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META: Mindfully Evolving, Thriving & Advocating: Week 3

“The good physician treats the disease; the great physician treats the patient who has the disease.” --Sir William Osler

Week 3 - July 25-29

Clinical Reasoning

Introduction to Clinical Reasoning:

Pre-Work - Reading:

Pre-Work -  Videos:

Total Viewing Time: 39:34

**these videos while designed to guide preceptors in working with students are an excellent review that provides detailed examples of high and low performance 

**Early in your training it is very difficult to have good hypothesis directed data collection due to your limited medical knowledge and experience.  However, you can start building this skill now, always considering based on your current knowledge what you think may be the most important, can’t miss and high-yield questions and exam maneuvers – i.e. a focused history and exam.  The practice of these skills will significantly enhance your learning for the future.  For now, be extremely cautious and we suggest you don’t limit your history-taking, exam unless directed to do so specifically for an exercise.  Even experienced physicians can sometime “anchor” on a diagnosis, become too focused and miss key history and physical exam findings.

Delve Deeper:

Listen to an episode of Car Talkb

Adverse Childhood Experiences Pre-Work

Pre-Work:

Library Lab Handouts

Handouts Complementing the Library Lab:

Exercises

Hands-on Practice - META Library Lab:

Medline Lab: Searching for Evidence

Types of Questions:

  • Background questions – ask for general knowledge about a disorder/topic: who, what, when, where, how, why
  • Foreground questions – ask for specific knowledge for patient care: PICO – Patient/problem, Intervention, Comparison (if relevant), Outcome

Handouts Complementing the PubMed Lab:

PubMed & General Searching Tutorials:

Medline Lab: Practice Exercise & Self Assessment

Search Exercise

This search is available for more structured practice searching the Medline database.  

Instructions:

  1. For the clinical scenario below, perform search in PubMed that would help answer the question posed. (There may be more information in the scenario than is necessary for the question asked.)
  2. Review the results for relevancy.
  3. Use the Search History on the Advanced Search page to complete the Self-Evaluation (linked below).

Clinical Scenario:
You saw RR for cluster headaches. You noted that his blood pressure was elevated and that hypertension control would be discussed at his next appointment. You know Mr. R is interested in lifestyle changes to help bring his blood pressure within normal limits. He also mentioned mild stress from his teenaged children. You decided to see if there is any evidence surrounding relaxation techniques, like yoga, meditation, or biofeedback to help control his hypertension.
 

P Middle aged patient with hypertension
I Meditation, Yoga, Biofeedback
C NA
O Normal blood pressure

Clinical Question:
In middle age patients with hypertension, are meditation, yoga, and biofeedback effective in bringing blood pressure within normal limits?
--Find randomized controlled trials to help answer the question. 
 (Hint: Limit to randomized controlled trial article type.)