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Biomedical subjects

V L Patel

Publications and source records attributed to V L Patel.

At least 73 records · Page 4Linked to original sources
PubMed1986

Differences between medical students and doctors in memory for clinical cases.

Many studies dealing with differences between students' and doctors' memory for clinical cases have yielded puzzling results. In this paper it is claimed that these are due to the use of inadequate techniques for isolating chunks inherent in the stimuli and the data. The purpose of this paper is to investigate whether the techniques of propositional analysis yield a clearer picture. Using this technique, the analysis of two sets of data is presented. The results show a clear difference between doctors and students when relevant clinical information is isolated from irrelevant information. This supports the notion that the process involved in the memory for clinical cases is far more complex and involves the ability to make inferences from a highly developed knowledge base.

Clinical Competence↗
PubMed1985

The clinical learning environments in medicine, paediatrics and surgery clerkships.

Using questionnaires, the students of the 1981 graduating class from McGill's Faculty of Medicine were investigated for their perceptions of the nature of the clinical instruction and of the roles of the consultant, resident and intern staffs during clerkships in medicine, paediatrics and surgery. Personal student diaries were used to assess time spent on various clinical activities. The results indicated that students perceived learning to be different in the three disciplines, with the acquisition of clinical skills (technical and problem-solving skills) greater in medicine and surgery than in paediatrics, and the acquisition of interpersonal skills and factual knowledge greater in paediatrics than in medicine and surgery. Students perceived themselves as passive observers in surgery and formed personal relationships more easily with staff in medicine and paediatrics than in surgery. In contrast, students perceived more emphasis on team effort in surgery. Time spent on activities related to direct patient encounter was greatest in medicine. The findings suggest that the learning environments in clinical disciplines are not homogeneous and this has implications for curricular planning and clinical teaching.

Clinical Clerkship↗
PubMed1985

Medical problem-solving: some questionable assumptions.

This paper questions the idea that expert doctors use the hypothetico-deductive method when developing diagnoses of routine clinical cases. Up to now, this has not been justified by empirical evidence but by two indirect arguments. The first is that it is the standard procedure of scientific method. The second is that it is supported by research in cognitive psychology comparing the problem-solving behaviour of experts and novices. It is argued in this paper that both areas have been misinterpreted. In particular, the evidence from research in cognitive psychology on expert-novice comparisons indicates that the use of the hypothetico-deductive method is a characteristic of novices rather than experts. Experts use what are called strong methods, which are dependent on a highly elaborated and structured knowledge base. It is concluded that a considerable amount of research on the nature of such strong methods in expert clinical reasoning is needed before any confident claims can be made regarding the use of the hypothetico-deductive or any other method.

Cognition↗
PubMed1984

Return to basic sciences after clinical experience in undergraduate medical training.

As part of the restructured undergraduate medical curriculum at McGill Medical School, a return to basic sciences was introduced in the students' final year. This follows the completion of the formal portion of their undergraduate clinical education. This paper describes this unique return to the basic science programme including the rationale behind the change and the effects of this programme on student learning, and student attitudes towards the programme. Final-year medical students in 1978 and 1981 were tested on educational and attitudinal variables. Data were collected using achievement tests, questionnaires and interviews. The findings of the study indicated that the major objectives of the programme, which were to facilitate student learning in greater depth and to integrate basic sciences with clinical knowledge, were achieved. The programme was enthusiastically received by the students in 1978 and also in 1981, indicating the outcome of the return to the basic science programme to be more than a 'Hawthorne effect' as suspected in 1978. The concept of a return to basic science is recommended for consideration by medical faculties.

Anatomy↗
PubMed1983

Transfer of student learning in medical education.

Transfer of learning among the cognitive, psychomotor, and affective domains and among three clinical disciplines--medicine, pediatrics, and surgery--was examined in the final year of a medical student clerkship program. Rather than following the traditional psychological approach, the authors used a model based on ethnographic analysis followed by performance measurement. The general assumption that what students learn in one subject area is transferred to another area was questioned. A total of 120 medical students were assessed in knowledge, skills, and attitudes prior to and after three clinical rotations. The results indicated that learning was discipline-specific as well as specific to the learning domain studied. Therefore, no generalizations can be made from the study of one subject area or one specific aspect of student learning to another. The use of an alternative methodology to study complex behavior rather than the traditional paradigm is suggested.

