Decision-making amidst clinical uncertainty
To what extent are decisions made by students and practitioners in concordance with experts in their respective field? Guest speaker Dr. Bernard Charlin visited the new Institute of Health Sciences Education (IHSE) in March to share his work on this question.
A professor in the Department of Surgery at University of Montr茅al, Dr. Charlin received a Masters Degree in education from Harvard University and a PhD in education from Maastricht University with a focus on reasoning (theory, learning and assessment).
鈥淚 very much enjoyed that discussion at the Institute and the theme seemed to interest participants,鈥� said Dr. Charlin after the event. 鈥淓xchanges were rich, exploring the many issues related to the theme.鈥�
Dr. Charlin began his presentation to Institute members with an overview of clinical reasoning theory followed by a quick snapshot of the principles guiding script concordance testing.
鈥淭he script concordance test (SCT) is used in health professions education to assess a specific facet of clinical reasoning competence: the ability to interpret medical information under conditions of uncertainty,鈥� wrote Dr. Charlin and coauthors, including Institute member Dr. Stuart Lubarsky, in a 2013 article in .
Learning by Concordance
Dr. Charlin then shared the principles of learning by concordance and gave real-world examples of its application with first year medical students.
In the example, students complete a secure online quiz that is not graded. Students are presented complex medical, ethical and professional situations and are required to select responses within a Likert scale.
Upon responding to a question, students then compare their response in relation to a panel of experts, whose candid remarks on why they selected a particular answer are included in the online platform.
This allows students to compare their response to the individual responses of experts. Students can then readily identify gaps in their knowledge and to acquire missing knowledge, improving their understanding of how to use this knowledge in practice. Further readings are included, allowing students to dig deeper if they choose.
鈥淭he interest of 鈥榚valuation and learning by concordance鈥� is that it allows thinking and deciding in the context of uncertainty that characterizes real-life practice,鈥� Dr. Charlin said. 鈥淭his helps students better prepare for reasoning in the context of grey areas that are so often present in our medical encounters.鈥�
