Evaluation of clinical reasoning skill and development of its educational program

• Project/Area Number: 23590870
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: General internal medicine (including Psychosomatic medicine)
• Research Institution: University of Tsukuba
• Principal Investigator: TOKUDA Yasuharu 筑波大学, 医学医療系, 教授 (20505036)
• Co-Investigator(Kenkyū-buntansha): KATAOKA Hitomi 岡山大学, 医学部, 教授 (20420490) ; NOGUCHI Yoshinori 京都大学, 大学院医学研究科, 非常勤講師 (30293872) ; TERASAWA Hidekazu 福井大学, 医学部, 教授 (30324164)
• Project Period (FY): 2011 – 2013
• Project Status: Completed (Fiscal Year 2013)
• Budget Amount: ¥4,810,000 (Direct Cost: ¥3,700,000、Indirect Cost: ¥1,110,000); Fiscal Year 2013: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000); Fiscal Year 2012: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000); Fiscal Year 2011: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000)
• Keywords: 臨床推論 / 診断推論 / 診断エラー / 認知バイアス / システム１ / システム２ / 国際情報交換：米国 / 国際情報交流：米国

Research Abstract

We evaluated clinical reasoning skills among medical students and identified the relationship between case difficulty and performance of reasoning processes. Intuitive reasoning performed better in simple cases but analytic reasoning did better in difficult cases.Intervention by providing differential diagnosis reminder was effective for solving difficult cases. Further, we developed electronic learning modules for learning clinical reasoning and proved its effectiveness for improving satisfaction and reasoning performance among students. Use of these interventions may enhance quality of care by improving patient outcomes.

Research Products

• [Journal Article] Preliminary report of a Web-based instrument to assess and teach knowledge and clinical thinking to medical student (2014)
  • Author(s): Gerald H. Stein, Hironobu Tokunaga, Hirotaka Ando, Mikako Obika, Tomoko Miyoshi, Yasuharu Tokuda, Miho Bautista, Hitomi Kataoka, Hidekazu Terasawa
  • Journal Title: International Journal of Medical Education Volume: 5 Pages: 1-6
  • DOI: 10.5116/ijme.52a7.7280
  • Peer Reviewed
• [Journal Article] Content analysis of medical students' seminars: a unique method of analyzing clinical thinking (2013)
  • Author(s): Yukari Takata, Gerald H Stein, Kuniyuki Endo, Akiko Arai, Shun Kohsaka, Yuka Kitano, Hitoshi Honda, Hidetaka Kitazono, Hironobu Tokunaga, Yasuharu Tokuda, Mikako Obika, Tomoko Miyoshi, Hitomi Kataoka, Hidekazu Terasawa
  • Journal Title: BMC Medical Education Volume: 13 Issue: 1 Pages: 156-156
  • DOI: 10.1186/1472-6920-13-156
  • Peer Reviewed
• [Journal Article] Effects of the use of differential diagnosis checklist and general de-biasing checklist on diagnostic performance in comparison to intuitive diagnosis (2013)
  • Author(s): Shimizu T, Matsumoto K, Tokuda Y
  • Journal Title: Medical Teacher Volume: 35(6)(Epub 2012 Dec 11. PubMed PMID : 23228085) Issue: 6 Pages: e1218-e1229
  • DOI: 10.3109/0142159x.2012.742493
• [Journal Article] 臨床推論 (2012)
  • Author(s): 徳田安春
  • Journal Title: 日本病院総合診療医学会雑誌 Volume: ３巻２号 Pages: 22-27
  • Peer Reviewed
• [Presentation] Effects of the use of differential diagnosis checklist and general de-biasing checklist on diagnostic performance in comparison to intuitive diagnosis (2012)
  • Author(s): Shimizu T, Matsumoto K, Tokuda Y
  • Organizer: Diagnostic error in medicine annual meeting
  • Place of Presentation: Baltimore, USA November
• [Presentation] 臨床推論 (2012)
  • Author(s): 徳田安春
  • Organizer: 日本病院総合診療医学会(招待講演)
  • Place of Presentation: 岡山大学
• [Presentation] Misdiagnosis of a case with acute aortc dissection (2011)
  • Author(s): Taro Shimizu, Kentaro Matsumoto, Yasuharu Tokuda
  • Organizer: Diagnostic Error in Medicine 2011
  • Place of Presentation: Chicago, IL, USA
• [Presentation] Effects of the use of differential diagnosis checklist and general de-biasing checklist on diagnostic performance in comparison to intuitive diagnosis
  • Author(s): Matsumoto K, Tokuda Y.
  • Organizer: Diagnostic Error in Medicine 2012
  • Place of Presentation: Baltimore（USA）
• [Book] 研修医になったら必ず読んでください。～診療の基本と必須手技、臨床的思考法からプレゼン術まで～ (2014)
  • Author(s): 岸本暢将、岡田正人、徳田安春
  • Total Pages: 253
  • Publisher: 羊土社
• [Book] Dr.徳田のバイタルサイン講座 (2012)
  • Author(s): 徳田安春
  • Total Pages: 113
  • Publisher: 日本医事新報社
• [Book] バイタルサイン講座 (2012)
  • Author(s): 徳田安春
  • Total Pages: 113
  • Publisher: 日本医事新報社
• [Book] バイタルサイン (2011)
  • Author(s): 徳田安春
  • Total Pages: 136
  • Publisher: 医学書院