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Biomedical subjects

H S Barrows

Publications and source records attributed to H S Barrows.

At least 37 records · Page 2Linked to original sources
PubMed1987

The clinical reasoning process.

Medical school teachers must have an accurate idea of the doctor's clinical reasoning process (CRP) in order to provide students with learning experiences and evaluations that will ensure their acquisition of an effective and efficient CRP. It is difficult to derive this understanding from much that has been written on the subject. It is important to recognize that clinical problems are ill-structured and that the doctor's reasoning is built around a temporal unfolding of information. A model for the CRP is described along with a critique of other models that have been suggested. The results of research that examines components of the process must be seen in relation to the overall process.

Clinical Competence↗
PubMed1987

Direct, standardized assessment of clinical competence.

Doctor ratings of clerkship performance are often discounted as not accurately reflecting clinical competence. Such ratings are influenced by the following uncontrolled variables: case difficulty; differing rater focus and standards; lack of agreement on what constitutes acceptable performance; and collective patient care responsibility masks individual contributions. Standardized direct measures of clinical competence were developed to control these factors and allow direct comparisons of student performance. Students saw 18 patients representing frequently occurring and important patient problems. Student actions and decisions were recorded and subsequent responses to questions revealed knowledge of pathophysiology, basis for actions, use and interpretation of laboratory investigations, and management. Actions and responses were graded using a pre-set key. The examination covered 73% of designated clinical competencies. Examinations scores corresponded with independent measures of clinical competence. Reliability studies indicated that new cases can be substituted in subsequent years with confidence that scores will maintain similar meaning. Costs are +6.95 per student per case, which is modest considering the quality and quantity of information acquired. Methods described are practical for evaluation of clerks and residents and for licensing and specialty certification examinations.

Clinical Clerkship↗
PubMed1986

A taxonomy of problem-based learning methods.

The increasingly popular term 'problem-based learning' does not refer to a specific educational method. It can have many different meanings depending on the design of the educational method employed and the skills of the teacher. The many variables possible can produce wide variations in quality and in the educational objectives that can be achieved. A taxonomy is proposed to facilitate an awareness of these differences and to help teachers choose a problem-based learning method most appropriate for their students.

Education, Medical↗
PubMed1983

Problem-based, self-directed learning.

There is an increasing concern that the curricula of many medical schools put too heavy an emphasis on memorization of facts and little stress on problem solving or self-directed study skills necessary for the practice of medicine. Problem-based, self-directed learning is a teaching-learning method specifically designed to emphasize these skills and to increase the retention of facts and their recall in the clinical situation. This approach, built on research into the problem-solving skills of physicians and principles of educational psychology, is employed by several medical schools and serves as an antidote to the many educational abuses seen in more traditional approaches.

Clinical Competence↗
PubMed1982

The clinical reasoning of randomly selected physicians in general medical practice.

Most formal studies of the clinical reasoning process have been carried out on physicians in the sub-specialties and do not permit generalizations about the nature of the process in the average practising physician. Eighteen family physicians and 19 general internists were randomly selected and assigned to 1 of 4 standardized simulated patient problems in a natural practice setting. Sixty-two physician-patient encounters were studied by direct observation, videotape recall, and subsequent analysis of encounter transcripts by the physician. Physicians consistently developed multiple diagnostic hypotheses early in the patient encounter to guide their inquiry in a manner that would allow them to choose the appropriate hypothesis. Their approach was primarily problem-oriented and was not based on a routine inquiry intended to gather a comprehensive body of data as a basis for making subsequent diagnostic decisions. Little variation occurred between different patient problems. The accuracy and promptness of hypothesis generation were seen to play a significant role in the accuracy of diagnostic formulations. The process must be understood by those concerned with teaching and evaluating clinical competence.

Adult↗
PubMed1981

Clinical problem-solving by medical students: a cross-sectional and longitudinal analysis.

The evolution of clinical reasoning in medical students was studied. A cross-sectional sample consisted of randomly-selected medical students from three classes. Additionally, twenty-two students were observed at yearly intervals from the preclerkship period to the first post-graduate year. Subjects were observed in a clinical examination of a simulated patient, and their thought processes were abstracted from a 'stimulated recall' of the videotaped encounter. The data were transcribed and coded for computer analysis, yielding several variables characterizing the clinical reasoning process, and four measures of outcome of the encounter. Analysis of variance of differences between students at various educational levels and a doctor criterion group indicated that the majority of the process variables were unrelated to educational level. By contrast, diagnostic and management outcomes were positively related to education. The single process variable which was related to both educational level and outcome was an 'hypothesis aggregate score', a measure of the content of the student's diagnostic hypotheses. The results of the study indicate that the problem-solving or clinical reasoning process remains relatively constant from medical school entry to practice. This observation has important implications for clinical teaching and evaluation.

Cross-Sectional Studies↗
PubMed1980

Bedside clinics in neurology. An alternate format for the one-day course in continuing medical education.

Five one-day workshops entitled "Bedside Clinics in Neurology" were conducted and evaluated at the annual American Medical Association conventions during the past four years. A problem-based, student-centered, small-group approach using simulated patient problems was used as a means of avoiding the educational assumptions made by the more conventional teacher-centered lecture-discussion format. The response by participants in an immediate evaluation and six-month follow-up of the last two workshops indicated that (1) this format was stimulating, (2) the workshop would be attended again if conducted in a different topic, (3) the participants would pay a mean cost of $70, and (4) the workshop provided practical and relevant information for their day-to-day practice situation. Further evaluation to assess the educational effectiveness of this format is being planned.

American Medical Association↗
PubMed1980

An initial evaluation of learning units to facilitate problem solving and self-directed study (portable patient problem pack).

This paper describes the initial evaluation of the portable patient problem pack, a learning unit designed to facilitate the development of problem-solving skills and stimulate self study. A cross-over design using two neurological patient problems, each presented in two formats (simulated patient and P4), was used with a sample of twenty-nine volunteer nursing and medical students. The results indicate that the P4 appears to be feasible and effective in stimulating problem solving and self-directed study. The suggested concurrent validity, low cost of production, and implementation make it a potentially potent tool for evaluation.

Education, Medical, Undergraduate↗