Clinical Reasoning Using Technology

Project Overview

Clinical reasoning is a preeminent focus of all health science graduate education. As we educate these young clinicians, it is imperative that they not only learn essential content for presenting conditions but can clinically reason to determine and appropriately manage the likely injury or illness. Clinical reasoning involves practitioners linking their existing content knowledge with the information obtained from the patient encounter. As this new information is obtained, the clinician utilizes high-level thinking and self-reflection to make individualized patient centered care decisions. Failure to effectively clinically reason is a major cause of medical errors, delayed diagnoses, and unnecessary diagnostic testing.

Case scenarios and outlining distinguishing injury characteristics are nothing new to athletic training evaluation courses, these are part of any Graduate Athletic Training Program. While these activities aren’t new, my goal was to reformat these with the use of technology to improve in-class student engagement and potentially their clinical reasoning. I dedicated these activities to both of my Orthopedic and Neurological Assessment courses.

Planning Process

Traditionally, I performed these activities with students by either simply talking through case scenarios or having them collaboratively write on the whiteboard. As we went through the summer workshop, these introduced tech tools spurred my thoughts toward improving my course delivery and hopefully overall student learning. EdPuzzle was a simple selection. Rather than simply reviewing presenting cases to the class, I had the chance to carefully create and record new ones. The ability to add word prompts in the video gave the students a natural pause to discuss their thoughts and reasoning to their diagnoses selections. Compared to traditional whiteboard work, the collaborative and anonymous nature of Padlet added more engagement. Rather than the dominant personalities solely contributing by writing on the board, all students had the chance to assist in creating these living study guides.

Implementation

Several video narrated clinical case scenarios were created in EdPuzzle for an in-class activity. As a group, students were presented with a patient case with me narrating the history followed by the rest of the evaluation portions, observations, palpations, range of motion, strength testing and applicable special tests. At the conclusion of each section, the video stopped to prompt a group discussion. The discussion centered around creating a differential diagnosis list with the most likely injuries. As the case progressed through each section, the group returned to their differential list to determine potential changes based on newly provided information. By ranking and prioritizing the most likely diagnosis, the students began to clinically reason in a collaborative, safe environment. For any students deficient, they had the ability to follow others’ reasoning.

As an in-class review activity, Padlets were created for each covered body area. Each pathology for the selected areas were listed with prompts for students to add the mechanisms of injury, signs and symptoms and applicable orthopedic special tests. Once this in-class activity was completed, I reviewed similarities and differences between the presented pathologies to the entire class. After the class, students had access to the Padlets for a study tool.

Assessment

These activities were informally assessed by the students following each case presentation and Padlet review. After tool utilization, students were asked to vote on their usefulness and whether to continue receiving different cases and Padlets. Consistently, they wished to continue both. Overall, they liked the ability of both activities to relate content knowledge to real-world applications. 

Reflections and Next Steps

Overall, the implementation of these activities met my expectations for improving engagement and beginning the process of assisting these students in developing clinical reasoning. Their feedback was overwhelmingly positive and receptive to utilizing the new tech tools. The only minor challenges were related to my own inexperience with the tech tools and time to construct the cases. As the semester progressed, both minor challenges began to dissipate.

   My next steps involve expanding the use of Edpuzzle for case scenarios. As my own narrated library increases, I want to have the students create their own scenarios for an assignment. Also, I hope to have their field preceptors create video cases to reflect on their own clinical experiences. Padlets will absolutely stay as part of both orthopedic evaluation courses. The class will work collaboratively to build each document. Access will remain open to all students for review.