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De Xin Ji Medical Case， in a narrative and discussion manner， emerged the doctors’attention to the temporal aspect of life， the shaping of personality， the promotion of plot and the intersubjectivity and ethics of treatment， as well as displayed rich storytelling characteristics. Based on the perspective of doctors， the author Xie Xinghuan conducted multiple-dimensional narrative reflections from perspectives of the relationship between doctors and patients and society， patient compliance， as well as self-medical behavior， which presented the doctor’s introspection and deep understanding of human nature. By depicting the interactive details between the characters， the medical case showed the relationship between doctors and patients， doctors and other doctors， and doctors and disciples， which not only contained the core connotation of narrative medicine， but also highlighted the unique cultural attributes of traditional Chinese medicine diagnosis and treatment.
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La formación docente, la investigación educativa, las relaciones pedagógicas y el saber articulan una compleja discusión que, en particular, pueden estar mediada por la "narrativa pedagógica"; es decir, un método que nos ayuda en la indagación por la acción docente y la experiencia "pedagógica", como crisis que se abre, profundiza, pero no se resuelve". Esto con el fin de descubrir interrogantes que nos conduzca a potenciales producciones "colaborativa[s] de saber pedagógico, la reconstrucción de la memoria pedagógica de la escuela y la transformación de las prácticas educativas" (Suárez, 2011, p. 17). Este dispositivo de transformación centra su atención en los relatos de experiencia docente que pregunta, relacionan, participan, focalizan y construyen estrategias para la indagación y reflexión a través de las narrativas.
Teacher training, educational research, pedagogical relations, and knowledge articulate a complex discussion that, in particular, can be mediated by the "pedagogical narrative;" that is to say, a method that helps us in the inquiry into the teaching action and the pedagogical experience. This in order to discover questions that lead us to potential "collaborative" productions of pedagogical knowledge, the reconstruction of the pedagogical memory of the school, and the transformation of educational practices (Suárez, 2011, p. 17). This transformation device focuses its attention on the accounts of teaching experience that question, relate, participate, focus, and build strategies for inquiry and reflection through narratives.
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Background: Providing immediate feedback to students has shown improvement in students’ knowledge, understanding, and confidence as it helps in identifying lacunae and loopholes in learning process. Despite the usefulness of feedback, common complaint from students is that they usually do not receive feedback immediately in their learning process. We also face similar situation with our students in institute. The aim of this study was to find out effect of giving immediate feedback and explore the views of medical students on immediate feedback during formative assessment. Aims and Objectives: The aims of this study were to evaluate the effect of immediate feedback on the medical students’ learning in medical education. Materials and Methods: The study was conducted in Department of Physiology, GMERS Medical College, Valsad on 183 students of 1st MBBS after ethical approval. Two types of modules were prepared on using “Hot Potatoes” software version 6.3. Module-1: Test 1 without feedback: consist of 20 MCQs and Module-2: Test 2 with feedback: consist of 20 MCQs, provide immediate feedback for each option of MCQ. Two modules were given one by one on WhatsApp group on mobile phone. Reflection writing and feedback from students were taken after that. Results: The qualitative data collected provided important information about the immediate feedback. Feedback responses of students on the questionnaire were analyzed using Likert scale. The Likert scale values were in strongly agree/agree part for Module-2 (with feedback). The students believed that immediate feedback was very helpful in clearing concepts, finding out lacunae, improvement in confidence, and self-learning. An excellent way for self-assessment and improved their deeper understanding of content areas. The students enjoyed innovative way of learning compared to conventional learning. Conclusion: Immediate feedback using this type of feedback modules should be implemented to improve students’ knowledge, understanding, memory, and confidence and can be used as self-directed learning tool.
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Background: Reflection is essential in training physicians mainly because it helps them to participate in collaborative teams, respond in unique and compassionate manner to clinical cases and situations and behave professionally and with empathy. Aims and Objectives: The objective of this study was to observe the reflective writing ability of the Phase II MBBS students of the institute after a structured training and to obtain student feedback about the experience. Materials and Methods: This was a prospective, observational study conducted at the Department of Pharmacology, of a Medical college. A total of 102 students were included in an interactive lecture on reflection writing. Over 3 weeks they were shown three different videos (two of them doctor patient/family member interactions and one a teacher student interaction). The students were asked to reflect about what they saw in the videos. Their reflection was under three heads - “what happened, what was your reaction, and what can be done next.” Their reflection was analyzed using a scoring system (score 1 no refection to score 6 with in depth reflection) by a single observer. Their feedback was obtained using a 5-point Likert scale. Results: Average scores of the students in the three reflection exercises were 2.85 ± 0.78, 2.98 ± 0.84, and 3.36 ± 0.57, respectively, showing improvement in reflection skills. Feedback from the students showed that most liked the experience and recommended for their peers. Conclusions: We concluded that 2nd year MBBS students, when taught the structure of a reflective exercise may be able to reflect better on their day to day experiences.