Clinical Clerkship↗
PubMed1983

Early career choice: an unsuccessful program.

During the 1960s, early educational specialization and increasingly elective curricula were promoted as instructional advances. More recently, early educational specialization has been suggested as a solution to high educational costs and knowledge overload. In 1973 the McGill University Faculty of Medicine introduced a program of early specialization ("streaming") in the senior clerkship. The streams were: medicine, surgery, psychiatry, and family medicine. The streams emphasized their own clinical areas but not to the exclusion of other subjects. After three years, streaming was disbanded as students chose the medicine stream with increasing frequency. Streaming may have contributed to poorer class performance on licensing examinations. Responses of the students to questionnaires revealed that streaming did not lead to an early career choice and that the students did not use electives to fill in perceived gaps. The students often chose streams independent of career plans. Thus, it was concluded that early specialization did not hold promise as a solution to the issues of educational costs or knowledge overload.

Achievement↗
PubMedDate not supplied

Cognitive evaluation of decision making processes and assessment of information technology in medicine.

This paper describes cognitive methods for analyzing medical decision making and evaluating medical information systems. The overall approach focuses on understanding the processes involved in the decision making and reasoning of health care workers, both with and without the use of information technologies. The issue of developing appropriate evaluation tools, for use in the design and analysis of medical information systems is considered to be of great importance. However, conventional methods are limited in their ability to identify and characterize the effects of information technology on the cognitive processes involved in decision making and reasoning. In this paper a range of methods are described involving video recording for collecting data on the use of information systems. The techniques described allow for the collection of an integrated data set consisting of transcripts of health care workers as they 'think aloud' in interacting with a medical system, along with complete video records of user-computer interaction. In addition, the methods can be extended to allow for the collection of process data from video recording of systems in actual clinical and emergency situations. The use of a variety of approaches, borrowing from research in cognitive science, is discussed. The development and application of these evaluation methods within the Canadian Centres of Excellence network HEALNet is subsequently described. Finally, implications for the development and evaluation of medical information systems are considered.

Cognition↗
PubMedDate not supplied

Evaluating evidence against diagnostic hypotheses in clinical decision making by students, residents and physicians.

Clinicians are faced with the difficulty of filtering large quantities of information and incorporating evidence to make safe and accurate diagnostic, therapeutic and management decisions. One solution to this difficulty is the development of evidence-based decision support tools designed to provide relevant and up-to-date evidence to clinicians. However, as investigations of medical decision making have found that hypothesis generation and clinical reasoning differ as a function of expertise, the gathering, interpretation and use of evidence against hypotheses depends on the prior knowledge of the clinician. The specific focus of the study is to understand how clinical evidence is gathered and evaluated during diagnostic reasoning. Verbal data during clinical interactions with physicians, residents and final year medical students were collected and transcribed. The dialogues were analyzed using three levels of coding: cognitive, epistemological and linguistic pragmatic perspectives. Results show that: (a) the ability to index and use adequate evidence by physicians, residents and students is a function of the early generation of accurate hypotheses: and (b) strategies for resolving inconsistent evidence differ as a function of medical expertise. The relationship between these findings and its application for the development of adequate knowledge-based systems for indexing and retrieval is discussed.

Clinical Competence↗
PubMedDate not supplied

Reasoning about diabetes and its relationship to the use of telecommunication technology by patients and physicians.

UNLABELLED: Health care is moving toward a team effort, with patients as partners. This requires effective communication between physicians and patients, who have different understandings of health and illness. These understandings in turn guide their decisions about management of health and illness. With the introduction of home-based technology, which provides an efficient way for doctors and patients to communicate, the question of the effectiveness of the decisions being made must be addressed. In this study, we assess the conceptualizations of health and illness related to diabetes and the relationship to the use of communication technology by patients and physicians. METHODS: The subjects were interviewed using a semi-structured questionnaire and were then asked to enter information into a telephone-based telecommunications system. Data were audiotaped, transcribed, and analyzed to characterize models of health and illness and for the factors that influence the decision making about diabetes management. Interactions with the system were then examined relative to these findings. RESULTS: Patients used lay concepts in providing explanations of their illness, whereas physicians used biomedical concepts. Use of these differing concepts influenced the use of telecommunication technology, with more errors in the communication of information being made by patients than by physicians. Examination of the organization of information required by the system showed it to be incongruent with the way patients normally reason, but in agreement with the way physicians reason. The paper discusses the implications of these findings for: (a) the nature of evidence used by patients and physicians; and (b) the design of technology to maximize effective doctor patient communication.

