Presentation Description
Barbara Masi1
Kellie Mullany2, Jaya Yodh2, Imanni Sheppard2, Grace Park2 and Samar Hegazy2
1 Virginia Maryland College of Veterinary Medicine
2 Carle Illinois College of Medicine, University of Illinois, Urbana-Champaign
Kellie Mullany2, Jaya Yodh2, Imanni Sheppard2, Grace Park2 and Samar Hegazy2
1 Virginia Maryland College of Veterinary Medicine
2 Carle Illinois College of Medicine, University of Illinois, Urbana-Champaign
BACKGROUND
Problem-based learning (PBL) enhances clinical reasoning by providing structure for knowledge acquisition/ integration and clinical reasoning skill development. Concept mapping (CM) is an evidence-based tool for learning and assessment, particularly in PBL. There is interest in integrating the social determinants of health (SDOH) framework in medical education to enhance patient-centered healthcare rather than disease-focused care. However, there are no clear standards for integrating/assessing the impact on clinical reasoning and problem-solving.
Problem-based learning (PBL) enhances clinical reasoning by providing structure for knowledge acquisition/ integration and clinical reasoning skill development. Concept mapping (CM) is an evidence-based tool for learning and assessment, particularly in PBL. There is interest in integrating the social determinants of health (SDOH) framework in medical education to enhance patient-centered healthcare rather than disease-focused care. However, there are no clear standards for integrating/assessing the impact on clinical reasoning and problem-solving.
SUMMARY-OF-WORK
This work investigated the impact of integrating the SDOH framework into PBL on students' clinical reasoning and problem-solving skills towards enhancing patient-centered healthcare. CM assignment, scoring rubric, and oral reflection on CM development were used to assess students' problem-solving strategies. Fourteen student volunteers were randomly assigned to control (CG) and experimental (EG) groups. CG explored two cases with clinical/basic science probes. EG explored the same cases with additional probes linking the SDOH-framework and completed group concept maps (CMs) to integrate concepts. To assess the intervention's impact, both groups were given new case vignettes to create individual treatment plan CMs supported by recorded narratives. Narrative transcripts were analyzed using inductive coding.
This work investigated the impact of integrating the SDOH framework into PBL on students' clinical reasoning and problem-solving skills towards enhancing patient-centered healthcare. CM assignment, scoring rubric, and oral reflection on CM development were used to assess students' problem-solving strategies. Fourteen student volunteers were randomly assigned to control (CG) and experimental (EG) groups. CG explored two cases with clinical/basic science probes. EG explored the same cases with additional probes linking the SDOH-framework and completed group concept maps (CMs) to integrate concepts. To assess the intervention's impact, both groups were given new case vignettes to create individual treatment plan CMs supported by recorded narratives. Narrative transcripts were analyzed using inductive coding.
RESULTS
Inductive coding of 28 total narratives identified four themes that align with clinical problem-solving and SDOH-framework: 1-Framing-Case, 2-Clinical-Reasoning-to - Diagnosis, 3-Clinical-Reasoning to-Treatment-Plan, 4-SDOH-Framework-Informed. Qualitative analysis revealed group differences in clinical problem-solving approaches. EG followed an SDOH-informed clinical reasoning approach to patient-centered treatment plans with balanced therapeutic/non-therapeutic elements. CG followed a clinical reasoning approach to a plan focusing mainly on the clinical aspects of the case.
Inductive coding of 28 total narratives identified four themes that align with clinical problem-solving and SDOH-framework: 1-Framing-Case, 2-Clinical-Reasoning-to - Diagnosis, 3-Clinical-Reasoning to-Treatment-Plan, 4-SDOH-Framework-Informed. Qualitative analysis revealed group differences in clinical problem-solving approaches. EG followed an SDOH-informed clinical reasoning approach to patient-centered treatment plans with balanced therapeutic/non-therapeutic elements. CG followed a clinical reasoning approach to a plan focusing mainly on the clinical aspects of the case.
DISCUSSION
SDOH integration into PBL using CM with narratives helped students visualize and reflect on integrated concepts, thus fostering patient-focused clinical reasoning skills.
SDOH integration into PBL using CM with narratives helped students visualize and reflect on integrated concepts, thus fostering patient-focused clinical reasoning skills.
CONCLUSIONS
This Curricular approach enhances student ability to provide patient- centered care by applying SDOH-informed clinical reasoning.
This Curricular approach enhances student ability to provide patient- centered care by applying SDOH-informed clinical reasoning.
TAKE-HOME MESSAGE
This novel approach provides an effective mechanism for SDOH integration in medical education toward developing patient-centered physicians.
This novel approach provides an effective mechanism for SDOH integration in medical education toward developing patient-centered physicians.
References (maximum three)
Hung CH, Lin CY. Using concept mapping to evaluate knowledge structure in problem-based learning. BMC Med Educ. 2015 Nov 27;15:212. doi: 10.1186/s12909-015-0496-x. PMID: 26614519; PMCID: PMC4662011.
Doobay-Persaud A, Adler MD, Bartell TR, Sheneman NE, Martinez MD, Mangold KA, Smith P, Sheehan KM. Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review. J Gen Intern Med. 2019 May;34(5):720-730. doi: 10.1007/s11606-019-04876-0. PMID: 30993619; PMCID: PMC6502919.Gruppen, Clinical Reasoning: Defining It, Teaching It, Assessing It, Studying It, 2018
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