Self-regulated learning processes across different physiotherapy clinical procedural skills and time intervals: A SRL microanalysis study.

PURPOSE OF THE STUDY: The performance of a clinical procedural skill by an individual student is associated with their use of Self-Regulated Learning (SRL) processes. However, previous research has not identified if an individual student has a similarity in their use of SRL processes across different clinical procedural skill tasks and at a time interval. The aim of this pilot study was to explore the similarity in the use of SRL processes by individual students across different clinical procedural skill tasks and at a time interval. METHODS: SRL-microanalysis was used to collect within-subject data on undergraduate physiotherapy students' use of the two key SRL processes (planning and monitoring) during their performance of different goniometry clinical procedural skills tasks and also at a fourth month interval. RESULTS: An individual student's use of key SRL processes across different clinical procedural skill tasks and at a time interval was similar. Also, this similarity was identified for students with initial successful and unsuccessful performances. CONCLUSION: Our findings have implications for the future wider practical implementation of SRL microanalysis to inform personalised SRL feedback for developing the clinical procedural skills of individual students. Further research with a greater number of students and across a wider range of clinical procedural skills will be required to confirm our findings, and also its effectiveness on feedback and future performance.

Using insights from cognitive science for the teaching of clinical skills: AMEE Guide No. 155.

Students have to develop a wide variety of clinical skills, from cannulation to advanced life support, prior to entering clinical practice. An important challenge for health professions' educators is the implementation of strategies for effectively supporting students in their acquisition of different types of clinical skills and also to minimize skill decay over time. Cognitive science provides a unified approach that can inform how to maximize clinical skill acquisition and also minimize skill decay. The Guide discusses the nature of expertise and mastery development, the key insights from cognitive science for clinical skill development and skill retention, how these insights can be practically applied and integrated with current approaches used in clinical skills teaching.

Estratégias de ensino do raciocínio clínico nos cursos de Medicina do Brasil - revisão integrativa / Teaching strategies for clinical reasoning in Brazilian medical schools - an integrative review

Resumo: Introdução: O raciocínio clínico é considerado uma das principais habilidades que devem ser desenvolvidas pelos estudantes de Medicina, porque permite a elaboração de hipóteses diagnósticas e orienta estratégias investigativas e diagnósticas de forma racional. Embora os educadores tradicionalmente foquem o ensino no modelo hipotético-dedutivo ou analítico, muitos professores de medicina enfrentam no seu dia a dia o desafio de encontrar novas estratégias para ajudar seus estudantes a desenvolver o raciocínio clínico. Objetivo: Este estudo realizou uma revisão integrativa da literatura para identificar as estratégias utilizadas no processo ensino-aprendizagem do raciocínio clínico, nas escolas médicas brasileiras. Método: A metodologia utilizada consistiu em seis etapas: 1. elaboração da pergunta da pesquisa; 2. definição dos critérios de inclusão e exclusão; 3. elenco das informações a serem extraídas; 4. avaliação dos estudos incluídos; 5. interpretação dos resultados; e 6. apresentação da revisão. Resultado: A maioria dos trabalhos apontam que o ensino do raciocínio clínico é realizado por meio de discussões de casos clínicos, de maneira incidental, em diversas disciplinas ou por meio do uso de metodologias ativas, como PBL, TBL e CBL. Apenas três trabalhos apresentados em congressos demonstraram experiências relacionadas à implantação de uma disciplina curricular obrigatória voltada especificamente ao ensino do raciocínio clínico. O ensino do raciocínio clínico é priorizado no internato em relação às fases clínicas e pré-clínicas. Conclusão: Poucos são os estudos que analisam a maneira como se dá o processo ensino-aprendizagem do raciocínio clínico nas escolas médicas brasileiras. Embora mais estudos sejam necessários, podemos verificar a falta de conhecimento teórico sobre raciocínio clínico como uma das principais causas de dificuldade para o desenvolvimento dessa competência pelos estudantes.

