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REVIEW ARTICLE
Year : 2021  |  Volume : 48  |  Issue : 1  |  Page : 10-12

Training medical students to develop the skills for establishing clinical diagnosis


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet, Tamil Nadu, India

Date of Submission21-Dec-2020
Date of Acceptance07-Mar-2021
Date of Web Publication5-May-2021

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_123_20

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  Abstract 


In the field of medicine, it is extremely important to establish a correct and timely diagnosis to ensure delivery of appropriate quality assured care, maintain patient safety, and minimize hospital-induced errors. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 6 articles were selected based on the suitability with the current review objectives and analyzed. There are no doubts that the process of making a precise clinical diagnosis is a complex one and is error prone. Amid these facts, it is a real challenge for the medical teachers to teach and train the medical students with an aim to accomplish the core competency of reaching a correct clinical diagnosis in authentic settings. One of the approaches adopted by the teachers is to provide learning opportunities to the students so that they can develop critical thinking and clinical reasoning skills. In conclusion, medical teachers have to adopt a systematic approach for teaching students the skill of establishing a clinical diagnosis in authentic settings. It is essential that the training should start from the early years and should be implemented in such a way that students get a number of learning opportunities in real settings to be more useful.

Keywords: Clinical diagnosis, feedback, medical students


How to cite this article:
Shrivastava SR, Shrivastava PS. Training medical students to develop the skills for establishing clinical diagnosis. J Sci Soc 2021;48:10-2

How to cite this URL:
Shrivastava SR, Shrivastava PS. Training medical students to develop the skills for establishing clinical diagnosis. J Sci Soc [serial online] 2021 [cited 2021 Jul 29];48:10-2. Available from: https://www.jscisociety.com/text.asp?2021/48/1/10/315448




  Introduction Top


In the field of medicine, it is extremely important to establish a correct and timely diagnosis to ensure delivery of appropriate quality assured care, maintain patient safety, and minimize hospital-induced errors.[1] In general, a medical student or doctor can arrive at the diagnosis by combining the elicited history, findings of the physical examination, and assessment of the laboratory or radiological investigations.[1] There are no doubts that the process of making a precise clinical diagnosis is a complex one, and a wide range of factors (namely history taking skills, physical examination findings, time available for the doctor to reach a diagnosis, and expectations of the patient) together determine the same.[1],[2]


  Methods Top


An extensive search of all materials related to the topic was carried out in the PubMed search engine. Relevant research articles focusing on establishing clinical diagnosis in medical education published in the period 2009–2020 were included in the review. A total of 9 studies similar to current study objectives were identified initially, of which two were excluded due to the unavailability of the complete version of the articles and one because of availability in the Russian language. Overall, six articles were selected based on the suitability with the current review objectives and analyzed. Keywords used in the search include clinical diagnosis and medical education. The collected information is presented under the following subheadings, namely Student engagement in online teaching, Challenges in reaching clinical diagnosis, Training medical students for clinical diagnosis, Strengthening analytical skills, Other teaching methods, Implications for practice, and Implications for research.


  Challenges in Reaching Clinical Diagnosis Top


Moreover, many diseases or conditions might present in an atypical manner or change their clinical presentations with the passage of time, and thus, it becomes the responsibility of the treating doctor to revise the diagnosis based on the recent findings or reports of the investigation.[1],[2] At the same time, we cannot ignore the fact that a patient suffering from multiple other comorbidities or who is consuming medications for various illnesses poses a bigger challenge to the health professionals. Acknowledging the presence of all these factors, it is not an unreal finding that the method for arriving at a clinical diagnosis is error prone regardless of the level of health care.[1]


  Training Medical Students for Clinical Diagnosis Top


Amid these alarming facts, it is a real challenge for medical teachers to teach and train medical students with an aim to accomplish the core competency of reaching a correct clinical diagnosis in authentic settings.[2] The move to shift from a traditional curriculum to a competency-based curriculum for undergraduate students is a welcome step and gives the teacher an opportunity to train and assess students in authentic clinical settings through the use of workplace-based assessment tools. These tools have a definite scope to help the medical students to develop problem-solving skills and at the same time give due attention to the overall clinical judgment, communication skills, professionalism, and other essential attributes.


