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Title: Diagnostic reasoning in medical students using a simulated environment
Author: Scott-Smith, Wesley
Awarding Body: University of Brighton
Current Institution: University of Brighton
Date of Award: 2013
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Diagnostic ability occupies a pre-eminent position in the skills of a doctor in modern society. Underpinning this attribute is a number of cognitive strategies which are gradually developed through a mixture of experience, acquired knowledge and training. These strategies include processing and structuring information, decision making, and the emergence of higher cognitive skills. The apprenticeship model in medicine assumes that students assimilate such skills during training, without ever questioning how they view or engage with the diagnostic role. The conceptual focus of this study is to use dimensional analysis (DA) to build theory from the perspective or ‘lens of the medical student’. This will use symbolic interactionism as its theoretical framework. DA acknowledges the relationship between the researcher‘s perspective and experience, the data and the participants using a constructivist, relativist epistemological philosophy. Filmed data has been analysed from real time simulated consultations between 3rd year medical students and a trained actor working from a standardised case (dyspepsia). Each participant completed a filmed consultation and a discussion of diagnostic ideas based upon the history alone. Diagnoses were re-evaluated in light of further examination data and the filming watched back with the researcher using a reflexive discussion approach. Nine participants completed the study providing a rich diet of interactive and reflective data from the simulations focussing upon diagnostic ideas. Emergent themes point to the central organising theory of intermediary cognitive adaptation during an important transition in the curriculum. This is characterised by the use of learnt cognitive strategies which act as failsafe mechanisms in maintaining process within the simulation. However, there are examples of naive cognition in applying aspects of conditional reasoning and interpreting clinical probability rules. The diagnostic process is driven by the clinical history with little integration of the physical examination features. This finding may explain the emergence of cognitive errors during undergraduate training, and links normative theory with diagnostic errors seen in clinical practice. Reconstruction of clinical skills and diagnostic thought through reflective analysis are evident. Under the right conditions, simulations can provoke a constructive (intrinsic) perspective on cognitive skills which can advance professional development in the diagnostic reasoning process.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: X000 Education