What to do first? Students need help figuring this out. McGregor CA et al. Preparing medical students for clinical decision making: A pilot study exploring how students make decisions and the perceived impact of a clinical decision making teaching intervention. Medical Teacher 2012;34:e508--e517.
Reviewed by Janet Meller
What was the study question?
What factors impact medical students' clinical decisions and does a teaching tool improve students' performance in this domain?
How was the study done?
A decision making tool was developed and introduced to senior medical students in Lanarkshire, United Kingdom. Twenty--three volunteer students were divided into three groups: 1) no decision making teaching, 2) clinical decision making tool given prior to the simulation, and 3) tool and tutorial given prior to the simulation. All groups participated in a simulation involving a clinical scenario which required making decisions, prioritizing issues, and asking for help. Students were observed and assessed according to a checklist. Students were then interviewed about the simulation session and how helpful the tool was.
What are the results?
Students were not able to make complex decisions regarding diagnosis, prioritize tasks, request help, and make simultaneous decisions. There were no clear differences between the three groups. It was unclear if the tutorial was useful. Students felt that the clinical decision making tool might be useful if introduced earlier in their training. They felt that simulation was a useful setting to practice clinical decision making.
What are the implications of these findings?
This study has identified gaps in our current undergraduate curriculums – students' ability to prioritize issues and request help when multiple tasks need to be done simultaneously. The teaching tool, while not shown to be effective in this study, may still be of value.
Editor's note: Recognizing that the students had not been asked to prioritize between patients before, their comments are, perhaps, not that surprising. But, the comments are still telling -- "I saw them first because I kind of knew what to do with them", "I saw whoever paged me first", "I thought I could ignore the pager if I was doing something else, I'm sure they will page someone else" – and indicate a need for direction on how to prioritize issues. While these authors assessed this skill in a simulation session, the ability to prioritize could also be assessed in different, less expensive, ways. Another potential idea for COMSEP – design both teaching and assessment modules for prioritization! (SLB).