QHPE 601 Experiential Learning Methods

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.

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.