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While modern medical technology improves human health, it also changes people’s ethical ways of understanding life, weighing interests, planning for a good life, and building public order and good customs. Technical reflection and clinical evidence-based practice are highly complementary. On the one hand, the cognitive purport of clinical practice changes from "causality" to "correlation". On the other hand, technical reflection opens the review perspective of ethical care. Technical reflection helps medical professionals improve working methods through technical control and ethical care, promote the transition of clinical practice from "cognitive domain" to "ethical domain", and then respond to the basic questions of "what should be done" and "how should be done" in clinical practice.
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We organized regular, student-led activities in which medical students listened to patients' narratives and engaged in casual conversation. This report reviews these activities, which were conducted 28 times between June 2020 and September 2022. Through the activities, we received feedback on feelings, new perspectives, and realizations that arose from both students and patients. Our findings suggest that listening to patients' narratives helped students self-reflect and understand the patients' perspectives. Moreover, interacting with students helped patients feel a sense of meaning and a new understanding of their illness.
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Taking G University as an example, through empirical research, this study finds out that the motivation of teachers on medical education research is insufficient; the support and incentive for young and middle-aged teachers to participate in higher education research is insufficient; and universities lack of an efficient higher education research organization system; the social influence of medical research and education is not enough, etc. We call on independent medical universities to further improve the higher education research organization system, change the current situation and increase the support and incentives for young and middle-aged teachers to participate in higher education research, guide teachers to summarize the characteristics of medical education teaching, improve the quality of medical personnel training, and expand the influence of medical education research.
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Objective:With the adjustment of epidemic prevention and control policies, the coronavirus disease infection has undergone incredible changes. The number of infected people has exploded in a geometric progression up to an astronomical number. In the face of a new round of stormy tests, it is not only necessary for the whole country to unite and help each other, unite as one, share weal and woe, and overcome the difficulties, but also for us to reflect on the current situation, problems and difficulties.
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The first author set up a study group with other members in 2014, aiming to improve multidisciplinary collaboration through reflection and discussions on discomfort ( “Moyatto” in Japanese) while focusing on group members’ experiences at work. One-hour online sessions were conducted monthly with multidisciplinary professionals from several institutions. We reflected on interprofessional collaboration based on Moyatto. This paper describes the history of the study group’s inception and development, the learning process of each session, and the theory as a framework. It also reports on the practice and changes in our study group, concluding that interprofessional collaboration requires first-order reflection within a same-profession group and second-order reflection among diverse professionals.
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The meridian theory is the pioneer of clinical diagnosis and treatment of diseases in Traditional Chinese Medicine (TCM). From Shang Han Lun to Pi Wei Lun, the meridian theory has contributed important theoretical organization materials and clinical practice experience to the establishment of the diagnosis system of external and internal injuries. The acupoints contained in its clinical acupuncture and moxibustion record symptoms, and some laws summarized have been absorbed and used for reference. It shows the positive significance of its exploration in clinical diagnosis and treatment. A system of differentiation and treatment of external and internal injuries with acupuncture has not been formed, even though the meridian theory of TCM has a long history with many areas being explored, such as diseases, acupoints, acupuncture methods and stimulation amount. Therefore, this paper starts from the academic development history of meridians, reviews and analyzes the contribution and limitations of TCM acupuncture and moxibustion in the diagnosis and treatment of internal injury, in order to enlighten the current study and understanding of TCM.