  Strengthening Analytical Skills Top


One of the approaches adopted by the teachers is to provide learning opportunities to the students so that they can develop critical thinking and clinical reasoning skills.[3] This has been accomplished by the use of problem-based learning or case-based learning or use of simulations, starting right from the initial years of training by promoting early clinical exposure.[4] This approach is based on the premise that there is a link between the history, clinical presentation, and diagnosis of a patient and this aspect only needs to be explored further for imparting clinical diagnostic skills.[3],[4] However, we cannot ignore the possibility that most of such teaching happens in a fictitious setting and does not give adequate complexity, which is expected in real hospital scenarios.[2],[3],[4]


  Other Teaching Methods Top


Some of the clinicians also prefer the student to use concept mapping, wherein all the potential predisposing factors or positive factors related to the patients are enlisted in the form of a graphical diagram and then an attempt is taken to arrive at a clinical diagnosis.[2],[5] In fact, in the initial years of clinical exposure, teachers often encourage for the use of mnemonics to ensure that any potential differential diagnosis is not undermined. At the same time, the emphasis has also been given toward the acquisition of nonanalytic skills (like though the findings of investigation are normal, but the patient is not well and we have to think what we are missing).[2],[6] The possession of nonanalytical skills by a medical student helps them to make a clinical diagnosis when limited information is available about the patient or the patient's clinical status keeps changing every day. In addition, the teacher has to give a specific feedback to the students about their performance and encourage reflection to ensure that the learning becomes deep in nature.[3],[4],[6]


  Implications for Practice Top


It is the need of the hour to plan and implement those kinds of teaching–learning methods that facilitate the process of making the right clinical diagnosis. This essentially includes the promotion of critical thinking, clinical reasoning, and decision-making skills. Moreover, the medical students have to be exposed to the patient-centered clinical care to further augment the process. At Shri Sathya Sai Medical College and Research Institute, a constituent unit of Sri Balaji Vidyapeeth, Deemed-to-be University, Puducherry, the Medical Education Unit has been organizing a series of workshops on evidence-based medicine and has played an important role in improving the diagnostic skills of the students.


  Implications for Research Top


Medical education researchers can employ different teaching–learning methods (problem-based learning, case-based learning, team-based learning, etc.) for improving the clinical diagnosis skills. The effectiveness of these methods in improving the clinical diagnostic skills can be analyzed by carrying out appropriate research projects. Subsequently, these methods can be evaluated to assess their effectiveness in improving the clinical diagnostic skills.


  Conclusion Top


Medical teachers have to adopt a systematic approach for teaching students the skill of establishing a clinical diagnosis in authentic settings. It is essential that the training should start from the early years and should be implemented in such a way that students get a number of learning opportunities in real settings to be more useful.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Newman-Toker DE, Pronovost PJ. Diagnostic errors – The next frontier for patient safety. JAMA 2009;301:1060-2.  Back to cited text no. 1
    
2.
Patel R, Sandars J, Carr S. Clinical diagnostic decision-making in real life contexts: A trans-theoretical approach for teaching: AMEE Guide No. 95. Med Teach 2015;37:211-27.  Back to cited text no. 2
    
3.
Pinnock R, Anakin M, Jouart M. Clinical reasoning as a threshold skill. Med Teach 2019;41:683-9.  Back to cited text no. 3
    
4.
Yousefichaijan P, Jafari F, Kahbazi M, Rafiei M, Pakniyat A. The effect of short-term workshop on improving clinical reasoning skill of medical students. Med J Islam Repub Iran 2016;30:396.  Back to cited text no. 4
    
5.
Tokuda Y. Programs for continuing medical education 2016: A session: 9. Clinical diagnosis based on physical examination. Nihon Naika Gakkai Zasshi 2017;106:505-9.  Back to cited text no. 5
    
6.
Russell SW, Desai SV, O'Rourke P, Ahuja N, Patel A, Myers CG, et al. The genealogy of teaching clinical reasoning and diagnostic skill: The GEL study. Diagnosis (Berl) 2020;7:197-203.  Back to cited text no. 6
    




 

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