QHPE 601 Experiential Learning Methods

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Questions and Answers

What is the primary purpose of scripts in clinical reasoning?

To eliminate the need for prior knowledge in decision making

To activate automatic decision-making in every case

To guide memory retrieval and integrate new information (correct)

To provide a rigid algorithm for clinical decisions

Which component is NOT part of the One-Minute Preceptor approach?

Encourage memorization of scripts (correct)

Push the student's comfort zone

Establish level of competence

Focus on a single learning point

How do scripts differ from algorithms in clinical reasoning?

Scripts focus solely on memorization, unlike algorithms

Scripts are used for automatic decision-making while algorithms are not

Scripts provide high-level, conceptual frameworks whereas algorithms are linear (correct)

Scripts are always more flexible than algorithms

What can be a negative consequence of relying on automatic decision-making in clinical practice?

Complacency and resistance to change Signup and view all the answers

What aspect of teaching to develop S1 scripts is emphasized in the content?

Focusing on high-level conceptual knowledge structures Signup and view all the answers

What is the role of 'slots' in a script template?

To organize components that can be filled with relevant information Signup and view all the answers

Which teaching method encourages students to examine their level of competence?

One-Minute Preceptor Signup and view all the answers

What is a decreased ability associated with the threat of expertise?

Automatic decision making leading to complacency Signup and view all the answers

What is essential for developing clinical reasoning according to the described teaching methods?

Integrating both scripts and analytical thinking Signup and view all the answers

Which of the following statements about scripts is true?

Scripts provide a structured way of applying conceptual knowledge Signup and view all the answers

What is the primary purpose of asking non-accusatory 'why' questions during clinical teaching?

To probe for supporting evidence Signup and view all the answers

Which of the following benefits is NOT associated with the One-Minute Preceptor (OMP) model?

Less effective feedback mechanisms Signup and view all the answers

Based on the evidence presented, how does SNAPPS compare to usual teaching methods?

Increases self-regulated learning activities Signup and view all the answers

What approach does SNAPPS primarily use to foster learner engagement?

Focusing on differential diagnosis and justification Signup and view all the answers

What element is emphasized in the SNAPPS model to enhance clinical reasoning?

Encouraging asking questions and expressing uncertainties Signup and view all the answers

In a study comparing SNAPPS and One-Minute Preceptor, which metric revealed the superiority of SNAPPS?

Reasoning questions and uncertainties Signup and view all the answers

What is an important characteristic of the feedback provided in effective clinical teaching?

Feedback needs to be timely and objective Signup and view all the answers

What outcome was observed in students using SNAPPS compared to their less structured peers?

Increased number of differential diagnoses Signup and view all the answers

Which of the following is a key feature of positive reinforcement in clinical teaching?

Acknowledging skills done well Signup and view all the answers

What is a significant finding from the systematic review on SNAPPS regarding diagnostic reasoning?

Improved diagnostic reasoning skills Signup and view all the answers

Study Notes

Experiential Learning Teaching Methods

Course: QHPE 601
Subject: Evidence-based Teaching and Learning
Course instructors (alphabetical order): Dr Ahsan Sethi, Dr Daniel Rainkie

Learning Objectives

Students will be able to describe approaches to teaching in workplaces.
Students will understand script formation (setting of clinical reasoning).
Students will understand the One-Minute Preceptor method.
Students will understand the SNAPPS method.

Scripts

Illness scripts and Management scripts
Scripts are frameworks for chunking information and thinking through problems.
Scripts are conceptual knowledge structures, not algorithms.
Scripts are activated by specific problems, such as diagnosis or presenting signs and symptoms.
Scripts provide structured knowledge for understanding actions.
They enable individuals to combine new information with existing knowledge and guide memory recall.
They help predict future events and guide actions.
They explain why actions occurred or might occur.

Clinical Reasoning

Diagnostic Reasoning: Problem-solving using illness scripts; low risk involved.
Management Reasoning: Diagnostic decision-making based on scripts, pretest, and post-test probability, likelihood ratios and thresholds. Risk involved.
- Therapeutic management reasoning involves treatment decision-making.

