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      Teaching clinical pharmacology and therapeutics with an emphasis on the therapeutic reasoning of undergraduate medical students

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          Abstract

          Background

          The rational prescribing of drugs is an essential skill of medical doctors. Clinical pharmacologists play an important role in the development of these skills by teaching clinical pharmacology and therapeutics (CP&T) to undergraduate medical students. Although the approaches to teaching CP&T have undergone many changes over the last decennia, it is essential that the actual teaching of CP&T continues to be a major part of the undergraduate medical curriculum.

          Objectives

          The learning objectives of CP&T teaching in terms of developing the therapeutic competencies of undergraduate medical students are described, with an emphasis on therapeutic decision-making. On the basis of current theories of cognitive psychology and medical education, context-learning is presented as an effective approach by which to achieve therapeutic competencies. An example of a CP&T curriculum is presented.

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          Most cited references35

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          The assessment of clinical skills/competence/performance.

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            Research in clinical reasoning: past history and current trends.

            Research in clinical reasoning has been conducted for over 30 years. Throughout this time there have been a number of identifiable trends in methodology and theory. This paper identifies three broad research traditions, ordered chronologically, are: (a) attempts to understand reasoning as a general skill--the "clinical reasoning" process; (b) research based on probes of memory--reasoning related to the amount of knowledge and memory; and (c) research related to different kinds of mental representations--semantic qualifiers, scripts, schemas and exemplars. Several broad themes emerge from this review. First, there is little evidence that reasoning can be characterised in terms of general process variables. Secondly, it is evident that expertise is associated, not with a single basic representation but with multiple coordinated representations in memory, from causal mechanisms to prior examples. Different representations may be utilised in different circumstances, but little is known about the characteristics of a particular situation that led to a change in strategy. It becomes evident that expertise lies in the availability of multiple representations of knowledge. Perhaps the most critical aspect of learning is not the acquisition of a particular strategy or skill, nor is it the availability of a particular kind of knowledge. Rather, the critical element may be deliberate practice with multiple examples which, on the hand, facilitates the availability of concepts and conceptual knowledge (i.e. transfer) and, on the other hand, adds to a storehouse of already solved problems.
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              A cognitive perspective on medical expertise: theory and implication.

              A new theory of the development of expertise in medicine is outlined. Contrary to existing views, this theory assumes that expertise is not so much a matter of superior reasoning skills or in-depth knowledge of pathophysiological states as it is based on cognitive structures that describe the features of prototypical or even actual patients. These cognitive structures, referred to as "illness scripts," contain relatively little knowledge about pathophysiological causes of symptoms and complaints but a wealth of clinically relevant information about disease, its consequences, and the context under which illness develops. By contrast, intermediate-level students without clinical experience typically use pathophysiological, causal models of disease when solving problems. The authors review evidence supporting the theory and discuss its implications for the understanding of five phenomena extensively documented in the clinical-reasoning literature: (1) content specificity in diagnostic performance; (2) typical differences in data-gathering techniques between medical students and physicians; (3) difficulties involved in setting standards; (4) a decline in performance on certain measures of clinical reasoning with increasing expertise; and (5) a paradoxical association between errors and longer response times in visual diagnosis.
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                Author and article information

                Contributors
                +31-20-4448090 , +31-20-4448100 , thpgm.devries@vumc.nl
                Journal
                Eur J Clin Pharmacol
                European Journal of Clinical Pharmacology
                Springer-Verlag (Berlin/Heidelberg )
                0031-6970
                1432-1041
                29 January 2008
                February 2008
                : 64
                : 2
                : 217-224
                Affiliations
                Department of Clinical Pharmacology and Pharmacy, Section Pharmacotherapy, VU University Medical Center (VUMC), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
                Article
                432
                10.1007/s00228-007-0432-z
                2235908
                18228012
                4d0a0177-5539-438e-b9a2-922770b91228
                © The Author(s) 2008
                History
                : 5 October 2007
                : 25 November 2007
                Categories
                Review Article
                Custom metadata
                © Springer-Verlag 2008

                Pharmacology & Pharmaceutical medicine
                education,undergraduate,clinical pharmacology & therapeutics,teaching,pharmacotherapy

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