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Describing complex clinical scenarios at the bed-side: Is a systems science approach useful? Exploring a novel diagrammatic approach to facilitate clinical reasoning

Overview of attention for article published in BMC Medical Education, October 2016
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Title
Describing complex clinical scenarios at the bed-side: Is a systems science approach useful? Exploring a novel diagrammatic approach to facilitate clinical reasoning
Published in
BMC Medical Education, October 2016
DOI 10.1186/s12909-016-0787-x
Pubmed ID
Authors

Saroj Jayasinghe

Abstract

Clinicians often encounter patients having complex clinical scenarios (CCS) where diverse and dynamic diagnostic and therapeutic issues interact. A limited range of bedside methods are available to describe such patients and most often it is a diagnostic summary, a problem list, or a list of differential diagnoses. These methods fail to portray the interconnected nature of CCCs. They prevent visualization of a system of networks or a web of causation operative in CCSs.A more holistic conceptualization is required and the author argues for an approach based on systems science. The latter views the human body to consist of several closely linked organ systems, constantly interacting with each other and embedded in, and 'open' to the external environment. In order to capture the systems nature at bedside, a tool based on network diagrams, termed a Clinical Reasoning Map (CRM) is proposed which depicts diseases or conditions as nodes linked to each other by lines or arrows. The latter linkages follow simple rules: possible causes or associations as mere lines; probable cause using a single dotted arrow with directionality (from 'cause' to 'effect'); definite causal pathways by directional arrows; and bi-directional arrows to indicate organs-systems influencing each other.CRM's utility was investigated in several groups of undergraduate medical students. The results varied: 289, 5th year and 4th year medical students showed that 245 (85.5 %) perceived CRM improve their understanding of the case. However, there was no clear advantage in the CRM over a list of diagnoses in recall of key information. A majority (83.9 %) were keen to learn the technique of drawing a CRM. Postgraduates too found the tool to be useful to understand the interconnected nature of real-life complex case scenarios and pathogenesis of their multifaceted condition to generate differential diagnosis and to select appropriate investigations. Effectiveness of CRM is supported by adult learning theories such as meaningful learning and experiential learning.The author proposes that systems science and tools based in this approach such as CRM has utility in understanding and managing complex case scenarios. They differ significantly from other diagrammatic methods available in the medical literature.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 75 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 1 1%
Unknown 74 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 10 13%
Lecturer 8 11%
Student > Bachelor 7 9%
Student > Ph. D. Student 6 8%
Professor 4 5%
Other 21 28%
Unknown 19 25%
Readers by discipline Count As %
Medicine and Dentistry 28 37%
Social Sciences 6 8%
Nursing and Health Professions 6 8%
Engineering 4 5%
Agricultural and Biological Sciences 3 4%
Other 10 13%
Unknown 18 24%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 October 2016.
All research outputs
#18,475,157
of 22,893,031 outputs
Outputs from BMC Medical Education
#2,756
of 3,338 outputs
Outputs of similar age
#242,414
of 320,091 outputs
Outputs of similar age from BMC Medical Education
#53
of 64 outputs
Altmetric has tracked 22,893,031 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
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