Example of Script Development

Diagnosis: Pneumonia
Likely management script: Chest x-ray, computed tomography of chest, complete blood count, procalcitonin, sputum culture, urine legionella and pneumococcal antigen, respiratory virus panel, antibiotics (broad/narrow), antipyretics, oxygen, pulse oximetry, pulmonology consult, infectious disease consult
Time: Community acquired pneumonia, pneumococcal pneumonia
Includes procedures like Chest x-ray, complete blood count, procalcitonin, sputum culture, urine pneumococcal antigen, etc.

Example Script Template

Components and descriptions are structured using "slots" to be filled in with information:
- Laboratory studies: Biological samples for patient information
- Imaging studies: Radiological views of internal structures
- Procedures: Medical or surgical interventions
- Specialists/consultants: Healthcare professionals for expert medical opinions
- Medications: Substances, chemicals, or drugs to treat health problems
- Monitoring: Patient physiologic parameters evaluation

Example of Comparison of Management Scripts

Different approaches between junior and senior clinicians for Acute Kidney Injury (AKI).
Junior clinician includes tasks like Nephrology consultation, CT abdomen, Urinalysis, IV fluids, Basic metabolic panel, CT abdomen (with or without contrast), Renal ultrasound, Basic metabolic panel, Serum calcium, magnesium, phosphorus, Cystatin C, etc.
Senior clinician includes tasks like Renal biopsy, Dialysis, Foley catheter, Pre-renal: IV fluids (normal saline, Ringer's lactate), Interstitial nephritis: corticosteroids, Glomerulonephritis: immunosuppressants, Strict intake and output, Daily weights, Bladder scans, Avoiding nephrotoxic agents.

Teaching to Develop S1 (scripts) and S2 (analytical)

Real-life problem solving combines System 1 and System 2 processing.
System 1 relies on repetitive practice, immediate feedback, and how-to instructions.
System 2 relies on variability in practice, knowledge elaboration, and feedback-by-reflection.
System 1 development is slower than System 2.

Threats of Expertise and Mastery

Automatic decision-making leads to complacency and resistance to change.

One-Minute Preceptor

A five micro-skill approach to guide preceptor-student interactions with learning focus.
Focus on a single learning point.
Encourage critical thinking and clinical reasoning.
Establish learner's competence and prompt the comfort zone.
Probe for supporting evidence (e.g., ask "why").
Reinforce what is done well
Give guidance and feedback about errors or omissions.
Teach a general principle and share experiences.

One-Minute Preceptor Evidence

Studies show effectiveness in multiple contexts, various experience levels and different healthcare professions.
Using OMP model is preferred over standard care for teaching,
Assess and develop student clinical reasoning,
Provide effective feedback.

SNAPPS: A Six Step Learner-Centered Approach

Concisely summarizes the history and findings of the case
Narrow down to two or three relevant diagnosis possibilities
Analyzes the list of differential possibilities as well as comparing and highlighting the confusions
Probing the preceptor for doubts or alternative solutions to current approaches
Plan the management or next action steps for the patient
Select a case-related issue for self-directed learning.

SNAPPS Evidence

Results in an increased number of differential diagnoses and justifications; encourages self-regulation in learning.
It improves clinical reasoning, including increased number of differential diagnoses and supporting them.

SNAPPS vs One-Minute Preceptor

Randomized, single-centered, parallel, active-controlled study.
Outcome analysis of SNAPPS and One-Minute Preceptor method.
SNAPPS provided better expression of clinical reasoning and presented justification for diagnosis compared.

Summary

Script formation fosters System 1 thinking; feedback, reflection, and variability in case presentations build System 2 thinking.
One-minute preceptor and SNAPPS are powerful teaching frameworks.
Evidence suggests SNAPPS may be superior in developing clinical reasoning.

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Description

This quiz focuses on experiential learning teaching methods as covered in QHPE 601, emphasizing evidence-based practices in workplace education. Students will explore different teaching approaches, including the One-Minute Preceptor method and SNAPPS, while learning about the importance of illness and management scripts in clinical reasoning.