Attitude to Computers↗
PubMedDate not supplied

Representing clinical guidelines in GLIF: individual and collaborative expertise.

OBJECTIVE: An evaluation of the cognitive processes used in the translation of a clinical guideline from text into an encoded form so that it can be shared among medical institutions. DESIGN: A comparative study at three sites regarding the generation of individual and collaborative representations of a guideline for the management of encephalopathy using the GuideLine Interchange Format (GLIF) developed by members of the InterMed Collaboratory. MEASUREMENTS: Using theories and methods of cognitive science, the study involves a detailed analysis of the cognitive processes used in generating representations in GLIF. The resulting process-outcome measures are used to compare subjects with various types of computer science or clinical expertise and from different institutions. RESULTS: Consistent with prior studies of text comprehension and expertise, the variability in strategies was found to be dependent on the degree of prior experience and knowledge of the domain. Differing both in content and structure, the representations developed by physicians were found to have additional information and organization not explicitly stated in the guidelines, reflecting the physicians' understanding of the underlying pathophysiology. The computer scientists developed more literal representations of the guidelines; addition were mostly limited to specifications mandated by the logic of GLIF itself. Collaboration between physicians and computer scientists resulted in consistent representations that were more than the sum of the separate parts, in that both domain-specific knowledge of medicine and generic knowledge of guideline structure were seamlessly integrated. CONCLUSION: Because of the variable construction of guideline representations, understanding the processes and limitations involved in their generation is important in developing strategies to construct shared representations that are both accurate and efficient. The encoded guidelines developed by teams that include both clinicians and experts in computer-based representations are preferable to those developed by individuals of either type working alone.

Brain Diseases↗
PubMedDate not supplied

Science and practice: a case for medical informatics as a local science of design.

Because scientific research is guided by concerns for uncovering "fundamental truths," its time frame differs from that of design, development, and practice, which are driven by immediate needs for practical solutions. In medicine, however, as in other disciplines, basic scientists, developers, and practitioners are being called on increasingly to forge new alliances and work toward common goals. The authors propose that medical informatics be construed as a local science of design. A local science seeks to explain aspects of a domain rather than derive a set of unifying principles. Design is concerned with the creation, implementation, and adaptation of artifacts in a range of settings. The authors explore the implications of this point of view and endeavor to characterize the nature of informatics research, the relationship between theory and practice, and issues of scientific validity and generalizability. They argue for a more pluralistic approach to medical informatics in building a cumulative body of knowledge.

Computer Systems↗
PubMedDate not supplied

Medical informatics and the science of cognition.

Recent developments in medical informatics research have afforded possibilities for great advances in health care delivery. These exciting opportunities also present formidable challenges to the implementation and integration of technologies in the workplace. As in most domains, there is a gulf between technologic artifacts and end users. Since medical practice is a human endeavor, there is a need for bridging disciplines to enable clinicians to benefit from rapid technologic advances. This is turn necessitates a broadening of disciplinary boundaries to consider cognitive and social factors pertaining to the design and use of technology. The authors argue for a place of prominence for cognitive science. Cognitive science provides a framework for the analysis and modeling of complex human performance and has considerable applicability to a range of issues in informatics. Its methods have been employed to illuminate different facets of design and implementation. This approach has also yielded insights into the mechanisms and processes involved in collaborative design. Cognitive scientific methods and theories are illustrated in the context of two examples that examine human-computer interaction in medical contexts and computer-mediated collaborative processes. The framework outlined in this paper can be used to refine the process of iterative design, end-user training, and productive practice.

Cognitive Science↗