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Simulation as a tool for the development of clinical reasoning

Author: 
Dr. José Arturo Vázquez Vázquez
Subject Area: 
Health Sciences
Abstract: 

The Flexner Report "Medical Education in the United States and Canada" is the publication on medical education among the proponents and detractors of this pedagogical proposal. This model has disadvantages within which the scientific approach is noted away from the integral vision of the human being. Clinical reasoning is the centerpiece of medical practice and is an undefined construct and that formal programs of medical schools do not include. It is extremely difficult to teach students to replicate the expert's reasoning, if they do not yet have their own experience, or with structured knowledge. This experience is only acquired by comparatively relating a clinical problem, with similar situations seen above. In medical education, the simulation focuses on placing the student in a context that mimics clinical reality and is defined as a technique that replaces or expands a real experience through a guided experience, replicating real-world aspects in a way interactive- At the undergraduate boarding school, a trained physician is expected to develop and competencies related to health problem care. The objective of this work is to evaluate the development of Clinical Reasoning in Undergraduate Internal Physicians, taking into account the use of clinical simulation within the different curricula. Material and Methods: A prospective multicenter experimental study was conducted, with under graduate in-house physicians, (MIP) students from four medical schools. Curriculums were analyzed, taking into account whether or not they included clinical simulation scenarios as a teaching tool. Sand formed two groups, MIP that were taught with simulation scenarios and had no teaching with simulation scenarios. They were evaluated in a real clinical scenario during the preparation of the medical history of a randomly selected patient in the General Surgery service. Results: 24 (100%) MIPgroup I evaluated with clinical simulation in their curriculum we obtained the following results: Regarding the Interrogation aimed at obtaining important data for the current condition 20 (83.3%), they obtained excellent score, 3 (12.5%) they scored well, 1 (4.2%), scored regularly, and 0 scored poorly. As for obtaining data for the integration of diagnosis, 21(87.5%) they scored excellent 1 (4.2%) got well score 0 got regular score and 2 (8.3) got poor score. Speaking of physical data collection, the result was: 20 (83%) with a score of excellent, 3 (12.5%) with a good score, 1 (4.2%) with a regular score and 0 with poor score. For diagnostic supplementation studies it refers to 21 (87.5%) scored excellent 1 (4.2%) scored well 1 (4.2%) scored regular and 1 (4.2%) got poor score. In treatment evaluation 23 (95.8%) got an excellent score of 0 had good score, 1 (4.2%) had a regular score, 0 got poor score. The 27 (100%) MIP group II without clinical simulation in its curriculum, the results were as follows: Regarding the Interrogation aimed at obtaining important data for the suffering actat, 3 (11.2%) got an excellent score, 5 (18.5%) scored well, 19 (70.3%) they got a regular rating, 0 got poor grade. As for obtaining data for the integration of diagnosis, 7 (26%) got an excellent score, 5 (18.5%) scored well, 9 (33.3%) scored regular, 6 (22.2%), scored poorly. Speaking of physical data collection, the result was: 4 (14.8%) with a score of excellent, 4 (14.8%) with a good score, 7 (26%), with a regular score and 12 (44.4%), with a poor score. As for diagnostic supplementation studies refersto ,4 (14.8%) scored 6 (22.2%) got a goodscore, 9 (33.3%) obtained a regulatory scoreof8 (29.7%) got poor score. In treatment evaluation 3 (11.1%) scored at 3 (11.1%) had a good score, 11 (40.7%), had a regular score, 10 (37%) got poor score. Conclusions: The fundamental axis of medical training is clinical reasoning; in the student and in the doctor his learning represents a challenge, since traditionally education medicine has been based on the memorization of contents. The antecedent of a curriculum that includes clinical simulation scenarios favors the development of non-technical skills within which clinical reasoning stands out. Internal physicians who were trained under an academic program with clinical simulation not only develop specific clinical medical skills and abilities, but also the application and development of clinical reasoning, during the stage of building the medical history.

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