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ABSTRACT The covid-19 pandemic in some countries has been declared over. Learning activities began to be transferred face-to-face as before. However, online learning that lasted for almost 2 years certainly left unforgettable memories. During the pandemic, physical education (PE) teachers have become one of those who feel the heavy impact of teaching online. The objective of this study is to explore the online teaching experience of PE teachers. The variable on this research is the difficulties perceived by PE teachers while delivering lesson during pandemic. This research is qualitative research that uses a narrative analysis design. A total of 8 PE teachers from junior and senior high school is being involved in the study. We delivered semi-structured interviews to explore the experiences of teachers during online teaching in the pandemic era. The experience contained in this article is related to problems that are commonly encountered by teachers in Indonesia when implementing online learning. It is argued that most problem are coming from student's side. However, they admitted that teacher also set drawbacks on online learning through limitations on computing skill, poor learning design, and low adaptation on migrating the course from offline to online. This research has the potential to help identify crucial strategies for utilizing ICT and digital technologies in blended teaching settings.
RESUMO A pandemia de covid-19 em alguns países foi declarada encerrada. As atividades de aprendizagem começaram a ser transferidas presencialmente, como antes. Porém, o aprendizado online que durou quase 2 anos certamente deixou lembranças inesquecíveis. Durante a pandemia, os professores de educação física (EF) tornaram-se um dos que mais sentiram o forte impacto do ensino online. O objetivo deste estudo é explorar a experiência de ensino online de professores de EF. A variável desta pesquisa são as dificuldades percebidas pelos professores de EF ao ministrarem das aulas durante a pandemia. Esta pesquisa é uma pesquisa qualitativa que utiliza um desenho de análise narrativa. Um total de 8 professores de educação física do ensino fundamental e médio estão envolvidos no estudo. Realizamos entrevistas semiestruturadas para explorar as experiências dos professores durante o ensino online na era da pandemia. A experiência contida neste artigo está relacionada com problemas que são comumente encontrados pelos professores na Indonésia ao implementarem a aprendizagem online. Argumenta-se que a maioria dos problemas origina-se do lado do aluno. No entanto, os professores também admitiram que criaram desvantagens na aprendizagem on-line através de limitações nas competências informáticas, no design de aprendizagem e limitada adaptação na migração do curso de off-line para on-line. Esta investigação pode então ser utilizada por professores e partes interessadas para maximizar a aprendizagem em antecipação à possível pandemia que se aproxima.
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Humans , Male , Female , Physical Education and Training , Teaching/education , Education, Distance , Faculty/education , COVID-19 , SchoolsABSTRACT
Introduction: Pelvic anatomy remains a challenge, and thorough knowledge of its intricate landmarks has major clinical and surgical implications in several medical specialties. The peritoneal reflection is an important landmark in intraluminal surgery, rectal trauma, impalement, and rectal adenocarcinoma. Objectives: To investigate the correlation between the lengths of the middle rectal valve and of the peritoneal reflection determined with rigid sigmoidoscopy and to determine whether there are any differences in the location of the peritoneal reflection between the genders and in relation to body mass index (BMI) and parity. Design: We prospectively investigated the location of the middle rectal valve and of the peritoneal reflection via intraoperative rigid sigmoidoscopy in colorectal cancer patients undergoing elective colorectal surgery. Results: We evaluated 38 patients with a mean age of 55.5 years old (57.5% males) who underwent colorectal surgery at the coloproctology service of the Hospital Santa Marcelina, São Paulo, state of São Paulo, Brazil. There was substantial agreement between the lengths of the middle rectal valve and of the peritoneal reflection (Kappa = 0.66). In addition, the peritoneal reflection was significantly lower in overweight patients (p = 0.013 for women and p < 0.005 for men) and in women with > 2 vaginal deliveries (p = 0.009), but there was no significant difference in the length of the peritoneal reflection between genders (p = 0.32). Conclusion: There was substantial agreement between the lengths of the peritoneal reflection and of the middle rectal valve, and the peritoneal reflection was significantly lower in overweight patients and in women with more than two vaginal deliveries. (AU)
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Peritoneal Cavity/anatomy & histology , Rectum/blood supply , Rectum/anatomy & histology , Health Profile , Body Mass Index , Sex Characteristics , Sigmoidoscopy , Delivery, ObstetricABSTRACT
To improve resident performance in clinical practice, the R2C2 model was developed for supervisors who need to guide their residents’ reflection. It consists of four stages: Relationship building, exploring Reactions, exploring Content, and Coaching. It has been shown to effectively engage residents in reflective, goal-oriented discussions and in developing a Learning Change Plan with their supervisors. This paper introduces the Japanese translated version of the model and the evidence of its use.