Abstract: Introduction: Clinical reasoning is considered one of the main skills that must be developed by medical students, as it allows the establishment of diagnostic hypotheses and directs investigative and diagnostic strategies using a rational approach. Although educators have traditionally focused the teaching method on the analytical model, many medical professors face the challenge in their daily lives of finding new strategies to help their students develop clinical reasoning. Objective: To carry out an integrative literature review to identify the strategies used in the teaching-learning process of clinical reasoning in Brazilian medical schools. Method: The methodology used consists of six steps: 1. creation of the research question; 2. definition of inclusion and exclusion criteria; 3. list of information to be extracted; 4. evaluation of included studies; 5. interpretation of results and 6. presentation of the review. Results: Most studies indicate that the teaching of clinical reasoning is carried out through discussions of clinical cases, incidentally, in different disciplines or through the use of active methodologies such as PBL, TBL and CBL. Only three studies presented at conferences disclosed experiences related to the implementation of a mandatory curricular discipline specifically aimed at teaching clinical reasoning. The teaching of clinical reasoning is prioritized in internships in relation to the clinical and pre-clinical phases. Final considerations: There are few studies that analyze how clinical reasoning is taught to medical students in Brazilian medical schools. Although more studies are needed, we can observe the lack of theoretical knowledge about clinical reasoning as one of the main causes of the students' difficulty in developing clinical reasoning.

Can medical residency keep young specialists in the place where they graduate? Cross-sectional and exploratory study of the first seven years after implementation of medical residency programs in the State of Tocantins, Brazil

ABSTRACT BACKGROUND: New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE: To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING: Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS: All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS: The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS: The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.

Estimulación del aprendizaje del razonamiento clínico mediante ludificación / Stimulation of the learning of clinical reasoning through gamification

Durante la última década las escuelas de medicina han incorporado herramientas de educación a distancia, existiendo numerosas áreas de intervención. El razonamiento clínico es un área que requiere una ejercitación continua y una retroalimentación efectiva. Dado esto se plantea la interrogante de la recepción de una herramienta de aprendizaje lúdico del razonamiento clínico médico que entregue la retroalimentación efectiva con fines de estimulación del aprendizaje. Para ello se desarrolló una herramienta multiplataforma compatible con dispositivos de escritorio y móviles basada en Ren'Py, la cual fue distribuida a estudiantes de cuarto y quinto año. Posteriormente, se aplicó una encuesta de percepción para evaluar la recepción de la herramienta. Dentro de los puntos evaluados destaca ser una forma motivante de reforzar los estudios, con entrega de información atingente y facilidad de uso. Permite además reconocer debilidades y es considerada un aporte a la formación por parte de los estudiantes. A raíz de esta implementación se pudo confirmar utilidad de la retroalimentación efectiva entregada de forma instantánea dentro de casos clínicos estructurados, abriendo nuevas posibilidades al abanico de herramientas disponibles en educación superior.

Over the last decade, medical schools have incorporated distance learning tools, with numerous intervention areas available. Clinical reasoning is an area that requires continuous training and effective feedback. Given this, arises the question about the reception of a gamified learning tool for medical clinical reasoning that delivers effective feedback intended for the stimulation of learning. For this, a multiplatform tool compatible with desktop and mobile devices was developed based on Ren'Py, which was distributed to fourth and fifth year students. Subsequently, a perception survey was applied to evaluate the reception of the tool. Among the points evaluated, it stands out to be a motivating way of reinforcing the studies, with delivery of pertinent information and ease of use. It also allows the recognition of weaknesses and is considered a contribution to training by the students. As a result of this implementation, it was possible to confirm the usefulness of the effective feedback delivered instantly within structured clinical cases, opening new possibilities to the range of tools available in higher education.

Simulation in physiotherapy students for clinical decisions during interaction with people with low back pain: randomised controlled trial.

