Exploring medical students' use of principles of self-explanation and structured reflection during clerkship.

Background: While educators observe gaps in clerkship students' clinical reasoning (CR) skills, students report few opportunities to develop them. This study aims at exploring how students who used self-explanation (SE) and structured reflection (SR) for CR learning during preclinical training, applied these learning strategies during clerkship.

Methods: We conducted an explanatory sequential mixed-methods study involving medical students.

Pathways, journeys and experiences: Integrating curricular activities related to social accountability within an undergraduate medical curriculum.

Background: Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA.

Harnessing a knowledge translation framework to implement an undergraduate medical education intervention: A longitudinal study.

Introduction: Implementation of evidence-informed educational interventions (EEI) involves applying and adapting theoretical and scientific knowledge to a specific context. Knowledge translation (KT) approaches can both facilitate and structure the process. The purpose of this paper is to describe lessons learned from applying a KT approach to help implement an EEI for clinical reasoning in medical students.

Implementation of three knowledge-oriented instructional strategies to teach clinical reasoning: Self-explanation, a concept mapping exercise, and deliberate reflection: AMEE Guide No. 150.

The teaching of clinical reasoning is essential in medical education. This guide has been written to provide educators with practical advice on the design, development, and implementation of three knowledge-oriented instructional strategies for the teaching of clinical reasoning to medical students: Self-explanation (SE), a Clinical Reasoning Mapping Exercise (CREsME), and Deliberate Reflection (DR). We first synthesize the theoretical tenets that support the use of these strategies, including knowledge organization, and development of illness scripts.

Newly approved IV acetaminophen in Canada: Switching from oral to IV acetaminophen. Is IV worth the price difference? A systematic review.

Context: The use of intravenous acetaminophen leads to meaningful health cost increases for paediatric institutions. Therefore, strict criteria for intravenous acetaminophen administration are needed.

Objective: To undertake a systematic review of available evidence comparing oral versus intravenous acetaminophen use in children.

A layered analysis of self-explanation and structured reflection to support clinical reasoning in medical students.

Self-explanation and structured reflection have been studied independently with results suggesting that both learning interventions can effectively support medical students' clinical reasoning development. Given this evidence, medical schools may want/begin to implement these interventions in their curricula. Implementing educational interventions requires educators to maintain the core philosophy and principles of the interventions intact while adjusting implementation techniques to the specificities of individual learning contexts.

Comparison of Assessment by a Virtual Patient and by Clinician-Educators of Medical Students' History-Taking Skills: Exploratory Descriptive Study.

Background: A virtual patient (VP) can be a useful tool to foster the development of medical history-taking skills without the inherent constraints of the bedside setting. Although VPs hold the promise of contributing to the development of students' skills, documenting and assessing skills acquired through a VP is a challenge.

Objective: We propose a framework for the automated assessment of medical history taking within a VP software and then test this framework by comparing VP scores with the judgment of 10 clinician-educators (CEs).

Expectations, observations, and the cognitive processes that bind them: expert assessment of examinee performance.

Performance-based assessment (PBA) is a valued assessment approach in medical education, be it in a clerkship, residency, or practice context. Raters are intrinsic to PBA and the increased use of PBA has lead to an increased interest in rater cognition. Although several researchers have tackled factors that may influence the variability in rater judgment, the critical examination of rater observation of performance and the translation of that data into judgements are being investigated.

Self-explanation in learning clinical reasoning: the added value of examples and prompts.

Context: Recent studies suggest that self-explanation (SE) while diagnosing cases fosters the development of clinical reasoning in medical students; however, the conditions that optimise the impact of SE remain unknown. The example-based learning framework justifies an exploration of students' use of their own SEs combined with the study of examples. This study aimed to assess the impact on medical students' diagnostic performance of: (i) combining students' SEs with their listening to examples of residents' SEs, and (ii) the addition of prompts (specific questions) while working with examples.

Does medical students' diagnostic performance improve by observing examples of self-explanation provided by peers or experts?

Educational strategies that promote the development of clinical reasoning in students remain scarce. Generating self-explanations (SE) engages students in active learning and has shown to be an effective technique to improve clinical reasoning in clerks. Example-based learning has been shown to support the development of accurate knowledge representations.

The role of the assessor: exploring the clinical supervisor's skill set.

Background: Clinical supervisors have several different responsibilities. Although their responsibilities as an assessor are important, little is known about what skill set should be acquired for this role and how to foster their development. Documenting assessor skills to study their acquisition and development is critical.

Students' self-explanations while solving unfamiliar cases: the role of biomedical knowledge.

Objective: General guidelines for teaching clinical reasoning have received much attention, despite a paucity of instructional approaches with demonstrated effectiveness. As suggested in a recent experimental study, self-explanation while solving clinical cases may be an effective strategy to foster reasoning in clinical clerks dealing with less familiar cases. However, the mechanisms that mediate this benefit have not been specifically investigated.

Optometrists' clinical reasoning made explicit: a qualitative study.

Purpose: Because the clinical reasoning processes engaged in by practicing optometrists have not previous been investigated, until now, there has been no way of knowing whether models of clinical reasoning from other health professions can be transposed to optometry. The purpose of this study has therefore been twofold: making explicit the clinical reasoning processes of optometrists at both the "competent" and "expert" levels and comparing these processes to highlight the characteristics of clinical reasoning expertise.

Methods: Four competent-level optometrists and four expert-level optometrists participated in this qualitative study.

The influence of medical students' self-explanations on diagnostic performance.

Context: Skill in clinical reasoning is a highly valued attribute of doctors, but instructional approaches to foster medical students' clinical reasoning skills remain scarce. Self-explanation is an instructional procedure, the positive effects of which on learning have been demonstrated in a variety of domains, but which remain largely unexplored in medical education.

Objectives: The purpose of this study was to investigate the effects of self-explanation on students' learning of clinical reasoning during clerkships and to examine whether these effects are affected by topic familiarity.

Incipient neuroleptic malignant syndrome with quetiapine/paroxetine combination treatment: atypical presentation and early, successful rechallenge with olanzapine.

A 26-year-old caucasian male developed incipient neuroleptic malignant syndrome (NMS) during the course of paranoid schizophrenia with catatonic signs at admission, while on quetiapine/paroxetine combination treatment. The clinical presentation was "atypical", but increased creatine kinase levels and positive myoglobinemia were highly suggestive of the diagnosis. Of note, the patient was successfully rechallenged with olanzapine.