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The radial artery pulse wave contains a wealth of physiological and pathological information about the human body, and non-invasive studies of the radial artery pulse wave can assess arterial vascular elasticity in different age groups.The piezoelectric pulse wave transducers were used to non-invasively acquire radial artery pulse waves at different contact pressures in young and middle-aged and elderly populations. The radial artery waveforms were decomposed using a triangular blood flow model fitting method to obtain forward and reflected waves and calculate reflection parameters. Finally a correlation analysis and regression analysis of the contact pressure Psensor with the reflection parameters was carried out. The results showed that the reflection parameters RM, RI and Rd had a strong negative correlation with Psensor in both types of subjects, and the correlation coefficients and slopes of the regression curves were significantly different between the two types of subjects (P<0.05). Based on the results of this study, excessive contact pressure on the transducer should be avoided when detecting radial artery reflection waves in clinical practice. The results also show that the magnitude of the slope of the regression curve between the reflection parameters and the transducer contact pressure may be a potentially useful indicator for quantifying the elastic properties of the vessel.
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Middle Aged , Aged , Humans , Blood Pressure/physiology , Arteries , Blood Flow Velocity/physiology , Elasticity , Pulse Wave Analysis , Radial Artery/physiologyABSTRACT
Pancreatic neuroendocrine neoplasms (pNENs) is one of the gastrointestinal malignancies of significantly heterogeneous, pathologically classified into well differentiated pancreatic neuro-endocrine tumors (pNETs) and poorly differentiated pancreatic neuroendocrine carcinomas. The prognosis and treatment response of pNETs are primely determined by tumor-intrinsic biolo-gical behavior. Accordingly, surgeons need to operate debulking surgery for low-risk patients, as well as implement adjuvant therapies for those at high-risk of relapse and metastasis after curative resection. Notably, as to two distinct subtypes of patients who suffer primary tumor with diameter less than 2 cm and functional pNETs, oncological benefits and functionally symptomatic control should be considered when formulating surgical strategies. In recent years, advances in next-generation sequencing and organoid technologies have provided practical tools for revealing the gene mutations and tumor microenvironment of pNETs. The four signalling pathways, including mTOR signalling, histone modification, altered telomere length and DNA damage repair pathways, are related to the occurrence and development of pNETs and can be used for the personalization precision therapy of pNETs and guiding the development of new drugs. Empirical therapy and clinical trial studies of pNETs are a continuum of contradictions. Therefore, clinicians need to summarize the rules in treatment and develop disciplines in the summary. Based on relevant literatures, the authors explore the hot issues related to pNENs in recent years, in order to provide reference for the diagnosis and treatment of this disease.
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Obesity is one of the most challenging global public health issues, and more than half of adults in Chia are overweight or obese. Obesity has been shown to be a risk factor for type 2 diabetes, cardiovascular disease, colon cancer and other specific cancers, and has become a serious threat and even a danger to the health and quality of life of the nation. With the mature development of bariatric surgery in the last 20 years, it is now widely recognized for its effectiveness and safety in the treatment of obesity and related metabolic diseases, as well as improving patients′ life expectancy and quality of life. However, previous data from the literatures suggest that some patients require revisional surgery after bariatric surgery, with the incidence of revisional bariatric surgery as 5% to 50%. The main reasons for revisional bariatric surgery are poor post-operative outcomes, including the lack of significant weight loss, weight regain and no significant improvement or even recurrence of associated metabolic disease, and other reasons include the development of anaemia, malnutrition and long-term chronic pain. Currently, there is only the East Asian expert consensus on revised bariatric surgery proposed by Chinese Society for Metabolic & Bariatric Surgery in 2018. However, there are still no uniform standards regarding the indications, contraindications and surgical modalities of revisional bariatric surgery in clinical practice. The authors summarize the latest researches of revisional bariatric surgery, in order to provide the guidance value for clinical practice.
