University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina.
University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
Am J Pharm Educ. 2023 Apr;87(4):ajpe8975. doi: 10.5688/ajpe8975. Epub 2022 Nov 8.
Clinical reasoning (CR) is one of the most important skills for pharmacy learners. Feedback has been proposed as a pedagogy to improve CR skills; however, essential components of CR have yet to be determined within pharmacy education. This study sought to streamline feedback to align with the Pharmacists' Patient Care Process (PPCP). The investigators used deidentified clinical reasoning "Keep," "Start," or "Stop" (KSS) feedback comments from student-written CR "think-aloud" sessions with pharmacy students in their third professional year. Sections were mapped to the PPCP and were coded by 2 independent investigators according to proposed essential components of CR, using an adapted grounded-theory approach. Investigators could inductively add codes after conferring with the other. Coded feedback was analyzed using a summative content approach. Intercoder reliability was calculated via Holsti index. Five essential components of CR were identified after analysis of 635 KSS comments. The 5 essential components of CR were coded 1178 times. "Accurate," "Concise," "Specific," and "Thorough" were identified a priori, while "Connected" was discovered during feedback comment review. Literature analysis added supporting data to these results through the Paul-Elder Critical Thinking Framework. To maintain consistency in language, these essential components will be referred to as "intellectual standards" moving forward. This novel study successfully identified 5 key intellectual standards of CR. These intellectual standards provide a framework for pharmacy educators to focus feedback to improve student CR. Future research of other intellectual standards pertinent to experiential education is imperative.
临床推理（CR）是药剂学学习者最重要的技能之一。反馈已被提议作为一种教学法来提高 CR 技能；然而，在药学教育中，CR 的基本组成部分尚未确定。本研究旨在精简反馈，使其与药剂师患者护理流程（PPCP）保持一致。研究人员使用了第三年药学专业学生在 CR“思考 aloud”会议上撰写的临床推理“保留”、“开始”或“停止”（KSS）反馈意见，并将这些意见与 PPCP 进行了映射，并根据 CR 的拟议基本组成部分由 2 名独立研究人员进行了编码，使用了一种改编的扎根理论方法。研究人员可以在与另一位研究人员协商后，对代码进行归纳。使用总结性内容分析方法对编码反馈进行分析。通过 Holsti 指数计算了编码者间的可靠性。在对 635 条 KSS 评论进行分析后，确定了 CR 的 5 个基本组成部分。CR 的 5 个基本组成部分被编码了 1178 次。“准确”、“简明”、“具体”和“全面”是事先确定的，而“关联”是在反馈评论审查过程中发现的。文献分析通过保罗-埃尔德批判性思维框架为这些结果提供了支持数据。为了保持语言的一致性，这些基本组成部分将在未来被称为“智力标准”。这项新研究成功确定了 CR 的 5 个关键智力标准。这些智力标准为药学教育工作者提供了一个框架，以集中反馈来提高学生的 CR。未来研究其他与体验式教育相关的智力标准至关重要。
