Personal Narrative: Improving Clinical Reasoning

 Demonstrated high level interpersonal, verbal and written communication skills: My interpersonal skills have been developed through working closely with colleagues whilst on placement but also through my employment at the coffee shop, this has been particularly useful when training new staff. I have found that by using active listening and

A patient experience that stands out as significant was the day my evening patient cancelled his or her appointment. On this day, I found a patient at the CSU. When I first approached this individual, he refused to go to the clinic. I explained to him that there is no cost for an assessment and that it is up to him to accept treatment or not. When he came in to the clinic, he looked nervous. I explained everything before starting the assessment to help him feel comfortable. After the assessment I told him about the findings. I explained to him what gingivitis is and what he can do as an individual to help bring his gums back to health. I talked to him about the consequences and the risks associated if he refused to decline treatment. He was

Medical education stimulates development clinical reasoning in medical students and residents to be able making the correct diagnosis for their patients. Clinical reasoning process in doctors develops through the time which gives them more competency to do that as experts. However, it is not known which instructional strategies that would

(Leonard 1993) suggested that different elements to be considered in addressing the theory and practice gap, these elements obstruct the transfer of knowledge in clinical situations, including students’ preference and style of learning, in effective teaching strategies and unsuitable approaches of teaching. According to (Blanchard et al. 1999) there are factors influence learning performance, firstly, internal factors such as motivation, knowledge, skills and attitudes and, secondly, environmental and task.

Week three in clinical was difficult for me, I had a great experience overall but I hated seeing and holding a baby that had passed away at 21 weeks. To know what the family could possibly be going through was heartbreaking. I wouldn’t exactly know what to do if I was with the patient and her family exactly. I do know that I did place her in the room when she was admitted to triage. I do feel good about seeing the scenario play out, while being a student rather than being in the field alone. Other than that I was able to see the beginning stage of labor as well as a C-section. Everyone was so bent out of shape on making sure I eat and that I don’t faint, but it seriously wasn’t bad. As a matter of fact I was too intrigued with the mother rather

I had such a great day at clinical yesterday. I was finally able to see a vaginal delivery and that entire process. When I arrived in the morning, the mom had just received Cytotec, to help induce labor and ripen her cervix. She was forty-one weeks and zero. Around ten thirty in the morning, she asked for her epidural to manage her pain. We bolused her with fifteen hundred milliliters of lactated ringers to prevent hypotension. Shane was the certified registered nurse anesthesiologist (CRNA) who administered the epidural. It was very cool watching him administer all the needed pain relief medication before he administered the epidural to make sure that it would be placed in the epidural space in the spine. Then administered a small test dose, waited till a few blood pressures were taken, then administered the remaining about through an epidural pump. After the epidural was administered, I was able to administer her foley catheter. I was so happy that I was finally able to place one. I learned a few tricks from Maura (my nurse) as well. She taught me that it was easier to take the top off of the lubricant syringe and to place the tip of the foley inside of the syringe, that way it will not wiggle around and become unsterile. She also taught me to grab from the bottom of the labia and pull up, that way it ensures that I will have a clear entrance to

Introduction Look Back/Elaborate I have had multiple clinical practices, however, out of all the experiences during my shifts, there is one particular event that holds great meaning for me. This event happened on my fifth clinical day of this semester, which was the day I first dealt with two clients.

My first week went really well! I was definately both nervous and excited on the first day. I was nervous because I wasn't sure how the clinic would run and I quickly learned that it is a very fast paced clinic. My CI sees patients every 15 minutes and he is both the only PT there and the owner of the clinic. I have been learning a lot about PT treatments as well as the buisness side of the PT clinic. He has a lot of PT aides that help with exercises and setting patients up with ice and stim ect. The fast paced clinic was definately something I had to get used to. I was a little overwhelmed when we would just start with a patient and a new patient would walk in the door. However, there is a very good flow in the clinic and everyone is always

Common strategies are designed to enhance self-esteem and confidence and build therapeutic momentum as patients gain energy, feel better, and disconfirm negative beliefs. ABC technique help highlight situations that evoke evaluations which in turn provoke emotional and behavioural reactions. Behavioural experiments can be used to check out the validity of predictions and beliefs. Questionnaires, thought records (NAT’s) and mood diaries help increase self awareness and give concrete evidence of improvement, or if there are no changes, treatment can be adapted. Goal setting or activity scheduling all aid practical problem solving and physical interventions can include relaxation techniques, physical exercise and or appraisal of sleeping problems and In vivo exposure entails confronting the patient with the avoided object or situation. The Socratic questioning contains elements of the learning cycle and alerts clients to observe their experiences (observation); develop new understandings of their problems (reflection); synthesise new possibilities and ways forward (planning new experiences). In other words cognitive techniques help the client create insights and possibilities (observation-reflection-planning) which are tested in the field (experience). By linking experience and cognition a more affective behavioural

Sept 10 & Sept 17 Sept 24th: On the 10th, it was orientation day because it was the first day for clinical. Gretta took us around BMC. It was nice to walk around and see each floor. We go our picture taken for our ID. On the 17th and 24th, we were not allowed to be on the floor yet because our ID was not ready.

I shadowed multiple physicians from various specialties, as I worked to confirm my desire to become a physician. Out of all of them, Dr. Brian Loveless, a family practice physician who utilizes osteopathic manipulative medicine, stood out to me the most. My time shadowing him at The Patient Care Center at Western University of Health Sciences exposed me to the philosophy of osteopathic medicine. Using osteopathic manipulative treatment techniques like high-velocity, low-amplitude, he was able to relieve patients of their pains or aches during the visit, without providing any medications. It was these moments that taught me the effectiveness about the philosophy of osteopathic medicine. As Dr. Loveless stated regarding one patient, he was treating

According to Hawkins, Elder, & Paul (2010) Clinical reasoning is “thinking through the various aspects of patient care to arrive at a reasonable decision regarding the prevention, diagnoses, or treatment of a clinical problem in a specific patient” (p. 3.) The

During the feedback conversation with my supervisor I started to realize that, I was not able to support my opinion. During this conversation I started to feel frustrated and disappointed with myself. It was shocked because I didn’t expect to be so hard to put all the information that came from the patient in the right order to make the correct decision and I was afraid that I couldn’t learn how to come to a conclusion never in my life. Throughout the conversation, my supervisor mentioned the words Clinical Reasoning and Diagnostic Clinical Reasoning which was something new for me. From that time, she gave me the stimulus to look more around that area with the aim to improve my clinical reasoning skill and to get diagnostic reasoning thinking.

Reflection has its importance in clinical practice; we always seek to be successful and that can be achieved by learning every day of our life through experiences we encounter. In that way we can reconsider and rethink our previous knowledge and add new learning to our knowledge base so as to inform our practice. Learning new skills does not stop upon qualifying; this should become second nature to thinking professionals as they continue their professional development throughout their careers (Jasper, 2006).

One of the competency dimensions for a health care provider is clinical reasoning. In other words, clinical reasoning is one of the core competencies that guides clinical practice of any health care professional. Berman, Snyder, and Frandsen (2015) defined clinical reasoning as a cognitive process in which a clinician utilizes “thinking strategies to gather and analyze client information, evaluate the relevance of the information, and decide on possible nursing actions to improve the client’s physiological and psychosocial outcomes” (p. 144). Levett-Jones et al. (2009) described clinical reasoning as a course of clinical encounters during which clinician collects patient information, processes it and generates an understanding of what is happening with the patient, what is the problem, and only then makes appropriate interventions and evaluates the results. It is important to note that competency and clinical reasoning are the major attributions of a good health