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Este é um Relato de Experiência de Aprimoramento em Coordenação e Manejo de Grupos. A experiência ocorreu durante a pandemia da COVID-19, sendo assim, desafios e adaptações estiveram presentes na vida cotidiana e acadêmica. A adaptação do aprimoramento para a modalidade on-line e em contexto pandêmico, provocou questionamentos a respeito do êxito da tarefa. O emprego dos dispositivos on-line para o aprimoramento de grupoterapeutas é um campo relativamente novo, justificando a relevância deste trabalho. Foi utilizado Diário de Campo para a coleta de dados e optou-se pelo referencial teórico de Pichon-Rivière, e outros autores da Psicanálise das Configurações Vinculares que discutem a questão da virtualidade na atualidade. Entendemos que a adaptação ao modelo on-line possibilitou a continuidade das atividades grupais programadas e a existência de um espaço de formação, troca e suporte entre pares. O Grupo Psicanalítico de Reflexão foi fundamental neste contexto, favoreceu a aprendizagem e o desenvolvimento de competências, oportunizou a construção e fortalecimento de vínculos, estimulou a postura crítica e criativa diante dos desafios, limites e potencialidades da adaptação ao modelo on-line, além de acolher as experiências decorrentes dos aprimoramentos do estado de pandemia.
This is an Experience Report on the Improvement Group Coordination and Management. The Experience occurred during the COVID-19 pandemic; therefore, challenges and adaptations were present in daily and academic life. Questions about the success of the task were raised after the adaptation of the Group Therapy to the modality due to the pandemic context. The usage of online devices to enhance group therapists is a relatively new field, justifying the relevance of this work. Field Diary was used for data collection. We opted for the theoretical framework of Pichon-Rivière, and the Psychoanalysis of Binding Configurations' authors, who discuss the issue of virtuality today. We understand that the adaptation to the online model enabled the continuity of scheduled group activities and the existence of training spaces, exchanges, and support peers. The Psychoanalytic Reflection Group was fundamental in this context, it favored learning and the development of skills. It provided the opportunity to build, strengthen bonds, and encourage critical and creative stances in the face of the challenges, limits, and potentials of adapting to the online model; and welcomed the experiences of improvements resulting from the pandemic state.
Este es un informe de Experiencia de Formación Profesional en la Coordinación y Gestión de Grupos. En el año de esta experiencia ocurrió la pandemia del COVID-19, desafíos y adaptaciones se hicieron presentes en la vida cotidiana y académica. La adaptación de la formación a la modalidad en línea y el contexto de pandemia, planteó interrogantes sobre el éxito de la tarea. El uso de dispositivos en línea para la formación de terapeutas grupales es un campo relativamente nuevo, que justifica la relevancia de este trabajo. Se utilizó Diario de Campo para recoger datos. Optamos por el marco teórico de Pichon-Rivière y autores del Psicoanálisis de las Configuraciones Vinculantes que discuten el tema de la virtualidad en la actualidad. Entendemos que la adaptación al modelo en línea permitió la continuidad de las actividades grupales programadas y la existencia de un espacio de formación, intercambio y apoyo entre pares. El Grupo de Reflexión Psicoanalítica fue fundamental en este contexto, favoreció el aprendizaje y el desarrollo de habilidades, brindó la oportunidad de construir y fortalecer lazos, estimuló una actitud crítica y creativa frente a los desafíos, límites y potencialidades de la adaptación al modelo en línea y acogió las experiencias de la formación derivadas del estado de pandemia.
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Psychoanalysis , Psychotherapy/education , Education, Distance , Education, Continuing , COVID-19ABSTRACT
Introdução: Debater artes durante a graduação pode ser uma forma criativa de desenvolver novas percepções e perspectivas para estudantes de medicina. Promover atividades que visem criar momentos envolvendo temáticas humanísticas, simultaneamente ao conhecimento técnico médico, como artes e atividades físicas em um ambiente lúdico, continua sendo um desafio. Nesse contexto, foi criado um Programa Extracurricular de Aperfeiçoamento Global de Estudantes de Medicina (GIPMS) da Universidade de Fortaleza, que incluiu encontros envolvendo diversos estímulos artísticos. Objetivo: O objetivo deste trabalho é avaliar se o contato com a arte durante a graduação no contexto do GIPMS pode gerar percepções, sentimentos e reflexões para proporcionar importantes debates. Métodos: Foi realizado um estudo qualitativo prospectivo com um total de 42 sessões de grupo focal, que foram gravadas e transcritas na íntegra. Cada grupo foi conduzido por 2 mentores, e todos os 6 grupos focais utilizaram questionários qualitativos padronizados nas sessões, que foram realizadas a cada 45 dias. Foi realizada uma análise temática das transcrições, confirmada com o software QSR NVIVO (versão 11). Resultados: Um total de 40 alunos (15 homens e 25 