决问题（n = 76）、评估信息（n = 62）和效率（n = 44）。对学生期末反思（n = 138）的主题分析包括两类：思维与改进。与思维演变相关的反思揭示了五个主题，其中前三个是解决问题（n = 89）、整体观（n = 55）和效率（n = 46）。关于改进的反思揭示了四个主题，其中前两个是持续应用（n = 74）和沟通（n = 23）。
这些主题表明，学生开始将临床推理理解为成为一名有效从业者所需的一组技能。
一门旨在培养临床推理技能的新颖课程可以帮助学生转变其对思维和学习策略的认知，并促使他们参与将知识应用于患者护理的过程。