BACKGROUND: Low back pain (LBP) is a condition with a high global prevalence, which is getting health professionals' attention, including physiotherapists as they must have the skills to provide treatment that increases the patient's quality of life. Clinical simulations could be a pedagogic strategy that facilitates adequate training for students to acquire skills to improve their professional reasoning in this clinical situation. OBJECTIVE: This study sought to determine the effects of clinical simulations with simulated patients (SP) on the physiotherapy students' clinical decision-making within a role-playing (RP) scenario while caring of LBP patients. METHODS: This experimental study included 42 participants from two Colombian universities, randomized into two groups (SP, n = 21; RP, n = 21). The clinical skill of performing the Objective Structured Clinical Examination (OSCE-LBP) was evaluated while students cared for patients with LBP; after that, a pedagogical method was conducted that included clinical simulation and, finally, the OSCE-LBP was applied again to compare both groups. RESULTS: Changes occurred in the OSCE-LBP among both groups of students: the scores increased (0.66 and 0.59 in RP and SP, respectively), and neither of the two was superior (p value 0.01; 95%CI - 0.21 to 0.23). CONCLUSION: Both types of simulation favor decision-making in professional reasoning in physiotherapy students during interactions with individuals with LBP. Trial registration https://clinicaltrials.gov/ct2/show/NCT04428892 Identifying number: NCT04428892. It was retrospectively registered.

Avaliação de competências individuais e interprofissionais de profissionais de saúde em atividades clínicas simuladas: scoping review / Assessment of individual and interprofessional skills of health professionals in simulated clinical activities: a scoping review / Evaluación de competencias individuales e interprofesionales de profesionales de salud en actividades clínicas simuladas: scoping review

Objetivo: identificar junto à literatura como tem sido realizada a avaliação de competências individuais e interprofissionais em atividades clínicas simuladas na formação e capacitação de profissionais da área de Saúde. Método: estudo realizado por meio de Scoping Review, conforme Joanna Briggs Institute. As buscas foram realizadas entre dezembro de 2015 a fevereiro de 2016 nas bases de dados eletrônicas estabelecidas, por intermédio dos descritores e sinônimos. Resultados: Foram analisados 20 estudos que atenderam aos critérios de inclusão estabelecidos; os itens avaliados com maior frequência em todas as categorias profissionais foram as habilidades procedimentais e de comunicação; os dhecklists foram os instrumentos mais frequentes para avaliar competências. Conclusão: o desenvolvimento e a avaliação de competências profissionais e interprofissionais em simulação clínica têm sido realizadod com o apoio de instrumentos e métodos variados, todavia, o conteúdo e utilização destes podem limitar e direcionar o processo avaliativo.(AU)

Objective: to identify in the literature how the assessment of individual and interprofessional skills in simulated clinical activities in the training and qualification of health professionals has been performed. Method: study conducted through a scoping review according to the Joanna Briggs Institute. The searches were conducted between December 2015 and February 2016 in the established electronic databases through descriptors and synonyms. Results: Twenty studies that were in line with the established inclusion criteria were analyzed; communication and procedural skills were the most frequently assessed items in all professional categories, and checklists were the most frequently used instruments to assess the skills. Conclusion: the development and assessment of professional and interprofessional skills in clinical simulation have been carried out with the support of different instruments and methods, however their content and use may limit and direct the assessment process.(AU)

Objetivo: identificar en la literatura cómo se ha realizado la evaluación de competencias individuales e interprofesionales en actividades clínicas simuladas en la formación y capacitación de profesionales del área de la salud. Método: estudio realizado por medio de Scoping Review, conforme el Joanna Briggs Institute. Las búsquedas se realizaron entre diciembre de 2015 y febrero de 2016 en las bases de datos electrónicas establecidas, por medio de los descriptores y sinónimos. Resultados: Se analizaron 20 estudios que atendieron los criterios de inclusión establecidos, los ítems evaluados con mayor frecuencia en todas las categorías profesionales fueron las habilidades procedimentales y de comunicación; las checklists fueron los instrumentos más frecuentes para evaluar competencias. Conclusión: el desarrollo y evaluación de competencias profesionales e interprofesionales en simulación clínica se han realizado con el apoyo de instrumentos y métodos variados; no obstante, el contenido y la utilización de los mismos pueden limitar y direccionar el proceso de evaluación.(AU)