mulheres) participaram deste estudo de um ano. As categorias encontradas foram: Os estímulos artísticos foram capazes de fazer os participantes pensarem (124 citações), sentirem (78, 65 sobre sentimentos positivos e 13 sobre sentimentos negativos) e lembrarem (41). Destacaram-se: a influência da carga horária de estudos no tempo dedicado às artes e às reflexões (61); relação entre arte e vida e produtividade acadêmica (75); mudanças de atitudes proporcionadas pelos estímulos artísticos propostos (38 citações). Conclusões: O programa foi capaz de gerar, de forma inovadora, novas percepções de sentimentos, sensações e reflexões, bem como evocar memórias que proporcionaram debates importantes, que, segundo os próprios alunos, serviram de inspiração para mudar perspectivas e atitudes e proporcionou benefícios subjetivos na vida acadêmica. [au]
Introduction: Debating arts during graduation can be a creative way to develop new perceptions and perspectives for medical students. To promote activities that aim to create moments involving humanistic themes, simultaneously to technical medical knowledge, such as arts and physical activities in a playful setting, remains a challenge. A extracurricular Global Improvement Programme of Medical Students (GIPMS) of the University of Fortaleza was created on this context, and included meetings involving various artistic stimuli. Purpose: The objective of this paper is to evaluate if the contact with art during graduation in the context of GIPMS can generate perceptions, feelings and reflections to provide important debates. Methods: A prospective qualitative study was conducted including a total of 42 focal group sessions, which were recorded and fully transcribed. Each group was conducted by 2 mentors, and all 6 focal groups used standardized qualitative questionnaires each session, which were performed every 45 days. A thematic analysis of the transcripts was performed, confirmed with the QSR NVIVO software (version 11). Results: A total of 40 students (15 men and 25 women) participated in this one-year study. The categories found were: Artistic stimuli were able to make participants think (124 quotes), feel (78, 65 about positive feelings and 13 about negative ones) and remember (41). The following stood out: the influence of the time load of studies in the time dedicated to the arts and the reflections. (61); relationship between the arts and life and academic productivity (75); changes in attitudes provided by the proposed artistic stimuli (38 citations). Conclusions: The program was able to generate, in an innovative way, new perceptions of feelings, sensations and reflections, as well as to evoke memories that provided important debates, which, according to the students themselves, served as inspiration to change perspectives and attitudes and provided subjective benefits in academic life. [au]
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Introduction: cognitive biases might affect decision-making processes such as clinical reasoning and confirmation bias is among the most important ones. The use of strategies that stimulate deliberate reflection during the diagnostic process seems to reduce availability bias, but its effect in reducing confirmation bias needs to be evaluated. Aims: to examine whether deliberate reflection reduces confirmation bias and increases the diagnostic accuracy of orthopedic residents solving written clinical cases. Methods: experimental study comparing the diagnostic accuracy of orthopedic residents in the resolution of eight written clinical cases containing a referral diagnosis. Half of the written cases had a wrong referral diagnosis. One group of residents used deliberate reflection (RG), which stimulates comparison and contrast of clinical hypotheses in a systematic manner, and a control group (CG), was asked to provide differential diagnoses with no further instruction. The study included 55 third-year orthopedic residents, 27 allocated to the RG and 28 to the CG. Results: residents on the RG had higher diagnostic scores than the CG for clinical cases with a correct referral diagnosis (62.0±20.1 vs. 49.1±21.0 respectively; p = 0.021). For clinical cases with incorrect referral diagnosis, diagnostic accuracy was similar between residents on the RG and those on the CG (39.8±24.3 vs. 44.6±26.7 respectively; p = 0.662). We observed an overall confirmation bias in 26.3% of initial diagnoses (non-analytic phase) and 19.5% of final diagnoses (analytic phase) when solving clinical cases with incorrect referral diagnosis. Residents from RG showed a reduction in confirmation of incorrect referral diagnosis when comparing the initial diagnosis given in the non-analytic phase with the one provided as the final diagnosis (25.9±17.7 vs. 17.6±18.1, respectively; Cohen d: 0.46; p = 0.003). In the CG, the reduction in the confirmation of incorrect diagnosis was not statistically significant. Conclusions:confirmation bias was present when residents solved written clinical cases with incorrect referral diagnoses, and deliberate reflection reduced such bias. Despite the reduction in confirmation bias, diagnostic accuracy of residents from the RG was similar to those from the CG when solving the set of clinical cases with a wrong referral diagnosis.
