Browsing by Author "Waechter, Jason"
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- ItemOpen AccessCanadian Recommendations for Critical Care Ultrasound Training and Competency(2014-01-01) Arntfield, Robert T; Millington, Scott J; Ainsworth, Craig D; Arora, Rakesh C; Boyd, John; Finlayson, Gordon; Gallagher, William; Gebhardt, Colin; Goffi, Alberto; Hockmann, Edgar; Kirkpatrick, Andrew W; McDermid, Robert C; Waechter, Jason; Wong, Natalie; Zavalkoff, Samara; Beaulieu, YanickOBJECTIVE: To achieve national consensus on standards of training, quality assurance and maintenance of competence for critical care ultrasound for intensivists and critical care trainees in Canada using recently published international training statements.DATA SOURCES: Existing internationally endorsed guidelines and expert opinion.DATA SYNTHESIS: In November 2013, a day-long consensus meeting was held with 15 Canadian experts in critical care ultrasound in which essential topics relevant to training ultrasound were discussed.CONCLUSIONS: Consensus was achieved to direct training curriculum, oversight, quality assurance and maintenance of competence for critical care ultrasound. In providing the first national guideline of its kind, these Canadian recommendations may also serve as a model of critical care ultrasound dissemination for other countries.
- ItemOpen AccessDeliberate practice of diagnostic clinical reasoning reveals low performance and improvement of diagnostic justification in pre-clerkship students(2023-09-21) Staal, Justine; Waechter, Jason; Allen, Jon; Lee, Chel H.; Zwaan, LauraAbstract Purpose Diagnostic errors are a large burden on patient safety and improving clinical reasoning (CR) education could contribute to reducing these errors. To this end, calls have been made to implement CR training as early as the first year of medical school. However, much is still unknown about pre-clerkship students’ reasoning processes. The current study aimed to observe how pre-clerkship students use clinical information during the diagnostic process. Methods In a prospective observational study, pre-clerkship medical students completed 10–11 self-directed online simulated CR diagnostic cases. CR skills assessed included: creation of the differential diagnosis (Ddx), diagnostic justification (DxJ), ordering investigations, and identifying the most probable diagnosis. Student performances were compared to expert-created scorecards and students received detailed individualized formative feedback for every case. Results 121 of 133 (91%) first- and second-year medical students consented to the research project. Students scored much lower for DxJ compared to scores obtained for creation of the Ddx, ordering tests, and identifying the correct diagnosis, (30–48% lower, p < 0.001). Specifically, students underutilized physical exam data (p < 0.001) and underutilized data that decreased the probability of incorrect diagnoses (p < 0.001). We observed that DxJ scores increased 40% after 10–11 practice cases (p < 0.001). Conclusions We implemented deliberate practice with formative feedback for CR starting in the first year of medical school. Students underperformed in DxJ, particularly with analyzing the physical exam data and pertinent negative data. We observed significant improvement in DxJ performance with increased practice.