introduction to clinical reasoning and year 2 communication skills general examination

1
Sunday, 16th January 2022
Week 1
Medicine
Introduction to clinical reasoning and year 2 communication skills general examination
Clinical reasoning
 Ability to sort through features presented by patients and assign a diagnostic label
with development of appropriate treatment as an end goal
 Experts recognise a characteristic sign or feature due to years of experience
o Why histories are important to help develop this knowledge
 What skills do you need?
o Communication skills
Year one communication skills
 Gathering information
o Open question
 Short summaries
 Reflections
 Long summaries
 Explore patient perspectives
Year one biomedical information
 Symptoms
o Cardiovascular
o Respiratory system
o Gastrointestinal
Clinical reasoning sessions
 Students struggling with these skills
 Clinical reasoning in medical education
 Increasingly recognised that you need to be taught to reason clinically
 block 9
o Symptom analysis
o Single sentence formulation
 Block 12
o Analysis of clinical reasoning process
o Deliberate practice of the clinical reasoning process
o Joining up the biomedical perspective
 More sessions for clinical reasoning in event of covid and online learning
Symptom’s analysis
 Want students to think of ways to discriminate between different causes
 How do you differentiate between causes?
o Heart attack
 Typically gives pain going into left arm
 Worse with exercise
o Acid reflux
 Worse when lying down
 Development of the abnormal
 Different conditions present at different ages
Single sentencer formulation – preparation for year 2 placements
 Many components
o Demographics

, 2
Sunday, 16th January 2022
Week 1
Medicine
o Pathophysiology
o Communication skills
o Hypothetico-deductive reasoning
o Surgical sieve
 Different disease processes
 Metabolic cause
 Infective cause
 Inflammatory cause
o Metacognitive awareness
 Novices who won’t necessarily notice patterns due to not having large amounts of
practice
 Can’t suddenly be an expert at driving and it is the same with clinical reasoning
o Need to break it down into different steps
o Why we have these sessions
 Breaks it down into different steps and skills
o Dangerous to look at someone and say this is what is wrong
 Learn more about gathering information with purpose
 Difficult news and patient distress also covered
Jargon
 Easy to use the jargon and technical terms but this is not easy for patients to
understand
 Important that this is remembered when communicating with patients
 Use appropriate information for the patient
Health literacy
 Cognitive and social skills to gain access to information to maintain good health
 Extends beyond the consultation
 Be careful not to make assumptions
 Communicate in a way patients can understand
Misconceptions and misunderstandings
 Familiar words in unfamiliar ways
 Unintentionally use unfamiliar words
o Sedentary
o Positive diagnosis
 Thinking they don’t when they do
 Supplement with leaflets and booklets and links to online resources
o Can be confusing for some patients
o Jargon
o Technical terms
o Level of language
Top tips
 Think about questions asking and why
 Think about terms being used and whether they will be understood
General physical examination
 Clinical grade PPE will still be worn
 Make sure you understand donning and doffing PPE.