Introdução: os vieses cognitivos podem afetar tanto os processos de tomada de decisão como o raciocínio clínico e o viés de confirmação está entre os mais importantes. O uso de estratégias que estimulem a reflexão deliberada durante o processo diagnóstico parece reduzir o viés de disponibilidade, mas seu efeito na redução do viés de confirmação precisa ser avaliado. Objetivos: examinar se a reflexão deliberada reduz o viés de confirmação e aumenta a acurácia do diagnóstico de residentes de ortopedia ao resolverem casos clínicos escritos. Métodos: estudo experimental comparando a acurácia diagnóstica de residentes de ortopedia na resolução de oito casos clínicos escritos contendo um diagnóstico de encaminhamento. Metade dos casos escritos tinha um diagnóstico de encaminhamento errado. Um grupo de residentes utilizou a reflexão deliberada (GR), que estimula a comparação e o contraste de hipóteses clínicas de maneira sistemática, e um grupo controle (GC) foi solicitado a fornecer diagnósticos diferenciais sem maiores instruções. O estudo incluiu 55 residentes de ortopedia do terceiro ano, 27 alocados no GR e 28 no GC. Resultados: residentes no GR tiveram escores diagnósticos mais altos do que o GC para casos clínicos com um diagnóstico de encaminhamento correto (62,0±20,1 vs. 49,1±21,0 respectivamente; p = 0,021). Para os casos clínicos com diagnóstico de encaminhamento incorreto, a acurácia diagnóstica foi semelhante entre os residentes do GR e os do GC (39,8±24,3 vs. 44,6±26,7 respectivamente; p = 0,662). Observamos viés geral de confirmação em 26,3% dos diagnósticos iniciais (fase não analítica) e 19,5% dos diagnósticos finais (fase analítica) na resolução de casos clínicos com diagnóstico de encaminhamento incorreto. Os residentes do GR mostraram uma redução na confirmação do diagnóstico de encaminhamento incorreto ao comparar o diagnóstico inicial dado na fase não analítica com aquele fornecido como diagnóstico final (25,9±17,7 vs. 17,6±18,1, respectivamente; Cohen d: 0,46; p = 0,003). No GC, a redução na confirmação do diagnóstico incorreto não foi estatisticamente significativa. Conclusões: o viés de confirmação esteve presente quando os residentes resolveram casos clínicos escritos com diagnósticos de encaminhamento incorretos e a reflexão deliberada reduziu esse viés. Apesar da redução do viés de confirmação, a acurácia diagnóstica dos residentes do GR foi semelhante à do GC na solução do conjunto de casos clínicos com diagnóstico de encaminhamento incorreto.
Subject(s)
Humans , Decision Making , Education, Medical , Clinical Reasoning , Internship and Residency , Diagnostic ErrorsABSTRACT
Coronavirus disease 2019 (COVID-19) is highly transmittable through contact with respiratory droplets. The virus is also shed in fecal matter. Some patients may present with effects in more than one system; however, there are no defined biomarkers that can accurately predict the course or progression of the disease. The present study aimed to estimate the severity of the disease, to correlate the severity of the disease with biochemical predictors, to identify valuable biomarkers indicative of gastrointestinal disease, and to determine the cutoff values. A cross-sectional study was conducted on COVID-19 patients admitted to the Kafrelsheikh University Hospital (isolation unit) between July 10, 2020, and October 30, 2020. The diagnosis of COVID- 19 was confirmed via reverse transcription-polymerase chain reaction (RT-PCR), which was employed for the detection of the viral RNA. We conclude that lymphopenia, elevated C-reactive protein (CRP) level, and liver enzymes were among the most important laboratory findings in COVID-19 patients. Statistically significant differences in platelet count, neutrophil count, D-dimer level, and fecal calprotectin levels were observed among patients presenting with chest symptoms only and patients with both chest and gastrointestinal symptoms (p=0.004;<0.001; 0.010; 0.003; and<0.001, respectively). C-reactive protein, D-dimer, and fecal calprotectin levels positively correlated with disease severity. The cutoff value for fecal calprotectin that can predict gastrointestinal involvement in COVID-19 was 165.0, with a sensitivity of 88.1% and a specificity of 76.5%. (AU)